CLINICAL PARASITOLOGY

LECTURER: MISS REYNA MAY V. GABUTAN, RMT I Topic 3

______________________________________________________________________

INTESTINAL NEMATODES LABORATORY DIAGNOSIS

CLASS NEMATODA ● Accomplished by recovery of eggs, larvae, and

occasional adult worm
● Multicellular parasites that appear round in cross ● Specimen of choice vary by species
section ● Cellophane Tape Preparations
● “Roundworms” ● Stool Samples
● Separate Sexes ● Tissue Biopsies
● Female adult worms are larger than male adult worms ● Infected Skin Ulcers
● Humans are the definitive host (sexual reproduction)
PATHOGENESIS AND CLINICAL SYMPTOMS
THREE BASIC MORPHOLOGIC FORMS:
● The three possible factors to the severity of a
EGGS Nematode infection:
1. Number of worms present
2. Length of time the infection persists
● Female sex cells after fertilization 3. Overall health of the host
● Vary in size and shapes ● Nematode infection last for up to 12 months or longer
(10-15 years)
LARVAE ● Infection of small number of worms remains
asymptomatic or cause minimal infection.
● “Juvenile worms” ● Infection of heavy number of worms experience severe
● Long and slender symptoms/complications.

ADULT WORMS
SYMPTOMS AND COMPLICATIONS

● Equipped with complete digestive and reproductive

● Abdominal pain
systems.
● Diarrhea
● Specific features vary with individual species
● Nausea
● Vomiting
GENERAL NEMATODE LIFE CYCLE ● Fever
● Eosinophilia
● Skin irritation

NEMATODE CLASSIFICATION

Phylum – Nemathelminthes
Class – Nematoda

________________________________________________________________________________________
MHAM COLLEGE INC. | 1 PAGE
KJET
CLINICAL PARASITOLOGY
LECTURER: MISS REYNA MAY V. GABUTAN, RMT I Topic 3
______________________________________________________________________

ENTEROBIUS VERMICULARIS LIFE CYCLE

Humans – only known host

COMMON NAMES Pinworm, Seatworm, or Dormitory
worm I. Initiated by ingestion of infective eggs
II. Eggs migrate through the digestive tract into the small
COMMON DISEASE Enterobiasis, pinworm infection intestine, where they hatch and release young larvae
NAMES III. Larvae continue to grow and mature into adult worms
IV. Adult worms reside in the colon
V. Gravid female worms migrates outside the body to the
perianal region and deposit up to 15,000 eggs
VI. Following 4-6 hours incubation, the developing eggs
achieve infective status
VII. VII. Once apart from the host, infective eggs may take
up residence in a number of locations
VIII. The eggs may become airborne
EGG MORPHOLOGY
IX. Infective eggs may survive for a few days up to several
SIZE 40-60 um long, 20-35 um wide weeks
X. Ingestion of infective eggs initiates a new cycle
SHAPE Oval, one-side flattened

EMBRYO • Stage of development varies; may be LABORATORY DIAGNOSIS

unembryonated, embryonated, mature
• Shell ● Cellophane Tape Preparation – specimen of choice
• Double-layered, thick, colorless
collected from the perianal region of infected person.

EPIDEMIOLOGY

● Worldwide, in temperate areas

● Common helminth in USA
ADULT WORM MORPHOLOGY ● Transmission occurs primarily by hand-to-mouth
contamination
LENGTH • Adult Female – 7-14 mm
• Adult Male – 2-4 mm
CLINICAL SYMPTOMS
WIDTH • Adult Female – up to 0.5 mm
• Adult Male – <0.3 mm ● Asymptomatic
● Enterobiasis: Pinworm infection
COLOR • Adult Male & Female – Yellowish-white
○ Common symptoms:
TAIL • Adult Female – Pointed; resembles pinhead ■ Intestinal irritation
■ Mild nausea
■ Vomiting
■ Irritability
■ Difficulty sleeping
■ Less frequent symptoms
■ Minute ulcers
■ Mild intestinal inflammation
■ Abdominal pain

________________________________________________________________________________________
MHAM COLLEGE INC. | 2 PAGE
KJET
CLINICAL PARASITOLOGY
LECTURER: MISS REYNA MAY V. GABUTAN, RMT I Topic 3
______________________________________________________________________
than females
TREATMENT • Albendazole
• Mebendazole ANTERIOR END Colorless; resembles a whip handle;
• Pyrantel pamoate contains a slender esophagus

PREVENTION • Practicing proper personal hygiene POSTERIOR END Pinkish-gray; resembles whip itself;
AND CONTROL (hand wash) contains digestive and reproductive
• Applying an ointment or salve to prevent systems; males possess prominent
egg dispersal into the environment curled tail
• Avoid scratching the infected area
• Cleaning of all the potentially infected
areas

TRICHURIS TRICHIURA

COMMON NAMES Whipworm

COMMON DISEASE Trichuriasis, Whipworm infection

NAMES

LIFE CYCLE

EGG MORPHOLOGY I. Ingestion of infective eggs initiates human infection.

II. Larvae emerge from the eggs in the small intestines.
SIZE 50-55 by 25 um III. Growth and development of the larvae occur and
migrate within the intestinal villi.
SHAPE Barrel, football; hyaline polar plug at IV. The larvae return to the intestinal lumen and proceed to
each end
the cecum, where they complete their maturation.
V. Adults take up residence in the colon.
EMBRYO • Unicellular, undeveloped
• Shell VI. Lifespan of untreated infection may be from 4-8 years.
• Smooth; yellow-brown color VII. Adult female lays her undeveloped eggs, this stage of
because of bile contact egg that is passed into the outside environment via
feces.
VIII. 1 month outside the human body, the embryonate
become infective and ready to initiate a new cycle.

LABORATORY DIAGNOSIS

● Stool – specimen of choice

ADULT WORM MORPHOLOGY ● Zinc sulfate flotation method – eggs are prominent in
infected samples
SIZE 2.5-5 cm long; males usually smaller ● Adult worms may be visible on macroscopic
examination of the intestinal mucosa.
________________________________________________________________________________________
MHAM COLLEGE INC. | 3 PAGE
KJET
CLINICAL PARASITOLOGY
LECTURER: MISS REYNA MAY V. GABUTAN, RMT I Topic 3
______________________________________________________________________

EPIDEMIOLOGY EGG MORPHOLOGY

FERTILIZED EGG
● Considered as the third most common helminth
● Found primarily in warm climates, poor sanitation SIZE 40-75 um by 30-50 um
practices and defecating directly in the soil or using
human feces as fertilizers. SHAPE Rounder than nonfertilized version
● Children most at risk for contracting the infection.
EMBRYO Undeveloped unicellular embryo

CLINICAL SYMPTOMS SHELL Thick chitin

● Asymptomatic – slight whipworm infection OTHER FEATURES May be corticated or decorticated

● Trichuriasis: Whipworm Infection
○ Children
■ Heavy Infection (500-5000 worms)
■ Wide variety of symptoms
(resembling of Ulcerative colitis)
■ Light infection (200 worms)
■ Chronic dysentery
■ Severe anemia ADULT WORM MORPHOLOGY
■ Growth retardation (children)
■ Increased rectal prolapse SIZE • Adult Female – 22-35 cm
○ Adult • Adult Male – up to 30 cm
■ Abdominal tenderness and pain
■ Weight loss/weakness COLOR • Adult Female – Creamy white; pink
■ Mucoid/bloody diarrhea tint
• Adult Male – Creamy white; pink tint

TREATMENT • Mebendazole OTHER FEATURES • Adult Female – Pencil lead thickness

• Albendazole • Adult Male – Prominent incurved tail

PREVENTION • Exercising proper sanitation practices

AND CONTROL • Avoidance of defecating directly into
the soil
• Avoid using of human feces as
fertilizers
• Mouth-to-hand practice

ASCARIS LUMBRICOIDES
LIFE CYCLE

COMMON NAMES Large intestinal roundworm, I. Ingestion of infected eggs that contain viable larvae.
roundworm of man II. Larvae emerge from the eggs once inside the small
intestine.
COMMON DISEASE Ascariasis: Roundworm Infection III. The larvae complete a liver-lung migration by first
entering the blood via penetration through the intestinal
wall.
IV. First stop is the liver
V. The larvae continue via bloodstream to the second
stop, the lung.

________________________________________________________________________________________
MHAM COLLEGE INC. | 4 PAGE
KJET
CLINICAL PARASITOLOGY
LECTURER: MISS REYNA MAY V. GABUTAN, RMT I Topic 3
______________________________________________________________________
VI. The larvae burrow their way through the capillaries into
COMMON DISEASE Capillariasis
the alveoli, Migration into the bronchioles
VII. The larvae transferred through coughing into the • It was described in the Philippines in 1963, after the death of
pharynx, where they are swallowed to the intestine. the first human case.
VIII. Maturation of larvae to adult worms, resides in the small
intestines.
IX. Passed in the feces into the soil.

LABORATORY DIAGNOSIS

● Stool – specimen of choice

● Direct fecal smear EGG MORPHOLOGY
● Kato technique or cellophane thick smear method
(qualitative) SIZE 36-45 um by 20 um
● Kato-katz technique (quantitative)
SHAPE Peanut-shaped with striated shells
● Enzyme-linked immunosorbent assay (ELISA)
and flattened bipolar plugs

EPIDEMIOLOGY

● Most common intestinal helminth infection in the

world.
● Warm climates, area of poor sanitation and human
feces fertilizer.
● Children – population most at risk.
ADULT WORM MORPHOLOGY

CLINICAL SYMPTOMS LENGTH • Female – 2.3 to 5.3 mm

• Male – 1.5 to 3.9 mm
● Asymptomatic – patients infected with small number of
OTHER FEATURES • Thin filamentous anterior end and
worms slightly thicker and shorter posterior
● Ascariasis: Roundworm Infection end.
● Abdominal pain • Female – vulva located at the
● Vomiting junction of anterior and middle thirds.
● Fever • Male – spicule is 230 to 300 um
● Distention long; unspined sheath.

TREATMENT • Albendazole
• Mebendazole

PREVENTION • Avoidance of human feces as fertilizer

AND CONTROL • Proper sanitation and personal hygiene
practices

CAPILLARIA PHILIPPINENSIS LIFE CYCLE

I. Female worms produce characteristic eggs and are

COMMON NAMES Pudoc worm
passed in the feces and embryonate in the soil or water.

________________________________________________________________________________________
MHAM COLLEGE INC. | 5 PAGE
KJET
CLINICAL PARASITOLOGY
LECTURER: MISS REYNA MAY V. GABUTAN, RMT I Topic 3
______________________________________________________________________
II. While in the water, it is ingested by small species of
freshwater or brackish water fish.
III. Hatch in the fish intestines and grow into the infective
larvae.
STRONGYLOIDES STERCORALIS
IV. Ingestion of infected uncooked fish, the larvae escape
from the fish intestines and develop into adult worms in
human intestines.
COMMON NAMES Threadworm
V. Passes in feces into the soil and water.
COMMON DISEASE Strongyloidiasis,
Threadworm infection
LABORATORY DIAGNOSIS

● Direct smear or wet mount – finding characteristic

eggs
● Stool concentration method
● Duodenal aspiration – parasite can also be recovered
from the small intestine.

EPIDEMIOLOGY

EGG MORPHOLOGY
● Northern Luzon in the Philippines – capillariasis was
first recorded SIZE Average, 48 by 35 um
● 2,000 cases in the Philippines has been documented.
● Described as “mystery disease” in 1998 resulted in TYPICAL GROWTH Contains well-developed larvae
death of villagers in Monkayo, Compostela Valley PHASE
Province due to misdiagnosis.
EMBRYONIC Two-, four-, or eight- stage, when
CLEAVAGE present
CLINICAL SYMPTOMS
SHELL Thin, hyaline

● Abdominal pains, Gurgling stomach (borborygmus), and

diarrhea
● After a few weeks noticeable:
○ Weight loss
○ Malaise
○ Anorexia
○ Vomiting
○ Edema
MORPHOLOGY
● Responsible for ulcerative and degenerative lesions in
the intestinal mucosa. RHABDITIFORM • Actively feeding stage
LARVAE • Average size 220 by 15 um
• Other features
TREATMENT • Albendazole
> Short buccal cavity; prominent
• Mebendazole
genital primordium
PREVENTION • Discouraging people in endemic areas
AND CONTROL from eating raw fish
• Good sanitary practices
• Feces should be disposed of in a
sanitary manner
• Educational programs to inform
populations at risk

________________________________________________________________________________________
MHAM COLLEGE INC. | 6 PAGE
KJET
CLINICAL PARASITOLOGY
LECTURER: MISS REYNA MAY V. GABUTAN, RMT I Topic 3
______________________________________________________________________
INDIRECT CYCLE

I. Rhabditiform larvae are passed into the environment

(soil) and mature into free-living adults that are non
parasitic.
II. Adult females produce eggs that develop into
rhabditiform larvae.
FILARIFORM • Nonfeeding stage III. This larvae mature and transform into the filariform
LARVAE • Average length 690 um stage, and initiate a new indirect cycle or become the
• Length of esophagus (long) infective stage for human host and begin a direct cycle.
• Tail (notched)
AUTOINFECTION

I. Rhabditiform larvae develop into filariform stage inside

the human host intestine.
II. The resulting infective larvae enter the lymphatic
system or bloodstream and initiate a new cycle.

LABORATORY DIAGNOSIS
ADULT FEMALE WORM MORPHOLOGY

APPROXIMATE SIZE 2 by 0.4 mm ● Stool concentration with zinc sulfate has successfully
recovered these eggs.
OTHER FEATURES • Colorless, Transparent body ● Fresh stool sample and duodenal aspirates – diagnostic
• Finely striated cuticle rhabditiform larvae.
• Short buccal cavity ● Sputum samples have also yielded S. stercoralis larvae.
• Long and slender esophagus
● Threadworm larvae have a typically higher recovery
rate in concentrated specimens.
● Serologic test (ELISA)

EPIDEMIOLOGY

● Found in the tropical and subtropical regions of the

world.
● Areas of poor sanitation

LIFE CYCLE
CLINICAL SYMPTOMS
DIRECT CYCLE
● Asymptomatic: light infection
I. Rhabditiform larvae in the threadworm are usually ● Strongyloidiasis: Threadworm Infection
passed in the feces. Eggs are only occasionally found ○ Most common symptoms: diarrhea and
in such samples. abdominal pain
II. Rhabditiform larvae develop directly into third-stage ○ Urticaria (eosinophilia), Vomiting, Constipation,
infective filariform in warm, moist soil. Weight loss, and Variable anemia
III. The remaining phase of the threadworm life cycle ○ Heavy infection – develop malabsorption
basically mimic the hookworm life cycle syndrome
○ Pulmonary symptoms – larvae migrating in
lungs
________________________________________________________________________________________
MHAM COLLEGE INC. | 7 PAGE
KJET
CLINICAL PARASITOLOGY
LECTURER: MISS REYNA MAY V. GABUTAN, RMT I Topic 3
______________________________________________________________________
• Necator 60-75 um
TREATMENT Ivermectin with Albendazole • Ancylostoma 55-60 um
• Width – 35-40 um
PREVENTION • Disposal of fecal material
AND CONTROL • Adequate protection of skin from EMBRYONIC Two-, four-, or eight-cell stage
contaminated soil CLEAVAGE

SHELL Smooth, colorless

HOOKWORMS

● Necator americanus
● Ancylostoma duodenale
● Ancylostoma ceylanicum

N. AMERICANUS AND A. DUODENALE RHABDITIFORM LARVAE

SIZE • Immature, newly hatched

NECATOR AMERICANUS rhabditiform larva – 270 by 15 um
• Rhabditiform larva (5 days old) –
COMMON NAMES New worm hookworm 540-700 um long

COMMON DISEASE Hookworm infection, Necatoriasis OTHER FEATURES Long buccal cavity, small genital
primordiums

ANCYLOSTOMA DUODENALE FILARIFORM • Infective, nonfeeding filariform larva

LARVAE • Length of esophagus – short
COMMON NAMES Old worm hookworm • Tail – pointed

COMMON DISEASE Hookworm infection, ancylostomiasis

ADULT WORM MORPHOLOGY

GENERAL • Color – Grayish-white to pink

MORPHOLOGY CHARACTERISTICS • Cuticle – Somewhat thick
• Anterior end – Conspicuous bend,
EGG hook

SIZE • Length SIZE • Female Adults – 9-12 mm long,

________________________________________________________________________________________
MHAM COLLEGE INC. | 8 PAGE
KJET
CLINICAL PARASITOLOGY
LECTURER: MISS REYNA MAY V. GABUTAN, RMT I Topic 3
______________________________________________________________________
● Primary means for diagnosis is recovery of the eggs in
0.25-0.50 mm wide
• Male Adults – 5-10 mm long, 0.2-0.4 stool samples.
mm wide ● Recovery and examination of the buccal capsule to
determine A. duodenale or N. americanus
OTHER FEATURES • Male Adults – Prominent posterior
copulatory bursa
EPIDEMIOLOGY
BUCCAL CAPSULE • Necator – contains pair of cutting
CHARACTERISTICS plates ● 25% of world’s population is infected with hookworm.
• Ancylostoma – contains actual
● Hookworm infection is high in warm areas, poor
teeth
sanitary practices, no proper fecal treatment and
disposal.
● Person at risk for infection – those who walk barefoot in
feces-contaminated soil.
● Primarily found in North and South America.

CLINICAL SYMPTOMS

● Asymptomatic – light hookworm infection

● Hookworm Disease: Ancylostomiasis, Necatoriasis
○ Ground Itch – Intense allergic itching at site of
penetration
○ Larvae migration to the lungs, Sore throat,
Bloody sputum, Wheezing, Headache, Mild
pneumonia with cough
○ Light worm burden (<500 eggs of feces seen)
■ Mild gastrointestinal symptoms, Slight
LIFE CYCLE anemia and weight loss or weakness
○ Heavy worm burden (>5000 eggs of feces
I. Humans contract hookworm when third-stage filariform seen)
larvae penetrate through the skin (feet). ■ Diarrhea, anorexia, edema, pain,
II. The filariform larvae migrate to the lymphatics and enteritis, epigastric discomfort, IDA,
blood system. weakness, and hypoproteinemia.
III. The blood carries the larvae to the lungs, penetrate the
capillaries and enter the alveoli. TREATMENT Mebendazole and Pyrantel pamoate
IV. Migration of the larvae continues into the bronchioles
and coughed up to the pharynx, swallowed and PREVENTION • Similar to A. lumbricoides
deposited into the intestine. AND CONTROL • Proper sanitation practices
V. Maturation takes place in the intestines • Proper fecal disposal
VI. Adult female lay 10,000-20,000 eggs/day • Prompt and thorough treatment of
VII. Passed into the feces and to the soil. infected persons
VIII. 24-48 hours, first-stage rhabditiform larvae emerge from
the cells.
ANCYLOSTOMA CEYLANICUM
IX. Larvae continue molting twice, up to third-stage
infective filariform and begin a new cycle.
● Common hookworm of domestic dogs and cats
throughout Asia.
LABORATORY DIAGNOSIS
● First human case was reported in 1968 from 53 years
old woman from Ilocos Norte (23 adult worms
collected).

________________________________________________________________________________________
MHAM COLLEGE INC. | 9 PAGE
KJET
CLINICAL PARASITOLOGY
LECTURER: MISS REYNA MAY V. GABUTAN, RMT I Topic 3
______________________________________________________________________
● Clinical Symptoms
○ Enteritis
○ Eosinophilia

________________________________________________________________________________________
MHAM COLLEGE INC. | 10 PAGE
KJET