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Phylum Nemathelminthes
(Aschelminthes)
Class Nematoda.
Class Nematoda -
The Roundworms
Terminology:
• Filariform larvae - the 3rd or infective stage; Long,
thread-like; Designed for penetration.
• Rhabditiform larvae - characterized by the
presence of a muscular esophagus and bulbular
pharynx. The worms leaving the egg are termed
“rhabditiform” larvae.
The parasitic nematodes are divided into:
1. Intestinal nematodes
1.1. Intestinal nematodes with tissue stage
A. Ascaris lumbricoides
B. Hookworms
C. Strongyloides stercoralis
1.2. Intestinal nematodes without tissue stage
A. Enterobius vermicularis
B. Trichuris trichuira.
2. Tissue and blood dwelling nematodes
2.1. Filarial worms
2.2. Dracunculus medinensis
2.3. Trichinella
2.4. Larva migrans.
INTESTINAL NEMATODES WITH
TISSUE STAGE
Class Nematoda -
The Roundworms
Ascaris lumbricoides
Diagnosis -
Identification of eggs and/or adults in fecal samples.
Major pathology and symptoms:
• Pneumonia associated with migration of larvae in the lungs.
• Obstruction of the intestines, appendix, or common bile duct.
• Vomiting and abdominal pain.
• May cause malnutrition in children with heavy infections or
poor diet.
• Some infections are asymptomatic.
Diagn
osis
Class Nematoda -
The Roundworms
Ascaris lumbricoides
Treatment
•pyrantel pamoate 11 mg/kg once; maximum 1 g,
•albendazole 400 mg once,
•mebendazole 100 g twice daily for 3 days or 500 mg once,
•ivermectin 150–200 mg/kg once.
Prophylaxis
•Preventing fecal contamination of soil.
•Treatment of vegetables and other garden crops with water
containing iodine 200 ppm for 15 minutes kills the eggs and
larvae of Ascaris and other helminths.
•Avoid eating raw vegetables.
•Improvement of personal hygiene. Treatment of infected
persons.
HOOK
WORMS
HOOK WORMS
1. Ancylostoma duodenale
2. Necator americanus
Life cycle:
• Eggs shed in soil hatch within 48 hours,
Female Male
becoming rhabditiform larvae (1st & 2nd stages).
• After ~ 7 days, worms stop feeding and molt,
transforming from the rhabditiform larvae to
infective filariform larvae.
• Infections are acquired when the filariform larvae
penetrates the skin of a human.
Hookworm egg
Class Nematoda -
The Roundworms
Ancylostoma duodenale & Necator americanus
Life cycle: (continued)
• Larvae enter the lymphatic system or
bloodstream, and travel to the lungs. After
maturating in the lungs, they migrate up the
trachea to be swallowed and reach the small
intestine, where they mature to adults.
• Immature adults attach to the intestinal mucosa
Hookworm rhabditiform larva by means of their stout mouth parts and suck
blood and tissue juices of the host.
• About five weeks after infection, the worms have
undergone a final molt to become sexually
mature adults. Fertilization occurs, and the
females begin to release eggs. Worm life span is
about 1 year.
Hookworm filariform larva
Class Nematoda -
The Roundworms
Ancylostoma duodenale & Necator americanus
Morphology:
• Rhabditiform larvae - long buccal cavity,
indistinct genital primordium. Filariform
larvae lose oral structures & have sharp
Hookworm rhabditiform larva
pointed tails.
• Adults - males: 7 to 11 mm long with a
Hookworm filariform larva copulatory bursa; females: 8 to 15 mm
long.
• Eggs - 55 to 70 x 35 to 40 microns; very
thin shell; usually seen in the 8 - 32 stage
of cleavage.
Hookworm egg
Class Nematoda -
The Roundworms
Ancylostoma duodenale & Necator americanus
Major pathology and symptoms:
• Serpent-like tunneling at site of penetration may
occur (cutaneous larva migrans).
• During migration through the lungs, patients may
experience a sore throat and / or bloody sputum.
• Heavy intestinal infections may result in enteritis,
anemia, weakness, and loss of strength due to the
anemia.
• Chronic infections may experience anemia,
weakness, weight loss and gastro-intestinal
symptoms.
• Nutritional and disease factors are commonly
seen in endemic areas. Children may exhibit
stunted growth and intellectual development.
• Blood loss can be up to 100 milliliters/day.
Class Nematoda -
The Roundworms
Ancylostoma duodenale & Necator americanus
Distribution:
Symptoms
Adult worms in the intestine feed on blood causing iron
deficiency anemia. The larvae may cause inflammation of the
lungs.
Diagnosis
Examination of stool by direct saline smear to detect the eggs.
Treatment
Mebendazole: 1 tab 2x daily for 3 days.
Strongyloides
Strongyloides stercoralis
The worms may be present as parasitic in the host or free living in the soil.
Morphology
Male: The male measures1 mm in length with curved posterior end and carries
two spicules
Female: The female measures 2.5 mm in length with straight posterior end.
Infection: follows skin penetration by filariform larvae
Class Nematoda -
The Roundworms
Strongyloides stercoralis - The Threadworm
Morphology:
• Rhabditiform larvae - short buccal cavity;
large, prominent genital primordium.
• Filariform larvae - tail has a notch in it, in
contrast with the filariform larva of
hookworms.
• Must be able to differentiate these from
Buccal cavity of rhabditiform larva
hookworm larvae.
• Eggs hatch in the intestine (not usually
passed in stool specimens). Eggs resemble
hookworm eggs, but are embryonated.
Symptoms
• Skin – allergic reactions; raised, itchy, red blotches at the site of larval
penetration.
• Lungs – pneumonia.
• Intestinal - abdominal pain, diarrhea, vomiting, weight loss, anemia,
eosinophilia. Light infections usually asymptomatic; Heavy infection - bowel
becomes edematous and congested.
• Death occurs in immunosuppressed patients due to heavy autoinfection.
Diagnosis:
• Recovery and identification of larvae in the feces.
Recovery and identification of eggs in duodenal drainage.
Treatment
Thiabendazole: 25 mg/kg twice daily for 3 days.
Class Nematoda -
The Roundworms
Strongyloides stercoralis - The Threadworm
Diagnosis:
Treatment
Pyrantel pamoate 11 mg/kg once, maximum 1 g,
Albendazole 400 mg once
Mebendazole 100 mg once
Prophylaxis
Maintainance of personal and community hygiene such as
frequent hand washing, _ nger nail cleaning, and regular bathing.
Frequent washing of night clothes and bed linen.
Class Nematoda -
The Roundworms
Trichuris trichiura
Life cycle:
• Infective, fully embryonated eggs are ingested, larvae hatch
in small intestine, penetrate and develop in the intestinal
villi, return to lumen and migrate to the area of the cecum.
• Larvae mature and live in the colon. Worms embed their
anterior portion (as much as two-thirds of the worm) into
the mucosa.
• Eggs must undergo development in the soil for
approximately 10 days to 3 weeks before they become
infective.
• The worm’s life span is estimated to be 4 - 8 years.
Class Nematoda -
The Roundworms
Trichuris trichiura