Nematoda 1

N EM ATO D A
Dr. SUHAEMI, SpPD,FINASIM
Phylum N em atoda
Roundworms
In nearly all habitats from poles to
tropics
Over 100,000 species
Tough cuticle covers body
Longitudinal but not circular muscles
Pseudocoelom acts as hydrostatic
skeleton and circulatory system
Complete digestive tract stylet
Dr. SUHAEMI, SpPD,FINASIM
IN TES TIN A L N EM ATO D ES
Ascaris lum bricoides

Giant intestinal
roundworm
Whitish or pinkish worm
More than 1 billion
individuals are affected
70% from Asia
Soil transmitted
helminth
Polymyarian
Somatic muscles are

numerous and project
well into the body cavity

Males = 10-31
cm
Ventrally curved
posterior end with

2 spicules
Females = 22
35cm
Straight, conical
posterior end

Trilobate lips

Unfertilized eggs
Narrower
Longer
Thin shell
Refractile granules
are not organized

Found in the absence
of males

Fertilized eggs
Thick transparent
hyaline shell
Ovoid mass of
protoplasm which
develops into
larvae at about 14
days

Embryonated
eggs
Infective stage
Embryonation
occurs in the soil
Retrieved fromhttp://parasitol.wkhc.ac.kr/image/nema/lifeal.JPG Feb. 2008

Pathogenesis and clininal
manifestations
Ascariasis
Causes varying degrees of pathology
Tissue reaction to larvae
Intestinal irritation to adults
Complications due to intestinal migration

Diagnosis
Direct fecal smear
Kato technique or
Cellophane Thick
smear method
Kato-Katz Technique
Quantitative
Intensity of infection
Per gram of feces
M igration ofW orm s

Larval forms enter blood and lymph
capillaries and travel to heart.

Heart to lungs, coughed up,
swallowed to the intestine

Then the worm can mature to an
adult.
Why such a pattern?

Treatment
Albendazole
Drug of choice
400 mg single dose
200 mg for children under 2 year old
Mebendazole
500 mg single dose
Pyrantel Pamoate
10 mg/kg body weight (max. of 1 g)
N ecator am ericanus
Hookworms that infect man
Soil-transmitted helminths
Blood-sucking
Attach to the intestinal mucosa
Small, cylindrical,
fusiform, whitish
worm
Female
Larger
(9-11 mm by 0.35mm)
Male
Smaller (5-9 mm by 0.30mm)

Posterior end has a
broad membranous
caudal bursa with riblike rays used for
copulation
Head
Curved opposite
the curvature of
the body
Like a hook at the
anterior end
Buccal capsule
semilunar cutting
plates
Ancylostom a duodenale
Slightly larger
than Necator
americanus
Head curves in
the same
direction as the
curvature of the
body
Buccal capsule
2 pairs of curved
ventral teeth
Copulatory bursa
of male
Rhabditiform larva
Resemble
Strongyloides
stercoralis
Larger
More attenuated
posteriorly
Longer buccal cavity
Smaller
genitalprimordium
Filariform larva
infective stage to
humans
OVA
Bluntly rounded
ends
Single, thin
transparent
hyaline shell
Unsegmented
during oviposition
2-8 cell stages in
fresh feces
LIFE CYCLE
Pathogenesis and Clinical Manifestations
Pathology of hookworm infection involves
The skin, at the site of entry of filariform larva
Maculopapular lesions ground itch or dew itch
Itching, edema, erythema leading to papulovesicular eruption
lasting for 2 weeks
The lung, during larval migration

Bronchitis
Pneumonitis
The small intestine, the habitat of the adult worm
Abdominal pain
Steatorrhea
Diarrhea with blood and mucus
Eosinophilia ( 30% to 60%)
Epidemiology
Over 900 million people infected
Associated anemia causes 50,000
deaths annually
Ancylostoma duodenale
Necator americanus
Prevention and Control
Sanitary disposal of human feces
Wearing of footwear
Health education
Treatment of infected individuals
Mass chemotherapy when prevalence is
greater than 50%

Protection of susceptible individuals through
Improved househod income
Improved diet to prevent malnutrition
Diagnosis
Direct fecal smear
only for heavy infections
Kato Technique
Increases detection rate
Kato Katz Method
Quantitative diagnosis
Zinc Sulfate Centrifugation

Formalin Ether Concentration
Harada-Mori
Allow hatching of larvae from eggs on strips of

filter paper with one end immersed in water
Ancylostom a caninum
Ancylostom a braziliense
Ancylostoma
caninum
Dog hookworm
Ancylostoma
braziliense
Cat hookworm
Both cause creeping

eruptions
Treatment
Albendazole
Drug of choice
Ovicidal and larvicidal
400 mg single dse in adults and children over 2
years old
Available in chewable tablets or suspension
Not recommended for pregnant women
Mebendazole
500 mg single dose in adults and children
Not recommended for children below 2 years old
Trichuris trichiura
Whipworm
Soil transmitted heminth
Often observed occuring together
with Ascaris lumbricoides due to

similarities in transmission and mode
of distribution
Holomyarian
Somatic muscles are small and closely
packed in narrow zones
Trichuris trichiura
Anterior three-fifths long and whiplike
Posterior two-fifths is thick and

fleshy
Inhabit the large intestine
Insert into the intestinal wall of the

cecum in a pin-fashion
Male
30-45 mm
Coiled posterior end
Single spicule
Retractile sheath
Female
35-50 mm
Bluntly rounded posterior end
Can produce over 60 million ggs
in an average life span of 2 years
Trichuris trichiura
Ova
Passed out
together with
feces
Embroyanation in
the soil (2-3
weeks)
Protuberant
bipolar mucus
plugs
Football in shape
Trichuris trichiura
Pathogenesis & Clinical
Manifestations
trichuriasis
Petechial hemorrhages predisposing to
amebic dysentery
Over 5,000 eggs /g of stool:
symptomatic
Over 20,000 eggs/g : severe diarrhea or
dysenteric syndrome
Trichuris trichiura
Rectal
prolapse
during heavy
infection
Trichuris trichiura
Trichuris trichiura
Diagnosis
Direct fecal
smear
Kato Thick
smear
Kato Katz
Concentration
Techniques
ZnSO4
Formalin Ether
Trichuris trichiura
Epidemiology
Distributed in warm. Moist areas of the
world
20% 30% prevalence in temperate
countries
60% - 85% in tropical countries
Children 5 to 15 years of age are
frequently infected
Trichuris trichiura
Treatment
Mebendazole
Drug of choice
500 mg single dose in light infections
2 3 days of consecutive treatment for moderate
and heavy infections
Contraindicated during early pregnancy and in
hypersensitivity
Albendazole
400 mg single dose
Contraindicated during pregnancy
Enterobius verm icularis

Pinworm or seatworm
Found in the lower ileum and cecum
Cuticular alar expansions : cephalic
alae
Prominent posterior esophageal bulb
Meromyarian
Somatic muscles arranged into 2-5 cells per
dorsal or ventral half

Male
2-5 mm by 0.1-0.2 mm
Curved tail with a single
spicule
Dies after fertilizing the
female
Female
8 13 mm by 0.4 mm
Long pointed tail
Uteri of gravid females
are distended with eggs
Gravid female lays 4,
672 to 16,888 eggs/day
(11,105 eggs on
average/day)
Dies after deposition

Ova
Assymetrical
D-shaped
Plano convex50-60 um
by 20-30 um
Embryonated when laid
Remain viable within 13
days in moist conditions
Translucent shell
Outer albuminous
covering for mechanical
protection
Inner lipoidal membrane
for chemical protection

Pathogenesis and Clinical
Manifestations
Enterobiasis or oxyuriasis
Familial disease
Pruritus perinei et periani
Other complications
Appendicitis
Vaginitis
Endometriosis
Salpingitis
peritonitis

Epidemiology
Temperate and tropical regions

208.8 million are infected
Prevalence
29% among schoolchildren in private schools
56% among schoolchildren in private schools
Only nematode infection that cannot be controlled
through sanitary human waste disposal

Infection
Inhalation
Ingestion
Retroinfection

Personal cleanliness ang hygiene
Chemotherapy for familial cases
Use of showers rather than bath tubs
Boiling of bed sheets, night wear,
blankets, etc.

Diagnosis
Finding the adult
worm
Finding ova in
stool (only in 5%
of infected
individuals)
Finding ova in
scotch tape swabs

Diagnosis
Graham s Scotch
Adhesive Tape
Technique
Cellulose Tape
Technique
Very sensitive and
specific

Treatment
Pyrantel pamoate
Drug of choice
10 mg/kg with a second dose 2 to 4 weeks later
Albendazole
Alternative drug
400 mg single dose

Chewable tablets
Mebendazole
500 mg single dose

Chewable tablets
Strongyloides stercoralis
Free-living females
Parasitic females
Free living males
Parasitic males have not reliably been
identified
Only species naturally pathogenic to
humans
other species infect mammals and
birds
Rhabditiform larva
Feeding
225 um by 16 um
Elongated esophagus
with pyriform
posterior bulb
Slightly smaller tha
hookworm larva
Shorter buccal
capsule
Larger genital
primordium
Filariform larva
Infective
Non-feeding and
slender
550 um in length
Notched tail
Ova
Clear, thin shelled
Similar to
hookworm but are

smaller
Strongyloides infections of
humans can be fatal in two
situations.
individuals who are

immunosuppressed
(artificially or by other
disease) are susceptible to
a disseminated, and usually
fatal, Strongyloides
infection.
In addition in areas of New
Guinea Strongyloides is the
causative agent of 'Swollen
Baby (or Belly) Syndrome'
in which young infants
develop massive
Strongyloides infections
which are fatal unless rapid
treatment is given.
Pathogenesis and Clinical
Manifestations
Strongyloidiasis
3 phases of infection
Invasion of the skin by filariform larvae
Erythema
Pruritic hemorrhagic papules
Migration of larvae inside the body

Lobar pneumonia (lungs)
Penetration of intestinal mucosa by female worms
Epidemiology
50 to 100 million people are infected
Frequently found among male children
(7 14 years old)
More of fecally-transmitted worm rather
than soil-tranmitted
Diagnosis
Eosinophilia
Duodenal
aspiration
Small bowel
biopsy
Concentration
techniques
Harada Mori
Culture
Baer mann funnel
Diagnosis
Eosinophilia
Duodenal
aspiration
Small bowel
biopsy
Concentration
techniques
Harada Mori
Culture
Baer mann funnel
Treatment
All infected individuals must be treated
Albendazole
Drug of choice
400 mg for 3 consecutive days for adults and children
over 2 yeas of age
Eradicate up to 80% of infection
Thiabendazole
50mg/kg (max. of 3 g/day) in 2 divided doses daily for 2
consecutive days after meals
Contraindicated in pregnant women and those with
hypersensitivity to the drugs
Capillaria philippinensis
Tiny nematode in small intestines
Thin filamentous anterior end
Slightly thicker and shorter posterior
end
Esophagus has rows of secretory cells
called stichocytes
Stichosome refers to the entire
esophageal structure
Male
1.5 to 3.9 mm
Has a spicule with an
unspined sheath
Female
2.3 to 5.3 mm
First generation of
female worms lay larvae
to build up the
population
Subsequent generations
produce eggs
Ova
Peanut-shaped
Striated shell
Flattened bipolar
mucus plugs
36 um x 45 um x 20
um
Passed out in the
feces
Embryonate in the soil
and water
1) Unembryonated eggs deposited in the intestinal lumen of either the avian or

human host are expelled in the feces, whereupon the eggs are released into the
external (usually aqueous) environment.
(2) The unembryonated eggs become embryonated while in the fresh- or
brackish-water.
(3) The embryonated eggs are ingested by fresh- or brackish-water fish. which
serve as the intermediate host for the Capillaria philippinensis. Inside the
intestinal lumen of the fish, the larvae hatch, burrow through the intestinal
mucosa, and permeate the fish's mesenteric and peripheral tissues.
(4) The parasite enters the intestinal lumen of humans, fish-eating birds, and
other animal hosts upon ingestion of raw or undercooked C. philippinensis
infected fish.
(5) The adult worms of Capillaria philippinensis burrow into the intestinal
mucosa (most typically of the jejunum).
(6)While in the intestinal lumen of the human or avian host, the female worms
deposit unembryonated eggs, which are subsequently expelled in the host's
feces. (Albeit a rare occurence, the eggs of Capillaria philippinensis may
become embryonated within the intestine of the human host. The subsequent
release of infective larvae leads autoinfection and hyperinfection. Photos on
this page courtesy of www.dpd.cdc.gov/.../ body_Capillariasis_page1.htm
Pathogenesis and Clinical Manifestations
capillariasis
Abdominal pains
Gurgling of the stomach (borborygmus)
Diarrhea
Noticeable weight loss, malaise, anorexia, vomiting,
edema
Severe protein losing enteropathy, malabsorption of
fats and sugars
Low electrolyte levels (especially K+)
High levels of IgE
death
Epidemiology
First recorded in Northern Luzon, Philippines
2,000 cases documented in the Philippines
Thailand, Iran, Japan, Egypt, Korea, Taiwan,
India
Infection is acquired by eating uncooked
raw freshwater/brackish water fish bagsit
Discouraging people in endemic areas to
eat raw fish

Good sanitary practices
Avoid washing fecally contaminated
bedsheets in lagoons
Educational programs
Treatment
Electrolyte replacement
High protein diet
Antidiarrheal drugs
Antihelminthic drugs
Albendazole
400 mg once a day for 10 days
Drug of choice
Destroys larval stages
Mebendazole
200 mg 2x a day for 20 days
B LO O D A N D TISS U E
N EM ATO D ES
W uchereria bancrofti
Pathogenesis
causes chronic
disfiguring disease
presenting as
lymphedema,
elephantiasis,
hydrocoele
Adults worms
Creamy, white ,
long filariform in
shape
Male
2 4 cm in length
Female
8 10 cm in
length
Microfilaria
Appear as minute
snake-like organisms
among the red blood
cells
270 um 290 um
enclosed in a sheath
that is longer than the
microfilaria
Central axis shows
dark-staning nuclei
Brugia m alayi
Adult worms
Male
13 23 mm
Female
43 55 mm
Indistinguishable
from adult female
W. bancrofti
Brugia m alayi
Microfilaria
177 230 um
Enlosed in a
sheath with
angular
curvatures and
secondary kinks
2 terminal nuclei
at the tip of the
tail
Brugia m alayi
Wuchereria bancrofti
Brugia malayi
Mean length
290 um
222 um
Cephalic space:
breadth
1:1
2:1
Sheath in Giemsa
unstained
pink
nuclei
Regularly spaced;
separately situated
Irregularly spaced
and overlapping
tail
Single row that does

not reach the tails
end
Single row that

reaches the tails end
Terminal nuclei
None
2 nuclei
Appearance in blood
film
Smoothly curved
kinky
Brugia m alayi
Brugia m alayi
Epidemiology
More than 1 billion people in over 80 countries are at risk

Over 120 million peole are affected
43 million are seriously affected
In the Philippines:
Camarines Norte
Camarines Sur
Albay
Sorsogon
Mindoro
Palawan
Romblon
Mountain Province
All provincrs of Mindanao
Brugia m alayi
Epidemiology
Wuchereria bancrofti
Anopheles minimus var. flavirostris
(principal vector for malaria) ; rural
Culex: urban
Aedes poecilus (abaca and banana plants)
Brugia malayi
Mansonia bonnae
Brugia m alayi
Diagnosis
Microscopic finding of
characteristic microfilariae
in wet smears or thick blood
smears
Diethylcarbamazine
provocative test (3mg/kg
single dose) stimulates
microfilariae to come out to
the peripheral circulation
Detection of circulating
filarial antigens
Ultrasonography may
demonstrate live worms in
the lymphatics
Brugia m alayi
Prevention an Control
WHO has targeted elimination of
filariasis by 2020
DEC medicated table or cooking salt
Elimination of microfilariae in the blood
Personal protective measures
Brugia m alayi
Treatment
Diethylcarbamazine (DEC)
Drug of choice
6 mg/kg body weight for 12 days
Divided doses after meals
Ivermectin
200 to 400 ug/kg body weight in a single
ral dose
Brugia m alayi
Brugia m alayi
Trichinella spiralis
3 species that can infect humans
Trichinella spiralis spiralis : temperate
regions
Trichinella spiralis nativa : arctic regions
Trichinella spiralis nelsoni : Africa
Adult worms
Whitish in color
1.5 to 3.5 mm by
0.04 to 0.06 mm
Female
3.5 mm by 0.06 mm
Single ovary
Oviduct, seminal
receptacle, coiled
uterus, vulva, vagina
Male
1.5 mm by 0.04 mm
Single testis
Posterior cloaca
Pair of caudal
appendages
Pair of papillae
Larva
80 to 120 um by
5.6 mm at birth
Reaches 900 to
1300 um by 35 to
40 um when it
enters the muscle
fiber
Spear-like
burrowing anterior
tip
Hosts serve both as final and intermediate
host by harboring the adut and larva stages

Host
Humans
Rats
Dogs
Cats
Pigs
Bears
Foxes
Carnivores/omnivores
Pathogenesis
Trichinosis: zoonosis
Self-limiting disease
Patients with approx. 10 larvae: light
infection: asymptomatic
50 to 500 worms: moderate infection:
symptomatic
1,000 larvae: severe: fatal
Pathogenesis
Clinical manifestations
Incubation and intestinal invasion
Diarrhea or constipation
Vomiting, malaise, nausea, abdominal
cramps, similar to acute food poisoning
Larval migration and muscle invasion

Myalgia, periorbital edema, eosinophilia
-complications: splenomegaly, meningitis,
cerebral lesions
Encystment and encapsulation
Diagnosis
Based on history
of exposure
Demonstration of
encysted larvae in
muscle biopsy
Biochemical tests
Becks
xenodiagnosis
Epidemiology
Occurs whenever meat is part of the diet
Human infection: dead end infection
Health education
Cooking of meat at 77 0C, storage at -15
C, for 20 days or -30 0C for 6 days

Smoking, salting, drying meat are not
effective
Meat inspection
Keep pigs in rat-free pens
0
Treatment
Thiabendazole
25 mg/kg body weight twice a day for 7 days
during the first week of infection expels the adult
worm from the GI tract
No effect on migrating larvae and infections
detected 2 weeks after exposure
Mebendazole
Larvicidal
Given at 20 mg/kg body weight 6-hourly for 10 to
14 days

Nematoda 1

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N EM ATO D A

Dr. SUHAEMI, SpPD,FINASIM

Dr. SUHAEMI, SpPD,FINASIM

IN TES TIN A L N EM ATO D ES

Ascaris lum bricoides

Somatic muscles are

Ascaris lum bricoides

posterior end with

Ascaris lum bricoides

Ascaris lum bricoides

are not organized

Ascaris lum bricoides

Ascaris lum bricoides

occurs in the soil

Ascaris lum bricoides

Retrieved fromhttp://parasitol.wkhc.ac.kr/image/nema/lifeal.JPG Feb. 2008

Ascaris lum bricoides

Ascaris lum bricoides

M igration ofW orm s

capillaries and travel to heart.

swallowed to the intestine

Ascaris lum bricoides

Smaller (5-9 mm by 0.30mm)

The lung, during larval migration

The small intestine, the habitat of the adult worm

greater than 50%

Direct fecal smear

only for heavy infections

Increases detection rate

Kato Katz Method

Zinc Sulfate Centrifugation

Allow hatching of larvae from eggs on strips of

Both cause creeping

with Ascaris lumbricoides due to

packed in narrow zones

Anterior three-fifths long and whiplike

Posterior two-fifths is thick and

Inhabit the large intestine

Insert into the intestinal wall of the

Petechial hemorrhages predisposing to

Enterobius verm icularis

dorsal or ventral half

Enterobius verm icularis

Enterobius verm icularis

Enterobius verm icularis

Enterobius verm icularis

Enterobius verm icularis

Temperate and tropical regions

through sanitary human waste disposal

Enterobius verm icularis

Enterobius verm icularis

Enterobius verm icularis

Enterobius verm icularis

400 mg single dose

500 mg single dose

hookworm but are

individuals who are

Migration of larvae inside the body

Penetration of intestinal mucosa by female worms

hypersensitivity to the drugs

1) Unembryonated eggs deposited in the intestinal lumen of either the avian or

eat raw fish

Single row that does