CHAPTER FOUR

HELMINTHS

Introduction to Helminths
Medical helminthology: study of HELIMINTHS(worms)
and their medical consequence.
Helminths derived from the Greek word helminths or
helminthose meaning worm.

 Either free living or parasitic organisms belonging to

phylum:
Nemathelminthes(round worm)
Platyhelminthes(flat worm ),
Acanthocephala (spinyheaded worms )or
Aannelida (segmented worm )

General features of helminths

Higher, multi cellular forms with specialized organs

Adult worms vary in size (6mm->10m)

Their life cycles may be simple or complex
Pathology, clinical sign and symptoms:
Depend on the location of the organisms
May be caused by adults, larva, or egg
Laboratory diagnosis mainly depends on
Detection and identification egg , larva or embryo and
rarely adults.

Classification of helminths

4.1. Nemathelminths

General features of Nemathelminths

Round in cross-section

Unsegmented

Digestive system complete

Possess mouth, oesophagus and anus

Have separate sexes

Can be oviparous/viviparous
Egg (ova) -Larva(L1-L4)-Adult

Possess a shiny cuticle (smooth/spined/ridged)

Mouth is surrounded by lips or papillae

Have Four larval stages

Burden and impact on human life

500,000 spp.
globally
Most are free
living
Abundant pathogens
in life-stock and pets
Important pests of
many crops
Cause numerous
human diseases

Classification of Nemathelminths

INTESTINAL NEMATODE
Small intestine
Ascaris

lumbricoides
Hook worm

Strongyloides stercoralis

Large intestine

BLOOD & TISSUE

NEMATODE
Adults or larval stage in
tissue
Filaria

Trichuris

trichuria
Enterobius vermicularis

Wuchereria bancrofti
Brugia malayi
Loa loa
Onchocerca volvulus

Trichinella spiralis,
Draconculus medinensis

Cont

INTESTINAL NEMATODES
General features
Live in gastro-intestinal tract

In humans, often spread by poor hygiene related to feces

Most species are geo-helminths (soil transmited)

Female worms are oviparous(producing eggs that hatch

outside body)

Humans are the only or major host of intestinal nematode

Transmission:

Ingestion of infective egg

Larva penetrating skin

Cont

It includes
Ascaris

lumbricoides
Strongyloides stercoralis
Ancylostoma duodenale
Nectator americanus
Trichuris trichiura
Enterobius vermicularis
Before becoming adults in their human host, the larvae of A.

lumbricoides, S. stercoralis , and hookworms have heart lung

migration.

Ascaris lumbricoides
Also known as large intestinal

round worm
the first human helminth recorded in chinise medical
literature(about 300-200 B.C.)
Epidemiology
world wide
1.45 billion people are infected annually
WHO estimated it resulted in 60,000 persons death
in 1995

Thediagnosticformistheegginfeces.Unmatedfemales
laynonfertilizedeggs.

5 types of Ascaris eggs in stool

A.

Fertilized Egg With Double Shell

Size: about 70m

Shape: oval, or some times round
Shell: The two layer are distinct,
rough , brown, covered with little
lumps
external shell and smooth,
thick, colorless internal shell.
Colour: brown external shell, and the
contents are colorless or pale yellow.
Content: a Single rounded granular
central mass.

Trichuris trichiura

Common name : whipworm, due to the whiplike form of the body.

Epidimology
The third most common round worm of humans
worldwide
Infections more frequent in areas with

tropical
weather and poor sanitation practices, and
among children

 ~ 112 billion cases world-wide

~ 1.05 billion people are infected annually

In Ethiopia
One national survey showed 36.1%
On

study in central and northern plateaus:

mean prevalence of 49%

Trichuris vulpes (dog whip worm in

the intestine of an infected dog

Enterobius vermicularls
. Common name: Pin Worm or threadworm or
seat worm
Epidimology
occurs world-wide
Children

(5-14 years ) are more commonly

infected than adults

Occur

in group living together

Pinworms eggs can

be spread throughout
a house and difficult
to eliminate.
Small children are
most appropriate to
pick them up during
the teething stage.

In Ethiopia : 5 % school children in rural

communities in Gonder region had
E. Vermicularis eggs under their finger nails
and that only 0.5% of them were found to shed
eggs in the stool
Recent

studies done using routine stool

examination method, a prevalence rate up to 1%
were reported

Adult Pinworms on the perianal skin

Strongyloides stercoralis
Common

name: Dwarf thread worm

Epidemiology
Found worldwide

An estimated 50 to 100 million cases

Favors warmer tropical and subtropical

climate

In Ethiopia
not highly prevalent in most areas and is found in
the same geographical areas with hookworm

rates up to 44% reported from 41 of the 50

communities in central and northern Ethiopia

The infection is rare or absent in many arid

lowland areas, including the Ogaden and
pastoral areas in the Awash Valley

Transmission and Life cycle

Transmission
1. Commonly by penetration of skin by filariform
larva

3.

Ingestion of food or water contaminated with

filariform larva( oral route)
Autoinfection with rhabiditform larva

4.

Rarely: Transmamary & Organ transplantation

2.

Hook Worms

Are hematophagous nematodes

Two major species

Ancylomstoma duodenale
Necator americanus

Less important : A. braziliense ,A. caninum , A.

ceylanicum, A.tubaeforme, A. buckleyi

Epidimology
widely

distributed throughout the tropics and

subtropics
more than 1 billion people are infected worldwide
cause daily blood loss of 7 million liters
Most
commonly infected are children,
agricultural workers and miners
Ancylostoma is found in Europe around the
Mediterranean, on the West coast of South
America and in parts of China and India
Necator is found over much of the western
hemisphere, Africa and South East Asia

Larva migrans disease resulted from migration of

larva

1. CUTANEOUS LARVA MIGRANS

2. VISCERAL LARVA MIGRANS
3. OCULAR LARVA MIGRANS
1.

CUTANEOUS LARVA MIGRANS

Caused by larvae of cat hook worm (Ancylostoma braziliense)
& dog hook worm (Ancylostoma caninum) in man
Commonly seen in children in the tropics and sub tropics

Image 037_02. Cutaneous Larva Migrans. Cutaneous larva migrans lesions of

the foot of a 10-year-old girl. In the United States this dog and cat hookworm
infection is most commonly seen in the southeastern states. These raised,
serpiginous, pruritic, migrating eruptions may extend rapidly.

Red Book Online Visual Library, 2006. Image 037_02. Available at:
http://aapredbook.aappublications.org/visual. Accessed December 7, 2007

Copyright 2006 American Academy of Pediatrics

Image 037_01. Cutaneous Larva Migrans. Cutaneous larva migrans lesions on

lower leg (caused by hookworm larvae of Ancylostoma braziliense and
Ancylostoma caninum).

Red Book Online Visual Library, 2006. Image 037_01. Available at:
http://aapredbook.aappublications.org/visual. Accessed December 7, 2007

Copyright 2006 American Academy of Pediatrics

Image 037_05. Cutaneous Larva Migrans. Cutaneous larva migrans infection of

the foot in an adolescent male

Red Book Online Visual Library, 2006. Image 037_05. Available at:
http://aapredbook.aappublications.org/visual. Accessed December 7, 2007

Copyright 2006 American Academy of Pediatrics

2. VISCERAL LARVA MIGRANS(VLM)

Migration of larval nematodes of the
dog ascarid (Toxocara canis ) ,
the cat ascarid (Toxocara catis )
3. Ocular Larva Migrans (OLM)
is potentially more serious as the retina may damaged and in
extreme cases may result in loss of visions or sever ocular
inflammation