Superfamily

oxyuridea
Enterobius vermicularis
)) oxyuris , pin worm, seat worm
Prevelance
It is the most common human parasitic infection.with high
prevelance among children.

It is most prevalent in cool and temperate zones where people less

frequently tend to baths and change their underclothes.
.
 Superfamily oxyuridea
 Habitat :
 large intestine.

 General Morphology:
They are stout, slender.
Oesophagus has a posterior Pharyngeal bulb (double bulbed oesophagus).
Buccal cavity absent or weakly developed
Excretory canal is X shaped

Females having sharply pointed tails

Males with no caudal bursa and no rays but with caudal alae supported with
arrangement of similar pedunculate papillae (caudal papillae),
one spicule and no gubernaculum.
Morphology
: General morphology
Stout, slender, glistening white with transversely
. striated cuticle
Three lips surround mouth followed by cuticular 
inflation of the head .( cervical alae)

At the anterior end Double bulbed oesophagus 

with posterior muscular bulb .(no buccal
capsule)
 Morphology

male female
curved posterior end with
conspicuous caudal alae supported long, slender and pointed posterior end
by caudal papillae

One copulatory spicule with no

gubernaculum
vulva is preequitorial open mid ventrally,

has one vagina which is long,extend posterioly from

vulva to join paired genital organs (2 uterus, 2
oviducts, 2 ovaries
 Morphology
Eggs:

Oval, colorless, contain embryonated

larva.compressed laterally, flattened on one
side (D shape), have thick shell (about
60×30μ).
The egg shell is double layered and relatively
thick, though transparent. The outer
albuminous layer makes the eggs stick to each
other and to clothing and other objects.
 Life cycle

 Direct life cycle

(No intermediate host)
Habitat is ileocecal region 2 weeks-
2 month

 Infective&diagnostic stage is egg .

 Eggs are partially developed then develop to infective in 6 hours at body
temperature .

 Eggs are resistant to disinfectants putrefaction cannot resist dryness or

sunlight.
Modes of infection :

1-Autoinfection
-External via direct anus to mouth transmission through perianal itching “ under
fingernails .
-Internal via hatching of the egg in the intestine before going to the outside.
2 -Airborne
3-Contaminated furniture, toys
clinical presentation
young (11-20 years of age) more than older people
Pinworm infection is the most common helminth infection
within the United States and Western Europe; prevalence rates in some areas may be as high as 30
to 50%.
1. In most cases, it is asymptomatic especially in light infection
2. Clinical symptoms are negligible but female are three times more symptomatic than males.
3. The most striking symptom is pruritus, which is caused by the migration of the female worms
from the anus onto the perianal skin before egg deposition. The sometimes intense itching results in
scratching and occasional scarification. In most infected people,
4. In heavily infected females, there may be a mucoidvaginal discharge, with subsequent migration
of the wormsinto the vagina, uterus, or fallopian tubes, where theybecome encapsulated.
5.Other symptoms particularly in children;
Are nervousness, insomnia, nightmares, and even convulsions
 6. Attached worms cause minute ulceration , mild Inflammation and Secondary
bacterial infection cause submucosal abscess,Rarely penetrate to submucosa cause
eosinophilic enterocolitis
 -Appendicitis by invasion of the wall with increase eosinophilia.
 But in whip worms appendicitis is caused by mechanical blockage of the
appendiceal lumen by masses of whipworms.
 Diagnosis
 Diagnosis depends on demonstrating the presence of eggs or adult
 worms.
 This is normally accomplished by sampling the perianal and perineal skin with cellulose tape (Scotch
tape), whichis applied sticky side down to the skin. The tape is transferredto a glass slide and examined
under the microscope for thepresence of eggs or adult worms adult pinworms.
 Eggs are rarely found in the stool (approximately 5% of the time), and sampling of the perianal folds
 . Since the female worms migrate on a sporadic basis, a series of four to six consecutive
 tapes may be necessary to demonstrate the infection. The
 tapes are used late in the evening, when the patient has
 been sleeping for several hours, or first thing in the morning
 before the patient takes a shower or goes to the bathroom.
 In cases of ectopic infection, diagnosis usually requires
 biopsy and histologic examination
Appendix histopathology

in enterobius vermicularis
 mucosa of appendix shows ulcerations
 chronic inflammatory cells.
 Cut section of EV worm with two cuticular crests

In trichuris trichura
 Appendix is infiltrated by inflammatory cells.
 Cut section of Trichuris trichura inside its lumen
 Treatment
 Systemic treatment:
Albendazole or mebendazole
Alternatives : Ivermectin
Any of these drugs are given in one dose initially, and then another single dose of the same
drug two weeks later.
The medication does not reliably kill pinworm eggs. Therefore, the second dose is to prevent
re-infection by adult worms that hatch from any eggs not killed by the first treatment.

 Local treatment: relief itching by

1%white ppt ointment at anus before sleep (decrease itching, prevent worm migration)
1%phenol (antiseptic, anaesthetic)
Saline enema to wash worms and eggs
Enterobius vermicularis causing acute
appendicitis, a case report
 A 23-year-old housewife patient presented to Emergency
 Department with a right lower abdominal pain for the past 8 h with
concomitant anorexia, nausea and vomiting twice. Other than
 having a mild fever, the patient had normal vital signs.
 Clinical examination revealed right iliac fossa (RIF) tenderness
 upon palpation and rebound tenderness upon release. Other signs
 like Rovsing and pointing signs were positive as well.
 Complete blood count revealed mild leukocytosis
 (12,000 m/mm3) while other routine investigations like urinalysis, blood urea and
serum creatinine were not remarkable.
 Abdominal and pelvic ultrasound reported no unusual findings
 The patient was diagnosed as a case of suspected acute appendicitis (S.A.A.).
 She was operated for appendicectomy . Intra operatively an inflamed
appendix obstructed by Enterobius vermicularis was
 noted. An eventful classical appendicectomy done.Terminal ileum and right ovary
checked and both were normal
 The patient recovered without any complications and was transferred to the
surgical ward for observation. Within 8 h, she passed
 flatus and started oral feeding. After 24 h, she was sent home in a
 good heath condition and scheduled to visit after 8 days, where she
 was healthy and the would stiches removed
Trichostrongylus sp

 Trichostrongylus nematodes are commonly found in herbivores throughout the world.

 Various species have been found in humans, and some are more clinically important
 than others.
 The following species of this genus have been reported from man

 T.colubriformis in Egypt & India with extensive distribution

 T.probolurus in North Afrtica & North America
 T.vitrinus in Egypt & Siberia
 T.instabilis in Siberia
 T.axei in Japan , Armenia & Siberia
 T.orientalis in Japan , korea , Taiwan & china
 T.skrjabini in Armenia
 T.brevis in Japan
Life Cycle and Morphology

 Trichostrongylus spp. are small worms, similar to hookworms, and live

embedded in the mucosa of the small intestine. Unlike the adult hookworms,
the adult worms
have no distinct buccal capsule with special mouth parts.

 Infection in humans is acquired through ingestion of the infective larvae

contaminating plant material.
 After reaching the small intestine, the larvae mature in 3 to 4 weeks without any
migratory pathway through the lungs.
 The eggs are very similar to those of hookworms, being oval and
somewhat longer, with the ends being more pointed than in hookworm
eggs.

The eggs may hatch within 24 h under favorable conditions (warm, moist
soil) and develop into infective larvae after about 60 h.
Clinical Disease

 Symptoms are related to the worm burden and damage to the intestinal mucosa.

 Hemorrhage and desquamation may occur (similar to findings in hookworm infection);

however, symptoms are usually not clinically significant

 unless several hundred worms are present. Patients present with epigastric pain, diarrhea,
anorexia, nausea, dizziness, andgeneralized fatigue or malaise;

 eosinophilia is usually present

 Heavy worm loads may lead to the development of anemia and cholecystitis, as the
worms enter the biliary tract.
Diagnosis
.The definitive diagnosis can be made by identification of eggs in the stool 

Hatched larvae can also be

differentiated from those of
hookworms and S. stercoralis
Strongyloide
stercoralis
Treatment

 Bephenium hydroxynaphthoate and 1-bromo-b-naphthol “ Alcopar “ , This

drug is a cholinergic agonist, causing paralysis of the parasite musculature
 Ivermectin
An Unusual Case of Hypereosinophilia and Abdominal
Pain: An
Outbreak of Trichostrongylus Imported From New
Zealand
 A62-year-old Caucasian woman presented to her general practitioner (GP) in UK,
 following a month long trip to visit friends in Australia and New Zealand. She spent
a week on a sheep farm in New Zealand. Shortly afterwards she felt dizzy and
nauseated. She then developed abdominal pain and bloating, followed by diarrhea
and weight loss of 2 kg.
 Initial investigaton showed leukocytosis and eosinophilia
 eosinophil count continued to rise rapidly,, the patient received an e-mail from two
friends who had been on the same trip, both of whom had developed similar
symptoms. Both had been investigated in New Zealand and found to have a peripheral
eosinophilia with Trichostrongylus spp. seen on stool microscopy
Examination of a stool sample revealed ova of Trichostrongylus spp She was 
treated with albendazole 400 mg twice daily for 3 days and recovered
.fully within 6 weeks 

Her peripheral eosinophilia was also resolved completely 