Phylum Nematoda (Revised) 2014 Edition

PHYLUM NEMATODA
Compiled by: Fortune Lapira Torrecampo, RMT, MPH
Nematodes or True Roundworms
Elongated, cylindrical, filiform with a definite antero-posterior axis Unsegmented Free living or parasitic Largest number of helminth parasites of man Vary in sizes from microscopic to as large as a lead pencil or a meter in length Separate sexes
INTEGUMENTARY SYSTEM
Consists
of non-nucleated cuticula secreted from the _________________ It may be ____________________ There are 3 layers: They lack _______ muscles Body cavity: _______________
DIGESTIVE SYSTEM
Has a _______ alimentary tract

MOUTH seen in the _______ end; it is frequently, although not always, provided with ______, ____, ____, ____, or other structures useful for attachment or for penetrating tissues, it is also provided with a _______ Oral or pharyngeal cavity- it may be large and hollowed out, short, long, and capillary, covered with ______ Esophagus- covered with ____, behind in the oral opening Midgut- lined with a single layer of ___cells which absorb digested food Rectum- situated behind the midgut and open thru the ___into the ____; covered with _____
TYPES OF ESOPHAGUS
1.
Filariform simple, long, and slender, seen in ____ groups of parasites 2. Rhabditiform- distal corpus or body, an isthmus, and a proximal bulb (esophageal bulb), seen in 3. Spiruroid- anterior muscular and posterior glandular, seen in 4. Strongyliform- short, muscular with a waist, seen in 5. Stichosoma- long, thin, capillary-like esophagus lined by esophageal gland cells (stichocytes), seen in
Circulatory System and Respiratory System are lacking Excretory System:

Consists
of 2 trunks called ________ or _______, have an excretory gland and an opening, the excretory pore which opens mid-dorsally in the cephalic or cervical region
Nervous system:
Consists of a ___, a ____, and 4 ____ longitudinal trunks with transverse commissures; the most important commissure is the ___________, which constitutes the nerve center. Nerve ending terminate in all of the important organs and in the integument especially in a sensory papillae Amphids or ______ are a pair of laterally placed minute receptor organs in the cephalic or cervical region of all nematodes Phasmids or caudal _______ are a pair of minute lateral postnatal organs in species without caudal glands
Reproductive system

Reproductive organs are bilateral, symmetrical, tubular, and coiled within the body Male genital system:
Testes Vas deferens Seminal vesicle Ejaculatory duct Cloaca

Gobernaculum Telamen Copulatory spicule Copulatory disk
Accessory copulatory apparatus:
Female Genital system:

Ovary Oviduct Seminal receptacle Uterus Ovijector Vagina Vulvar opening
Reproductive System continued:

Egg-consists
of a multinucleated mass of protoplasm, usually containing ______ The shell is made up of 3 layers:
Vitelline
membrane- fertilization membrane, secreted on the surface of ovum just after fertilization; it is waxy, colorless and lipoidal in nature Chorionic or true shell- chitinous in nature, synthesized from glycogen and ovarian nitrogen Albuminous covering- outermost layer; has tanning action
DEVELOPMENTAL STAGES
Nematodes have 5 successive fundamental stages, 4 larval stages and the adult.
2 TYPES OF LIFE CYCLE

Direct
Homogenic
do
not require an intermediate host From egg, they develop into the infective stage
Indirect
Heterogenic
Require
1 or 2 intermediate host for the development into the infective stage
MANNER OF INFECTION
Ingestion of embryonated eggs thru contaminated food or drinks. Ex: Ingestion of encysted larvae. Ex: Skin penetration by filariform larvae. Ex: Thru bite of arthropods or insect vectors. Ex:
MODES OF ATTACHMENT
Oral attachment to mucosa by sucking Anchorage with their attenuated ends Penetration of the tissues Retention in the mucosal folds pressing against it
MEANS OF NUTRITION
Sucking
and ingestion of blood Ingestion of lysed tissue Feeding on the intestinal contents Ingestion of nourishment from body fluids
CLASSIFICATION OF NEMATODA
Aphasmidia
(Class Adenophorea) - lacking phasmids, lacks caudal chemoreceptors Phasmidia (Class Secernentea)- with phasmids

Aphasmidia
Phasmidia
Trichinella spiralis
Ascaris lumbricoides
Trichuris trichiura
Capillaria philippinensis Capillaria hepatica Dioctophyma renale
Enterobius vermicularis
Necator americanus Ancylostoma duodenale Ancylostoma brazilense
Strongyloides stercoralis
Toxocara cati Toxocara canis Gnathostoma spinigerum
Angiostrongylus cantonensis Wuchereria bancrofti Brugia malayi Loa loa Onchocerca volvulus Mansonella perstans Mansonella streptocerca Mansonella ozzardi Drcunculus medinensis
Aphasmidia
Trichinella spiralis Trichuris trichiura Capillaria philippinensis Capillaria hepatica Dioctophyma renale
COMMON NAME:
Trichina worm
DISEASE:
Trichinosis or Trichinellosis
GEOGRAPHICAL DISTRIBUTION:
Worldwide
MORPHOLOGY:
Male: measure about 1-2mm x 40-60u in its transverse diameter. Delicate anteriorly and rounded posteriorly. Cloaca, which is situated at the caudal portion is guarded by 2 conspicuous papillae which is evertible during coitus Female: measure about 3-4mm with the vulva opening situated at the anterior 5th of the body with a single ovary found near the caudal end
EPIDEMIOLOGY:

Two hosts are required for completion of its life cycle. Man acquires the infection by consuming inadequately cooked meat
SYMPTOMS AND PATHOLOGY
A few days after eating undercooked meat, usually pork, the patient experiences diarrhea followed 1 to 2 weeks later by:

Fever Muscle pain Periorbital edema Eosinophilia
Subconjunctival hemorrhages are an important diagnostic criterion Signs of cardiac and central nervous system disease are frequent, because the larvae migrate to these tissues as well. Death, which is rare, is usually due to congestive heart failure or respiratory paralysis
LABORATORY DIAGNOSIS:

Muscle biopsy Bachman intradermal test Serological test Xenodiagnosis Blood picture Proper cooking of meat products Destruction of all carcasses and viscera of hogs dying on the farms Elimination of garbage feeding Extermination of rats or mice Deep freezing of all pork consumed by man
PREVENTION:

Trichuris trichiura
COMMON NAME:
Human whipworm
DISEASE:
Trichuriasis
Worldwide, with infections more frequent in areas with tropical weather and poor sanitation practices, and among children. It is estimated that 800 million people are infected worldwide.
Trichuris trichiura
MORPHOLOGY
Trichuris trichiura
MORPHOLOGY:
ADULT WORMS:

flesh colored attenuated in the anterior 3/5 of the body, fleshy posterior portion
FEMALE:

Oviparous Club shaped posterior end Reproductive system consist of a single:

sacculate ovary oviduct uterus which constricts as it nears the vulva at the anterior extremity of the fleshy portion of the worm
Trichuris trichiura
MALE:
caudal extremity coiled at 360 degrees or more Male genitalia has a long, sacculate testes, vas deferens, ejaculatory tubule which empties into the cloaca Has a lanceolate spicule which protrudes thru a retractile pineal sheath
OVA
Passed with stools in unsegmented condition requiring at least 2 wks for embryonation in the soil Barrel-shaped with 3 layers (thick walled) Outermost layer is bile stained with bipolar hyaline plugs, less resistant to dessication, heat, and cold than Ascaris JAPANESE LANTERN LEMON SHAPE
Trichuris trichiura
SYMPTOMS AND PATHOLOGY

Bloody or mucoid diarrhea 0.005ml/day Weight loss, abdominal pain Rectal prolapse- particularly in ________
LABORATORY DIAGNOSIS

DFS Concentration methods Sedimentation
PREVENTION
Proper disposal of feces
TREATMENT

Mebendazole is the treatment of choice Thiabendazole alternative drug
Capillaria philippinensis
COMMON NAME:
Pudoc
worm
DISEASE:
Intestinal
capillariasis
In
the Pacific In the Philippines- Cagayan, Ilocos Norte, Ilocos Sur, La Union, and Pangasinan
MORPHOLOGY:
Adult
worms live burrowed into the mucosa of the small bowels with both ends hanging or free
Males
Measure
2-3 mm Ventrolateral caudal expansions Smooth spicular sheath
MORPHOLOGY:
Females
Measures from 2.5 4mm with the body divided almost into 2 equal parts Anterior half is occupied by the esophagus and esophageal glands Posterior part containing the intestines, reproductive organs with slightly prominent vulva Usually have eggs in the uterus which may be 8-10 eggs arranged in a row wherein the eggs are segmented with thick striated shell and bipolar mucus plugs Eggs that are 45-50 are arranged in two or three rows, the eggs are multisegmented or embryonated with thin shell and devoid of bipoplar plugs
MORPHOLOGY
Ova
Similar
to Trichuris except for its smaller size and more striated shell Plugs are not protruded and the shells are more straight than convex
PATHOGENESIS
Associated with malabsorption syndrome:
Diarrhea Weight loss Weakness Muscle wasting Abdominal distention Edema

DFS Concentration and sedimentation methods
TREATMENT
Thiobendazole
Capillaria hepatica
COMMON NAME:
Capillary
liver worm
DISEASE:
Human
infection is rare usually indicates spurious infection due to eating of infected liver
Capillaria hepatica
MORPHOLOGY:

Adults: half as long Males:

Chitinized spicules Oviparous Membranous vulvular opening
Females:
Ova:

Barrel shaped with mucous plugs at both ends Shell pitted like a golf ball PEANUT SHAPED
Capillaria hepatica
The
presence of C. hepatica eggs in human stool during routine ova-and-parasite (O&P) examinations indicates spurious passage of ingested eggs, and not a true infection Diagnosis in humans is usually achieved by finding adults and eggs in biopsy or autopsy specimens.
Dioctophyma renale
COMMON NAME
Giant
kidney worm
DISEASE
GEOGRAPHICAL DISTRIBUTION
Worldwide
Dioctophyma renale
MORPHOLOGY
Adults
Blood in color
Males
Bell shaped bursa not supported by rays but inner part is covered with papillae
Females
Mid-ventral vulva
Ova

Ellipsoidal Brownish yellow Pitted
Dioctophyma renale
Eggs
in urine
PHASMIDIA

Ascaris lumbricoides Enterobius vermicularis Necator americanus
Ancylostoma duodenale
Ancylostoma brazilense Strongyloides stercoralis Toxocara cati
Angiostrongylus cantonensis Wuchereria bancrofti Brugia malayi Loa loa Onchocerca volvulus Mansonella perstans Mansonella streptocerca Mansonella ozzardi Drcunculus medinensis
Toxocara canis
Gnathostoma spinigerum
OBJECTIVES

Be able to discuss the phasmidia group Know the diseases that they cause, their life cycle, and laboratory diagnosis Have a better awareness of their impact on health
COMMON NAME:
Giant intestinal roundworm Large intestinal roundworm
DISEASE:
Ascariasis
Most common human helminthic infection Worldwide distribution Highest prevalence in tropical and subtropical regions, and areas with inadequate sanitation.
DISCOVERER:
Linnaeus, 1758
HABITAT:
Small intestine (jejunum and ileum)
MODE OF TRANSMISSION:
Ingestion of fully embryonated eggs from contaminated soil Use of human excreta as fertilizers Rainfall-provide essential moisture and redistribute the eggs
MORPHOLOGY:
ADULT
White, creamy, or pinkish yellow when freshly expelled Elongated, cylindrical, and a faint longitudinal white lateral lines is seen on each side
Curved posterior end and is usually shorter and slender compared to the female When freshly passed, the spicules may protrude when pressure is applied on the curved posterior end Measure 15-30cm by 3mm Measures 20-45 cm by 5mm with a straight posterior end Vulvar opening is situated at the anterior 1/3 with a single conical vagina leading into an ovijector which branches to the pair of genital tubules, each consisting of the uterus, seminal receptacle, oviduct, and ovary
MALES

FEMALES

MORPHOLOGY:
EGGS
FERTILIZED

Broadly oval Golden brown in color Measures 45-75 by 35-45 microns When freshly expelled, the egg consists of a single cell inside The egg has 3 layers: Inner lipoidal nonpermeable vitelline membrane (absent in infertile eggs) Thick transparent middle layer glycogen membrane Outermost coarsely mamillated albuminoid layer
MORPHOLOGY:
EGGS
UNFERTILIZED

Generally larger Narrower and elongated compared to fertilized eggs Measuring 88-94 microns by 44 microns Shell is thinner with an irregular coating of albumin Inside the egg shell are highly refractile granules of various sizes May lack the outer albuminous coat
MORPHOLOGY:
EGGS
EMBRYONATED

Same as fertilized Inside structure contains the larva of the embryo
Both fertile and unfertilized eggs at times lack the outer albuminous coat Fertilized eggs require a period of incubation before they are infective
PATHOGENESIS AND SYMPTOMATOLOGY Damage in man may be due to

Migrating
larva Adult worms
PATHOGENESIS AND SYMPTOMATOLOGY
MIGRATING LARVA
Trauma and minute or petechial hemorrhages: occur in the lungs as the larvae breaks out of the lung capillaries into the air sacs Pneumonia, cough, fever, high eosinophilia during lung migration: LOEFFLERS SYNDROME Ascaris pneumonitis: massive infection, damage to the pulmonary tissues is considerable and may occur
SYMPTOMS: Asthmatic type of respiration, cough, bronchial rales, urticarial rash, angioneurotic edema, eosinophilia in the circulating blood
Granulomatous reactions: lodge in various foci and provoke mild or severe symptoms. Larvae may lodge in the brain, spinal cord, eyeball, and kidneys
ADULT WORMS
Worms in the lumen of the small intestines feed on the liquid nutrient in the intestinal fluids Decreased fat and nitrogen absorption, increase nitrogen loss in feces, malabsorption or intolerance of lactose, decreased growth rates in children Diarrhea, vague, abdominal pain, nausea, and loss of appetite Vomitted ascaris may pass into the larynx and produce suffocation May reach the lungs and produce pulmonary gangrene Enter the eustachian tube and provoke otitis media Some worms may be entangled resulting in intestinal obstruction Invade the appendix and cause acute appendicitis May enter the liver parenchyma producing multiple abscesses May block the pancreatic duct producing acute pancreatitis Perforate the bowel and cause peritonitis
DFS Cellophane
Thick Smear (Kato technique) Concentration methods X-ray Finding larvae in gastric washings or sputum
TREATMENT
Both mebendazole and pyrantel pamoate are effective
CONTROL

Mass treatment Selective treatment
PREVENTION

Sanitary disposal of human excreta Personal hygiene like washing hands Avoid the use of human feces for fertilizer in vegetable gardens Thorough cooking of food particularly vegetables Washing fruits before eating
COMMON NAME:

Pinworm Seatworm
DISCOVERER:
Linnaeus, 1758; Leach 1853
DISEASE:
Enterobiasis, Oxyuriasis, Pinworm infection
Worldwide
MORPHOLOGY
ADULT
Small,
whitish or brownish in color At the anterior end is a pair of lateral cuticular expansion known as lateral wings or cephalic alae Oral tip lacks a true buccal capsule, but is provided with three lips and dorsoventral bladder-like expansions of the cuticle Esophagus has a predominant posterior bulbous and a prebulbar swelling
MORPHOLOGY
MALES
Measures 2-5mm in length Smaller than the female Ventrally curved tail with a single spicule and a caudal alae
FEMALES
8-13 mm in length and has a long pointed tail and a rigid body Uteri of gravid female are distended with eggs
MORPHOLOGY
OVA

Measure 50-60 by 20-30 microns Elongated Ovoidal Flattened on the ventral side giving an appearance similar to a letter D Egg shell is composed of two layers

Outer thick hyaline albuminous shell Inner embryonic, lipoidal membrane
Eggs become fully embryonated and mature within a few hours after oviposition (6 hours at body temperature) Fully embryonated eggs are already infective Eggs deposited by a single female vary from 4,672 to 16,888 with a mean of 11,105/day
HABITAT:
Cecum, appendix, portions of ascending colon, perianal region
MODE OF TRANSMISSION:

By anus to mouth thru contaminated fingers or fomites, common in children Through contaminated food and drinks, especially if the foodhandler is a carrier Airborne or inhalation, viable ova can float in air Retroinfection-gravid female after laying their eggs in the perianal area, goes back thru the anus to the large intestine, the larvae upon hatching, migrates back to the large intestine
PATHOGENESIS:
Minute ulceration:
abscess develop in the cecal mucosa, hemorrhages from ulceration, which may become infected causing intolerable itchiness
Nocturnal Pruritis ani:
During oviposition, there is intense itching or pruritis in the perianal region which results in scratching until the area is scarified. Pruritis ani gives rise to hemorrhage, eczema, and pyogenic infection of the anal and perianl regions and perineum
Appendicitis
Worms may enter the appendix
Urinary tract infection (very rare) Vulvovaginitis
In female patients, the migrating worm may oviposit in the genital organs with mucoid vaginal discharge
SYMPTOMATOLOGY:
Generally, there is:

Loss of appetite Weight loss Restlessness Irritability Insomnia

Anal swab Graham Scotch tape method Perianal scrapings Fingernails Mild eosinophilia
TREATMENT
Either mebendazole or pyrantel pamoate is effective. They kill the adult worms in the colon but not the eggs, so retreatment in 2 weeks is suggested Reinfection is very common
PREVENTION

Personal hygiene Bed linens and clothing of infected persons should be sterilized by boiling Fingernails should be cut short Home and community sanitation Mass treatment
HOOKWORMS

Necator americanus Ancylostoma braziliense Ancylostoma caninum Ancylostoma duodenale
HOOKWORMS
HOOKWORM COMMON NAME TEETH OTHER MORPHOLOGY Spicule-barbed and fused Dorsal ray- bipartite, deep cleft Fan like bursa Small, almost as broad as long Short, stubby rays Flaring, long moderate rays New World Hookworm Paired semilunar American murderer cutting plates American Hookworm Cat hookworm Smallest hookworm Dog hookworm 2 pairs of ventral teeth 3 pairs of ventral teeth 2 pairs of ventral teeth
N. americanus
A. braziliense
A. caninum
A. duodenale
Old World hookworm European hookworm Germ of laziness
Bell-shaped bursa, dorsal rays tripartite Shallow cleft Spicule not barbed, not fused
Hookworms
MORPHOLOGY
ADULTS
Small
cylindrical, fusiform Grayish white in fresh feces Reddish brown due to blood
MALE
Single
reproductive organ
FEMALE
Paired
reproductive organ
Hookworms
MORPHOLOGY
EGGS
Oval
or ellipsoidal Colorless with a single, transparent, thin hyaline membrane Unsegmented at oviposition 4-8 cell stage of division in fresh feces Embryo may develop in constipated feces
Hookworms
MORPHOLOGY
RHABDITIFORM LARVA

FILARIFORM LARVA

Short esophagus (flask shaped) with bulb Large buccal capsule Gential primordium- small, inconspicuous Snake-like motility Feeding stage
Long esophagus with bulb Tail pointed Lashing movement Infective stage to man Non feeding stage to man Sheat- protective covering
Life Cycle (intestinal hookworm infection): N. americanus and A. duodenale
Life Cycle (cutaneous larval migrans): Ancylostoma brazilense and Ancylostoma caninum
Hookworms
PATHOGENESIS, PATHOLOGY, AND SYMPTOMATOLOGY
Pathogenic stages are the larva and the adult
Larval lesion

when it penetrates the skin, it produces maculopapules and localized erythema Itching called ground itch or dew itch If many migrate to the lungs, bronchitis or pneumonitis may result in sensitized individuals
Adult lesions

Chronic infection with no acute symptoms Most prominent characteristic in moderate or heavy chronic infection is progressive secondary microcytic hypochromic anemia of nutritional deficiency due to loss of blood May lead to cardiac hypertrophy and rapid pulse Dyspnea Weakness Dizziness Anorexia Vomitting Disturbances in sleep Some degree of mental retardation
Hookworms
Based on the severity of symptoms

1. Mild (with blood compensation) anemia negligible and symptoms lacking 2. Moderate (with appreciable blood decompensation)-symptoms consist of:

Heartburn Flatulence Feeling of fullness in the abdomen Epigastric pain Relieved by eating bulky food or ingesting clay(geophagia) Vasomotor disturbances Dyspnea Low grade intermittent fever Palpitation
3. Severe (with complete decompensation)
Classical picture present with Constipation or diarrhea Dry skin Geophagia intensified Edema around the eyes Pot belly in children Albuminuria Child may be physically and mentally retarded
Hookworms
Creeping eruption or cutaneous larvae migrans

More on A. braziliense and A. caninum Cutaneous lesion commonly resulting from exposure of the unprotected skin of man to filariform larvae of canine or feline strains of A. braziliense and A. caninum Can also be caused by Strongyloides larvae, Gnathostoma spingerum, cutaneous larval filariasis, and linear cutaneous lesions caused by migration of fly maggots Also know as plummers itch and duck-hunters itch Usually affect the feet, arms, back, and abdomen Dry and crusted
Hookworms
Direct
Fecal Smear Concentration methods: Zince sulfate method Copro-culture: To differentiate hookworm from _____ Baermans technique Charcoal culture Egg counting
Hookworms
EPIDEMIOLOGY
General
prevalence of hookworm infection is determined
by:

Extent of infection in a community environment favorable for the existence and development of the free living larva Adequate source of infection in the human population Sewage disposal and degree of soil contamination Sanitary habit and economic status of the people
TREATMENT
Both
mebendazole and pyrantel pamoate are effective
Hookworms
PREVENTION
Treatment
of infected hosts ( human and animals) Good and sanitary disposal Protection of susceptible individuals
COMMON NAME
Threadworm
DISEASE
Strongyloidiasis, strongyloidosis, Cochin-China diarrhea

Tropical and subtropical areas, but cases also occur in temperate areas (including the South of the United States). More frequently found in rural areas, institutional settings, and lower socioeconomic groups.
HABITAT
Mucosal epithelium of upper intestine
MORPHOLOGY
TWO
PHASES OF DEVELOPMENT
Free
living or Indirect phase Parasitic or Direct phase

Known
as facultative parasites due to its ability to survive both in a free-living and parasitic conditions
MORPHOLOGY
FREE
LIVING OR INDIRECT PHASE
Under
favorable condition, the rhabditiform larva moults several times into the free-living rhabditoid adult males and females which reproduce and multiply in the soil Such existence is indefinite depending upon the environmental conditions
MORPHOLOGY
PARASITIC
When
OR DIRECT PHASE
the free living conditions become unfavorable to the parasites, the worms follow the parasitic form of development
MORPHOLOGY
ADULT

WORMS
MALE
PARASITIC
Measures about 0.7mm Rhabdititoid in type and almost identical with the free living males except for the slightly larger buccal cavity than the latter Posterior end id curved ventral to the tail Has 2 short equal copulatory spicule and a gobernaculum but no caudal alae
MORPHOLOGY
ADULT

WORMS
FEMALE
PARASITIC
Measures about 2.2 mm in length by 0.04 mm With slender tapering anterior end Conical short pointed posterior end Esophagus is cylindrical occupying 2/5 on the anterior 3rd of the body Paired uteri, oviduct, and ovarian tubules which arises from a short vagina giving rise to the anterior and posterior reproductive system Vulvar opening is situated in the posterior 3rd of the worm
MORPHOLOGY
FREE LIVING FEMALES

Measures about 1mm x 0.06mm Rhabdititoid in shape possessing 2 horned uteri and a short vulva which opens near the middle of the ventral side Muscular esophageal pharynx is double bulbed Reproductive organs are paired Uteri containa single column of thin shelled, transparent segmented ova occupying most of the space along the intestine Ova measure about 70 x 40u Uteri contain a single row of 8-12 thin shelled transparent segmented ova (50-58 x 30-34 u) and occupies posterior half of the body
MORPHOLOGY
LARVAL STAGES
RHABDITIFORM LARVA

Measures 175-225u Has a short and wide buccal cavity Muscular esophagus with a characteristic club-shaped anterior portion, post median constriction and a posterior bulb Conspicuous genital primordium located ventrally Posterior end is sharply attenuated Long Delicate organism with a long esophagus occupying about 40% of the body length Forked posterior end Infective to man Remain viable in the soil for several weeks
FILARIFORM LARVA

MORPHOLOGY
OVA
50-58u Partially
embryonated when laid Thin shelled, transparent, ovoidal ova which usually hatches in the tissues
IN SUMMARY:
INDIRECT
Based essentially on the generation of free living growth and transformation into the parasitic phase under certain environmental conditions that are primarily present in moist tropics
DIRECT
Primarily responsible for human infection since it requires the parasitic phase for its continuation Usual or predominant type in temperate climates
AUTOINFECTION
Provides filariform larvae perianal infection or for internal reinfection without leaving the host
AUTOINFECTION
Reinfection 2
without leaving the host
types:
External autoinfection
When rhabditiform larvae transform to filariform larvae in the anal mucosa to reach the superficial vessels and initiate reinfection by internal route Associated with radiating perianal creeping eruption Or simply autoinfection when transformation occurs in the GIT Rhabditiform becomes filariform and penetrates the mucosa to reach the mesenteric vessels and enter the portal circulation
1.
2.
Superinfection or hyperinfection
MODE OF TRANSMISSION
Skin
penetration by infective larvae Autoinfection
FILARIFORM LARVA
Penetration in the skin

Petechial hemorrhages Congestion and edema Violent pruritis at the site of skin penetration
In the lungs
Delay in larval migration due to host response Mature in the lung parenchyma and invade the brochial epithelium causing destruction and consolidation of the lungs (strongyloides pneumonitis)
Penetration of the colon and go to venous circulation carrying with them microorganisms in the intestine (E.coli) resulting to bacteremia and septicemia
In autoinfection

ADULT
By
mechanical or chemical irritation Produce intestinal disturbances like severe diarrhea, abdominal pain, severe infection, paralytic ileus Hypereosinophilia
COCHIN CHINA DIARRHEA
Light infection
Asymptomatic
Moderate infection

Mid-epigastric pain Tenderness Nausea and vomiting Diarrhea and constipation (alternate)
Heavy infection

Anemia Malabsorption Weight loss Chronic dysentery with low grade fever
Examination
of feces, sputum, and duodenal contents Baermann technic Charcoal cutures Harada-Mori technique or Filter paper strip method
EPIDEMIOLOGY
Strongyloides is known to exist on all continents except for Antarctica, but it is most common in the tropics, subtropics, and in warm temperate regions The global prevalence of Strongyloides is unknown, but experts estimate that there are between 3 100 million infected persons worldwide.
TREATMENT

Ivermectin is the drug of choice Thiabendazole is an alternative drug.
PREVENTION
Prevention involves disposing of sewage properly and wearing shoes.
Toxocara canis and Toxocara cati
COMMON NAME:
Dog
ascarid (T. canis) Cat ascarid (T. cati)
DISEASE:
Visceral larva migrans (VLM) and Ocular larva migrans (OLM)
GEOGRAPHIC DISTRIBUTION:
Worldwide
MORPHOLOGY
T. canis 4-6 cm 6.5-10 cm T. cati 4-6 cm 4-13 cm
MORPHOLOGY Size Male Female Cervical alae (wing-like structures) Egg (unembryonated)
Longer than broad
Broader than long
75-85u 65-70u Subglobular with thick Subglobular with thin and coarsely pitted shell and free pitted shell
Toxocara canis
Toxocara cati
PATHOGENESIS
PATHOGENESIS:
Larva
dont develop into adult in ____ host (like man). Larva migrates to the different organs, during migration, host cells attack the larva producing a ___ S/S depends on the organ involved; number of larva; number of granulomatous lesions produced is ____ related to the number of infective stage (ova)ingested and the number of hatched larva which gained entry to the extraintestinal viscera
PATHOGENESIS
In
older children, most common eye involvement without generalized infection 3 types of ocular involvement:________ S/S varies from asymptomatic with persistent eosinophilia to those characterized by hypereosinophilia, hepatomegaly, cardiac disturbances, pulmonary diseases, nephrosis, and allergic manifestation
DIAGNOSIS
Liver biopsy Serological test
TREATMENT
The treatment of choice is either albendazole or mebendazole, but there is no proven effective treatment. Many patients recover without treatment.
PREVENTION
Dogs should be dewormed, and children should be prevented from eating soil.
DISEASE
Gnathostomiasis
Asia, especially Thailand and Japan; recently emerged as an important human parasite in Mexico
Ingestion of the 3rd stage larva from improperly cooked infected birds, reptiles, amphibians, mammal, and fishes Skin penetration of 3rd stage larva Transplacental experimentally
PATHOGENESIS
L3 ( both infective and pathogenic stage)
Tissue, skin, muscle, viscera, eyes, and brain
CLM and VLM
PATHOGENESIS
Gnathostoma
VLM Patient
interna:
experiences nausea, vomiting, urticaria, eosinophilia up to 90% S/S depend on the organ involved

Lung: Kidney: Eyes: Ocular gnathostomiasis with ____and ______ Brain: Cerebral gnathostomiasis, focal cerebral lesions, often with coma, there is marked peripheral _____ and CFS show an eosinophilic pleocytosis
PATHOGENESIS
Gnathostoma
Occurs
externa:
1 month after G. interna Parasite goes to the cutaneous region like the chest, abdomen, upper extremities, head, and thigh Involvement of the skin and mucous membranes between the ___ and ___, there is itchiness and pain with regional lymph gland inflammation and migrating subcutaneous edema as the larva moves from one area to another leaving a __ or ___ or ___ edema Skin abscess resembling ______
ELISA Histology
and morphology of worm if excised
Angiostrongylus cantonensis
COMMON NAME:
Rodent lungworm
DISEASE:

Eosinophilic meningitis Cerebral angiostrongyliasis
Common in the Pacific, Thailand
MORPHOLOGY:

3 small lips, transparent when ___;with ___ esophagus, tapering in both ends Male measures about 17-25 mm Females measure about 21-25 mm; ____ uterus around the blood filled intestine (_____ pole)
DEFINITIVE HOST:
Rattus
rattus, R. norvegious Parasite lives on the ____of the ___ and ___ artery of the rat
SNAIL HOST:
Achatina
fulica (__ __ snail), Pila polita, P. gracius, P.
ecpansa
EPIDEMIOLOGY:
Most
cases of eosinophilic meningitis have been reported from Southeast Asia and the Pacific Basin, although the infection is spreading to many other areas of the world, including Africa and the Caribbean. Abdominal angiostrongyliasis has been reported from Costa Rica, and occurs most commonly in young children.
PATHOGENESIS
Associated with dead or degenerating worm in the ___ of man Granulomatous lesion composed of ___and occasional___ Dead worms are usually surrounded by ___ and a diffuse eosinophilic infiltration of the meninges and many _______ S/S:
Headache and neck stiffness Paresthesia Cranial nerve palsy- ___ nerve Eosinophilia with CSF eosinophilia
Diagnosing A. cantonensis infections can be difficult, in part because there are no readily available blood tests Important clues that could lead to the diagnosis of infection are a history of travel to where the parasite is known to be found and ingestion of raw or undercooked snails, slugs, or possibly transport hosts (such as frogs, fresh water shrimp or land crabs) in those areas. A high level of eosinophils, a blood cell that can be elevated in the presence of a parasite, in the blood or in the fluid that surrounds the brain can be another important clue.
TREATMENT:
No specific treatment for A. cantonensis infection
BLOOD AND TISSUE NEMATODES IN MAN
FILARIAL PARASITES (WORMS)
Adult stage

Threadlike Varies in length Formed in different lymphatics or body cavities Eggs are laid embryonated which when hatched are called ___ If it escapes from its shell, it is said to be ___, otherwise, it is __ Snake-like in appearance with column of cells from the anterior most portion down to the posterior end Larval stages are extruded in the peripheral circulation Two phases of development: Taking place within the ___ host Taking place within the ____ host which also acts as ____
Larval stage

SHEATHED MICROFILARIAE:
Wuchereria bancrofti: Brugia malayi: Loa loa:
UNSHEATHED MICROFILARIAE:
Onchocerca volvulus Mansonella perstans Mansonella streptocerca Mansonella ozzardi Dracunculus medinensis
Location of microfilaria in man:

Peripheral
blood: Lymph spaces of skin, subcutaneous nodules: No microfilarial stage in man, female discharges: rhabditory larvae:
Vectors:
Mosquitoes Flies Small
crustaceans Biting midges
Filarial worms that cause elephantiasis: Diagnosis:

In all cases, do blood smears except for ____ wherein a ___ of the subcutaneous nodules should be performed In W. bancrofti and B. malayi, blood smear should be taken at ___, in the case of Loa loa, blood smear should be taken at ____

W. Bancrofti Periodicity Lengtth Excretory cell G-cells Tail Nocturnal 224-296u Small, near excretory pore G2,3,4 far behind G1, small, similar sizes Tapering to delicate point; no terminal nuclei B. malayi Nocturnal 177-230u Large, far, behind excretory pore Larger, G1 near and larger than G2,3,4 Diurnal 250-300u Similar to B. malayi Similar to B. malayi Loa loa
Often constricted between Tapering gradually; 2 terminal nuclei caudal nuclei continuous with those of the trunk Similar to B. malayi Fugitive swelling of subcutaneous tissue
Appearance Pathology
Graceful, sweeping curve Stiff, with 20 kinks Regional lymphangitis Similar to W. bancrofti and lympadenitis, later, confined mostly to lymphvarix, elephantiasis lymphatics of extremities of scrotum as well as extremities

Develops to maturity in lymphatics, body cavities, and/or connective tissue of human host
Adults in lymphatics of man
Female gives birth to larval embryo
Larva deposited on the skin of man during insect bite
Microfilaria is ingested by blood sucking insect vector
3rd stage filariform larva ( i.s.) gets into the proboscis of the insect host
Penetrates the intestne and passes to thoracic muscle where it turn into a sausage shaped larva
Wuchereria bancrofti
DISEASE:
Bancroftian
filariasis, wuchereriasis, elephantiasis
Encountered
in tropical areas worldwide In the Philippines, endemic in _____ regions Urban type filariasis in : Rural type of filariasis:
MORPHOLOGY:
CLINICAL MANIFESTATIONS:
Symptomatology Divided
depends upon:
into 3 stages
Adult worms in the lymphatic channels cause proliferation of the lining of the endothelium Surrounding infiltration of eosinophils, macrophages, lymphocytes, and giant cells causes filarial granulation tissue leading to obstruction, secondary infection, fibrosis, and calcification Acute lymphangitis, filarial abscess, lymphadenopathy, elephantiaisis, hydrocoele, and chyluria Tropical pulmonary eosinophilia (TPE) occurs in individuals who are hyper-responsive to filarial antigens, giving rise to nocturnal cough, wheeze, and low-grade fever
Stained
TREATMENT
Diethylcarbamazine
thin and thick
films Wet blood films CSA Knotts concentration method Heparinized preparation Serologic test
Brugia malayi
COMMON NAME:
Malayan
filarial worm
DISEASE:
Malayan
filariasis
Malay
peninsula, Asia
Brugia malayi
MORPHOLOGY
Adults:
Delicate, whitish, thread-like roundworms which are coiled up in pairs in dilated lymphatics Males: 22mm Females: 5 cm Microfilaria: 2 styletes in the anterior end and 2 terminal nuclei at the tip of the tail with constriction in between, column cells are arrranged compactly
Brugia malayi
CLINICAL MANIFESTATIONS:
Cardinal
symptoms: __________ In more advanced cases, patients may be asymptomatic with microfilarias in peripheral blood at night or have elephantoid enlargement of one or more limbs
Same
with W. bancrofti
TREATMENT
Hetrazan
Brugia malayi
Loa loa
COMMON NAME:
Loaworm,
eyeworm
DISEASE:
Loaiasis,
fugitive swelling, Calabar swelling
West
Africa, Sudan
Loa loa
MORPHOLOGY
Adults

Males: 34 mm, caudal end, curves ventral and is provided with a marrow wings Females: 60 mm in length, with vulvar opening located in the cervical region Sheathed, has active phase in the pulmonary blood, embryos appear in peripheral blood only during the passive phase
Microfilaria
Humans are infected by the bite of the deer fly (mango fly), Chrysops, which deposits infective larvae on the skin.
Loa loa life cycle. Source: CDC
Loa loa
CLINICAL MANIFESTATIONS
Migrating adult worm in the subcutaneous tissue provoke _____ Swelling develop rapidly and last for 2-3 days, transient subcutaneous (_____) swellings due to hypersensitivity to adult excretory products Pain and swelling due to hosts reaction to worms metabolism Eosinophilia is also a prominent finding Nodular fibrosis occur when there is encapsulation and calcification of the worm Adult worm appear under the conjunctiva and can be removed surgically Symptoms include fatigue, chronic pruritis, rerely encephalopathy or nephropathy
Loa loa
DIAGNOSIS
Identification of microfillaria in the peripheral blood during the day or by removal of the adult worms from their tunnels
TREATMENT
Suramin, Hatrazan Diethylcarbamazine eliminates the microfilariae and may kill the adults Worms in the eyes may require surgical excision.
PREVENTION
Control of the fly by insecticides can prevent the disease.
Onchocerva volvolus
COMMON NAME
Convoluted
filaria
DISEASE:
Onchocerciasis,
onchocercosis, Coastal erysipelas, Blinding filariasis, River blindness
Worldwide
but usually found in Africa, Central and South
America
Onchocerva volvolus
TRANSMISSION
Humans
are infected when the______, deposits infective larvae while biting The larvae enter the wound and migrate into the subcutaneous tissue, where they differentiate into adults, usually within _______ The female produces microfilariae that are ingested when another blackfly bites The microfilariae develop into infective larvae in the fly to complete the cycle Humans are the only _______
Onchocerva volvolus
MORPHOLOGY
Adults:

round mouth with papillae, cuticle-traversely striated
Found in tumors of subcutaneous tissues, noduels in pelvic arch, junction of long bones, scalp Live for more than 11 years
Microfilaria

tail is pointed and nuclei free
Rarely found in blod Found in lymphatics of cutaneous layers as well as in the st. germinativum and conjuctiva Microfilaria and/or metabolites of adult damage the optic nerve
Onchocerva volvolus
PATHOGENESIS
Intermediate
host is the ____ or ____ (simulium) with development of fibrous encapsulation (benign lesion) Cause elephantiasis of ______ Congo Dermoepidermatitis (_______) Photophobia, lacrimation, blepharoplasm, sensation of foreign body, keratitis, iritis
Onchocerva volvolus
Skin
snip (biopsy), nodule aspirate
TREATMENT
Surgical
removal of tumor Hetrazan
Mansonella perstans
COMMON NAME:
Persistent filaria
DISEASE:
Causes only minor allergy (Dipetalonemiasis)
The infection is widely distributed in Africa but is more localised in Central and South America. M. perstans does not occur in Asia.
Transmitted by the _____ insects. These midges have an aggressive and very annoying biting behaviour, principally at dusk, but also to a lesser extent at night and during the day.
Mansonella perstans
MORPHOLOGY
The adult worms are 4 to 8 cm long and very thin. They are only rarely observed, for example during a laparotomy. The microfilariae are small (100-200 m m by 5 m m) and have no sheath. The tail is short and contains nuclei. They are aperiodic.
Mansonella perstans
PATHOGENESIS
Adult found in mesentery, retropertioneal tissues, pleural and pericardial cavities Microfilariae in peripheral blood and lung capillaries Intermediate hosts: Unsheathed microfilaria The adult worms live in body cavities (peritoneum, pleura, pericardium) and in perirenal fat Most patients infected with Mansonella perstans are asymptomatic A number of different symptoms and allergic reactions are sometimes ascribed to this parasite, but the disease spectrum has not yet been fully established.
Mansonella perstans
The diagnosis is established by detecting the typical small microfilariae in the peripheral blood The tail is rounded with nuclei at the extremity The head spot sometimes has a V-shaped appearance. Serology is of little use Mansonella perstans frequently occurs together with other filariae. Mansonella perstans should be distinguished from Microfilaria semiclarum (a parasite of animals which sometimes causes accidental infections in humans). Sometimes confusion is possible if the blood smear is randomly infected during or after preparation with a mould such as Helicospora. This organism, however, is considerably smaller and thinner than a microfilaria.
Mansonella perstans
TREATMENT
If
asymptomatic, no treatment is necessary. If disease is suspected, therapy with mebendazole (Vermox), best in combination with levamisole (Ergamisol), is indicated. Ivermectin, albendazole and DEC are inactive.
Mansonella streptocerca
DISEASE:
Streptocercosis
Confined
in Central and West Africa
Bite
of Culicoides midges
MORPHOLOGY
The adult worm measures 2 cm by 0.06 mm. Microfilariae are 180 to 240 m m by 2.5 to 5 m m in size. The tail is characteristically coiled (hook) and contains nuclei.
PATHOGENESIS

Adult worms live in the skin. Live worms cause no lesions, but a local inflammatory reaction occurs when they die, with papules and possibly subsequent fibrosis. There are no eye lesions. Differentiation from onchocerciasis is necessary. Many infected people are asymptomatic. Most frequent symptom is chronic pruritus. Skin is thickened and there are papules. Hypopigmented patches can occur, which must be distinguishedfrom leprosy, endemic treponematosis and onchocerciasis. Lymph nodes can be enlarged.
The
microfilariae are found in the skin. Detection is as for onchocerciasis (skin snip, scarification with collection of dermal fluid). In the event of doubt or suspicion of leprosy, a biopsy is useful. Mazzotti reaction as in onchocerciasis.
TREATMENT
Ivermectin is highly active against this parasite
Mansonella ozzardi
DISEASE:
Mansonelliasis
ozzardi, Ozzards filariasis
South
America and the Caribbean (Haiti)
Bite
of Culicoides and Simulium sp.
Mansonella ozzardi
MORPHOLOGY
The adult worms are 3 to 5 cm long by 70 to 150 m m wide and live in the body cavities, mesentery and subperitoneal tissues. T he aperiodic microfilariae live in the blood and skin. They have no sheath, measure 200 m m long by 3 to 4 m m wide and have a long thin tail without nuclei. The microfilariae should be distinguished from those causing onchocerciasis
Mansonella ozzardi
PATHOGENESIS
In
general, the infection is well tolerated, but there may be symptoms of general malaise, pruritus, joint pain and arthritis Occasional hyrocoele
Mansonella ozzardi
Blood
examination
TREATMENT
Ivermectin
Dracunculus medinensis
COMMON NAME
Medina worm, guinea worm, serpent worm, dragon worm of fiery serpent of the Israelites
DISEASE
Dracunculliasis, dracumulosis, dracontiasis
An ongoing eradication campaign has dramatically reduced the incidence of dracunculiasis, which is now restricted to rural, isolated areas in a narrow belt of African countries.
Transmitted by ingestion of infected cyclops in raw water
MORPHOLOGY
Head
and tail are poorly developed Females-viviparous
PATHOGENESIS
The adult female produces a substance that causes inflammation, blistering, and ulceration of the skin, usually of the lower extremities The inflamed papule burns and itches, and the ulcer can become secondarily infected Early symptoms
Urticaria Erythema Dyspnea Vomitting Pruritis Giddiness due to allergy to toxic substances
Diagnosis
is usually made clinically by finding the worm in the skin ulcer X-ray may show calcified worm or larva
TREATMENT AND PREVENTION

The
time-honored treatment consists of gradually extracting the worm by winding it up on a stick over a period of days. Thiabendazole or metronidazole makes the worm easier to extract. Prevention consists of filtering or boiling drinking water.

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PHYLUM NEMATODA

Compiled by: Fortune Lapira Torrecampo, RMT, MPH

Nematodes or True Roundworms

Nematodes or True Roundworms

Nematodes or True Roundworms

Has a _______ alimentary tract

Nematodes or True Roundworms

Nematodes or True Roundworms

Circulatory System and Respiratory System are lacking Excretory System:

Nematodes or True Roundworms

Nematodes or True Roundworms

Testes Vas deferens Seminal vesicle Ejaculatory duct Cloaca

Accessory copulatory apparatus:

Female Genital system:

Ovary Oviduct Seminal receptacle Uterus Ovijector Vagina Vulvar opening

Nematodes or True Roundworms

Reproductive System continued:

Nematodes or True Roundworms

2 TYPES OF LIFE CYCLE

1 or 2 intermediate host for the development into the infective stage

Nematodes or True Roundworms

Nematodes or True Roundworms

Nematodes or True Roundworms

SYMPTOMS AND PATHOLOGY

Fever Muscle pain Periorbital edema Eosinophilia

Oviparous Club shaped posterior end Reproductive system consist of a single:

SYMPTOMS AND PATHOLOGY

DFS Concentration methods Sedimentation

Proper disposal of feces

Mebendazole is the treatment of choice Thiabendazole alternative drug

2-3 mm Ventrolateral caudal expansions Smooth spicular sheath

Associated with malabsorption syndrome:

Diarrhea Weight loss Weakness Muscle wasting Abdominal distention Edema

DFS Concentration and sedimentation methods

Adults: half as long Males:

Chitinized spicules Oviparous Membranous vulvular opening

Ellipsoidal Brownish yellow Pitted

Ascaris lumbricoides Enterobius vermicularis Necator americanus

Small intestine (jejunum and ileum)

Same as fertilized Inside structure contains the larva of the embryo

PATHOGENESIS AND SYMPTOMATOLOGY Damage in man may be due to

larva Adult worms

PATHOGENESIS AND SYMPTOMATOLOGY

PATHOGENESIS AND SYMPTOMATOLOGY

Both mebendazole and pyrantel pamoate are effective

Mass treatment Selective treatment

Linnaeus, 1758; Leach 1853

Enterobiasis, Oxyuriasis, Pinworm infection

Outer thick hyaline albuminous shell Inner embryonic, lipoidal membrane

Cecum, appendix, portions of ascending colon, perianal region

Nocturnal Pruritis ani:

Worms may enter the appendix

Urinary tract infection (very rare) Vulvovaginitis

Generally, there is:

Loss of appetite Weight loss Restlessness Irritability Insomnia

Necator americanus Ancylostoma braziliense Ancylostoma caninum Ancylostoma duodenale

Old World hookworm European hookworm Germ of laziness

Life Cycle (intestinal hookworm infection): N. americanus and A. duodenale

PATHOGENESIS, PATHOLOGY, AND SYMPTOMATOLOGY

Pathogenic stages are the larva and the adult

PATHOGENESIS, PATHOLOGY, AND SYMPTOMATOLOGY

Based on the severity of symptoms

3. Severe (with complete decompensation)

fulica ( snail), Pila polita, P. gracius, P.