Agents of Neglected Parasitic Diseases Schistosoma sp.

Causes schistosomaisis Concentrated at Africa

3. The chronic phase which occurs mainly in the endemic areas PREVENTION Prevention of shcistosomiasis includes: 1. Elimination of infection source 2. Protection of snail-bearing waters from contamination with infectious urine or feces; 3. Control of snail hosts, and 4. Protection of persons from cercariaeinfested waters. Wucheria bancrofti & B. malayi

Reproduction Unlike other trematodes, the shistosomes are diocious i.e., the sexes are separate. The two sexes display a strong degree of sexual dimorphism, and the male is considerably larger than the female. The male surrounds the female and encloses her within his gynacophoric canal for the entire adult lives of the worms. They reproduce sexually. *Miracidium infective stage to snails. Will not develop if ingested by humans *Cercariae infective stage to humans. Develop in the liver to become adults.

W. bancrofti Mean length (m) Cephalic space: breadth Giesma sheath Nuclei 290 1:1 unstained Regularly spaced; separately situated Single row of nuclei not reaching tails end

W. malayi 222 2:1 pink Irregularly spaced; overlapping Single row of nuclei reaching tails end 2 nuclei; w/c bulge the cuticle, conspicuously placed Kinky

Location of Parasites: S. japonicum small intestine S. haematobium gastro-urinary system S. mansoni colon

Tail

Pathogenecity Schistosomiasis can be divided into 3 phases: 1. The migratory phase lasting from penetration to maturity 2. The acute phase w/c occurs when the schistosomes begin producing eggs and

Terminal Nuclei Appearance in blood film

None

Smoothly curved

Philippine filariasis About 29 million Filipinos are at risk of developing filariasis Lymphatic Filariasis, simply known as filariasis is the second leading cause of long term and permanent disability among people.

Pathogenesis The disease manifests as elephantiasis or the thickening of the skin and underlying tissues, which is caused when the microfilarial worms are lodged in the lymphatic system. The more physical manifestation-Infected individuals are reported to experience injuries in the lymph vessels, to enlargement of extremities (chronic) and other body parts during the chronic stage of the disease.

On children can cause retarded mental and physical growth Travels through the blood to the lungs and into the throat where it is swallowed Eggs are shed in hosts feces and hatch on warm moist soil Larvae then bore through the feet of a new host Entry point is through wounds in the skin, sometimes in the mouth, but has lower chances of surviving

*Ancylostoma and Necator are different in mouth parts LIFE CYCLE Enters skin Juvinile goes to the lungs Go to the intestines and attach there. Causing severe ulceration

Life Cycle W. bancrofti wide range of vectors *mosquitoes vector Humans L3 Stage (Infective Stage) Mosquito Microfilariae (Infective Stage) W. malayi vectors: *Mansonia & Aedes Mosquitoes. ---------------------------------------------------------------SOIL TRANSMITTED HELMINTHES

Necator americanus The American killer new world hookworm Probably introduced by slave trading Major impact on development of southern US

Ancyclostoma duodenale Old world hookworm Predominately found in southern Europe. Northern Africa, India, China, southeast Asia In mines of England and Belgium

*Eggs can survive for many years in the soil Pathology - Three phases of pathology: HOOKWORMS Hook into intestinal walls Feed off hosts blood causing anemia Cutaneous or invasion period Pulmonary stage Intestinal Stage

Pathology Cutaneous or invasion period o When juvenile penetrate the skin o Tissue reaction worms may be killed-results in ground itch. Pulmonary phase o Juveniles leave lung capillaries to alveoli Intestinal phase o Blood loss-iron deficient anemia up to 200ml of blood per day in heavy infection o Loss of appetite, pain (geophagy soil eating) o Protein deficiency-edema o Poor white trash o Creeping eruption

Eggs are lumpy, non-fertilized eggs oval, fertilized round.

Migration of worms Larval forms enter blood and lymph capillaries and travel to the heart Heart to lungs, coughed up, swallowed to the intestine Then the worm can mature to an adult

Pathology Little damage is caused by the penetration Some worms migrate to ectopic sites (spleen, liver, lymph nodes, brain) and dependent upon number and here cause various inflammatory responses. These can lead to very severe allergic reactions. Transplacental migration can also occur Worms destroy capillaries in the lungs causing haemorrhage, heavy infections can lead to pools of blood which can block air sacs

Ascaris lumbricoides The large roundworm of humans Lives in hosts intestines and eggs pass out of feces Extremely resistant to adverse conditions Uncooked veggies, soiled fingers or toys Travel through the heart in blood to the lungs and break out in sacs of lungs Make their way up through the trachea and get swallowed again so that they can grow to maturity in the intestines Causes allergic reactions and intestinal blockage

How the worms cause pathology: Normal worm activities Rob the host of nutrients Abdominal pain, restlessness, allergic reactions. Intestinal blockage Penetration of intestine or appendix w/c can be fatal Females wander in search for male Overcrowding leads to wandering If worms migrate to stomach, acid irritates them leading to nauseous stomach.

Morphology: Large worms 3 prominent tips Ovaries are extensive contain up to 27 million eggs at a given time

Aspiration of a committed worm can result in death. If worms migrate to lungs, they can cause extensive damage and possible death.

o o o

High rainfall, high humidity Clay soil Shade

Trichuris trichuria Produces 1k to 7k eggs per day, eggs are embryonated in the soil When swallowed infective juvenile hatches n small intestines enter intestinal cysts After development re-enters lumen

Pathogenesis Usually asymptomatic Heavy infection variety of symptoms o Anemia haemorrhage of digestive tract o Secondary bacterial infection o Prolapse rectum o Possible cause of appendicitis

Epidemiology Indiscriminate defecation particularly near areas of habitation seeds the soil with eggs Even if sanitation practices are initiated, contaminated soil can lead to reinfection for many years Children become infected by ingesting soil Nightsoil, the eggs may contaminate unwashed vegetables and water supplies Eggs can be carried by cockroaches, flies, wind and even on money Poor sanitation Physical conditions o Warm climate