MDL 2016

NEMATODES

OVERVIEW

Who are they?

Trichuris trichiura
Whipworm
Ascaris lumbricoides
Large Intestinal Roundworm
Necator americanus
New World Hookworm
Ancylostoma duodenale
Old World Hookworm
Strongyloides stercoralis
Threadworm

Intestinal-Tissue
Species

Intestinal Species

Enterobius vermicularis
Pinworm/ Seat worm/ Society
worm

Trichinella spiralis
Trichina worm

Terms to Remember
Infective Stage

Stage in the parasitic cycle capable of invading

a definitive host
Auto reinfection Reinfecting oneself
Buccal cavity
Long oral cavity
Corticated
Eggs containing a mammillated albuminous
substance
Decorticated
Eggs lacking a mammillated albuminous
substance
Copulation
Mating of worms
Cuticle
Surface covering present on adult nematodes
Embryonated
Fertilized egg
Unembryonated Unfertilized egg
Larva
Juvenile worms

General Characteristics
Three Basic Morphologic Forms

Vary in size
and shape

EGGS

Located inside
the fertilized
eggs; emerge
and continue
to mature

Develop from the maturing

larvae
Sexes separate (females
larger than males)
Equipped with a digestive
and reproductive system

LARVAE

ADULT
WORMS

General Characteristics
Free living and parasitic

species
Size may range from 2
mm to 1 meter
Two distinct sexes

Male: smaller; curved or

coiled posterior end; some
with copulatory bursa
Female: larger and longer

Long-lived

Morphology
Unsegmented and

bilateral symmetry
Long and cylindrical
Oral hooks, teeth or
plates
Body is fairly complex
Body wall:

Cuticle
Hypodermis
Muscle layer

Methods of Nourishment

Sucking with ingestion of blood

Ingestion of lysed tissues
Feeding on intestinal contents
Ingestion of nourishment from body fluids

Nematodes

Mode of transmission:

Ingestion of infective stage

Larval penetration of skin
Insect bite

Pathogenicity

Larval migration
Piercing of intestinal wall
Blood sucking

General Life Cycle of Intestinal

Nematodes
Humans ingest infective eggs
Larvae hatch in intestine
Male and female adults develop in the intestine
Fertilized eggs are produced

Diagnostic stage eggs or larvae in feces

Larvae will develop in warm moist, soil

Ascaris lumbricoides
(Giant Intestinal Roundworm)

Overview
Final Host: Man
Habitat: Small Intestine
Diagnostic Stage: Egg (fertilized

or unfertilized)
Infective Stage: Embryonated

egg
Mode of Transmission:

Ingestion of egg
Portal of Entry: Mouth

Morphology-Lips

Lips

Tri-radiate or trilobate

Seen at the anterior end

Margin of each lip is lined

with minute teeth

Morphology-Adult
Adults

Creamy white to pinkish

yellow

Male: 15-30 cm; strongly

curved tails; small and
slender; with copulatory
spicule

Female: 20-35 cm;

straight tails; a bit fatter;
tapered at both ends

Morphology-Adult

Morphology-Egg
Unfertilized egg:

Narrower and longer

Thin shell
No vitelline layer
With coarse lecithin
granules
Corticated or
decorticated

Morphology-Egg
Fertilized egg:
Oval or spherical
Thick walled
Inner vitelline layer
Middle glycogen layer
Outer albuminous coat
(absent in decorticated egg)

Fertilized and unfertilized eggs:

underdeveloped eggs are being
passed in the stool

Morphology-Egg
Embryonated egg:

Infective stage
Embryonation occurs in the soil

Life Cycle

Pathology
Ascariasis

Larva:

Ascaris pneumonitis or Loefflers

Syndrome
Difficulty in breathing, coughing,
fever, lung infiltration
May become erratic

Adult:

Diarrhea, malnutrition, worm

bolus/obstruction, appendicitis,
pancreatitis

Diagnosis

Direct Fecal Smear

Eggs easily found (240,000 per day)

Kato-Katz Technique
Quantitative
Intensity of infection

Treatment

Albendazole
Drug of choice
400 mg single dose
200 mg for children under 2 years old
Mebendazole
500 mg single dose
Pyrantel Pamoate
10 mg/kg body weight (max. of 1 g)

Enterobius vermicularis
(The Pinworm)

Overview

Final host

Man

Diagnostic stage

Egg

Infective stage

Embryonated egg

Mode of transmission

Ingestion of inhalation
Contact with contaminated lines or clothing

Habitat

Large intestine

Synonym

Oxyuris vermicularis

Other common names

Seatworm or society worm

General
Characteristics

Cervical or cephalic alae

Wing-like flaps or
extensions
Esophageal bulb

Morphology
Adult Male

Smaller

2-5 mm in length

Curved, relatively blunt posterior

end

Rarely seen

Morphology
Adult Female

Longer

Long pointed tail

Gravid female lays (11,105

eggs on average/day)

Morphology

Morphology

Egg

Colorless and transparent

Thin-shelled

One side is flattened (D-shaped)

Content: larva

Life Cycle

Pathology

Enterobiasis or oxyularis

Itchiness
Nocturnal pruritus ani
Migration of the gravid females
from the anus and deposition of
eggs in the perianal folds of the
skin

Diagnosis

Scotch Tape Swab

Eggs and female adults removed

from the skin in the perianal regions

Made in the morning before the

patient has washed or defecated

Treatment

Pyrantel pamoate

Drug of choice
10 mg/kg with a second dose 2 to 4 weeks late

Albendazole

Alternative drug
400 mg single dose

Mebendazole

500 mg single dose

Trichuris trichiura
(The Whipworm)

Overview

Final host

Man

Diagnostic stage

Unembryonated egg

Infective stage

Embryonated egg

Mode of transmission

Ingestion of egg

Portal of entry

Mouth

Habitat

Wall of the cecum

(large intestine)

Morphology-Adult

Adults

Flesh colored or pinkish

slender worm

Thick posterior portion

and long thin anterior
portion

Whip-like appearance

Morphology-Adult
Male

30-45 mm
Coiled posterior portion
Single spicule
Refractile sheath

Female

35-50 mm
Bluntly rounded posterior
end
Can produce over 60
million eggs (average life
span of 2 years)

Morphology-Egg
With protuberant

bipolar mucus plugs

Thick-shelled
Brown in color

Foot ball-shaped
Lemon-shaped
Barrel-shaped
Japanese lanternshaped

Life Cycle

Pathology
Trichuriasis leading to rectal

prolapse during heavy infection

Iron Deficiency Anemia

Occurs quite frequently with A. lumbricoides due to

similarities in MOT and MOD

Treatment
Mebendazole

Drug of choice
500 mg single dose (light infections)
2-3 days of consecutive treatment for
moderate and heavy infections
Contraindications: early pregnancy and
hypersensitivity

Albendazole

400 mg single dose

Contraindicated during pregnancy

Hard to expel because it attaches to the

mucosa of the cecum by burying its
anterior portion in a pin-fashion manner

The Hookworms
Necator americanus
Ancylostoma duodenale

Overview
Final host

Man

Diagnostic stage

Egg

Infective stage

Filariform larva

Mode of transmission

Skin penetration of infective larvae

Non-human hookworms

Causes cutaneous larva

migrans or creeping erruptions

or ground itch
Ancylostoma braziliense

cat hookworm

Ancylostoma caninum

dog hookworm

Comparison of Hookworms
Points of
differentiation

Common
name

Habitat

Ancylostoma
duodenale

Necator
americanus

Old world hookworm New world hookworm

Small intestine
(duodenum)

Small intestine
(jejunum)

Comparison of Hookworms
Points of
differentiation

Ancylostoma
duodenale

Necator
americanus

Size
Body
curvature

Bigger

Smaller

C shaped

S shaped

Comparison of Hookworms
Points of
differentiation

Dental pattern

Ancylostoma
duodenale

Necator
americanus

2 pairs of teeth

Semi-lunar cutting
plates

Comparison of Hookworms
Points of
differentiation

Ancylostoma
duodenale

Necator
americanus

Copulatory
bursa of the
male

Circle (top view)

Tridigitate/tripartite
With unfused spicules

Oval (top view)

Bipartite/bidigitate
With fused spicules

Life Cycle

Morphology-Egg
Ovoid
Thin-shelled (hyaline)
Bluntly round ends
In the early stage of

segmentation, 2-8 cell

stage (blastomeres)

Comparison of Larvae
Rhabditiform larva (L1)

Filariform larva (L3)

Short
Feeding stage larva
Open mouth
Flask-shaped esophagus

Long
Non-feeding stage
Closed mouth
With pointed tail and sheath

Pathology
Larval migration
Dermatitis or ground itch
(Wakana Disease)
o Allergic reaction
o Petechiae or papule
o Itching and burning

sensation
Pneumonitis
o Cough, asthma, hemoptysis

Hookworm Rhabditiform Larva

Hookworm Filariform Larva

Diagnosis

Harada-Mori Technique
Allowing hatching of larvae from eggs on

strips of filter paper

Direct Fecal Smear
For heavy infections
Kato Katz Method
Quantitative diagnosis

Treatment

Albendazole
Drug of choice
400 mg single dose in adults and children over

2 years old

Mebendazole
500 mg single dose in adults and children

Not recommended for children below 2 years old

Strongyloides
stercoralis
(The Threadworm)

Overview
Final host

Man

Diagnostic stage

Rhabditiform larva

Infective stage

Filariform larva

Habitat

Small intestine

Facultative parasite

Free living (soil)

Parasitic (human body)
Reproduction without fertilization

Parthenogenic females

Morphology-Larva

Rhabditiform

Smaller, stouter, spindle-shaped

Short buccal cavity and a muscular
esophagus

Filariform

Long esophagus
Forked or notched tail without a
sheath

Strongyloides Rhabditiform Larva

Strongyloides Filariform Larva

Comparison of Larva
L1 Rhabditiform
Buccal capsule
Genital
primordium
L3 Filariform
Esophagus
Tail end
Sheath

Hookworm

S. stercoralis

Long
Small

Short
Prominent

Shorter
Pointed
Yes

Longer
Notched
Yes

Life Cycle

Pathology

Strongyloidiasis producing Cochin China

Diarrhea or Honey Comb Ulcers

Invasion of skin by filariform
Migration of larva inside the body
Penetration of intestinal mucosa by female

worms

Diagnosis

Eosinophilia
Duodenal Aspiration
Small bowel biopsy
Concentration techniques
Harada Mori culture

Mode of transmission: skin penetration

Larvae penetrate skin and migrate to the lungs

Treatment
Albendazole
Drug of choice
400 mg single dose for adults and children

over 2 years of age

Eradicate up to 80% of infection

Thiabendazole
500 mg/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
(The Pudoc Worm)

Morphology-Adult

Female
Eggs in utero arranged in

single or multiple rows

Male
Chitinized spicule
Long sheath extending beyond

the length of the worm

Morphology-Adult

Habitat: small intestine

Female: 2.5-4.4 mm
Male: 2.2-3.2 mm; with chitinized spicule and a long spicule sheath

Morphology-Egg
Moderately thick striated egg

sheath
Flattened bipolar plugs
Peanut-shaped
Guitar-shaped
Mistaken for Trichuris egg

Life Cycle

Pathology - Capillariasis

Borborygmi (gurgling stomach)

Abdominal pain and diarrhea
Weight loss
Malabsorption

Mode of transmission

Eating raw freshwater fish

Intermediate hosts

Brackish water fish: bagsit

Fresh water fishes: ipon, birot, bagsing
or bagtu

Treatment
Albendazole
400 mg once a day for 20 days
Drug of choice
Destroys larval stages

Mebendazole
200 mg 2x a day for 20 days

Trichinella spiralis
(The Trichina or Muscle Worm)

Overview

Habitat

Small intestine (adults)

Encysted in muscles of pigs (larva)

Mode of transmission

Ingestion of raw/undercooked meat

containing encysted larva

Portal entry

Mouth

Diagnostic specimen

Skeletal muscle biopsy

Morphology
Female

3.5 mm by 0.06 mm
Club-shaped uterus
Viviparous

Male

1.5 mm by 0.04 mm
Pair of papillae to hold
the female during
copulation

Encysted Larva

Spear-like burrowing
anterior tip
Infective stage

Encysted Larva

Life Cycle

Life Cycle

Needs two hosts for the completion of life cycle

Serve both as final and intermediate hosts

Each hosts harbors both the adult and larval stages
Hosts: humans, rats, dogs, cats, pigs, bears, foxes,

carnivores or omnivores

Pathology
Trichinosis
Intestinal invasion
Diarrhea or constipation
Vomiting, abdominal
cramps, nausea
Larval migration and

muscle invasion
Myalgia, eosinophilia
Complications:

splenomegaly, cerebral
lesions
Encystment

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
20 mg/kg body weight 6-hourly for 10 to 14

days

Nothing

worth having comes easy.

-END OF PRESENTATION-