INTESTINAL NEMATODES : ASCARIS LUMBRICOIDES

GEO dist  Cosmopolitant, especially in tropical & subtropical countries

 Affect all age, but children are more commonly (frequent
exposure to soil
 Long with tapering ends MALE FEMALE
 Creamy or pink in colour 15-20cm x 20-40cm x 6mm
 Finely striated cuticle 2mm (D) (D)
 Terminal mouth with 3 lips Posterior end Posterior end
(1 dorsal & 2 subventral), curved straight
each lip provide with fine ventrally
ADULT teeh & sensory papillae Has 1 set Has 2 set
 Club shape esophagus genitalia genitalia
provided with Vulva open
2 small equal ventrally at the
spicules junction of Ant
MORPHOLOGY

1/3 of body
Type FERTILLIZED UNFERTILLIZED DECORTICATED
Size 60 x 45 90 x 45 Similar to fertilized egg except
Shape Oval Long & narrow that the mammilated layer is lost
Shell -Outer thick regular albuminous -Less developed thin irregular
mammilations albuminous mammillations
-Inner thick egg shell -Thin egg shell
EGG Colour Brownish Brownish
Content Immature ovum (one-cell- Retractile granules
stage)

Habitat Small intestine

DH Man DS Adult worm & Egg
nd
IS Egg containing 2 –stage rhabditiform larva
1. Swallowing water or raw vegetables polluted with
embryonated eggs containe larva
MOT 2. Through contaminated hands by polluted soil
3. By inhalation to nasopharynx
4. House flies & cockroaches carry larvated egg
Egg larvated egg larva  adult
 Eggs are voided with stool (200,000 egg/day)
 mature in soil after 2 weeks under suitable
LIFE CYCLE

condition (25’C, humidity, shade & oxygen)

 Develop 1st stage of Rhabditiform larva within
the shell
 After 1 more week, larva molts into 2nd stage
rhabditiform larva within the eggs
Stage  Eggs hatch in the intestine & rhabditiform larvae
penetrate intestinal wall entering the
circulationHeartlung undergo 2nd & 3rd
moult (Filariform larvae)
 pass up to bronchiolebronchitrachea
epiglottis swallowed to reach final habitat in
small intestine (4TH moult)
 Egg appear in faeces 2 month after infection &
adult live 12-18 month
 MIGRATING LARVAE
1. Lung (lofller’s syndrome)
 Light infection :Slight damage with unnoticed pathological lesion
 Heavy infection: migrating larvae in lung result in
o lobular pneumonitis, there is cellular infiltration, serous exudates
o Haemorrhage causing cough & bronchial irritation (asmatic effect)
o Expectoration with blood stained sputum & edema of lips
o microscopically larvae may be detected in sputum with esinophil
2. General circulation
 Some larvae reach general circulation & distributed to various organs
as LN, brain, spleen & Kidney (ectopic sites) leading to abnormal
clinical manifestation as result of visceral larva migrans
ADULT WORM
 Usual infection consist of 5-10 worm, often goes unnoticed by the host &
discovered on a routine stool examination or worm passed spontaneously
 Most frequent complaint is abdominal pain with distension, diarrhea or
PATHO-
constipation, vomiting & dyspepsia
GENESIS
1. Traumatic effect
 Heavy infection intestinal obstruction
 obstruction of bile ducts by the worm obstructive jaundice
 Appendix appendicitis
 Obstruction of ampulla of vater acute hemorrhagic pancreatitis
 Perforation of intestinal wall peritonitis
 Some worm may ascend via stomach & esophagus to nasopharynx,
enter the larynx causing suffocation especially in children
 May come out from mouth or nose or even Eustachian tube from
pharynx resulting damage of the inner ear
2. Toxic effects
 metabolic by product of living or dead worm may give rise to fever,
allergic manifestation & nervous irritability
3. Nutritional Impacts
 Loss of appetite  Malnutrition & impairement of growth with
vitamin A & C deficiency
CLINICAL
 Symptom are indistinguishable from those other intestinal helmith
 abdominal pain ,distension, diarrhea or constipation, vomiting & dyspepsia
LABORATORY
1. Detection of eggs in stool (direct smear, after concentration, stoll’s
DIAGNOSIS
technique)
2. Detection Migrating larvae: in sputum or in gastric lavage content
3. Detection of adult : passing out with or without stool or in vomitus
4. Eosinophilia (7-12%)
5. Radiology: barium meal show cylindrical filling defect (string sign)
DRUG
1. LEVAMIZOL HYDROCHLORIDE (KETRAX)
2. MEBENDAZOLE (ANTIVER, VERMOX) or flubendazol( fluvermal)
TREATMENT 3. PIPERAZINE CITRATE, hydrate or adipate (parazine,vermizine,uvilon)
SURGICAL
 For treatment of complication : eg, Intestinal obstruction, obstruction of
appendix or bile duct
1. Mass treatment of infected persons.
2. Sanitary disposal of excreta & Health education.
3. Cleanliness (washing hands before meal).
CONTROL 4. Proper washing of green raw vegetables.
5. Pure water supply & Control of flies and other insects.
6. Stool should not be used as a fertilizer unless being treated by chemicals or
temperature of 50°C or higher to kill eggs