1. Soil-mediated nematodes Transmitted by eggs Ascaris lumbricoides Enterobius vermicularis Trichuris trichiura Ascaris lumbricoides Ascaris lumbricoides 1. Disease: ascariasis 2. Distribution: cosmopolitan 3. orphology: a! Adult: o "ong #ith tapering ends o $reamy or pin% in color o &inely striated cuticle o Terminal mouth #ith 3 lips o $lub shaped esophagus b) Egg b) Egg o 'n(ertili)ed egg: si)e: *+,-.u/ long and narro#/ less developed mammilated layer/ thin egg shell o &ertili)ed egg: si)e01+,-.u/ oval #ith 2 covering: 1- outer mammilated/ 2- inner thic% egg shell/ color bro#nish/ contents: immature ovum 4. 4. Life cycle Life cycle o Adult live in the small intestine o( man o 2mmature eggs pass in the (aeces32+++++ egg4day! o 'nder (avorable conditions the rhabdit(orm larva develops inside the egg in about 2 #ee%s. A(ter one #ee% this larva moults into second-stage larva3in(ective stage! o an is in(ected by s#allo#ing #ater or ra# vegetables polluted #ith eggs containing in(ective larva o Eggs hatch in small intestine and rhabditi(orm larvae penetrate the #all o( small intestine and enter circulation and reach the heart then the lungs #here it brea% out the capillary and enter alveoli. 5er it remain (or some days and undergo their second and third moults o Then they pass up the bronchioles to the bronchi/ the trachea/ the epiglottis #here they are s#allo#ed to reach their (inal habitat in the small intestine/ here they moult (or the (ourth time and become adult o Eggs pass in stool about 2 months a(ter in(ection 5. 5. Pathoe!esis a!d cli!ical "ictures Pathoe!esis a!d cli!ical "ictures o igration stage: can lead to: 6 inute hemorrhages and pneumonitis 6 Allergic mani(estation as asthma and edema 6 &ever/ cough and e,pectoration o( blood stained sputum 1 6 7-ray (indings 6 Emboli to di((erent organs o Adults in the intestine may cause: Traumatic damage 2ntestinal obstruction 8enetrate the intestinal #all causing acute peritonitis 9cclude the bile duct/ pancreatic duct/ or appendi, igrate to the stomach and vomited o To,ic e((ects :y-product: nervous irritability/ loss o( appetite and #eight Trypsin produced by #arm: abdominal discom(ort/ colic/ dyspepsia/ vomiting/ diarrhea or constipation DIA#NOSIS DIA#NOSIS o Stool e,amination: Eggs o :lood Eosinophilia o "arvae: coughed in sputum during pulmonary stage Treatme!t Treatme!t o ebenda)ol: 1++mg , bid , 3 Days o 8ipera)ine citrate: ;.mg4%g single or divided over t#o days #ith ma,. o( 3..gm o 8yrantel pamoate: 11mg4 %g single oral dose #ith ma,. 1 gm o "evamisole hydrochloride 3<etra,!: 2mg4%g a single oral dose o 5e,ylresorcinol: 2 gm orally Trichuris trichiura Trichuris trichiura Disease: Trichuriasis Distribution: cosmopolitan Morphology: o Adults: resemble a #hip 6 Anterior 34. th thin and posterior 24. th thic% 6 $ellular esophagus 6 Anus 1! ale: 3 cm long 8osterior end curved ventrally 5as 1 set o( genitalia provided #ith 1 spicule inside a retractile sheath 2! &emale: - cm long 8osterior end straight and blunt 5as 1 set o( genitalia The vulva opens at the =unction o( the thin and thic% portions o Eggs: Si)e: .+ > 2+ u Shape: barrel- shaped 32ndian 6drum! 2 polar prominences 2 Thic% shell Life cycle Life cycle o Adults live in the caecum #ith the thin portion embedded in the submucosa o 2mmature eggs pass in the (aeces o "arva develop inside the egg in about 3 #ee%s o an in(ected by s#allo#ing #ater or vegetables polluted #ith embryonated eggs o Eggs hatch in the small intestine and larva become adult in (e# days migrates to their (inal habitat in the large intestine o Eggs appear in (eces about 2 months a(ter in(ection $li!ical "icture $li!ical "icture o "ight in(ection is usually asymptomatic/ o 5eavy in(ection may cause: 1. Abdominal pain and distention 2. ?ausea/ vomiting and bloody diarrhea 3. "oss o( #eight -. @ectal prolapse .. Eosinophilia 1. Anemia ;. Appendicitis Dia!osis Dia!osis Stool e,amination: (inding the eggs in the (aeces Treatme!t Treatme!t o ebenda)ole: 1++ mg t#ice daily (or 3 days o Stilba)ium iodide: 1+ mg 4%g t#ice daily (or 3 days o Dichlorvos: 12mg 4 %g single oral dose o 5e,ylresorcinol: .++ ml +.2A retention enema (or 1 hour E!terobius %ermicularis E!terobius %ermicularis Disease: enterobiasis/ o,yuriasis Distribution: cosmopolitan Morphology: 1! Adult: o 2 cuticular #ing-li%e e,pansions at the anterior end o 2 lateral thic%enings along the length o( the #orm o 3 retractile lips o Double-bulbed esophagus o Anus o( cloaca subterminal 3 ale: o About .mm in length o 8osterior end curved ventrally o 5as 1 set o( genitalia #ith 1 spicule &emale: o About 1+ mm in length o 8osterior end straight #ith long pointed end 2! Egg: o Si)e: .+ > 2+ u o Shape: 8lano-conve,/ shell has 2 layers covered by a third outer thin albuminous stic%y layer o $olor: translucent o $ontents: (ully developed moving larva Life cycle Life cycle o The adult live in the caecum and ad=acent parts o( small and large intestine o Bravid (emales migrates to the perianal region 3at night! #here the eggs are laid o Eggs mature and are in(ectious in (e# hours o an in(ected by one o( the (ollo#ing #ays 1. Autoin(ection 3hand to mouth! 2. 2n (ood or drin% 3. 5andling contaminated clothing or bedding -. 2nhalation o( air 6born eggs in dust .. @etroin(ection o Eggs hatch in the intestine and larvae moult t#ice to become adults o Eggs are laid in 2-- #ee%s a(ter in(ection Pathoe!icity Pathoe!icity o 8ruritus ani is the main symptom/ it may be severe causing (atigue and insomnia o $hildren may su((er (rom nervous irritability and enuresis o Corms may migrate to the vagina/ uterus/ tubes/ and even the bladder leading to irritation and in(lammation o The presence o( the #orms in the appendi, may give a picture o( appendicitis Dia!osis Dia!osis o Eggs are seldom (ound in (aeces o Adult #orm may be seen in stool o Eggs are best obtained by s#abbing the perianal region in the morning be(ore de(ecation by: 1. ?. 2. 5 s#ab 2. Scotch adhesive tape s#ab Treatme!t Treatme!t - o 8ipera)ine: a daily dose o( 1. mg 4%g orally 3ma,imum 2..gm! (or ; days o ebenda)ol 1++mg repeated a(ter 2 #ee% o 8yrvinium pamoate: . mg 4%g 3ma,.2.+ mg! single oral dose repeated a(ter 2#ee%s o 8yrantel pamoate: a single oral dose o( 11mg4%g 3ma,. 1gm! repeated a(ter 2#ee%s o A mercurial ointment is applied to the perianal region at night. @elieve itching and %ill (emales P Pre%e!tio! a!d co!trol re%e!tio! a!d co!trol o $utting nails short o Cashing hands a(ter using toilet and be(ore meals o 2n(ected children should #ear tight 6 (itting trousers o 2n(ected person should sleep alone/ their under#ear and beddings boiled and #ashed o &ood and drin% should be protected (rom dust and hands o( in(ected person o ass treatment o( all persons in any in(ected community/ e.g./ (amily or school .