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Nematodes Nematodes

INTESTINAL NEMATODES INTESTINAL NEMATODES


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
.

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