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[PARASITOLOGY 2- DR AYOCHOK 2ND HOUR] Sept.

30, 2014
Trichuris trichura (whip worm)
Adult Worm (aphasmid):

flesh colored

attenuated thin anteriorly; thick fleshy posteriorly

attached to wall of cecum (appendix, rest of the


colon or post. Ileum)
Bacillary band found ventrally and anteriorly (only
seen if a cross-section is done)= areas of
cuticular pores, each with an underlying tall
columnar cells called hypodermal gland cells
stichosome is still present at the anterior part of
the worm

**Cecum of patient on proctoscopy: see only the


posterior portion of parasite; entire anterior portion is
burrowed deep in the intestinal mucosa.
Eggs(50-54um x 2-23um)
barrel shaped, lemon shaped,
Japanese lantern shaped, football
shaped

with prominent bipolar


intralaminar plugs or prominence

Deposit from females as


unsegmented eggs; 10-14 days embryonation
(maturation)

1 female = 1000 eggs/day


Moisture essential for development (die in dry
sandy soil)

Unsegmented egg: see a


mass
Segmented egg: see larvae
(infective stage to man)
Life cycle:
a) Swallow fully embryonated egg
b) Larvae hatches in small intestine
c) Larva enters crypts of lower intestine and colon
d) Epithelium of cecum = established firmly (rarely go to
other organs)
e) Grows to adult worm in 3months
f) As worm matures: posterior portion extruded and
hangs in intestinal lumen, anterior portion burrowed
g) *Oviparous female discharge eggs
h) Sexual Copulation: discharge of unsegmented eggs in
feces> 2wks in moist soil>fully embryonate>
infective to man (promiscuous defecation)

Males:

shorter, curved posteriorly (may present as


>360 degrees coil)

1 Sacculated testis > vas deferes >


ejaculatory tubule> cloaca (out)

Single lanceolate copulatory spicule


retractable thru a spicule sheath with
retractable spines
Females

Single sacculate ovary > oviduct>uterus


(constricts as it joins vagina)

Vagina continues as a serpentine tubules to


the vulva (located anteriorly)

oviparous

Epidemiology:

Cosmolopitan in distribution

[PARASITOLOGY 2- DR AYOCHOK 2ND HOUR] Sept. 30, 2014

Warm moist shade soil: favorable for egg


development
Less resistant to dessication than Ascaris eggs
Readily susceptible to direct sunlight, intense
cold, putrefying medium
Small children: more commonly infected

Pathology:

Dependent primarily on worm burden

Blunting of villi of small intestine

Inflammatory infiltrates: plasma cells,


lymphocytes, eosinophils

Dysentery: mucosa is edematous and friable

Loss of anal sphincteric tone in prolonged very


heavy infections

Rectal prolapse

Mechanical trauma in heavy infection

Common finding: Eosinophils, and CharcottLeyden Crystals = produced in a non-specific


allergic type of reaction
Symptomatology

Dependent on:
a) Worm burden and Intensity of infection
b) Duration of infection
c) Age and nutritional status of host
(common to children playing with
infected soil)

Majority of cases: moderate to light infection:


eggs in stools but pt may be asymptomatic

Heavy: diffused colitis, chronic diarrhea

Massive: chronic dysentery, tenesmus

Hypochromic anemia(prolonged, massive


infection) related to malnutrition causing IDA
(NOT by mechanical burrowing that causes
bleeding)

Eosinophilia: uncommon, rarely >15%


Diagnosis
Elicit history of eating contaminated food
Demonstration of eggs in feces
o Light: 10 eggs per smear
o Moderate: 10-15 eggs per smear
o Heavy: over 50 eggs per smear
o Massive: TNTC (too many to count)
Proctoscopy, Colonoscopy and biopsy (done if there
is a high index of suspicion but negative stool
exam)
Treatment and prevention

Mebendazole (standard)

Sanitary disposal of feces

Children train not to defecate promiscuously on


the ground

Capillaria philippinensis

Common name: Pudoc worm


Causes: aphasmid intestinal capillariasis (protein
losing dse)

1963: 1st case in Ilocos norte (Malabsorption syndrome onoff diarrhea for 6 months, patient died in PGH and upon
autopsy, saw the parasite)

1967: Pudoc, Ilocos Sur


Morphology
Male: smaller (2.3-3.17mm) than female (2.54.3mm)
Males: ventrolateral caudal expansions (posterior),
long smooth specular sheath covering a copulatory
spicule
Female: body divided into 2 almost equal parts
o Anterior: esophagus, stichosomes (esophageal
glands) up to of parasite
o Post: intestine and reproductive organs with
very prominent vulva where eggs are
discharged
o Adult female have ability to burrow itself and
may be observed cross-sectionally in biopsy
Female adult is ovoviviparous
Females: can produce typical non-operculated eggs,
atypical eggs ova with thin shells and free larvae
(causing internal autoinfection)
Discharged in feces: Unembryonated eggs

Eggs: prominent flat bipolar plugs, see striations on


the shell of the egg. (Peanut shaped)

MALE CAPILLARIA

[PARASITOLOGY 2- DR AYOCHOK 2ND HOUR] Sept. 30, 2014

Size: 2.3-3.17mm
ventrolateral caudal expansion
extraordinary
long
smooth
sheath

spicular

FEMALE CAPILLARIA
- may be typical or atypical

Life cycle:

10-14days to embryonate fully and be infective to


intermediate host

3weeks: development of larvae in fish (IH)

Fish eaten raw with juvenile (3rd) larval stage

Larva develop into adults (females burrow to


intestinal mucosa> lay eggs)

Sometimes, 1st generation larvae can reinfect the


patient (internal autoinfection) and remains to
lumen and molt twice (2nd and 3rd larva) and
become egg-laying adults (4th)
Causes autoinfection: new juvenile larvae can
reestablishment of lifecycle and reinvade
intestinal mucosa

Patient discharges unsegmented eggs in feces


(diagnostic)

Pathology

invasion of small intestine (jejunum)

Protein losing enteropathy

Malbsoprtion syndrome (weakness, edema)

Loss of fluids, electrolytes, proteins

Intestinal wall thickened and indurated


mucosal surface (non-specific)

Lumen distended with fluid filled with adult


and larvae

Inflammatory cells absent around the parasite


(no inflammation response, parasite able to
invade well)

Effects of electrolyte depletion: malabsorption


which may cause the death of patient
o Heart: Vacuolization of myocardial
sarcoplasm
o Kidneys: Vacuoles in cells of the
proximal convoluted tubules
o Lungs: Pulmonary edema

Adult sticosome (pointed). Below female


adult worm burrowed
Intestinal malabsorption symptoms

Stools: voluminous (increased amount with


chronic diarrhea (like cholera)

Borborygi: most constant feature (hyperactive


bowel sounds)

Loss of weight rapid

Death: due to electrolyte depletion and causes:


pneumonia, heart failure, hypokalemia, cerebral
edema (death is NOT by bleeding)
Treatment:

Thiabendazole

[PARASITOLOGY 2- DR AYOCHOK 2ND HOUR] Sept. 30, 2014

Mebendazole (DOC) = in cases of relapses


give a 30day regimen

Prevention:

Dont eat fish


Cook fish thoroughly

Notetaker: Mary Anne Lorraine Kua