October 7, 2014

Dr. Ayochok (continuation of phasmids)

Ancylostoma Duodenale Ova

Eggs are formed in the ovaries
As they pass through the uterus, the protective
covering (vitelline membrane and shell) is added
If copulation takes place, fertilization occurs in the
seminal receptacle and are discharged in the lumen
of the intestines.

Daily output: 25000-30000 eggs/day

Thin shell, ovoid in shape that contains a

disorganized mass.
*S. stercoralis and hookworm eggs look alike in feces.
LIFE CYCLE:
*Parallels S. stercoralis
a) FREE LIVING PHASE:

Adults discharge eggs in early cleavage stages

Moist, shady, warm, sandy loam.
Moist environment is the most favourable
environment for the development of the ova.

Hatch 1-2 days: emergence of the 1st stage

larva (L1 stage, Rhabditoid)

Rhabditoid Larva:
o flask-shaped esophagus (dxtic morph)
o long narrow buccal chamber
o inconspicuous genital primordium
o molts once to filariform (L3)

5-8 days: filariform larva, viable in soil for

weeks
b) PARASITIC PHASE

We acquire the parasite through skin

penetration (L3 stage)-> travel through
subcutaneous tissue via BV->

Goes to the right side of the heart and into the

lungs, up the respiratory tree
o A. duodenale does not need migration
to the lungs so we easily swallow the
larva, no essential development
o important for N. americanus life cycle

Ascend through esophagus, then we swallow>down the GIT molts again: becomes mature
worms (small intestines)-> adults produce
partially embryonated eggs that are discharged
with the feces-> egg develop into rhabditoid
larva in the environment

By 5 weeks: from filariform larva up to the time

the mature females are ready to deposit their
eggs into the intestines (oviposition) and out
with feces.

Usually infects cats in SE Asia, but can also infect

humans and dogs causing intestinal infection.

Does not produce cutaneous larva migrans in

man!!!!

Ancylostoma braziliense (cat hookworm)

-MOST COMMON cause of Cutaneous larva migrans in
humans
MALE: 8mm (same)
o Bursa as broad as long with short lateral
rays
FEMALE: 10mm
o Angular bend at the level
of vulva
Buccal capsule: larger pair and a
smaller pair of teeth.

To distinguish from duodenale,

In A. ceylanicum there as an obvious difference

in the size of the teeth (unfused)
(In A. duodenale, more conspicuously fused

Ancylostoma ceylanicum
MALES: 8mm long
o Caudal expansion->Bursa (broader)
->lateral rays more curved
FEMALES: 10mm long
Buccal capsule: teeth with configuration
At anterior edge of the mouth capsule.
On each side is one large tooth and behind (or
below) is a very small tooth (back to back
teeth)

teeth)
Found in wild and domesticated feline and canine hosts
Tropics and subtropics
Ancylostoma caninum (dog hookworm)

Naturally infects dogs

MALE: 10mm, bursa with moderately slender rays
FEMALE: 14mm
BUCCAL CAPSULE: only hook worm having 3 pairs of
teeth
OVA: look very similar to duodenale ova except that
they are larger
Causes creeping eruption and skeletal muscle fiber
invasion in human

strongly flexed dorsalward at the anterior end

grayish-yellow; sometimes reddish
Small buccal capsule: ventral (upper) and
dorsal (lower) pair of semilunar cutting plates
o With subventral and subdorsal lancets
on both sides of buccal capsule
Amphidial excretory, esophageal glands>serve as exodigestive functions
o anticoagulant function (for amphidial
gland)

MALES: 7-9 mm X 0.3 mm

Bursa long and wide
spicules long, slender and fused at the tip
(which distinguishes it from duodenale),
forming a barb
o retractable
FEMALES: 9-11mm X 0.4 mm
vulva middle or anterior paired organs
Anterior: two semilunar plates

Necator americanus (New world Hookworm)

American hookworm

American murderer
Adults:

tapere
d/atte
nuate
d
*Teeth and Dental patterns
A
0 - has cutting plates
B
2 -2 pairs of teeth
C
3 -3 pairs of teeth
D
2 -2 pairs of teeth
* Ancylostoma ceylanicum

Necator americanus
Ancylostoma brazilienze
Ancylostoma caninum
Ancylostoma duodenale

= 2 pairs of back to

back teeth

anteriorly
flexed dorsally (sexy compared to S.
stercoralis)

OVA: longer and more elongated than that of A.

duodenale,
shell very thin; disorganized mass inside.
Also causes cutaneous larva migrans


Ancylostoma: low temperature tolerant
PATTERN OF RAIN FALL:
- Dampness, condensation: infective larvae
migrate to soil surfaces (readily penetrate the
skin)
- Dryness: larvae retreat
DUNG BEETLES: form soil-feces mixture (which favors
larval development)
PHILIPINES: N. americanus is a more serious concern
Suitability of the environment for eggs and larvae:
DAMP, SANDY, FRIABLE SOIL (24-32 deg C)
Fecal Pollution of soil (teach children to defect at the
right place)
Extent of contact between infected soil and skin/mouth
HOOKWORM INFECTIONS AND DISEASES

LIFE CYCLE
Adults: small intestine (jejunum, ileum) attached to the
mucosa
tendency to detach from attachment from time
to time for mating and feeding
Requires PULMONARY MIGRATION for essential
development in the lungs as 3rd stage larva
before maturity in the intestine
Parasites practice ratio-proportion of eggs and adults

Light infections: 100-500 eggs/female/gm of feces

Moderate to heavy infections: egg laying capacity is

decreased so that worms can still get the most out
of their host
o More adult worm than eggs
o walang kulangan
o
lahat sila ay mabuhay ng matiwasay
Mode of Infection:

Skin penetration

Worms may also undergo transmammary

transmission (same as for A. duodenale) upon
arrest of larval development
HOOKWORM INFECTION AND DISEASE
Disease: Intestinal infection (+ anemia = chronic infxn)
Epidemiology:
Endemicity dependent on:
1. Continuous presence of human infections
2. Defecation habits ensuring eggs are deposited
in favorable locations for extrinsic development
of the parasite
3. Appropriate environmental conditions (shady
and sandy humus)
4. Opportunity for filariform stage to come in
contact with the skin
TEMPERATURE: major factor affecting geographic
distribution and prevalence

Necator: high temperature tolerant

1. CUTANEOUS LESIONS

filariform larvae migration

site of entry: itching sensation

Develop to Ground itch pruritis, erythema,

popular lesion
o
lesion may become vesicular

Prone to secondary bacterial infection (abrasions

due to scratching)
2. CUTANEOUS LARVA MIGRANS
Aka: Creeping
eruption

A. braziliense: most important; most common

cause.

A. caninum and N. americanus also cause this to

a lesser extent

Itching papules, forms serpiginous tunnels

o
Red, then becomes elevated and
vesicular
o
By larval movement: several mm/day
Pruritus: scratching allows entrance of pyogenic
organisms
Migration on skin: continues for weeks to months

***Larvae of A. braziliense / A.caninum

- able to infect by mouth
- can migrate to deeper tissues
- when extensive: can have picture of pneumonitis:
larvae, eosinophils, Charcot-leyden crystals in
sputum
- can invade the cornea
***Infections of hookworms can be acquired via:

Contact with moist or wet sandy or sandy-loam

soil containing filariform larvae from dogs and
cats

Unprotected sandboxes

Bathing in beaches

Under houses with leaky pipes

*** Old lesions appear dryer and elevated.
Cutaneous worms may be manually removed.
3. PULMONARY LESIONS
aka: Wakana
disease
-Syndrome caused by migrating larvae
-Initial: nausea, vomiting, salivation, pharyngeal itch and
hoarseness

-After several days: cough, dyspnea, hypereosinophilia,

chest x-ray infiltrates
-allergic reaction to larvae

Minute focal hemorrhages in alveoli

Manifest pneumonitis in massive larval infection

Typical: no high degree of sensitization which is

characteristic of Ascaris or Strongyloides
4. INTESTINAL INFECTION

Attached to intestinal mucosa

-temporary head then permanent head are
established
-Digest portions of villi upon permanent head
attachment

Blood sucked out of tissues

-greater amount of blood lost thru bleeding
sites of attachment
-bleeding ceases shortly after worm leaves site

Acute heavy hookworm infection

-Fatigue: n/v, diarrhea (black to red),
weakness, pallor, burning/cramping abdominal
pain
-massive intestinal hemorrhage: very heavy
infections that need surgical management

Eosinophilic leukocytosis, Charcot-leyden crystals

in feces
-allergic reaction to parasite
-more common in A. duodenale and other
Ancylostomas
Chronic heavy hookworm infection:
o
Iron deficiency anemia

-Pallor, facial/pedal edema; enlarged heart

-Hookworm disease ->microcytic,
hypochromic anemia (intestinal)
Mental/Physical retardation

***CLINICA SEVERITY: worm burden

<5 eggs/mg feces (not enough to produce s/s)
>20 eggs/mg feces: significant anemia
>50 eggs/mg feces: massive
***Good nutrition can prevent hookworm dse infection
IF it is light or moderate.

Notetaker: Geas-Ann Kho

Kua, Mary Anne Lorraine

Extra:

Necator americanus
o New World hookworm
(Necator = New )
o American hookworm
o American murderer
Ancylostoma duodenale
o Old World hookworm
o Identified during the early 19th
century: found in miners
working in Germany
Ancylostoma caninum
o Dog hookworm
Ancylostoma braziliense
o Cat hookworm

L1 Rhabditiform= always open-mouthed (that

is why they are for Feeding stage)
L3 Filariform= closed mouth (they cannot feed
so they infect by penetration)

STRONGYLOIDES VS HOOKWORMS
Strongyloides
stercoralis

Hookworm

Short
conspicuous

Long
inconspicuou
s

Longer
notched

Short flask
shaped
pointed

Smaller
2-4 cell stage

Larger
2-8 cell stage

Rhabditiform larva

Buccal cavity

Esophagus

Genital
primordium
Filariform larva
Tail

Egg

Size
Cell
segmentation