NEMATODES

Classification of medically
significant nematodes
A. Based on the presence of absence of caudal
receptor.
a. Class Enoplea- with caudal receptor and
with caudal glands.
- trichuris trichura
- trichinella spiralis
- capillaria philipinensis
2. Class Rhabditea- with caudal receptor but without
caudal glands
- ascaris lumbricoides
- stronglyloides stercoralis
- enterobius vermicularis
- filarial worms
- hookworms
- dracunculus medinensis
- anglostrongylus cantonensis
 Based of habitat
A. Intestinal nematodes
1. Small intestine
- ascaris lumbricoides
- capillaria philipinensis
- hookworms
- strongyloides stercoralis
2. large intestine
- trichuris trichura
- enterobius vermicularis
b. Extra intestinal Nematodes
1. Trichinella spiralis- muscle
2. Filarial worms- lymphatic tissue
3. Dracunculus medinensis- tissue
4. Anglostrongylus cantonensis- brain
 ASCARIS LUMBRICOIDES
 Giant intestinal roundworm
 Disease- human ascariasis
 Adult
- largest and most common
- 15-30 cm by 3 mm male
- 20-40 cm by 5 mm female
- cylindrical, elongated, tapering in the end
- containing lateral lines seen as whitish streak along the
entire length of the body
- terminal mouth with trilobate lips with a small triangular
buccal cavity
 Ova
 Fertilized ova
 Broadly ovoid, golden brown in color
 45-75 by 35-45 micron with 3 thick transparent
layers
 Vitelline membrane- inner non permeable
 Glycogen membrane- thick transparent middle layer
 Albuminous/ mammilary coat- outermost layer
 Fertilized ova

 Decorticated fertilized
ova
 Unfertilized ova
 Larger, longer, elongated or sometimes irregular in
shape
 88-94 microns
 Two layers
 Glycogen membrane
 Albuminous layer
 * vitelline layer is absent
 Unfertilzed Ova
 Life cycle
 Adult in small intestine
 Eggs passes out in the feces
 Embryonation in 1-2 weeks
 Fully embryonayed egss ingested by man
 In the small intestine, larva penetrate the mucosa and
enters the blood circulation
 Heart and lung migration, molt twice
 Larvae ascend respiratory tree and swallowed,
descend to the small intestine to mature
 Pathology
Adult
 Feeds on intestinal contents

 abdominal pain, diarrhea, nausea, loss of appetite

 Due to eratic migration might lead to regurgitation

and escape through the nostril

 Vomited ascaris may pass the larynx and might lead

to suffocation or reach the lung producing gangrene

 might enter the eustachian tube and provole otitis

media
 Extra intestinal pathology
 May invade bile duct, gall bladder, appendix
 May cause hemorrhagic pancreatitis
 Migration to the peritoneal cavity leads to peritonitis
 Even the worms cause little or no traumatic damage
the by product of living or dead worms may rarely
produced toxic manifestation such as edema and
urticaria accompanied by loss of appetite and weight
 Diagnosis
 Direct fecal smear
 Kato-thick
 Kato- katz
 Concentration technique
 Treatment
 Piperazine citrate
 Pyrantel pamoate
 Mebendazole
 Albendazole
 *piperazine and pyrantel pamoate with
neuromuscular blocking effect that paralyses the
parasites.
 Prevention and control
 Treatment of infected individual
 Sanitary waste disposal
 Hand washing before meals
 Proper personal hygiene
 Thorough washing and cooking of food
 Avoid using human excreta as fertilizer
 TRICHURIS TRICHURA
 Whipworm
 Trichuriasis
 Adults
 Attached to the wall of the caecum
 Whiplike and posterior end is more robust
 Female- 3.5- 5 cm
 Male- 3-4.5 cm and coiled posterior end
 Ova
 Unsegmented, barrel shaped, lemon, football
shaped ova
 Bi-polar plugs
 With 3 layers
 Embryonation takes place in the soil where the
first stage larvae is formed within 3 weeks
 Life cycle
 Adult worms attached to the wall of the
caecum
 Eggs passes out of the feces
 Embryonate in 2-3 weeks
 Embryonated eggs ingested by man
 Larvae hatch in the intestine
 Pathology
 Small streaked diarrheic stool
 Abdominal pain and tenderness
 Nausea and vomiting
 Hypochromic anemia
 Weight loss
 Rectal prolapse
 Diagnosis
 Direct fecal smear analysis
 Kato-thick or kato Katz
 Concentration technique
 Treatment
 Albendazole
 Mebendazole
 Pyrantel pamoate
 Prevention and control
 Treatment of infected individual
 Sanitary waste disposal
 Hand washing before meals
 Proper personal hygiene
 Thorough washing and cooking of food
 Avoid using human excreta as fertilizer
 Enterobius vermicularis
 Pinworm or seatworm
 Enterobiasis or oxyuriasis
 Adults
 Small whitish or brown in color
 Male- 2-5 mm coiled tail end
 Female- 8-13mm pointed tail end
 Diagnostic in the presence of cephalic alae and
distinct or prominent esophageal bulb.
 Ova
 Elongated
 50-80 by 20-30 microns
 Flattened lateral side, lopsided D
 Two egg-shell layer
 Albuminous layer- outer
 Embryonic or lipoidal membrane- inner
 Embryonated when laid
 Resistant to disinfectant
 Under favorable condition, it remains viable for 13 days
 Life cycle
 Adults in the caecum
 Gravid females migrate to the perianal area to
deposit embryonated egg
 Ova are infective to man 6hrs after deposition
 Ova are ingest of inhaled by man
 Larvae hatch in the duodenum
 Migrate to its final habitat in the large intestine
 Pathology
 Poor appetite
 Insomia
 Weight loss
 Irritability
 Grinding of teeth
 Nausea
 Vomiting
 Pruritus ani
 Diagnosis
 Scotch tape swab
 Treatment
 Albendazole
 Mebendazole
 Pyrantel pamoate
 Transmission
 Hand to mouth
 Inhalation
 autoinfection
 Trichinella spiralis
 Trichina worm
 Trichinosis
 Adult
 Minute
 Male-1.5 by 0.04 mm with single testis near the
posterior end
 Female- 3.6 by 0.06 mm with single ovary
 The female is viviparous or larviparous capable of
producing 1,500 larvae
 Larvae
 80-120 micron by 5.6 microns at birth
 900-1300 micron by 35-40 microns
 Spear like burrowing anterior
 Life cycle
 Encysted larvae in pig
muscle
 Ingestion of improperly
cooked pork
 Infected flesh is digested by
gastric juice
 Adults in the duodenum
 Larviparous female burrows
into mucosa and deposit
larvae
 Larvae enters the circulation
 Encyst in striated muscle
 Dead end cycle
 Pathology
 Incubation and intestinal invasion
 Includes diarrhrea, constipation, vomiting
abdominal cramps, nausea
 Larval migration muscle invasion
 Fever, facial edema, urticaria, pain and swelling
weakness
 Splenomegaly, gastric and intestinal hemorrhages
 Encysment and encapsulation
 Fever, weak, pain
 Diagnosis
 Muscle biopsy
 Serological- ELISA
 Treatment
 Thiabendazole during the first week
 Mebedazole larvicidal
 Prevention and control
 Cook meat 77 C 177 F
 Freezing- - 15C for 20 days or -30 C for 6
days
 Smoking, salting, or drying is not effective
 Hookworms
 Necator americanus- New World Hookworm
 Ancylostoma duodenale- old world hookworm
 Ancylostoma braziliense- cat hookworm
 Ancylostoma caninum- dog hookworm
 Necator americanus
 S-shaped
 Buccal capsule id provided with semilunar
cutting plate
 With amphidial gland that secretes
anticoagulant
 Copulatory bursa is longer than broad with
bipartite dorsal ray and a long slender
copulatory spicules that is fused at the tip
forming a delicate barb.
Necator americanus
Adult necator
Tail- end
Necator Ova
 Ancylostoma duodenale
 Stout, body contour into letter c
 2 pairs of ventral teeth
 With copulatory bursa characterized as bristle
like with tridigitate dorsal ray
Ancylostoma duodenale
Ova
 Ancylostoma brazilienze
 With a pair of teeth and a pair o f
inconspicuous median teeth in the buccal
capsule
 Broad and long copulatory bursa with short
lateral rays
Filariform, rhabditiform
Ova
 Ancylostoma caninum
 With 3 pair of ventral teeth
 Secretes anticoagulant that delays the
coagulation of blood.
Ancylostoma caninum
Ova
 Larval stage
 Rhabditiform
 Long narrow buccal cavity
 Flask shaped esophagus
 With inconspicuous genital primordium
 Open mouth
 Feeding stage
 Filariform
 Longer and slender with pointed posterior end
 Closed mouth with protective covering
 Non feeding stage
 Infective stage
 Life cycle
 Adults in the small intestine
 Ova in feces
 Rhabditiform larvae 1-2 days
 Filariform 5-8 days
 Filariform penetrate the skin
 Enters the circulation
 Lungs
 Trachea
 Swallowed
 Esophagus
 Pathology
 Ground itch- pruritus, secondary bacterial
infection
 Pulmonary lesion- Wakana disease
 Creeping eruption- dermatitis characterized by
intracutaneous lesion
 Hookwrom anemia- microcytic hypochromic
 Albuminea- low level of albumin due to
combined loss of blood, lymph and protein
 Diagnosis
 Direct fecal smear
 Harada-mori
 Treatment
 Mebendazole
 Albendazole
 Thiabendazole
 Strongyloides stercoralis
 Threadworm
 Cochin-china diarrhea
 Capable of both free living and parasitic
 2-7 mm and 30-40um in width
 Colorless, semitransparent nematode
 Larvae
 Rhabditiform- short buccal cavity, elongated
esophagus with pyriform posterior bulb and
conspicuous genital primodium
 Filariform- long delicate larvae with long
esophagus and forked or notched tail
 Life cycle
 Small intestine
 Ova in feces
 Rhabditiform larvae-------------filariform—adult free living---
 Filariform --ova---rhabditiform---filariform-----host
 Skin ----adult
 Circulation
 Heart
 Lungs
 Trachea
 esophagus
 Prevention
 Proper waste disposal
 Personal hygiene
 Avoid being barefooted on suspected infected
area
 medication
 Treatment
 Mebendazole
 Albendazole
 thiabendazole
 Precaution
 Administration of ORS to prevent dehydration
and loss of electrolytes
 Filarial worms
 Arthropod transmitted
 Invades circulatory system, muscle, serous cavities,
lymphatic system
 2-50cm with inconspicuous buccal cavity
 Males with two copulatory spicule
 Viviparous females gives birth to prelarval
microfilaria
 Microfilaria is motile , snakelike with dark staining
nuclei occupying most of the entire body
 Sheathed ( with embryonic sheath )
 Unsheated ( with no embryonic sheath )
 Periodicity
 Noctunal
 Diurnal
 Subperiodic
 Subpeiodic diurnal
 Subperiodic nocturnal
 Wuchereria Bancrofti
 Bancroft’s filarial worm
 elephantiasis
 Males- 2-4 cm
 Females- 8-10 cm
 Microfilaria is nocturnal with curvatures and graceful
appearance, tapering tail with no terminal nuclei
 Lower lmphatics
 Elephantiasis
Microfilaria ( wuchereria bancrofti )
 Pathology
 Tropical pumonary eosinophilia
 Granuloma of the spleen
 In the lymph nodes they promote
pseudotubercular granulomatous reactions,
leads to edema, vascular and lymphatic
hyperplasia, fibrosis and caesation
 Elephantiasis- scrotum, vulva, enlargement of
the genitals and lower lymphatics
 Diagnosis and treatment
 Blood smear ( check periodicity )
 Treatment
 DEC- Diethyl carbamazine
 Aedes

 Anopheles
 Brugia malayi
 Malayan filarial worm
 Malayan filariasis
 Male- 13-23 mm
 Female- 43-55 mm
 With two distinct or discrete nuclei at the tip
of the tail
Vector Mansonia uniformis
 Treatment
 DEC
 Loa Loa
 African Eye worm
 Calabar swelling
 Sheathed microfilaria
 Subcutaneous tissue ( Habitat )
 Vector- chrysops
 Disease
 Calabar swelling
 Conjunctiva granuloma
 Bug eye- painless edema of the eyelids
 Protopsis- bug eye
Calabar swelling
 Treatment and control
 Protection from the bite of the vectors
 Control of the vector
 Chemotherapy with diethylcarbamazine
 Onchocerca volvulus
 Convoluted filaria
 River blindness
 Nodules in the subcutaneous tissue
 Males- 19-42 mm
 Females- 33.5-50mm
 Vector simulium
 Pathology
 Fever
 Eosinophilia
 Urticaria
 Blindness
 Pruritus
 Hyperkeratosis
 Hanging groin
 Diagnosis and treatment
 Skin snip of the subcutaneous nodules
 Not found on the blood but can be found on
the urine
 Surgical removal of the nodule
 DEC followed by suramin
 Mebendazole as an alternate drug of choice
 Toxocara canis and Cati
 Dog and cat ascaris
 Normal habitat- cats and dogs, human
accidental host
 Visceral larval migrans
 Life cycle- same as humans
 Pathology
 Visceral larval migration
 Hemorrhage
 Necrosis and granuloma
 Eosinophilia
 Liver damage
 Pulmonary inflammation
 Ocular problems
 Diagnosis and Treatment
 Marked eosinophilia
 Hepatomegaly
 Hyperglobulinemia
 Direct fecal smear
 Tx
 Thiabendazole
 Prevention and control
 Avoid contact with infected animals
 Animal under 6 mos. Should be dewormed
with piperazine
 Proper waste disposal of animal droppings
Toxocara canis ova
Toxocara cati
Toxocara canis ova
 Capillaria philipinensis
 Pudoc worm
 Borborygamy
 Diarrheal disease
 dehydration
Capillaria ova
 Other nematodes
 Angiostrongylus cantonensis
 Rat lungworm
 Pila, planaria, fresh water prawns are intermediate
host
 Infection to rats involves lungs for development
 In humans stays in the brain
Pila Africana
Planaria
 Dracunculus medinensis
 Guinea worm, dragon worm, fiery serpent
worm of the israelites
 Inhabits the tissue
 Female 70-120cm
 Life cycle
 Adults in the cutaneous tissue
 Larva escapes from skin blister 1st stage
 Free swimming ( rhabditiform )
 Ingested by cyclops, copepods
 Body cavity of cyclops or copepods
 Infective stage ( filariform )
 Ingested by man
 Adults in the tissue
 Diagnosis includes flooding of the ulceration
on the skin
 Treatment- niridazole, metronidazole and
thiabendazole
Copepods
Cyclops