UNIT – THREE

HELMINTHES
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 Learning objective
At the end of this unit the students will be able to:
• Define helminths
• Describe the general features of helminths
• Describe the taxonomic classification of helminths

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 Outline

• Introduction to helminthes
• General features of helminthes
• classification of helminthes

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 3.1. Introduction to Helminthes
Medical helminthology: study of the parasitic
worms and their medical consequence
Helminthes derived from the Greek word
“helminths” or “helminthose” meaning
worm
Worm - An imprecise term applied to
elongated invertebrates with no
appendages.

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• Either free living or parasitic organisms belonging to phylum:
– Nemathelminthes(round worm)
– Platyhelminthes(flat worm ),
– Aacanthocephala (spiny headed worms )or
– Aannelida (segmented worm )

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 3.2.General features of helminthes
Are invertebrates characterized by elongated , flat
or round bodies.
Adult worms vary in size (6mm->10m)
Bilaterally symmetrical
Their life cycles may be simple or complex

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Pathology, clinical sign and symptoms:
Depend on the location of the organisms
 May be caused by adults, larva, or egg

Laboratory diagnosis mainly depends on

 Detection and identification egg , larva or
embryo and rarely adults

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 Classification of helminths
HELMINTHES

NEMATHELMINTHES PLATYHELMINTHES
(NEMATODES)

TREMATODES CESTODES

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 Summary
• Define helminths

• Describe the general features of helminths

• Classify helminths

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Unit Four
NEMATHELMINTHES
(NEMATODES)

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 Learning objective
At the end of this unit the students will be able to:
• Describe the general epidemiological aspects of nematodes
• Discuss the characteristics of each nematode
• Explain the life cycle of each nematode
• Apply the necessary laboratory procedures for the detection
and identification of nematodes

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 Outline
• General features of Nemathelminths
• Burden and impact on human life
• Classification of nemathelminths
• Intestinal nematodes
– General features
– For each species:
 Epidemiology , morphology, transmission life cycle , clinical
features, laboratory diagnosis treatment, prevention& control

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 4.1. General features of Nemathelminths
(Nematodes)

• The name Nematode means thread

like(nema-thread )
• Round in cross-section
• Adult vary in size from <5mm to >1meter
• Unsegmented with tapering ends
• Digestive system complete
 Possess mouth, oesophagus and anus

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 Con…
• Can be oviparous/ovoviviparous/viviparous
– Egg (ova) -Larva(L1-L4)-Adult
 Possess a shiny cuticle (smooth/spined/ridged)
 Mouth is surrounded by lips or papillae
 Have separate sexes
 Male is generally smaller than female
 Excretory & nervous system are rudimentary

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• Have Four larval stages

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4.2. Burden and impact on human life
• ≈ 500,000 spp. globally
• Most are free
living
• Abundant pathogens in
life-stock and pets
• Important pests of many
crops
• Cause numerous human
diseases

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•The warm regions of the world = tropical regions.
•High burden
•In the rural villages
•unsanitary overcrowded cities
•'big three' (Ascaris, Trichuris & Hookworm) is common
•Temperate and cold climates are not spared.

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Infection with nematode parasite is acquired
by:-
1. Ingestion of
 Food & water contaminated with embryonated eggs
e.g. A. lumbricoid, E. vermicularis
 Encysted embryo in infected pork, e.g. T.spiralis
2. Penetration of skin, e.g., filariform larvae of hook
worm, S.stercoralis
3. Blood sucking insects, e.g., W. bancrofti,
O.volvulus, B.malayi

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 4.3. Classification of Nemathelminths
• INTESTINE NEMATODE
• Small intestine
– Ascaris lumbricoides
– Hook worm
– Strongyloides stercoralis
• Large intestine
– Trichuris trichuria
– Enterobius vermicularis
• BLOOD & TISSUE NEMATODE
• Adults or larval stage in tissue
• Filaria –
– Wuchereria bancrofti
– Brugia malayi
– Onchocerca volvulus
– Loa loa
• Trichinella spiralis,
• Draconculus medinensis

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 Cont…

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 Animal nematode of less medically important or low
occurrence
INTESTINAL NEMATODE BLOOD & TISSUE NEMATODE
• Toxocara catti & • M. ozardi,
Toxocara cani
• A. canninum & A. • M. peristance,
braziliens • M. stereptocerca
• Cappilaria species
• S. fulliborni
• Trichostrongylus species

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 4.4. INTESTINAL NEMATODES
General features

• Live in gastro-intestinal tract

• In humans, often spread by poor hygiene related to feces

• Most species are geo-helminths (soil transmitted)

• Female worms are oviparous

• Humans are the only or major host of intestinal nematode

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– Transmission:
– Ingestion of infective egg
– Larva penetrating skin
– Laboratory diagnosis:
– Egg in faeces ( most often)
– Larva in faeces
– Recovering egg in the skin around the anus
– Occasional adult worms: A. lumricoudes, E. vermicularies

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 It includes
Cont…
• Ascaris lumbricoides
• Trichuris trichiura
• Enterobius vermicularis
• Strongyloides stercoralis
• Ancylostoma duodenale
• Nectator amircanus

– Before becoming adults in their human host, the larvae of

A. lumbricoides, S. stercoralis , and hookworms have
heart lung migration

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 4.4.1. Ascaris lumbricoides
Common name: round worm
Also known as large intestinal round worm
the first human helminth recorded in chinse
medical literature(about 300-200 B.C.)

Epidemiology
 world wide, most prevalent through out the
tropics, sub-tropics and more prevalent in the
rural areas with poor sanitation
Geohelminths

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1.45 billion people are infected annually

WHO estimated it resulted in 60,000 persons death in

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• Geographical distribution :
• Occurs worldwide. It is particularly common throughout
Asia, and also prevalent throughout Africa.
• Age distribution :
• Ascariasis occurs in all ages, though children seem to be
affected more severely than adults.

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• In Ethiopia
– Ranges from 17% to 77.7%

– Highest rate in school children (2/3rd)

– Distributions affected by altitude and climate

was 29% in highlands, 35% in the
temperate areas and 38% in the lowlands

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Taxonomy
Kingdom - Animalia,
– Phylum - Nematoda,
• Class - Secernentea,
– Order - Ascarida,
• Family - Ascarididae,
• Genus - Ascaris,
• Species - A. lumbricoides

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Habitat

Adult: In the small intestine particularly the

jejunum of man
Egg: In the faeces
 extremely resistant to adverse
environmental condition and chemicals
 remains viable in soil and dust for up to 10
years

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Morphology
Adult: largest intestinal nematode
colour pinkish, cylindrical with
tapering ends
Male: Size: about 15–30cm curved tail
with two copulatory spicules
Female: size 25-40cm, with a tail
The female has a lifespan of 1 – 2
ye years and is capable of producing
2 200,000 eggs per day !!
which corresponds to
just under 3000eggs/gram of faeces.

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 Transmission and Life Cycle
• Transmission
– A. lumbricoides is spread by faecal pollution of soil
– Infective stage:- egg containing 2nd stage larva

• A person acquire infection by

1- Ingestion of food or water contaminated with infective
eggs

2- Eating soil(geophge) frequently seen in children

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3-putting contaminated finger or toys with infective egg
in to mouth

4- rarely by inhalation of eggs carried in air

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The infection is common in areas with
 high density of human population

Poor sanitation

Habit of people to defecate indiscriminately in

and around settlements

Use of infected faeces as fertilizer

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Factors favoring the spread of the transmission:
1. Simple life cycle.
2. Enormous egg production ( 200,000 eggs/ day/
female ).
3. These eggs are highly resistant to ordinary
disinfectants( due to the ascroside). The eggs may
remain viable for several years.
4. Social customs and living habits.
5. Disposal of feces is unsuitable.

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 Life cycle
• Embryonated eggs containing rhabditiform
larvae are pathogenic to man
• Man acquire infection by ingestion of food,
water or raw vegetables contaminated with
Embryonated eggs
• Fully embryonated eggs are swallowed & L2
hatches in the stomach( duodenum)
• L2 penetrate stomach or duodenal mucous
membrane
• L2 enter blood stream & leave through alveoli
into lung

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 Life cycle
• Then molt several times in the lungs to
L3/L4
• Then move up and get swallowed
• 2-3 months after infection the adult worms
start laying eggs (200,000 daily)
• Eggs are shed with the feces and
embryonate within 2-3 weeks depend on
temperature & humidity

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Pathogenesis:
1. “Verminous” pneumonia, lung tissue damage due to
migratory larvae.

2. Bowel obstruction - too many adult worms.

3. Parasite secretes trypsin inhibitor, prevents host from

digesting proteins.

4. Aberrant migration of “irritated” adult worms to:

a. Common duct
b. Liver
c. Pharynx
d. Peritoneum

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 Pathogenesis:
5. By robbing the nutrition of host it affect the
nutritional status.
 Long term effect of malnutrition caused by
ascariasis is retardation of growth
6. Release of toxic fluid(ascaron) of adult
worm in the body of patient may lead to
various allergic manifestations such as
fever, urticaria

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• With heavier worm
loads a tangled mass
of worms can
obstruct the bowel,
or an individual
worm can block a
duct

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 Laboratory Diagnosis
A. Finding and identification of eggs in the stool.
– Direct wet mount
• adequate for detecting moderate to heavy
infections
– concentration technique may be used In light
infection,
Formolo-ether concentration technique

B. Adult worms occasionally passed in the stool or

through the mouth or nose

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C. Larvae
can be identified in sputum during the
pulmonary migration phase
examine formalin-fixed organisms for morphology
D. Serodiagnosis: Ascaris Ab can be detected by
Indirect haemagglutination (IHA)
Immunofluorescence Ab (IFA)
E. Eosinophilia: it is seen larval invasion stage.

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 The diagnostic form is the egg in feces. Unmated females
lay non fertilized eggs.

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 4 types of Ascaris eggs in stool
A. Fertilized Egg With Double Shell
– Size: about 70m
– Shape: oval, or some times round
– Shell: two layer are distinct, rough ,
brown, covered with little lumps
• External shell an outer most coarsely mammillated
layer
• Smooth, thick, colorless internal shell,
– Colour: brown external shell, and the
contents are colorless or pale yellow.
– Content: a single rounded granular central
mass.

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B. Unfertilized Egg With Double Shell
– size: 80-90m
– shape; more elongated (elliptical)
– shell: brown, puffy external shell and
thin internal shell.
– content: full of large round very
refractile granules
 Which is produce in the absence of male
worms
 Are heaviest of all helminthic eggs

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C. Decorticated Fertilized Egg
 Similar to Type A but With out the
external Shell / no lumps
 outer most mammillated layer is
sometimes lost such eggs are
called decorticated eggs
– Shell: single , smooth, thick and
colourless or pale yellow.
– Content: a single rounded colourless
granular central mass.

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E. Embryonated Egg

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Treatment
Mebendazole,
Albendazole
In case of blockage surgical removal

Prevention and Control

1.Prevention of infection by
Washing hands before eating & trimming finger
Avoid eating uncooked foods such as vegetables

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2. Preventing soil become faecally polluted by
• sanitary disposal of faeces in latrines
• avoiding the use of night soil as a fertilizer

3.Treatment and health education

• Mass de-worming programmes repeated at 3-6
month intervals, have been advocated in areas of
high prevalence (Albendazole or mebendazole )

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 4.4.2.Trichuris trichiura
• Common name : whipworm, due to the whip-like
form of the body.

Epidimology
– The third most common round worm of humans
worldwide

– Infections more frequent in areas with tropical weather

and poor sanitation practices, and among children

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 – About 500 million people are infected with
Trichuris trichiura

In Ethiopia
One national survey showed 36.1%

On study in central and northern plateaus:

mean prevalence of 49%

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Taxonomy
Kingdom - Animalia,
Phylum - Nematoda,
Class - Adenophorea,
Order - Enoplida,
Family - Trichuridae,
Genus - Trichuris,
Species - T. trichiur

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Habitat
Adult: large intestine particularly in caecum and
less common in appendix

Eggs : In the faeces, not infective when passed

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Morphology
 Adults: whip-like shape, anterior 3/5th of the worm vey
thin & hair like resembles a whip & the posterior 2/5th
are thick, resembling handle of the whip
Male : Size 30-45 mm , coiled tail
Female: 35-50mm, straight thick tail
 Lives in the large intestine with long, thin anterior end
hidden in the mucosa & thicker posterior end.
 Are white in color

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Egg:
Size: 50-54m
Shape: "tea tray eggs” or barrel-
shaped with a colorless protruding
mucoid plug at each end
Shell: fairly thick and smooth, with
two layers
Color: yellow brown
Content: a central granular mass
which is Unsegmented ova & not
infective to man.

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• Transmission and life Cycle
Transmission
Ingestion of embryonated egg in contaminated
water , food or from contaminated hand

life Cycle
• Have direct life cycle/ no intermediate host
• The unembryonated eggs are passed with the stool
of infected individuals

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 Mature within three weeks of being deposited in
soil.
– Require a warm, moist environment with plenty of
oxygen to ensure embryonation
– The embryonated eggs are extremely resistant to
environmental conditions

• When embryonated eggs are swallowed larvae are

released into the upper duodenum
• The larvae emerge through one pole of the eggs.
• Then attach themselves to the villi of small intestine
or invade the intestinal walls

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• After 3-10 days they move down to the
caecum & ascending colon where they
mature into adult worms
• The adult worms are fixed with the anterior
portions threaded into the mucosa

• The females begin oviposit 60 to 70 days after

infection & shed 3,000 - 20,000 eggs per day

• Adult worms may live 7 to 10 yr.

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 Clinical features
• Are largely determined by the worm burden:

– < 10 worms are asymptomatic (99%

asymptomatic)
– Heavy worm burden
• Mechanical damage/inflammation to the intestinal
mucosa
• Chronic profuse mucus and bloody diarrhea with
abdominal pains and edematous prolapsed rectum

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 Con…
• Allergic response by the host
• Dysentery - inflammation of intestine
accompanied by pus in stool, fever, pain in the
abdomen
which is similar with E.histolytica but whip worm
dysentery is more chronic
• Abdominal complication

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– Anaemia from blood loss and iron deficiency,
malnutrition, weight loss and sometimes death
– Each adult worm sucks about 0.005 ml of blood
per day

– Rarely a child will develop congestive cardiac failure

because of anaemia and fluid retension
hypoproteinemia and edema

– The worm inhibit appendix may give rise symptom of

acute appendicitis.

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 Colonoscopic images of Trichuris dysentery syndrome
- by using flexible fiber optic endoscope used to examine the
colon & to obtain tissue sample

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Trichuris vulpes (dog whip worm in
the intestine of an infected dog

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The diagnostic stage is the egg in fecal samples.

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Laboratory diagnosis
1.Finding of characteristics barrel-shaped egg in
faeces
– Direct wet mount
• adequate for detecting moderate to heavy
infections
– concentration technique may be used In light infection,
Sodium chloride floatation technique &
Formolo-ether concentration technique

2. Sigmoidoscopy may enable visualisation of worms

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Treatment
Mebendazole 200 mg for adults & 100 mg for
children, for 3 days is effective.
 Treat the iron deficiency anaemia
Prevention and Control : the same as described
for A. lumbricodes

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ANY QUESTIONS?

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