Phylum Nematoda  Body is usually tapered to a pointed

posterior end, and to a rounded

Morphology
anterior end
 The body is covered by a noncellular,
highly resistant coating “the cuticle”
 They have complete digestive system
with mouth, esophagus, midgut and
anus.
 All are non-hermaphroditic (separate
sexes); the female is usually larger
than the male.

Life Cycle

The life cycle of the individual nematodes

are similar but organism-specific. An
 Multicellular parasites that appear intestinal nematode infection may be
round in cross section initiated in several ways.
 Basic morphologic forms:
- Eggs (female sex cells after Pinworms- ingestion of the infected eggs
fertilization) vary in sizes and transmits the disease.
shape;
Hookworm larvae- burrow through the
- Juvenile worms known as
skin of the foot and make way into the
larvae; and
intestinal tract.
- Adult worms
The exact means whereby each organism
In the appropriate environment, developing
enters the host and migrated into the
larvae located inside fertilized eggs emerge
intestinal tract varies by species. The eggs
and continue to mature. These larvae are
or larvae, depending on the species,
typically long and slender. The growing larvae
continue to develop into adulthood. The
complete the maturation process, resulting in
resulting adult worms reside in the
the emergence of adult worms.
intestine, where they concentrate on
General Features obtaining nutrition and reproduction.

 Have elongated, cylindrical, smooth, Laboratory Diagnosis

unsegmented, flesh-colored bodies.
  May be accomplished by the recovery Nematode Classification
of eggs, larvae, and occasional adult
worms.

Phylum (Nemathelminthes)
Intestinal Species (
 Specimen of choice vary by species Enterobius vermicularis,
and include cellophane tape Trichuris trichiura, Ascaris
preparations taken around the anal lubricoides, Necator
americanus, Ancylostoma
opening, stool samples, tissue duodenale, Strongloides
biopsies, and infected skin ulcers. Class (Nematoda) stercoralis)
 Serologic test methods are available
for the diagnosis of select nematode
Interstinal-Tissue Species
organisms. (Trichinella spiralis,
Crancunculus medinensis)
Pathogenesis and Clinical Symptoms

In general terms, three possible factors may

Enterobius vermicularis
contribute to the ultimate severity of a
nematode infection: Introduction
(1) the number of worms present;  Enterbius vermicularis, commonly
known as pinworm or seatworm
920 the length of time the infection persists;
and  E. vermicularis is parasitic only to
humans
(3) the overall health of the host.  Adults inhabit the ileocecus, that is
cecum and adjacent ascending colon
Infections with nematodes
and distal ileum. The infection of E.
 Known to last for up to 12 months or vernicularis may cause Enterobiasis
longer depending on the specific  World-wide distribution, it is
species involved. commonly found in kindergarten and
 Occurrence may increase the primary school students
infection time up to several years and  Most common worm parasite in the
beyond; some remain asymptomatic U.S.
or cause minimal discomfort.  Causes little disease
 Patients with heavy worm burden  Infects 30% of children and 16% of
with other health problems, are adults in the U.S.
probably more likely to experience  Adults (females about 12mm long)
severe symptoms and/or live in the large intestine and cecum
complications.  Females migrate to anal region at
The life cycle of each of the nematodes night and lay eggs -> causes itching
involves the intestinal tract.  Scratching anal region contaminants
hands and bedclothes
Nematodes may cause intestinal infection  Eggs develop rapidly and become
symptoms at some point during their infective within 6 hours at body
invasion of the host. temperature
 Abdominal pain, diarrhea, nausea,  When swallowed, hatch in small
vomiting, fever, and eosinophilia intestine and mature in large
 Skin irritation, the formulation of skin intestine
blisters, and muscle involvement may Morphology
also be present
 Enterobius vermicularis Egg: Typical Characteristics at a
Glance
Parameter Description
Size 48-60 um long, 20-35 um wide
Shape Oval, one-side flattened
Embryo Stage of development varies; may be
unembryonated, embryonated, mature
Shell Double-layered, thick, colorless

Enterobius vermicularis
Adult: Typical Characteristics at a Glance
Characteristics Adult Female Adult Male

Length 7-14 mm 2-4 mm Life Cycle

Width Up to 0.5 mm ≤0.3 mm Disease: Enterobius vermicularis causes
Color Yellowish-white Yellowish-white inworm infection Enterobiasis

Tail Pointed; Life cycle:

Resembles  The life cycle is confined to humans
Pinhead
 The infection is acquired by ingesting
*Adult males are only rarely seen.
the worm eggs
Laboratory Diagnosis  The eggs hatch in the small intestine,
where the larvae differentiate into
Diagnosis depends on finding the eggs
adults and migrate to the colon
or the adult pinworms individual eggs are
 The adult male and female worms live
invisible to the naked eye, but they can be
in the colon, where mating occurs
seen using a low-power microscope.
 At night, the female migrates from
On the other hand, the light-yellowish the anus and releases thousands of
thread-like adult pinworms are clearly visually fertilized eggs on the perianal skin
detectable, usually during the night when and into the environment
they move near the anus, or on toilet paper.  Within 6 hours, the eggs develop into
embryonated eggs and become
Transparent adhesive tape applied on
infectious
the anal area will pick up deposited eggs, and
 Reinfection can occur if they are
diagnosis can be made by examining the tape
carried to the mouth by fingers after
with a microscope.
scratching the itching skin
 Microscopic identification of eggs  When the eggs being ingested, it
collected in the perianal area by hatch in the duodenum. The emerging
cellophane (Graham Scotch) tape pinworm larvae grow rapidly to a size
method or anal swabs. This must be of 140 to 150 micrometers in size, and
done in the morning, before migrate through the small intestine
defecation and washing towards the color.
 Detection of adult on anal skin  The male and female pinworms mate
in the ileum whereafter the male
pinworms usually die, and are passed
out with stool. The gravid female
pinworms settle in the ileum, caecum,
appendix and ascending colon, where
 they attach themselves to the mucosa o Infecting about 10% of
and ingest colonic contents. population in developed
 Almost the entire body of a gravid countries, the infection rate in
female becomes filled with eggs. The children is even higher
egg-laying process begins o U.S: E. vermicularis is the
approximately five weeks after initial most common of all
ingestion of pinworm eggs by the helminthic infections (42
human host. million cases in 1980s);
 The gravid female pinworms migrate prevalence 15-50% in children
through the colon towards the  Pinworm infection is particularly
rectum. They emerge from the anus, common among:
and while moving on the skin near the o Children, institutionalized
anus, the female pinworms deposit groups, and households
eggs either through. o Not associated with
1) Contracting and expelling the socioeconomic level
eggs
Clinical Symptoms
2) Dying and then disintegrating,
or  One third of individuals with pinworm
3) Bodily rupture due to the host infection are totally asymptomatic.
scratching the worm  The main symptoms are pruritus ani
i.e., itching in and around the anus.
After depositing the eggs, the female dies.
 The itching occurs mainly during the
The reason the female emerges from the anus
night, and is caused by the female
is to obtain the oxygen necessary for the
pinworms migrating to lay eggs
maturation of eggs.
around the anus. Both the migrating
females and the clumps of eggs are
irritating. The intensity of the itching
varies, and it can be described as
ticking, crawling sensations, or even
acute pain.
 The itching lead to continuously
scratching the area around the anus,
which further results in tearing of the
skin and complications such as
secondary bacterial infections,
including bacterial dermatitis (I.e.,
skin inflammation) and folliculitis (i.e.,
hair follicle inflammation).
 General symptoms are insomnia and
restlessness. A considerable
proportion of children suffer from
anorexia, weightloss, irritability,
Epidemiology emotional instability, and enuresis.
 Enterobius vermicularis, or pinworm,  Pinworms cannot damage the skin,
is highly prevalent throughout the and they do not normally migrate
world through tissues. However, in women
they may move onto the vulva and
into the vagina, from there moving to
 external orifice of the uterus, and Ascaris lumbricoides Fertilized Egg: Typical
onwards to the uterine cavity, Characteristics at a Glance
fallopian tubes, ovaries, and Parameter Description
peritoneal cavity. This can cause Size 40-75 um by 30-50 um
 vulvovaginitis, i.e. an inflammation of Shape Rounder than nonfertilized version
the vulva and vagina. This causes
vaginal discharge and pruritus vulvae, Embryo Undeveloped unicellular embryo
i.e., itchiness of the vulva. Shell Thick chitin
Other May be corticated or decorticated
Treatment

 Pyatantel pamoate, albendazole,

mebendazole Ascaris lumbricoide Unfertilized Egg: Typical
 Secondary dose may be necessary Characteristic at a Glance
 Cure only after seven perineal smears Parameter Description
 Egg reduction rate are hard to Size 85-95 um by 38-45 um; size variations
determine because eggs are from possible
perineal area and not from feces Shape Varies
Embryo Unembryonated; amorphous mass of
 Contraindications to drugs: pregnancy
protoplasm
and hypersensitivity
Shell Thin
 Effects of drugs: gastrointestinal
Other features Usually corticated
disturbance, headache

Prevention and Control

Laboratory Diagnosis
 Washing hands with soap & water
Stool
(after using toilet, before eat)
 Trimming nails regularly & avoid  The specimen of choice for the
biting the nails recovery of A. lumbricoides eggs.
 Avoid scratching anal area.  Adult worms may be recovered in
 Showering every morning and several specimen types, depending on
washing the anal area (to remove the the severity of infection, including the
eggs) small intestine, gallbladder, liver, and
 Do not co-path with infected people appendix. In addition, adult worms
 Cleansing bathroom & toilet may be present in the stool, vomited
up, or removed from the external
nares, where they may attempt to
Ascaris lumbricoides escape.
 An enzyme-linked immunosorbent
Morphology assay (ELISA) is also available.
Ascaris lumbricoide Adults: typical Characteristics at Egg detection
a Glance
Characteristics Female Adult Male Adult  Both fertilized and unfertilized eggs
can be detected by stool examination.
Size (length) 22-35 cm Up to 30 cm
Color Creamy white Creamy white Larva detection
pink tint pink tint
Other features Pencil lead Prominent  During the early pulmonary migratory
thickness incurved tail phase, larvae can be found in sputum
 or gastric aspirates before the eggs Clinical Symptoms
appear in the stool.
The main symptoms include the following:
Adult worm detection
 Low grade fever
 Adult worms may be detected in stool  Cough and bloody sputum
of the patients by naked eye.  Wheezing
 X-ray of the GIT may demonstrate the  Abdominal cramping and
adult worm in the intestine. discomfort
Life Cycle  Nausea
 Vomiting worms
 Anorexia
 Diarrhea and passing worms in
stool
 Small bowel obstruction (mainly
in children)
 Pancreatitis (worm migration)
 Appendicitis (worm migration)

Asymptomatic:

 Patients with a small number of

worms (5 to 10)
 Patients usually ingest only a few
eggs. They may only learn of their
infection if they happen to notice an
adult worm in their freshly passed
feces or if they submit a stool for a
routine parasite examination.

Epidemiology Treatment

 Agent and life cycle- Ascaris  Requires treatment consist of

lumbricoides lives in small intestine of medications deigned to rid the body
humans. of parasitic worms. These include
 Egg production is very heavy about albendazole and mebenazole.
2,400,000 eggs per day. Prevention and Control
 These become embryonated in
external environment and infective in The way to prevent ascariasis is to always:
2-3 weeks.
 Avoid ingesting soil that may be
 On ingestion they hatch in small
contaminated with human feces,
intestine and move to liver and then
including where human fecal matter
lungs via blood. In lungs they moult
(“night soil”) or wastewater is used to
twice, break alveoli and reach
fertilize crops.
bronshile where they are coughed up
 Handwashing
and swallowed
 Wash, peel, or cook all raw
 On reaching intestine, mature in to
vegetables and fruits before eating,
adults in 60 to 80 days. Average life
particularly those that have been
span is 6 to 12 months.
 grown in soil that has been fertilized Pathogenesis and Laboratory Diagnosis
with manure.
Pathogenesis & Clinical Findings
Transmission of infection to others can be
 Although adult Trichuris worms
prevented by:
burrow their hairlike anterior ends
 Not defecating outdoors. into the intestinal mucosa, they do
 Effective sewage disposal systems. not cause significant anemia, unlike
the hookworms
 Trichuris may cause diarrhea, but
Trichuris trichiura (whip worm) most infections are asymptomatic
 Trichuris may also cause rectal
Morphology
prolapse in children with heavy
Eggs are lemon shaped with plug-like infection
translucent polar prominences 50-54um
Laboratory Diagnosis
Trichuris trichiura Egg: Typical Characteristics at a Glance  Diagnosis is baed on finding the
Parameter Description typical eggs, i.e., barre;-shaped
Size 50-55 by 25um (lemon-shaped) with a plug at each
Shape Barrel, football; hyaline polar plug at each end, in the stool
end
Embryo Unicellular; undeveloped Life Cycle
Shell Smooth; yellow-brown color because of bile
contract

The worm is divided into a thin whip-like

anterior part measuring 3/5 of the
worm and a thick fleshly posterior
part of 2/5 the length.

Male: The male measures 3-4.5 cm in length.

Its posterior end is coiled and possess
a single cubicle.

Female: The female measures 4-5 cm in

length. Its posterior end in straight

Infective stage and mode of infection:

Infection is by ingestion of eggs containing

larvae with contaminated raw Epidemiology
vegetables.  800 million people infected
worldwide
Trichuris trichiura Adults: Typical Characteristics at a
 Children living in poverty in the
Glance
Parameter Description tropics and subtopics
Size 2.5-5 cm long; ,males usually smaller than  It is most common in poor rural
females communities and areas in which
Anterior end Colorless; resembles a whip handle; sanitary facilities are lacking and
contains a slender esophagus hands, food, and drink are easily
Posterior Pinkish-gray: resembles whip itself; contains contaminated
end digestive and reproductive systems; males
possess prominent curled tails.
  Many people harbor infections with Decreases whipworm ATP production,
both Trichuris and Ascaris causing energy depletion,
 In up to 10% of patients in endemic immobilization, and death.
areas worm burden may be high (up
Prevention and Control
to 200 worms/pts) and suffering from
disease  Prevent contamination of soil with
 Genetic studies: 25% of the variation human feces
in susceptibility to infection with T.  Construction of latrines
Trichiura is due to genetic factors  Washing hands before eating
Clinical Symptoms (children, soil worker).
 Washing vegetables & fruits
Asymptomatic  Do not use the night soil as fertilizer
 Patients who suffer from a slight Trichinella spiralis
whipworm infection often remain
asymptomatic. Morphology

Trichuriais (whipworm infection) 1. Adults: 1.5mm, 3-4mm, both have a

single set of reproductive organs.
 Heavy infection of 500 to 5000 worms 2. Juvenile (larva): 124x6um, one or
produce a wide variety of symptoms. more coil in a cyst in the skeletal
 The conditions that a whipworm muscle fibers
infection may simulate vary with the
age. An infection of as few as 200 Trichinella spiralis Encysted Larva: Typical
worms may cause a child to develop Characteristics at a Glance
chronic dysentery, severe anemia, Parameter Description
and possibly growth retardation Average juvenile size 75-120 um long, 4-7 um wide
 Increase rectal prolapse and Average mature size Up to 1 mm in length
peristalsis are common in infected Appearance Coiled
children. Encysted in Nurse cells of striated muscle
 Infected adults experience symptoms Notable features Inflammatory infiltrate
that mimic those of inflammatory present around nurse cell
bowel disease.7
 Common symptoms found in infected Trichinella spiralis Adult: Typical Characteristics at a
persons include abdominal Glance
tenderness and pain, weight loss, Characteristic Adult Female Adult Male
weakness, and mucoid or bloody
diarrhea Size 4 by 0.5 mm 2 by 0.04 mm
Treatment Notable Blunt, round Curved posterior
features posterior end; end with two
 Mebendazole (Vermox) single ovary rounded
Causes worm death by selectively and with vulva in appendages
irreversibly blocking glucose uptake anterior fifth of
and other nutrients in the susceptible body
adult intestine where helminths Common to Both Adult Males and Females
dwell. Thin anterior end
 Albendazole (Albenza) Small mouth
Long slender digestive tract
Laboratory Diagnosis  The incidence of infection in cadaver
increase with age. A high rate is found
 Examination of the affected skeletal
at autopsy in the older age group and
muscle is the method of choice for
a relatively low rate in the younger
recovery of the encysted larvae.
age groups and in Negroes.
 Serologic methods are also available.
 Other laboratory findings such as Clinical Symptoms
eosinophilia and leukocytosis may
 Larvae infect animals that eat flesh of
also serve as indicators for disease.
other animals.
 Elevated serum muscle enzyme levels,
 Humans eat the meat (often pork),
such as lactate dehydrogenase,
and larvae mature to adult forms
aldolase, and creatinine
 Adult reproduce, and larvae exit GI
phosphokinase, may also aid in T.
tract & migrate to striated muscles.
spiralis diagnosis.
Skeletal muscles- Encyst and calcify.
It is important to note that several tests
may be required to confirm the presence
of T. spiralis.

Life Cycle

Treatment

 Patients are instructed to get plenty

of rest, supplemented by adequate
fluid intake, fever reducers, pain
relievers.
 Patients with severe infections that
may be potentially life-threatening
are usually treated with prednisone.
Epidemiology  Thiabendazole may also be given,
even though research to date
 In general the incidence of trichinous indicated that the effectiveness of this
is less in the tropics and subtropics medication is questionable.
than in the temperate zones, chiefly  Mild cases
owing to lower consumption of pork o Supportive treatment like
products. bedrest, analgesics and
 Religious bans on cating pork explain antipyretics
the absence of the infection in certain  Moderate cases
countries and races. o Albendazole (400mg BID for 8
 Trichinosis shows seasonal day) or
fluctuations, reaching its peak during o Mebendazole (200-400 mg TID for
the winter months when there is 3 days, then 400 mg TID for 8
greatest consumption of pork. days)
 Severe Cases
 o Add glucocorticoids like smaller than the female, measuring only 21 by
prednisolone to albendazole or 0.4 mm.
mebendazole
Laboratory Diagnosis
Prevention and Control
 Blister Formation
1. Proper Cooking of pork  The skin outline of worm under the
2. Regulate inspection by Trichiniscopy skin
3. Freeze of Pork meat at -15C for 20 - Enhanced by reflected light
days to Kill larvae  Detection of Adult Worm:
4. Control of Rodents - Gravid female worm appears
at the surface of skin
- After death may become
Dracunculuc medinensis (Guinea Worm calcified detected radiological
Disease)  Detection of Larva
- Contact with water- Large
 Guinea Worm- a white worm amount of larva discharges
emerging from a skin lesion. - Microscopic examination
 Its length is between 60cm-120cm  Serology
(=1m) - Antibody seen in serum by
 Infection occurs when a person drinks ELISA & Fluorescents antibody
contaminated water containing water test
fleas (Cyclops) infected with guinea  Skin test
worm larvae - Antigen is injected
Morphology intradermal to see wheal
reaction
Dracunculus medinensis First-Stage Larva: Typical
Characteristics at a Glance Life Cycle
Parameter Description
Average size 620 by 15um
Tail characteristics Consume one third of body length;
culminates in a point

Dracunculus medinensis Adults: Typical Characteristics at

a Glance
Characteristics Adult Female Adult Male
Size 840 by 1.5mm 21 by 0.4mm
Other features Prominent rounded Anterior end coils
anterior end itself at least once

Larvae. There are two larval stages. The

diagnostic stage, also known as the first stage
Epidemiology
or rhabditiform larvae, is relatively small. The
third-stage larvae, which reside in an In 1986, there were an estimated 3.5
intermediate host, have not been well million cases of Guinea worm in 20 endemic
described. nations in Asia and Africa. The number of
cases has been reduced by more than 99% to
Adults. Considered as one of the largest adult
3,190 in 2009, 3,185 of them in the four
nematodes. The rarely seen adult male is
remaining endemic nations of Africa: Sudan,  There is no successful drug treatment,
Ghana, Mali and Ethiopia although some drugs may be used to treat
symptoms
Clinical Symptoms
 Worms may also be surgically removed
 Disease- Drancunculosis before ulcer formation
 Clinical features develop a year afyer  Analgesics (aspirin and ibuprofen) are
infection following the migration of worm used to reduce swelling
to the subcutaneous tissue of the leg  Antibiotic ointment may be used to
 Blister formation- rupture of blister when prevent bacterial infections
in contact with water  Wet compressions relieve discomfort.
 Ulceration- release of larvae by adult
Prevention and Control
female worm
 Secondary bacterial infection of ulcer  The main way to prevent infection is
 Symptoms of dracunculiasis occur as through education
worms migrate under the skin  Educate individuals in areas prone to
 Female releases metabolic wastes that infection to:
cause toxemia that causes a rash, nausea, - Drink water from underground
diarrhea, and dizziness sources free from contamination
 The adult female produces a substance - Do not enter drinking water
that causes inflammation, blistering, and sources with an ulcer
ulceration of the skin, usually of the lower - Use a filter for drinking water to
extremities. The inflamed papule burns remove copepods
and itches, and the ulcer can become  Unsafe water can be boiled or treated
secondarily infected. with an approved larvicide to kill
 No s/s until about 1 year after infection copepods
 A few hours before worm emerges,  Drink water only from protected water
person may develop fever, swelling, and bodies free of contamination
pain in area  Teach villagers to cook their fish properly
 >90% of worms come out at legs and feet  Encourage dog owners to keep out
 Wound can develop secondary bacterial infected dogs
infection

Treatment

 Removal of Worm
o By twisting it around
o Take weeks to months
 Metronidazole, Niridazole, Mebendazole
are sometimes used to limit inflammation
and facilitate worm removal.
 Surgical removal of worm
 Worms that have emerged from skin may
be successfully removed by wrapping the
worm around a small stick. This process
often lasts a few weeks to months.
Occasionally it may take only a few days