Clinical Parasitology

LECTURE / 1ST SEMESTER / PPT-BASED

PARASITOLOGY ERRATIC
 It is the area of biology concerned with the phenomenon  It is when a parasite is found in an organ which is not its
of dependence of one living organism on another. usual habitat.

MEDICAL PARASITOLOGY OBLIGATE PARASITE (Most Parasites)

 Is concerned primarily with parasites of human and  Parasites that need a host at some stage of their life
their medical significance, as well as their importance in cycle to complete their development and to propagate
human communities. their species.
 Example: Tapeworms
BIOLOGICAL RELATIONSHIPS
FACULTATIVE PARASITE
SYMBIOSIS  May exist in a free-living state or may become parasitic
 Is living together of unlike organisms. It may also involve when the need arises.
protection of other advantages to one or both
organisms. ACCIDENTAL/INCIDENTAL PARASITE
 A parasite, which establishes itself in a host where it
COMMENSALISM does not ordinarily live.
 It is a symbiotic relationship in which two species live
together and one species benefits from the relationship PERMANENT PARASITE
without harming or benefiting the other.  Parasite remains on or in the body of the host for its
 Example: Entamoeba coli in the intestinal lumen are entire life.
supplied with nourishment and are protected from
harm, while it does not cause any damage to the tissue TEMPORARY PARASITE
of its host.  Lives on the host only for a short period of time.

MUTUALISM SPURIOUS PARASITE

 It is a symbiosis in which two organisms mutually benefit  It is a free-living organism that passes through the
from each other. digestive tract without infecting the host.
 Like Termites and the flagellates in their digestive
system, which synthesize cellulose to aid in the HOSTS
breakdown of ingested wood. Hosts can be classified into various types based on their role
in the life cycle of the parasite.
PARASITISM
 Is a symbiotic relationship where one organism, the DEFINITIVE/FINAL HOST
parasite, lives in or on another, depending on the latter  One in which the parasite attains sexual maturity.
for its survival and usually at the expense of the host.  In Taeniasis, for example, humans are considered
 One example of a parasite is Entamoeba histolytica, the definitive host.
which derives nutrition from the human host and causes
amebic dysentery. INTERMEDIATE HOST
 Harbors the asexual or larval stage of the parasite.
PARASITES  Pigs or Cattle serve as intermediate host of Taenia
Parasites are often described according to their habitat or spp. While Snails are hosts of Schistosoma spp.
mode of development.
PARATENIC HOST
ENDOPARASITE  One in which the parasite does not develop further to
 A parasite living inside the body of a host. later stages. However, the parasite remains alive and is
able to infect another susceptible host.
ECTOPARASITE  For example, Paragonimus metacercaria in raw
 A parasite living outside the body of a host. wild boar meat can pass through the intestinal wall
of humans and complete its development.
INFECTION
 The presence of an endoparasite in a host. RESERVOIR HOST
 They allow the parasite's life cycle to continue and
INFESTATION become additional sources of human infection.
 The presence of ectoparasite on a host.  Examples:
Pigs - Balantidium coli
Field Rats - Paragonimus westermani
Cats - Brugia malayi

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Clinical Parasitology
LECTURE / 1ST SEMESTER / PPT-BASED
VECTORS MODES OF TRANSMISSION
Vectors are responsible for transmitting the parasite from one  Since the most colon source of parasitic infection is
host to another. contaminated food and water, the lost likely portal of
entry is the mouth.
BIOLOGIC VECTOR  Skin Penetration is another route of transmission.
 Transmits the parasite only after the latter has  Arthropods also serve as vectors and transmit
completed its development within the host. parasites through their bites.
 When Aedes mosquito sucks blood from a patient  Another way of acquiring infection is through
with Filariasis. congenital transmission.
 Other ways of acquiring the infection include
MECHANICAL/PHORETIC VECTOR inhalation.
 Only transports the parasite.  Sexual intercourse
 Flies and Cockroaches that feed on fecal material.
INJURIOUS EFFECTS OF PARASITES ON THE HOST
EXPOSURE AND INFECTION 1. Suck blood or body fluids
Majority of parasites are pathogens which are harmful and - Hookworms, ticks, fleas
which frequently cause mechanical injury to their hosts. 2. Feed and Destroy body tissues
- Hookworms, liver flukes
CARRIER 3. Complete/Absorb food intended for host
 It harbors a particular pathogen without manifesting - Tapeworm, Ascaris worm
any signs and symptoms. 4. Mechanical Obstruction
- Ascaris (bile duct), Filaria (lymph vessels)
5. May cause pressure atrophy, tumors, nodules
EXPOSURE
- Hydatid cyst of tapeworms
 It is the process of inoculating an infective agent, while
6. May Destroy host cells by growing in them
Infection connotes the establishment of the infective
- Plasmodium inside Red Blood Cells
agent in the host.
7. May produce irritation, allergic reaction, toxic
substances, inflammation through enzymes
INCUBATION
 The period between infection and evidence of
NOMENCLATURE
symptoms. It is sometimes referred to as Clinical
 Each Phylum is divided into classes, which further
Incubation Period.
subdivided into orders, families, genera, and species. At
times, the further divisions of suborder, superfamily, and
PRE-PATENT PERIOD subspecies are employed.
 It is the period between Infection or acquisition of the
 Scientific names are latinized; family names are formed
parasite and evidence of demonstration of infection, also
by adding “-idea” to the stem of the genus type; generic
known as Biologic Incubation Period.
names consist of a single word written in initial capital
letter; the specific name always begins with a small
AUTOINFECTION letter. The names of the genera and species are
 Results when an infected individual becomes his own italicized or underlined when written.
direct source of infection.
 In enterobiasis, infection may occur through hand-
LIFE CYCLE
to-mouth transmission.
 Through adaptation to their hosts and the external
 Alternatively, parasites may multiply internally, such
environment, parasites have developed life cycles, which
as Capillaria philippinensis.
may be simple or complicated.
 Most parasitic organisms attain sexual maturity in their
SUPERINFECTION/HYPERINFECTION definitive hosts.
 Happens when the already infected individual is further  Some spend their entire lives within the host with one
infected with the same species leading to massive generation after another, while others are exposed to
infection with the parasite. the external environment before being taken up by an
 An alteration in the normal cycle of Strongyloides appropriate host.
results in a large increase in worm burden.  The larval stage of the parasite may pass through
different stages in an immediate host before it reaches a
SOURCES OF INFECTION: final host.
 The most common sources are contaminated soil and
water. EPIDEMIOLOGIC MEASURES
 Another possible source of infection is food, which may
contain the infective stage of the parasite. EPIDEMIOLOGY
 Arthropods can also transmit infection.
 It is the study of patterns, distribution, and occurrence of
 Other sources of infection include another person, this disease.
beddings and clothing, as well as the intermediate
environment he has contaminated, or even one’s self.

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INCIDENCE COVERAGE
 It is the number of new cases of infection appearing in a  Refers to the proportion of the target population reached
population in a given period of time. by an intervention. It could be the percentage of school-
age children treated during a treatment day.
PREVALENCE
 It is the number of new cases of infection appearing in a EFFICACY
population in a given period of time.  It is the effect of a drug against an infective agent in
ideal experimental conditions and isolated from any
CUMULATIVE PREVALENCE context.
 Is the number (usually expressed as percentage) of
individuals in a population estimated to be infected with EFFECTIVENESS
a particular parasite species at a given time.  It is a measure of the effect of a drug against an infective
agent in a particular host, living in a particular
INTENSITY OF INFECTION environment with specific ecological, immunological,
 Refers to burden of infection which is related to the and epidemiological determinants.
number of worms per infected person.
DRUG RESISTANCE
MORBIDITY  Is a genetically transmitted loss of susceptibility to a
 Clinical consequences of infections or diseases that drug in a parasite population that was previously
affect and individual's well-being. sensitive to the appropriate therapeutic dose.

TREATMENT

DEWORMING
 It is the use of anthelminthic drugs in an individual or a
public health program.

CURE RATE
 Refers to the number (usually expressed as a
percentage) of previously positive subjects found to be
egg negative on examination of a stool or urine sample
using a standard procedure at a set timer after
deworming.

EGG REDUCTION RATE (ERR)

 It is the percentage fall in egg counts after deworming
based on examination of a stool or urine sample using a
standard procedure at a set time after the treatment.

SELECTIVE TREATMENT
 Involves individual-level deworming with selection for
treatment based on a diagnosis of infection or an
assessment of the intensity of infection, or based on
presumptive grounds.

TARGETED TREATMENT
 Is group-level deworming where the (risk) group to be
treated (without prior diagnosis) may be defined by age,
sex, or other social characteristics irrespective of
infection status).

UNIVERSAL TREATMENT
 Is population-level deworming in which the community
is treated irrespective of age, sex, infection status, or
other social characteristics.

PREVENTIVE CHEMOTHERAPY
 Is the regular, systematic, large-scale intervention
involving the administration of one or more drugs to
selected population groups with the aim of reducing
morbidity and transmission of selected helminth
infections.

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MORPHOLOGY AND LIFE CYCLE

 Members of the class Nematoda.
 Three basic morphologic forms:
1. Eggs (Female sex cells after fertilization)
2. Juvenile Worms/Larvae
3. Adult Worms
 In the appropriate environment, developing larvae
located inside fertilized eggs emerge and continue to
mature. These larvae are typically long and slender.
The growing larvae complete the maturation process,
resulting in the emergence of adult worms. TRICHURIS TRICHIURA
 Sexes are separate.  Common name: Whipworm
 The adult female worms are usually larger than the  Common associated disease and condition names:
adult males. Trichuriasis, whipworm infection.
 The adults are equipped with complete digestive and
reproductive systems. MORPHOLOGY:
 The life cycles of the individual nematodes are similar Eggs:
but organism-specific.  Barrel-shaped (Football-shaped)
 50 to 55𝜇m by 25𝜇m
LABORATORY DIAGNOSIS  The undeveloped unicellular embryo is surrounded by a
 Recovery of eggs, larvae, and occasional adult worms. smooth shell that retains a yellow-brown color from its
 The specimens of choice vary by species and include contact with host bile.
cellophane tape preparations taken around the anal  A prominent hyaline polar plug is visible at each end.
opening, stool samples, tissue biopsies, and infected Adults:
skin ulcers.  2.5 to 5cm in length
 Serologic test methods are available for the diagnosis  The anterior end of the adult appears colorless and
of select nematode organisms. contains a slender esophagus.
 The posterior end assumes a pinkish-gray color,
PATHOGENESIS AND CLINICAL SYMPTOMS consisting of the intestine and reproductive system.
 Three possible factors may contribute to the ultimate  The adult female is usually larger than the adult male.
severity of a nematode infection:  In addition to a digestive system, intestinal tract, and
1. Number of worms present reproductive organs, the male possesses an easily
2. Length of time the infection persists recognizable curled tail.
3. Overall health of the host  The posterior end of the adult T. trichiura is large and
 Infections with nematodes have been known to last for resembles that of a whip handle.
up to 12 months or longer (some infections may last 10
to 15 years or more), depending on the specific species
involved.
 The life cycle of each of the nematodes involves the
intestinal tract. With one exception, all the nematodes
may cause intestinal infection symptoms at some point
during their invasion of the host.
 Abdominal pain, diarrhea, nausea, vomiting, fever, and
eosinophilia. Skin irritation, the formation of skin blisters,
and muscle involvement.

NEMATODE CLASSIFICATION
 The nematodes belong to the Phylum Nemathelminthes.
 The nematode species may be divided into two groups,
those primarily involved with the intestinal tract, termed
intestinal species, and those that migrate into the
tissues following initial contact with the intestinal tract,
termed intestinal-tissue species

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LABORATORY DIAGNOSIS TRICHINELLA SPIRALIS
 The specimen of choice for the recovery of T. trichiura eggs  Common name: Trichina worm
is stool.  Common associated disease and condition names:
 These eggs are particularly prominent in infected samples Trichinosis, trichinellosis
processed using the zinc sulfate flotation.
 Adult worms may be visible on macroscopic examination MORPHOLOGY:
of the intestinal mucosa. Adults may also be seen in areas  Encysted Larvae. The average juvenile encysted larvae
of the intestinal tract down to and including the rectum in measures from 75 to 120𝝁m by 4 to 7𝝁m
heavy infections.  A fully developed larva may reach up to a length of
1mm. These larvae settle by coiling up in muscle fibers
LIFE CYCLE and becoming encysted.
 Ingestion of infective T. trichiura eggs containing larvae  Biopsies of these larvae often reveal a distinctive
initiates human infection. inflammatory infiltrate
 The larvae emerge from the eggs in the small intestine. Adults:
 Growth and development of the larvae occur as they  The female measures 4 by 0.5mm, whereas the male is
migrate within the intestinal villi. The larvae return to the significantly smaller, measuring 2 by 0.04mm.
intestinal lumen and proceed to the cecum, where they  The male adult characteristically possesses a thin
complete their maturation. anterior end equipped with a small mouth, a long and
 The resulting adults take up residence in the colon, slender digestive tract, and curved posterior end with
embedding in the mucosa. two somewhat rounded appendages.
 The life span of the adult worms in untreated infections  The female differs from the male in two respects. The
may be from 4 to 8 years. female possesses a blunt, rounded posterior end and
 Following copulation, the adult female lays her a single ovary with a vulva located in the anterior fifth
undeveloped eggs. It is this stage of egg that is passed into of the body.
the outside environment via the feces.
 Following approximately 1 month outside the human
body, usually in the soil, the eggs embryonate, become
infective, and are ready to initiate a new cycle.

EPIDEMIOLOGY
 Considered as the third most common helminth.
 Primarily found in warm climates of the world where
poor sanitation practices are common
 Persons most at risk for contracting whipworm LABORATORY DIAGNOSIS
infections include children as well as those in  Examination of the affected skeletal muscle is the
psychiatric facilities method of choice for recovery of the encysted
larvae.
CLINICAL SYMPTOMS  Serologic methods are also available.
 Asymptomatic. Patients who suffer from a slight  Other laboratory findings such as eosinophilia and
whipworm infection often remain asymptomatic. leukocytosis may also serve as indicators for
 Trichuriasis. Whipworm Infection: Heavy infections 500 disease.
to 5000 worms produce a wide variety of symptoms.  Elevated serum muscle enzyme levels, such as
Ulcerative colitis Peristalsis lactate dehydrogenase, aldolase, and creatinine
Adults: Experience symptoms that phosphokinase.
Chronic dysentery
mimic inflammatory bowel disease
Severe Anemia Abdominal tenderness and pain LIFE CYCLE
Growth retardation Weight Loss  Infection is initiated after consuming undercooked
Rectal Prolapse Mucoid or Bloody diarrhea contaminated meat, primarily striated muscle.
 Human digestion of the meat releases T. spiralis
TREATMENT larvae into the intestine. Maturation into adult
 Mebendazole or Albendazole are considered as the worms occurs rapidly.
treatment of choice for whipworm infections.  Mating occurs and the gravid adult female migrates
into the intestinal submucosa to lay her live larvae
PREVENTION AND CONTROL because there is no egg stage in this life cycle.
 Proper sanitation practice  The infant larvae then enter the bloodstream and
 Thorough treatment of infected persons travel to striated muscle, where they encyst nurse
 Educating children and aiding institutionalized mentally cells.
handicapped persons in their personal hygiene and  Over time, a granuloma forms, which becomes
sanitation practices. calcified around these cells.
 Because human are not the traditional hosts,
completion of the T. spiralis life cycle does not occur
and the cycle ceases with the encystation of the
larvae.

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LECTURE / 1ST SEMESTER / PPT-BASED
CLINICAL SYMPTOMS  The first generation of female worms produces larvae to
 Trichinosis, Trichinellosis build up the population. Subsequent generations
 T. spiralis is known as the great imitator because predominantly produce eggs, although there are always
infected patients may experience a variety of symptoms a few female worms that produce both larvae and eggs,
that often mimic those of other diseases and conditions. or larvae only. Some of these larvae are retained in the
 Persons with a light infection typically experience gut lumen and develop into adults. This leads to
diarrhea and possibly a slight fever, suggestive of the hyperinfection and autoinfection, which result in the
flu. production of very large numbers of worms.
 Heavily infected patients complain of symptoms such as  Fish-eating birds are believed to be the natural hosts of
vomiting, nausea, abdominal pain, diarrhea, C. philippinensis, and humans are considered incidental
headache, and perhaps a fever during the intestinal hosts.
phase of infection.
 As the larvae begin their migration through the body,
infected persons experience a number of symptoms,
particularly eosinophilia, pain in the pleural area, fever,
blurred vision, edema, and cough. Death may also
result during this phase.
 Muscular discomfort, edema, local inflammation,
overall fatigue, and weakness usually develop once the
larvae settle into the striated muscle and begin the PATHOGENESIS AND CLINICAL MANIFESTATIONS
encystation process.
 Abdominal pain and borborygmi
 Intermittent diarrhea
TREATMENT  Weight loss, malaise, anorexia, vomiting, and edema
 No medication is indicated if the infected person has a  Laboratory findings show severe protein-losing
non-life –threatening strain of the disease. These enteropathy and hypoalbuminemia; low serum
patients are instructed to get plenty of rest, potassium, sodium, and calcium; and high levels of
supplemented by adequate fluid intake, fever reducers, immunoglobulin E.
and pain relievers.  Micro-ulcers in the epithelium
 Patients with severe infections that may be potentially  Histologically, the intestines also show flattened and
life-threatening are usually treated with Prednisone or denuded villi, and dilated mucosal glands. The lamina
Thiabendazole propria is infiltrated with plasma cells, lymphocytes,
 Under appropriate conditions, steroids may also be macrophages, and neutrophils.
administered.
DIAGNOSIS
PREVENTION AND CONTROL  Eggs in the feces by Direct Smear or Wet Mount, as well
 Thorough cooking of meats. as by stool examination methods.
 The parasites can also be recovered from the small
CAPILLARIA PHILIPPINENSIS intestines by duodenal aspiration.
 Common name: Pudoc Worm
 Human infection with C. philippinensis was first reported TREATMENT
by Chitwood et. al. in 1963 in a 29-year-old male from  In severe cases with electrolyte and protein loss,
Northern Luzon. patients should be given electrolyte replacement and a
 The parasites in this superfamily characteristically have high protein diet.
a thin filamentous anterior end and a slightly thicker  The drug of choice for this treatment of intestinal
and shorter posterior end. capillariasis is Mebendazole or Albendazole.
 The male worms are about 1.5 to 3.9mm in length, while
females are 2.3 to 5.3mm long. The male spicule is 230
EPIDEMIOLOGY
to 30𝟎𝝁m long and has an unspined sheath.
 First recorded in Northern Luzon in the Philippines
 Female worms produce characteristic eggs, which are
(Pudoc West, Taguidin, Ilocos Sur)
peanut-shaped with striated shells and flattened
 Cases of human capillariasis have been subsequently
bipolar plugs.
reported in Thailand, Iran, Japan, Indonesia, United
 These eggs, which measure 36 to 45𝝁m by 20𝝁m, are
Arab Emirates, South Korea, India, Taiwan, Eqypt, and
passed in the feces and embryonate in the soil or water.
Lao People’s Democratic Republic.
 They must reach the water in order to be ingested by
 Infections are acquired by eating uncooked small
small species of freshwater or brackish water fish.
freshwater/brackish water fish
 The eggs hatch in the intestines of the fish and grow into
the infective larvae. When the fish is eaten uncooked,
PREVENTION AND CONTROL
the larvae escape from the fish intestines and develop
 Improve sanitation and health educational programs to
into adult worms in human intestines. prevent indiscriminate disposal of human waste and to
discourage eating raw fish are important in controlling the
spread of infection.
 Early and accurate diagnosis and treatment is important in
preventing mortality

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Clinical Parasitology
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ASCARIS LUMBRICOIDES CLINICAL SYMPTOMS
 The most common intestinal nematode of men Asymptomatic:
 Common name: Giant Round Worm, Roundworm of  Patients infected with a small number of worms
Men  They may only learn infection if they noticed an adult
 Common associated disease and condition: Ascariasis, worm as they defecate.
Roundworm infection Symptomatic:
 Abdominal pain, vomiting, fever, and distention
MORPHOLOGY  Obstruction of intestine, appendix, liver or bile duct
Unfertilized Eggs:  Discomfort from adult worms exiting the body through
 Oblong shaped the anus, mouth, or nose.
 85-95𝜇m to 45𝜇m  Protein malnutrition
 Thin shell and irregular mamillated coating filled with (Lung Stage)
refractile granules.  Pulmonary symptoms – low-grade fever, cough,
Fertilized Eggs: eosinophilia, pneumonia
 45-75𝜇m by 35𝜇m  Asthmatic reaction
 Circle shaped
 There is an outer coarsely mamillated albuminous DIAGNOSIS
covering which may be absent or lost in “decorticated”  Microscopic examination of stool
egg.  Usual technique in laboratory used for diagnosis of
 Thick, transparent hyaline shell with thick outer layer. Ascariasis:
 Delicate vitelline, lipodia, inner membrane 1. Direct Fecal Smear
(Highly permeable) 2. Kato-Technique or Cellophane Thick Smear
 Corticated egg is not smooth Method
Adults: 3. Kato-Katz technique
 Whitish or Pinkish large larvae.
 Males: 10-31cm in length TREATMENT
 Females: 22-35cm in length  Albendazole – drug of choice
 With smooth striated cuticles  Mebendazole and Pyrantel pamoate
 With terminal mouth with three lips and sensory
papillae. PREVENTION AND CONTROL
 Males: vertically curved posterior end with two spicules. 1. Sanitary disposal of human feces
 Females: paired reproductive organs in the posterior 2. Health education
two thirds while male have a single, long tortuous tubule. 3. Mass chemotherapy done practically, once, twice or
thrice a year.
LIFE CYCLE
 Infection begins following the ingestion of infected eggs HOOKWORMS
that contain visible larvae  Hookworms refers to two organisms, Necator
 Once inside the small intestine, the larvae emerge from americanus and Ancylostoma duodenale.
the eggs  Primary differences:
 The larvae then complete a liver-lung migration by first 1. Geographical distribution
entering the blood via the bloodstream to the second 2. Morphological differences (Adult)
stop, the lung  Soil transmitted helminthes
 Once inside the lung, the larvae burrow their way  Blood-sucking nematodes that attach to the mucosa of
through the capillaries into the alveoli. Migration into the the small intestine
alveoli. Migration into the bronchioles then follows.
 From here, the larvae are transferred through coughing NECATOR AMERICANUS
into the pharynx, where they are swallowed and  Common name: New World Hookworm
returned to the intestine.  Common associated disease and condition:
 Maturation of the larvae occurs, resulting in adult Necatoriasis
worms, which take up residence in the small intestines
 The adults multiply and a number of the resulting ANCYLOSTOMA DUODENALE
undeveloped eggs (up to 250,000/day) are passed in  Common name: Old Hookworm
the feces.  Common associated disease and condition:
Ancylostomiasis
EPIDEMIOLOGY
 Most common intestinal helminth infection
 Warm climates and areas with poor sanitation,
particularly where human feces is used as fertilizer and
where children defecate directly to the soil.

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MORPHOLOGY CLINICAL SYMPTOMS
Eggs: Hookworm disease:
 Eggs are quite difficult to distinguish:  Intense allergic itching (site of penetration) – ground
o N. americanus – 60-75𝜇m in length itch.
o A. duodenale – 55-65𝜇m in length  Sore throat, bloody sputum, wheezing, headache, mild
 Bluntly round ends and a single thin transparent hyaline pneumonia with cough (Lung)
shell  Gastrointestinal symptoms, slight anemia, weight loss
 Unsegmented at oviposition and in the 2-8 cell stages. and weakness (Chronic infection)
 Reported as: Hookworms  Diarrhea, anorexia, edema, pain enteritis, and epigastric
Rhabditiform larvae: discomfort (Acute – Intestinal phase)
 Immature, newly hatched hookworm
 15 x 270𝜇m DIAGNOSIS
 Long oral cavity (Buccal cavity/Buccal capsule)  Final diagnosis depends on finding parasite eggs in feces
 Small genital primordium  Techniques:
Filariform larvae: 1. Direct Fecal Smear
 Infective, non-feeding stage 2. Kato-technique
 Emerges after the Rhabditiform larva completes its 3. Concentration method: Zinc sulfate flotation
second molt 4. Culture method: Harada Mori
 Two notable characteristics:
o Slender larva has a shorter esophagus TREATMENT
o Distinct tail  Increased risk of reinfection – priority is given to
Adults: pregnant women, children, and patients with
 Rarely seen malnutrition, pulmonary tuberculosis or anemia
 Grayish-white to pink with thick cuticle  Drug of choice – Albendazole
 Anterior end: conspicuous bend (hook)
 The hook is more pronounced in the N. americanus than TOXOCARA CANIS
A. duodenale.  Intestinal roundworms of dogs
 Adult females: 9-12mm in length by 0.25-0.55mm  Similar to Ascaris lumbricoides, but with few
 Adult males: 5-10mm by 0.2-0.4mm additional frills
 The male is equipped with prominent, posterior,  Assuming a dog has never been infected with
umbrella-like structure (Copulatory bursa) Toxocara, the first time it is infected, the worms
 Buccal capsule: develop as describes for Ascaris.
o N. americanus – pair of cutting plates  Reinfection: the eggs do not develop into adults.
o A. duodenale – actual teeth Rather, they remain in the dog’s tissue as “second
stage somatic larvae”
LIFE CYCLE  Visceral larval migrans (VLM) – animal to human
 Humans contract hookworm when third-stage Filariform infection
larvae penetrate through the skin
 The Filariform larvae migrate to the lymphatics and TOXOCARA CATI
blood system  It is a common parasite of domestic cats
 The blood carries the larvae to the lungs, where they  Can also cause VLM
penetrate the capillaries and enter the alveoli  Much less common that of Toxocara canis
 Migration of the larvae continuous into the bronchioles,  Thick rough shell
where they are coughed up to the pharynx,
subsequently, and deposition into the intestines

EPIDEMIOLOGY
 Geographical distribution of human hookworm used to
be regarded as relatively distinct.
o N. americanus – Europe and Southwest Asia
o A. duodenale – Tropical Africa and Americas
 Greater distribution on agricultural areas (Farmers)
 Method of human infection
o N. americanus – percutaneous
o A. duodenale – percutaneous and oral routes
(vegetables fertilized by feces)

Paras, RCP 8