Lecture 6 Parasitic Nematodes - Simplified

Phylum Nematoda
Common name: Nematodes – Round worms

General features
• The nematodes are unsegmented worms without any
appendages.
• They are elongated and cylindrical in appearance, both ends are

often pointed (i.e., tapered).
• Their sizes show a great variation, < 5 mm to 1 m
• Their body is covered with a tough cuticle.
• They have a body cavity in which the various organs e.g., digestive
and genital systems are suspended. Excretory and nervous
systems are rudimentary (poorly developed).
• The alimentary canal is complete consisting of oral aperture,
a mouth, oesophagus, intestine and sub-terminal anus.
• The mouth cavity when present may have teeth or cutting

plates; in other cases, where the mouth cavity is absent, the
oral aperture is directly continuous with oesophagus.
• Nematodes have separate sexes (i.e., dioecious). The male is

generally smaller than the females and its posterior end is
curved/coiled ventrally (see next figure).
Classification of parasitic nematodes
1. According to habitat of adult worms in man
(a). Intestinal
• Ascaris lumbricoides (common round worm)
• Ancylostoma duodenale (The old world hookworm).
• Necator americanus (The American hookworm).
• Strongloides stercolaris
• Trichinella spiralis
• Enterobius vermicularis (the threadworm or pin worm).
• Trichuris trichiura (whipworm)
(b). Somatic – inside tissues and organs
(i) Lymphatic system
- Wuchereria bancrofti
- Brugia malayi and Brugia timori
(ii). Subcutaneous tissues

- Loa loa (African eye worm)
- Onchocerca volvulus
- Dracunculus medinensis (The guinea worm).
(iii). Lungs
-Strongyloides stercolaris
(iv). Conjuctiva
Loa loa
Systematic classification of nematodes
1. Subclass Aphasmidia (no caudal chemo-receptors).
• 2 species of medical importance

Trichinella spiralis
Trichuris trichiura
2. Subclass Phasmidia (having caudal chemo-receptors)
- Order Rhabditida
- Strongyloides stercolaris
3. Order Oxyurida
- Enterobius vermicularis (pin worms)
4. Order Strongylida
- Ancylostoma duodenale
- Ancylostoma braziliense and A. caninum (hookworms of
cats and dogs, respectively, may infect man causing
cutaneous larva migrans).
- Necator americanus
5. Order Ascaridida
- Ascaris lumbricoides
- Toxocara canis and Toxocara cati (ascarids of dog and
cat, respectively).
5. Order Filarida – commonly called filarial worms
- Wuchereria bancrofti
- Brugia malayi and B. timori
- Onchocerca volvulus
- Loa loa
- Dracunculus medinensis
The female nematodes may be divided as follows:
• Viviparous – giving birth to larvae e.g., W. bancrofti, T. spiralis
• Oviparous – laying eggs., A. lumbricoides, T. trichiura, A.

duodenale, N. americanus
• Ovoviviparous – laying eggs containing larvae which are

immediately hatched out e.g., E. vermicularis.
Generalized life cycle of nematodes
- Man is the optimum host for most of parasitic nematodes.
- Nematodes pass their life cycle is one host (i.e., direct life
cycle) except the filarial worms which may require a
second host, often an insect vector in which larval
development takes place.
Modes of infection of nematode parasites
• By ingestion of: (i). Embryonated eggs containing food

and drink e.g., A. lumbricoides, E. vermicularis, T.
trichiura etc. (ii). Growing embryos in an intermediate
host (e.g., infected cyclops as in D. medinensis, (iii).
Encysted pig’s flesh as in T. spiralis.
• By penetration through skin e.g., hook worm larval

stages e.g., A. duodenale, N. americanus
• By blood sucking insects e.g., W. bancrofti
• By inhalation of infected dust containing embryonated

eggs e.g., A. lumbricoides and E. vermicularis.
Larval forms in nematodes
1. Rhabditiform larva- the length of the oesophagus is

short compared to the length of the larva and its
posterior end is dilated like a bulb.
2. Filariform larva – the oesophagus is long compared to

the length of the larva; its posterior end is not dilated like
a bulb.
Order Strongylida – Hookworms
- Hookworms have well developed mouth cavity (i.e., buccal

capsule) and may contain teeth or cutting plates.
- Eggs have a transparent shell and larvae develops in moist

conditions.
- Four important species of hookworms that infect man
Common (prevalent) species

1. Ancylostoma duodenale (the old world hookworm).
2. Necator americanus (the American hookworm)
Less common species

1. Ancylostoma braziliense (cat hookworm).
2. Ancylostoma caninum (dog hook worm).
Ancylostoma duodenale
- Geographical distribution – tropical and sub-tropical regions

where humidity and temperature are favourable for the
development of larvae in soil.
- Also found in Europe, Africa, India, China, Pacific islands and

southern states of America.
Habitat – adult worms lives in the small intestines of man, particularly in the
jejunum, less common in the duodenum and ileum.
- The digestive system of this nematode is associated with several glands

e.g., the oesophagus glands which secretes blood anti-clotting substances.
Morphology
- The buccal capsule (mouth cavity) is large and has 2
pairs of ventral anterior teeth.
- The copulatory bursa in males is at the posterior end
and contains two spicules that separate distally i.e., at
the tip.
- The eggs usually have 4 cells
(blastomeres) when passed
out in faces.
Life cycle
- No intermediate host is required as the parasite has a direct life cycle.
- Eggs are passed out in faeces of humans. Man is the only definitive host for
A. duodenale
- Under favourable conditions (moisture, warmth, shade) in the soil, the eggs
hatch out a Rhabditiform larvae (larval stage 1 a non-infective stage to man)
in about 1-2 days.
- The released rhabditiform larvae grows in faeces or soil, moults twice, at

first it moults into larval stage 2 and then larval stage 3 that develops into
filariform larvae.
- The filariform larvae is the infective stage to man. Infection to man
occurs when he walks bare-footed on soil contaminated with
faecal material.
- The filariform penetrate directly through the skin. The common

site of entry is between the toes, the inner side of soles with thin
skin. In case of gardeners and miners, the skin of the hands may
be the portal of entry.
- Infection can also occur via accidental drinking of water

contaminated with the filariform larvae, though this method is
very rare.
- On reaching the subcutaneous tissues, the larvae enter into the
lymphatics, then into circulation where they are carried to the
right heart, then into lungs where they migrate upward to the
trachea and finally into pharynx where they are swallowed.
- They then settle in the small intestines where they undergo a

4th moulting into adults. The buccal capsule at this stage is
complete with teeth. The adults attach to the walls of the small
intestines.
- Sexual maturity is attained in 3-4 weeks and the fertilized

females begin to lay eggs in faeces. The cycle is thus repeated.
Pathogenicity of hookworms
- Hookworms causes hookworm disease or ancylostomiasis

in man.
Pathologic effects caused by larval forms
- Larval forms entering the skin include lesions in the skin or

dermatitis (allergic reactions) at the site of entry of the larvae.
- Creeping eruption also called cutaneous larva migrans may

occur when the filariform larvae wander about through the skin
in an aimless manner for several weeks to months (sometimes
up to 2 years) creating tunnels in the skin.
- The tunnels indicate the path traversed by the larvae and may
open when scratched.
- The migrating filiform larvae move in the tunnel and progress
very slowly at a rate of 1-2 cm per day.
- This is especially common for non-human hookworms such as A.

braziliense and A. caninum which are not adapted to man and
therefore after penetrating the skin layers they cannot proceed
to the normal site of localization (i.e., the small intestines).
- Lesion in the lungs e.g., inflammation of branchial tubes
(bronchitis) may occur when the larvae break the
pulmonary capillaries and enter alveolar space.
- An elevated number of eosinophils, a condition called

eosinophilia, may occurs at this stage.
Pathologic effects caused by the adult worms
- Adult worms may also cause intestinal lesions at the site of

attachment due to erosion of mucosa.
- Adults worms are blood suckers and cause iron deficiency

anaemia.
- Anaemia occurs by either (i). chronic blood loss due to

haemorrhages from punctured sites or blood drawn from the
host by the hookworm or (ii) nutritional deficiencies in the diet.
- N. americanus and A.duodenale are capable of drawing 0.03
and 0.2 ml of blood per day, respectively.
- In heavy infections such daily withdrawals of blood by a large

number of parasites over a prolonged period of time would be
sufficient to cause anaemia.
- e.g., Assuming that one is infected with 1,000 A. duodenale

parasites, then, 1000*0.2ml = 200 ml of blood is lost daily.
- Chronic blood loss can be cured completely iron treatment or

through diet.
- Hookworm infection can increase host susceptibility to
other infections such as malaria, secondary bacterial
infections at the sites with lesions or ulcerations etc.
Clinical features due to hookworm anaemia include
- Abnormal appetite for things like soil, mud or lime.
- May impair cognitive/intellectual development in children.
- It causes malnutrition due to malabsorption of food, reduced

appetite and thus physical retardation in children.
- Reduces productivity in infected people due to anaemia and

diminished oxygen supply affecting country’s economy
- Iron deficiency anaemia may cause a low secretion of gastric acid

which may interfere with digestion.
Diagnosis
- Direct examination of stool to find the adult worms and their
characteristic hookworm eggs.
- PCR and ELISA-based methods.

Treatment
- Expulsion of worms by anthelmintic drugs e.g., thiabendazole

(effective for migratory and dormant larvae), albendazole, etc.
- Treatment of anaemia using oral iron (ferrous sulphate) and diet

supplements.
Prophylaxis
-Treatment of infected persons
- Prevention of soil-pollution by proper control of sewage disposal.
- Disinfection of faeces or soil.
- Personal protection – wearing of boots and gloves.
Necator americanus – in brief
- 1st discovered in America. Also found in India, Far East , Australia,
Africa.
- The life cycle, general morphology, pathogenicity, diagnosis and
treatment as the same as described for A. duodenale.
- However, the buccal capsule contains 4 chitinous cutting plates (2
on the ventral surface and 2 on the dorsal surface) instead of
teeth.
- The copulatory bursa also contains 2 spicules that are fused
distally (at the tip) unlike in the A. duodenale where they are
separated.

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Phylum Nematoda

Common name: Nematodes – Round worms

• They are elongated and cylindrical in appearance, both ends are

• Their sizes show a great variation, < 5 mm to 1 m

• Their body is covered with a tough cuticle.

• The mouth cavity when present may have teeth or cutting

• Nematodes have separate sexes (i.e., dioecious). The male is

(ii). Subcutaneous tissues

1. Subclass Aphasmidia (no caudal chemo-receptors).

• 2 species of medical importance

• Viviparous – giving birth to larvae e.g., W. bancrofti, T. spiralis

• Oviparous – laying eggs., A. lumbricoides, T. trichiura, A.

• Ovoviviparous – laying eggs containing larvae which are

- Man is the optimum host for most of parasitic nematodes.

• By ingestion of: (i). Embryonated eggs containing food

• By penetration through skin e.g., hook worm larval

• By inhalation of infected dust containing embryonated

1. Rhabditiform larva- the length of the oesophagus is

2. Filariform larva – the oesophagus is long compared to

- Hookworms have well developed mouth cavity (i.e., buccal

- Eggs have a transparent shell and larvae develops in moist

Common (prevalent) species

Less common species

- Geographical distribution – tropical and sub-tropical regions

- Also found in Europe, Africa, India, China, Pacific islands and

- The digestive system of this nematode is associated with several glands

- The released rhabditiform larvae grows in faeces or soil, moults twice, at

- The filariform penetrate directly through the skin. The common

- Infection can also occur via accidental drinking of water

- They then settle in the small intestines where they undergo a

- Sexual maturity is attained in 3-4 weeks and the fertilized

- Hookworms causes hookworm disease or ancylostomiasis

- Larval forms entering the skin include lesions in the skin or

- Creeping eruption also called cutaneous larva migrans may

- This is especially common for non-human hookworms such as A.

- An elevated number of eosinophils, a condition called

- Adult worms may also cause intestinal lesions at the site of

- Adults worms are blood suckers and cause iron deficiency

- Anaemia occurs by either (i). chronic blood loss due to

- In heavy infections such daily withdrawals of blood by a large

- e.g., Assuming that one is infected with 1,000 A. duodenale

- Chronic blood loss can be cured completely iron treatment or

- Abnormal appetite for things like soil, mud or lime.

- May impair cognitive/intellectual development in children.

- It causes malnutrition due to malabsorption of food, reduced

- Reduces productivity in infected people due to anaemia and

- Iron deficiency anaemia may cause a low secretion of gastric acid

- PCR and ELISA-based methods.

- Expulsion of worms by anthelmintic drugs e.g., thiabendazole

- Treatment of anaemia using oral iron (ferrous sulphate) and diet

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