NEMATODES
Ascaris lumbricoides Trichuris trichiura Enterobius vermicularis
CN Giant intestinal round worm Whipworm Pin worm, seat worm, society worm
FH Man Man Man
H Small intestines Cecum, Large intestines Lower Ileum & Cecum, Large intestine
Life Span 12 months 4-6 years
MOT Ingestion Ingestion Ingestion
DS Ova, Adult Ova Ova, Adult
IS Fully embryonated egg Fully embryonated egg Fully embryonated ova
Soil-transmitted helminth (STH) STH Contact borne
Src of Infection Air borne
Autoinfection
Somatic Polymyarian Holomyarian Meromyarian
muscle
Color Creamy white/pinkish Flesh/pinkish gray Whiish & brownish
Cylindrical Slender
Covering CHITIN [Pseudocoelomate]
Triradiate/trilobulate lips 3/5 Thin attenuated Cephalic alea (lateral wing)
Narrow esophagus Esophagus bulb: flask shaped
Morphology
Anterior
Rhabditiform larva (L2)
150 μm by 10 μm
pass through intestinal wall > blood stream
> liver > lungs [Moult (2x >L4)]
Straight (curved for male) end posterior Whip-like structure
Posterior Thicker posterior anus
Robust: 2/5 Intestine/Repro-organ
Chemorecepto Ampids ✔ ✔ ✔
r Phasmids ✔ ✖ ✔
Insert in intestinal folds Pin fashion manner Minute ulceration form at the site of
Attachment
attachment
Images by Tai Soon Yong
Male
360° curved posterior 360° curved w/ 1 spicule Curved
Posterior Retractile sheath [After fertilization, it dies]
Whip-like structure
Spicule 2 1 6
Length 10-31μm 30-45 mm 2-5 μm by 0.1-0.2mm
Images by Tai Soon Yong Stereo microscopic observation of a female
adult of Enterobius vermicularis after formalin
fixation.
Female
(
Bigger w/ taperized ends
(Mature) Constriction @middle VULVA (Genital
ring)
Very pointy Bluntly rounded Long pointed
Posterior
Whip-like structure
Length 22-35 μm 35-50 mm 13mm by 0.4mm
Eggs 200,000/day 10,000/day 11,000/day
1 (Distended Uterus: GRAVID – filled with
infected eggs) > Perinal skin
Uterus (2¿¿ 3 Posterior)¿ [At low temp.: promotes aerobic
2 environment & oxygenation for female]
Mamilation
corticated uncorticated
Fertilized
>45-70 μm by 35-50 μm
>Think, transparent hyaline
shell
>larvae in 14days
Unfertilized
>88-94 μm by 39-44 μm
>longer & narrower than
fertile egg
>thin shell
>lecithin granule
Embryo JAPANESE LANTERN shape
Tadpole embryo
Lipoidal vitelline membrane Bipolar mucous plug
“D”-shaped embryo, assymetrical
(chorionic) Glycogen membrane One side flat, other convex
Mamilated albuminous membrance 50-54 μm by 23 μm
Contact transmitted
Shell: very thick
Infective: 4-6hrs after deposition
Bile Stain: Brown
<Fully embryonated>
Embryonated Ova Very fast embryonization outside host
↑Resistance to dessication
Moist condition: viable in 13days
Oviposition: unsegmented
2-3 weeks Embryonization: outside host (2-3wks)
I2 Stain: Brownish
Molting: in lungs
Pathology VLM: Viceral Lavae Host sensitation =allergic Diarrhea Enterobiasis/Oxyuuriasis
Migram (non-human manifestation Iron deficiency anemia (IDA) >perinial itching/pruritus ani
Ascaria) -lung infiltration Hypoalbuminemia
-asthmatic attack Epigastric pain Nocturnal pruritus ani (NPA)
Toxocara cati –Dog
Larva -edema of lips Loss of appetite
Toxocara canis – Cat Rectal Prolapse @ very↑ infection Irritablility
Migration: Insomia
Ascaris suum – Pig Eosinophilia pneumonia/ Petechial hemorrhages 2° Bacterial INfection
Löffler's syndrome Amebic dysentery Abdominal pain
Adult Epigastric pain Appendicitis/Granulomas
Malnutrition Mild catarrhal inflammation of intestinal
Diarrhea Heavy chronic Trichuriasis mucosa
Complication: worm bolus >attachment & mechanical irritation
Appendicitis No Heart-Lung Migration
Irritation by mechanical/toxic action
Pathology Associated with 3 Reasons:
1. Ingestion & migration of larva
2. Adult parasites in the intestines
3. “Wandering” adults outside the intestines
DFS DFS 1. Scotch tape swab – early in the morning
Routine stool exam
Concentration tech >colon & rectum 2. Graham’s depressor (tongue depressor)
=AECT
=FECT Concentration tech 3. Swellengrebel swab (glass pestle)
=Flotation tech =AECT
=ZnSO4/Brine CT =FECT
Dx Kato tech./Cellophane Thick Smear mtd. Kato tech./Cellophane Thick Smear mtd.
(Qualitative) (Qualitative)
Kato-Katz (Qunatitative) Kato-Katz (Qunatitative)
-Glycerol malachite green sol’n >CR: cure rate
-Cellophane >ERR: Egg reduction rate
-Template >intensity of infection
-Wire mash
Protoscopy for rectal mucosa
Albendazole [drug of choice] Mebendazole [drug of choice] Pyrantel pamoate [drug of choice]
Tx Mebendazole -contraindication: hypersensitivity/early Mebendazole
Broad-serum Pyrantel pamoate pregy Albendazole
Anthelminthics: Albendazole
--contraindication: pregnancy
>Sanitary disposal of human feces >Tretment of infected individuals >Personal hygiene
>Health educ. > Sanitary disposal of human feces by >Cut short fingernails
>Mass chemotheraphy periodically construction of toilets and proper disposal >Frequent hand washing
>Washing of hands with soap After toilet use/before & after meals
Health educ. on sanitation and personal >Use shower than bathtubs
Prevention
hygiene >Handle w/ care, boiled & laundered:
>Thorough washing and scalding of Underwear, night clothes, blankets & bed
uncooked vegetables sheets
>Chemotherapy (family)
