HELMINTHES

PHYLUM NEMATODA
• True roundworms
• Non-segmented, elongated
• Bilaterally symmetrical
• Cylindrical
• With complete digestive system
• Acquired when
• Egg is ingested
• Larva penetrates the skin
• Via vector
• Sexes are separated except Strongyloides stercoralis
• Female: larger pointed posterior, no spicule
• Male: small, curved posterior: with spicule
Class Phasmida (with chemoreceptors)
A. Species with parasitize the small
intestines in man D. Species which parasitize the tissues of
• Ascaris lumbricoides man
• Hookworms • Wuchereria bancrofti
• Necator americanus. • Brugia malayi
• Ancylostoma duodenale
• Strongyloides stercoralis Class Aphasmida
B. Species which cause larva migrans in A. Species which parasitize the small intestine
man in man
• Ascaris lumbricoides - Visceral Larva • Trichinella spiralis
Migrans • Capillaria philippinensis
• Hookworms - Cutaneous Larva Migrans B. Species which parasitize the large
• Ancylostoma braziliense intestines in man
• Ancylostoma caninum • Trichuris trichiura
C. Species which parasitize the large
intestine in man
• Enterobius vermicularis
Ascaris lumbricoides
• Common name = Giant Intestinal Roundworm • Longitudinal muscle layer
• Habitat: small intestine • 2 uterus
• Final Host: Man • Ovary
• Diagnostic Stage: Ova found in stool (fertilized or • intestine
unfertilized) Dental Pattern
• Infective stage: embryonated egg • Three lips at anterior end with minute teeth
• MOT: ingestion of infective stage of the parasite Eggs
• Portal of entry: mouth •Fertilized Corticatied Ascaris lumbricoides Egg
• Member of STH •Circular or Round Shaped
• Life span= 12 months •Innermost Layer: Vitelline Layer
Adult Worm
•Middle layer: Glycogen layer
• Male
•Outermost Layer: Albuminous Layer
• Shorter
• Lateral line with excretory canal intestine (slender, •Fertilized Decorticated Ascaris lumbricoides Egg
long) •Innermost Layer: Vitelline Layer
• Cuticle and hypodermis •Middle layer: Glycogen layer
• Longitudinal muscle layer
•No Albuminous Layer
• Vas deferens
•Unfertilized Corticated Ascaris lumbricoides Egg
• Testis
• Pseudocoel •Inside: Coarse Granules composed of Lecithin
• Female •Embryonated Ascaris lumbricoides Egg
• Longer •Larva - L2 inside
• Cuticle and hypodermis
Life cycle: Pathology due to adult
• 2 phases: lung and intestinal • Bolus
• Egg ingested, hatches in duodenum; larvae • Erratism
penetrate intestinal wall, enter blood vessels • Epigastric Pain
and embolize through liver to lungs • Diarrhea
• They then migrate into airspaces, up trachea • Malnutrition
and are swallowed, taking up permanent
adult residence in the small intestine; ~2 Seasonal (summer)
months from egg to mature adult Eosinophilia (allergies)
• Each female produce 200,000 eggs per day
• Adult worms can live 1 to 2 years. Diagnosis:
• DFS
Pathology due to Larva • FECT
• Visceral Larva Migrans (VLM) • X-ray
• Ascaris Pneumonitis
• Irritation of intestinal mucosa Treatment:
Albendazole and Mebendazole
Male Female
 Ascaris lumbricoides -
Corticated Fertilized Egg

Albuminous
layer Glycogen
layer

Lipoidal
layer

Ascaris lumbricoides - Corticated F. Egg

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 Ascaris lumbricoides - 

Decorticated Fertilized Egg

Ascaris lumbricoides - Decorticated F. Egg

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 Ascaris lumbricoides -
Unfertilized Egg
• Coarse Lecithin Granules
• Glycogen Layer

Coarse
Granules
Lecithin

Glycogen
Layer
Ascaris lumbricoides - Unfertilized Egg
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 Ascaris lumbricoides
Trilobate Lips of Adult

Ascaris lumbricoides
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 Ascaris lumbricoides
Cross Section of Female

Uterus

Intestine

Ascaris lumbricoides
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Trichuris trichiura Adult Worm
• “Whipworm” • Male
• STH • Prominent Curled Tail
• Habitat: large intestines • Single Spicule, Retractable
• Final Host: Man • Female
• MOT: ingestion of embryonated • Bluntly Rounded
egg Egg
• IS: embryonated egg • Thick Shell Cream in Color
• Pathology: Anemia, rectal • Prominent bipolar plugs
prolapse, bacterial infection • Football-shaped
• Drug of choice: albendazole, • Japanese lantern
mebendazole • Barrel-shaped
 Trichuris trichiura - Adult Female

ant
robust (att erio
enu r
(posterior) ate
d)

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Trichuris trichiura - Adult Female
 Tapered; attenuated Trichuris trichiura - Adult Male
Anterior

robust; thick
(posterior)

Spicule

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Trichuris trichiura - Adult Male
 Trichuris trichiura - Egg
• Football Shaped
• Japanese Lanter Shaped
• Barrel Shaped

Non Striated

Bipolar
Mucus Plug
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Trichuris trichiura - Egg
Enterobius vermicularis • Female
• “Pinworm, society worm, seat worm, • Long Pointed Tail
tiwa” • Gravid
• H: Large intestines • Distended with Eggs
• FH: Man Symptoms:
• MOT: ingestion of embryonated egg • Pruritus ani
• IS: Embryonated egg • Weight loss
Egg • Irritation
• Embryonated after 4-6 Hours • Vaginitis
• Thick Transparent Shell • Bacterial infection
• D Shaped, Lopsided Diagnosis:
Adult Worm • Cellulose tape Method
• Cephalic Alae • DFS = have 5% survival in stool
• Bulb or Flask Shaped Esophagus • Swellen grebel method
• Male
• Curved tail, Single Spicule DOC: Mebendazole or Pyrantel Pamoate *
Albendazole
 Enterobius vermicularis -
Female

Cephalic
Alae Bulb Shaped
Esophagus

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Enterobius vermicularis - Female
 Enterobius vermicularis -
Male

Cephalic
Alae

Flask / Bulb
Shaped
Esophagus

Spicule

Posterior is
Enterobius vermicularis - Male Curved
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 Enterobius vermicularis - Egg
• D Shaped / Lopsided
• Inner Lipoidal Layer
• Outer Albuminous Layer
• Sx: Perianal Swab

Inner
Outer Lipoidal
Albuminous Layer
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Enterobius vermicularis - Egg Layer
Capillaria philippinensis Pathology: Intestinal Capillariasis, Mystery
• CN: Pudoc worm disease; Severe watery Diarrhea, Gurgling
• FH: Man Stomach
• Natural Host: Migratory Host (also FH) Can cause microulceration, depression of
• IntH: glass fish: guppy (lives in fresh / intestinal villi
brackish water) Borborygmi
• H: small intestines Abdominal pain
• IS: larval stage of the parasite in the infected Diarrhea
fish Malabsorption
• MOT: ingestion of raw/undercooked fish Low plasma electrolyte concentration
Egg
• Thick Striated Egg Shell Laboratory test:
• Flattened Bipolar Plugs • DFS
• Peanut Shaped • Concentration techniques (FECT)
• Guitar Shaped • Kato Katz
Adult Worm • Examination of duodenal aspirate
• Male
• Copulatory Spicule Rx of choice:
• Female Albendazole, Mebendazole
• Pointed Posterior End
 Capillaria philippinensis -
Typical Egg
• Guitar Shaped
• Peanut Shaped

Striated
Flattened
Mucus Plug

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Capillaria philippinensis - Typical Egg
 Capillaria philippinensis -
Adult Female
• Notice the eggs present
inside the adult

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Capillaria philippinensis - Adult Female
 Capillaria philippinensis -
Adult Male
• Spicule

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Capillaria philippinensis - Adult Male
Capillaria philippinensis
Intermediate hosts
Guppy - Poecilia reticulata
Bukto - Chonophorus
melanocephalus
Bagsang - Ambassis miops
Ipon - Sicyopterus sp.
Capillaria
philippinensis
Intermediate hosts
Guppy - Poecilia
reticulata
Bukto - Chonophorus
melanocephalus
Bagsang - Ambassis
miops
Ipon - Sicyopterus sp.
HOOKWORM Ancylostoma braziliense
Necator americanus
•Common Name: Cat Hookworm
•Common Name: New World Hookworm
• Commonly infects cats
•Ground itch, diarrhea, vomiting, abdominal pain, iron
deficiency anemia •Cutaneous Larva Migrans
•Blood-Lung phase •MOT: Skin penetration of the filariform
•Habitat: Small Intestine larvae
•MOT: Skin penetration of the filariform larvae •Larva migrate from skin to subcutaneous
•Diagnosis: Ova in stool tissue; do not mature but “creep” in
•Treatment: Albendazole, Mebendazole, Pyrantel Pamoate,
subcutaneous tissue
and Iron Supplements (anemia)
• Treatment: Thiabendazole
•Control: Educational awareness, sanitation
Ancylostoma duodenale Ancylostoma caninum
•Common Name: Old World Hookworm •Common Name: Dog Hookworm
•same as Necator •Commonly infects dogs
•Habitat: Small Intestine •Eosinophilic entritis (adult worm), itchy rash
•MOT: Skin penetration of the filariform larvae “cutaneous larva migrans”
•Diagnosis: Ova in stool
•MOT: Skin penetration of the filariform
•Treatment: Albendazole, Mebendazole, Pyrantel
Pamoate, and Iron Supplements (anemia)
larvae
•Control: Educational awareness, sanitation •Treatment: Thiabendazole
 HOOKWORM LARVAE
Ova of Hookworm Rhabditiform larva Filariform larva
•Colorless, Smooth, Thin shell (1st Stage) (2nd Stage)
•30 - 50 um Short and tout Long and slender
1.2 - 8 cell stage blastomeres develop in soil then the
Feeding stage larva Non Feeding Stage
larval stages (rhabiditiform then filariform)
Open Mouth Closed Mouth
2.Fecal Smear on a moist filter paper strip for 5 - 7 days Flask Shaped With Pointed tail and
(Harada-Mori) Esophagus sheath
With long narrow With Pointed tail and
Rhabditiform Larvae buccal chamber and sheath
•250 um Flask shaped
•Bulbous esophagus esophagus
•Long Buccal Cavity Points of Necator Ancylostoma
Differentiation americanus duodenale
Filariform Larvae Size Smaller Bigger
•700 um Body Curvature S Shaped C Shaped
•Straight esophagus Dental Pattern / Semilunar cutting 1 pair of true
Buccal Pattern plates teeth
•Pointed tail
Copulatory bursa Oval (top view) Circle (top view)
•Long buccal cavity of the male bipartite / tripartite /
bidigitate with tridigitate with
fused spicules unfused spicules
Pathogenesis and Clinical Manifestations Clinical Disease for Hookworm Infestation
1.Larval Migration
Site Symptoms Pathogenesis
• Dermatitis known as “ground itch” or “stool poison”. The larvae
penetrating the skin cause allergic reaction, petechiae or papule with Dermal Local erythema, Cutaneous invasion
itching and burning sensation. Scratching leads to secondary infection. papules (ground itch) and subcutaneous
• Pneumonitis (allergic reaction) Loeffler’s syndrome: cough, asthma, migration of larva
low fever, blood tinged sputum or hemoptysis, chest pain,
inflammation shadows in lungs under X-ray. These manifestations go Pulmonary Ground itch = Migration in Lung
on about 2 weeks cutaneous larva bronchi, trachea
2.Adults in Small Intestine migrans
• Epigastric pain as that of a duodenal ulcer. Bronchitis,
pneuomonitis,
• A large worm burden results in Microcytic hypochromatic anemia
eosinophilia
(blood loss). The symptoms are lassitude, edema, palpitation of the
WAKANA disease
heart. In severe case, death may result from cardiac failure or physical
Gastrointestinal Anorexia, epigastric, Attachment of adult
exhaustion.
gastrointestinal, worms and injury to
• Allotriophagy (or pica) os due to the lack of trace element iron.
hemorrhage intestine
• Amenorrhea, sterility, abortion may take place in women.
Hematologic Iron deficiency Intestinal blood loss
• Gastrointestinal bleeding
anemia
• Infantile hookworm disease
Diagnosis •Kato Katz Methods
•Harada Mori
•Direct Fecal Smear •Quantitative Diagnosis
•Allow hatching of larvae from eggs on
•Only for Heavy Infections •Zinc Sulfate Centrifugation
strips of filter paper with one end
•Kato Techniques •Formalin Ether Concentration
immersed in water
•Increase Detection rate
 Hookworms- L1 / Rhabditiform Larvae
• Open Mouth
• Long Buccal Capsule
• With Small Genital Primordium
• Feeding Stage

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Hookworms- L1 / Rhabditiform Larvae
 Hookworms- L1 / Rhabditiform Larvae
• Open Mouth
• Long Buccal Capsule
• With Small Genital Primordium
• Feeding Stage

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Hookworms- L1 / Rhabditiform Larvae
 Hookworms- L1 / Rhabditiform Larvae
• Open Mouth
• Long Buccal Capsule
• With Small Genital Primordium
• Feeding Stage

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Hookworms- L1 / Rhabditiform Larvae
 Hookworm- L3 / Filariform Larvae
• Short Esophagus
• Sheated
• Pointed Tail
• Non-Feeding Stage

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Hookworm- L3 / Filariform Larva
 Hookworm- L3 / Filariform Larvae
• Short Esophagus
• Sheated
• Pointed Tail
• Non-Feeding Stage

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Hookworm- L3 / Filariform Larva
 Hookworm- L3 / Filariform Larvae
• Short Esophagus
• Sheated
• Pointed Tail
• Non-Feeding Stage

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Hookworm- L3 / Filariform Larva
 Necator americanus
Dental Pattern
• Cutting Plates

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Necator americanus - Dental Pattern
 Necator americanus
Dental Pattern
• Cutting Plates

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Necator americanus - Dental Pattern
 Ancylostoma duodenale
Dental Pattern
• 2 pairs of Teeth

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Ancylostoma duodenale - Dental Pattern
 Ancylostoma duodenale
Dental Pattern
• 2 pairs of Teeth

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Ancylostoma duodenale - Dental Pattern
 Ancylostoma braziliense -
Dental Pattern
• Small Inner Pair of Teeth

Ancylostoma
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braziliense - Dental Pattern
 Ancylostoma braziliense -
Dental Pattern
• Small Inner Pair of Teeth

Ancylostoma
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braziliense - Dental Pattern
 Ancylostoma caninum -
Dental Pattern
• 3 pairs of Teeth

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Ancylostoma caninum - Dental Pattern
 Ancylostoma caninum -
Dental Pattern
• 3 pairs of Teeth

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Ancylostoma caninum - Dental Pattern
 Ova of Hookworm
•Colorless, Smooth, Thin shell
•30 - 50 um
1.2 - 8 cell stage blastomeres develop in
soil then the larval stages (rhabditiform
then filariform)
2.Fecal Smear on a moist filter paper strip
for 5 - 7 days (Harada-Mori)

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Hookworm - Egg
 Hookworm - Egg
• Egg Cell Stages

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Hookworm - Egg
Strongyloides stercoralis Filariform larvae
•Common Name: Threadworm •Infective stage, Non-Feeding Stage
•Skin pruritus; diarrhea with malabsorption •600 um
•Cutaneous, pulmonary and Intestinal Disease •Lacks bulb on the long esaphagus
•Blood - lung phase •Short buccal cavity
•Parthenogenic •Forked or Notched tail without a sheath
•Habitat: Small Intestine
•MOT: Skin penetration of the filariform larvae; Autoinfection Threadworms Infections
•Diagnosis: Rhabiditiform / Filariform in feces •Abdominal pain and Cochin-china diarrhea
•Treatment: Thiabendazole or Ivermectin •Pulmonary symptoms (Loeffler’s syndrome)
•Eosinophils accumulate in the lung in response to a parasitic
Ova of Strongyloides stercoralis infection
•Similar to hookworm •Urticarial rashes
•50 - 58 um X 30 - 34 um Diagnosis
•Eosinophilia
Rhabditiform larvae •Duodenal aspiration
•Diagnostic stage , Feeding Stage •Beale’s String Test
•250 um; stourt; spindle shaped •Small Bowel Biopsy
•Short buccal cavity •Concentration Techniques
•Prominent primordial genetalia •Harada - Mori Culture
•Club - shaped esophagus with Posterior bulb (muscular) •Baermann funnel
 Strongyloides stercoralis -
L1 / Rhabditi Larvae
• Feeding Stage
• Short Buccal Cavity
• Prominent Genital Primordium

Strongyloides stercoralis -
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 Strongyloides stercoralis -
L1 / Rhabditi Larvae
• Short Buccal Cavity
• Prominent Genital Primordium
• Feeding Stage

Strongyloides stercoralis -
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 Strongyloides stercoralis -
L1 / Rhabditi Larvae
• Short Buccal Cavity
• Prominent Genital Primordium
• Feeding Stage

Strongyloides stercoralis -
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 Strongyloides stercoralis -
L1 / Rhabditi Larvae
• Short Buccal Cavity
• Prominent Genital Primordium
• Feeding Stage

Strongyloides stercoralis -
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 Strongyloides stercoralis -
L3 / Filariform Larvae
• Notched / Forked / Bifid Tail
• Long Esophagus
• Non-Feeding Stage

Strongyloides stercoralis -
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 Strongyloides stercoralis -
L3 / Filariform Larvae
• Notched / Forked / Bifid Tail
• Long Esophagus
• Non-Feeding Stage

Strongyloides stercoralis -
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 Strongyloides stercoralis -
L3 / Filariform Larvae
• Notched / Forked / Bifid Tail
• Long Esophagus
• Non-Feeding Stage

Strongyloides stercoralis -
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FILARIAL WORMS
•Lives in the Lymph Nodes DIAGNOSTIC PROCEDURES
•Wuchereria bancrofti •Thick Smears with Giemsa or Hematoxylin
•Brugia malayi and Eosin Stain
•Both are sheathed •Knott’s Concentration Technique
•Lives in Subcutaneous Tissues •Centrifugation with 2% Formalin
•Loa Loa •Tissue Biopsy
•Anchocerca volvulus •Bentonite Flocculation
•Lives in Body Cavities • Nucleopore - Filtration
•Mansonella ozzardi •Macman Intradermal Test
•Dipetalonema perstans •Xenodiagnosis
•Diagnostic Stages: Microfilarial worm in •LDH and CK
Blood
•Habitat: Adult - Lymphatic System
Wuchereria bancrofti
•Common Name: Bancrofti Filarial Brugia malayi
Worm •Common Name: Malayan worm
•Disease: Elephantiasis •Disease: Lymphadenopathy
•Lower Part of the Body •Upper Part of the Body
•Cephalic Space: As long as Wide •Cephalic Space: Longer than Broad
•Cephalic to Spicule Ratio: 1:1 •Cephalic to Spicule Ratio: 1:2
•Terminal Nuclei: None •Terminal Nuclei: 2
•Somatic Cell: Discrete / Separate •Somatic Cell: Overlapping
•Reaction with Giemsa: Unstained •Reaction with Giemsa: Stained
Wuchereria
bancrofti

Brugia
malayi
 Wuchereria bancrofti -
Diagnostic Stage

Wuchereria
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bancrofti - Diagnostic Stage
 Wuchereria bancrofti
(Microfilaria)
• Sheated
• Regulary Spaced body Nuclei
• Graceful Curve

Wuchereria
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bancrofti - Diagnostic Stage
 Brugia malayi
(Microfilaria)
• 2 Terminal Nuclei
• Overlapping Body Nuclei
• Kinky appearance

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Brugia malayi
Trichinella Spiralis LIFE CYCLE
•Common Name: Muscle Worm / Trichina Worms •Sylvatic Cycle
•Spiral •Domestic Cycle
•Attached / Tangled / Encircles to Muscles •Larva in Small Intestine
•Diseases •From Female - Larviparous
•Trichinosis - Acquired from eating raw / uncooked •Encysted in Muscles
pork infected with the microscopic Parasite
•Trichinellosis - Muscle Pain •Dean End Cycle
•Final Host: Man And Other Vertebrate •Blinded Ally - Infection
•Habitat •No More Transmission
•Adult - Small Intestine •Rodents and Rats - responsible for maintaining
•Larva - Encysted in Skeletal Muscles Endemicity
•Accidental and Dead-end Hosts: Humans •Rat - Rattus
•MOT: Ingestion of Encysted larvae from uncooked / •Male - No copulatory Spicule
undercooked pork •Female - Larviparous
•Diagnostic and Infective Stage: Encysted Larvae •Male and Female are almost the same size
•Treatment: Mebendazole
 Trichinella spiralis
• Encysted larva

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Trichinella spiralis - Encysted Larvae
 Trichinella spiralis
• Encysted larva

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Trichinella spiralis - Encysted Larvae
 Trichinella spiralis
• Encysted larva
• Infective and Diagnostic Stage
• Kinky appearance

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Trichinella spiralis - Encysted Larvae
 Trichinella spiralis
• Encysted larva
• Infective and Diagnostic Stage
• Kinky appearance

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Trichinella spiralis - Encysted Larvae
 Trichinella spiralis
• Male - Yellow
• Female - Pink

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Trichinella spiralis
 Kato Katz / Cellophane Technique Hookworms deteriorate rapidly and
Supplies disintigrates 1 hour after preparation
Direct Fecal Smear
•Glass slides Procedure
Supplies
•Green cellophane (cover slip size) 1.Sieve - Stool in newspaper (metal screen and
•Glass slides •Metal screen stick)
•Cover slips •Markers 2.Fill up then removed - Template board in
•Wooden applicator stick •Illustration board with hole diameter glass slide
•Normal saline solution (0.85% NaCl) •Glass Jar •Cylinder of stool
•Lugol’s Iodine Solution (1%) •Sticks, Forceps 3.Press and flatten (pre soaked in green
•Markers •Newspaper cellophane with slide)
•Lysol working solution (disinfectant) •Rubber stopper 4.Incubate
Procedure •Yellow Plastic Bag 1.RT - 1hr
•Label •Cellophane - Soaked overnight in glycerol 2.40c - <1hr
•Drop NSS and Lugol’s on Slide solution (clearing agent) 5.Count Eggs (epg)
•Fecal sample on slide 6.Dispose
Thickness Hole Amount of EPG =
•Dispose stick (Lysol solution) Diameter Stool Count X
Kato Katz - Detection rate; Quantitative
•Scan LPO - HPO Factor
1 mm 9.0 mm 50 mg 20 methods for helminth eggs and to establish
•Dispose Slide (Lysol Solution)
1.5 mm 6.0 mm 41.7 mg 24 burden of parasitic infection

0.5 mm 6.5 mm 20 mg 50
Kato thick - Qualitative Method
Formalin Ether Concentration Technique Harada Mori Culture
1.Collect stool sample Supplies
2.Fix Sample with 10% Formalin •Plastic pipets
•5 mL strained with gauze into a 15 mL conical tube •Glass slides
3.Concentrate Using •Filter paper
1.Add 10% formalin up to 15 mL •Wooden applicator stick
2.Centrifuge (500g for 10 mins) •15 mL - Conical tube
3.Resuspend sediment with 10% formalin (mix) •Forceps
4.Add 4 mL Ether Equipments
5.Shake vigorously 30 Secs •Microscope
6.Centrifuge (500g for 10 mins) Procedure
7.Add 10% formalin to sediment 1.PPE
8.Read under microscope 2.Filter paper
4.Examination a wet mount of the sediment •Cut - taper at one end
•Smear - Middle 0.5 - 1 gram feces
3.1.5 Conical tube
•3-4 mL Distilled water
4.Insert the filter paper to tube
•Water level - 0.5 inches below the fecal spot (maintained)