NEMATODES: Intestinal

Ascaris lumbricoides (Linneaus. 1758)

Common Infective
Diagnostic Stage Habitat Host MOT Diagnosis Treatment
Name Stage
Giant Ova & Adult Ova Small Definitive  Depends on LabDx: Broad Spectrum
Intestinal worms Intestine Host & socio- o DFS Antihelminthics:
Roundworm Resevoir: economic o Kato-Thick  Albendazole
Man factors o Kato-Katz  Mebendazole
 Fecal-oral o Conc. Technique  Levamisole
SeroDx: Commonly used  Piperazine salts
1 Indirect Hemagglutination  Pyrantel pamoate
2 Immunoflourescent Ab
Imaging
 X-ray, Ultrasound, CT Scan
Pathology & Clinical Manifestation Prevention & Control Epidemiology
A Pathology due to larvae migration Control:  Over 1 billion people globally are
- initial pathological lesion in Ascaris is associated with  Mass Drug Administration estimated to have Ascariasis
migrating larvae  Selective Tx  The risk of infection exists
-the severity of lesion depends on: Prevention: wherever fecal disposal is improper
1. Sensitivity of the host 1 Sanitary Disposal of Human Excreta Infection:
2. Nutritional status of the host 2 Use of sanitary facilities a. High density of human
3. Number of the migrating larva 3 Personal hygiene population
B Pathology due to adult worm 4 Avoiding the use of fresh human feces for b. Poor Sanitation
1. Mechanical Action – obstruction of the intestinal fertilizer c. Habit of people to defecate
tract in heavy infection 5 Thorough cooking of food particularly indiscriminately in and around
2. Sporiative Action – affect the nutritional status of vegetables settlement
the host by robbing off its nutrition 6 Health Educ. d. Use of infected feces as
3. Allergic Reaction – metabolites of the living or the fertilizer
dead adults are toxic and immunogenic
Notes:
Ascaris suum: pig roundworm
 The distribution of the parasite is cosmopolitan
 Asacaris occus most frequently in tropical and subtropical and estimated to infect 1.2 billion individuals
 There are two separate populations and reservations of the parasite: one consists of adult parasitizing man and the other of eggs/ova in the environment
 Transmission to man depends mainly on socioeconomic factors
Morphology
 Creamy-white or pinkish-yellow when freshly expelled
 Female: bigger, tapered at both ends
 Male: smaller, curved posteriorly
 The anterior end is provided with 3 lips and a buccal cavity at the center of the lips
 At the junction of the anterior and middle third of the female worm is a depression around the body where the vagina is located (genital ring). The male worm aided by its
curved tail should locate this depression during copulation
 The reproductive potential of a mature female worm is about 240,000 eggs per day
Eggs/Ova
 Two types of ascaris eggs are found on microscopic stool examination: fertilized and unfertilized
Fertilized Unfertilized
Appearance - Broadly ovoid, golden brown in color - Larger, longer, elongated, irregular in shape
- Usually contains a single cell inside - Mass of disorganized highly refractile granules
- Mass of organized fine granules
Layers - Vitelline membrane - Vitelline and glycogen membranes are absent
- Glycogen membrane
- Albuminous/ mammilary
Development - Will develop into larvae - Will not undergo any further development
Stool exam may give NEGATIVE finding in:
1. Worms are still immature in the lumen
2. During the larval migration
3. Infection with only male Ascaris worm
4. Extra intestinal infection
Serodiagnosis: frequently used in the diagnosis of extra intestinal Ascariasis
Treatment
 The Ascaris adults do not have organs for attachment to the intestinal wall, hence antihelminthics will paralyze the worm should work in expelling it.
 Drugs (Broad Spectrum Antihelminthics) have a neuromuscular blocking effect on the parasite causing paralysis
 Trichuris trichiura (Linneaus, 1771)
Common
Diagnostic Stage Infective Stage Habitat Host MOT Diagnosis Treatment
Name
Whipwor Unembryonate Embryonate Large Definitiv  Indiscriminate LabDx:  Albendazole
m d eggs passed d eggs are Intestin e Host: defecation of children o DFS  Mebendazole
in feces ingested e- Man around yards o Kato Technique/  Pyrantel
rectum  Frequent contact bet. Cellophane Thick smear pamoate
Fingers and soil among o Kato-Katz Technique
children at play o Concentration Technique
 Poor health education Heavy Infx: Stool (frequently
 Poor personal, family, mucoid) & has Chartcot-Leyden
and community hygiene Crystals
Pathology & Clinical Manifestation Prevention & Control Epidemiology

 Light infx=asymptomatic; w/o clinical significance Similar to those Source of Infx: soil & food contaminated
 Symptoms; due to unique mode of attachment to the wall of LI recommended for with embryonated egg
 Deg. of clinical symptoms is directly proportional to the intensity of the infx. Ascariasis
 Diarrhea, hypoalbuminemia, and IDA (Iron Deficiency Anemia)  80-90% of prevalence in the PH and
 Prolapse of the anus and rectum :heavy infx; frequent loose bowel movement usually parallel with Ascariasis
 Appendix: Acute appendicitis  Most infections are light to moderate and
Prevelance & Intensity of Infection: seldom produce clinical symptoms
 Below 100 eggs/gram of feces - asymptomatic  It has been observed that Trichuris ova in
 500 eggs/gram of feces – symptomatic the soil are less resistant to adverse
 20,000 eggs/gram of feces – severe diarrhea or dysenteric syndrome conditions that Ascaris ova

Notes:
- Next most common intestinal roundworm to Ascaris especially in urban disadvantage communities
- Occurs quite frequently with Ascaris probably due to their very similar epidemiology and method of transmission to man
- It is estimated to affect some 500 million people, children aged 5 to 14 years are particulary vulnerable
Morphology
ADULT
- Flesh colored or pinkish slender worms which are much smaller than ascaris
- The anterior three-fifths of the worm consists of a fine, hair-like structure which forms the esophagus while the posterior two-fifths is thick and fleshy and
contains the intestine and reproductive organs
- The esophagus is characteristically embedded in glandular cells called stichocytes
- The tail of the female worm is straight and blunt while that of the male worm is characteristically curved
EGGS/OVA
- Barrel-shaped/Lemon-shapred/football-shaped with thick, smooth, double layer, yellowish-brown eggs shells and two prominent plugs protruding at both ends
 Strongyloides stercoralis (Bavay, 1876 ; Stiles and Hassal , 1902)
Common Name Diagnostic Stage Infective Stage Habitat Host MOT Diagnosis Treatment
Threadworm - Presence of egg L3 larva Mucosa Definitive - Penetration of LabDx:  Albendazole
- Presence of L1 (filariform) of Small Host: the skin by 1 Stool Microscopy  Thiabendazole
(Rhabditiform) Intestine Man Filariform larvae 2 Stool Culture
- Transmammary a. Harada-Mori
- Ingestion of b. Baermann Funnel Method
food and drink using Charcoal
contaminated with c. Agar Plate Method
larvae Aspiration or String Test:
-Organ transplant collection of duodenal fluid IF
FECES ARE NEGATIVE

SeroDx: ELISA, IHA, IFA

Pathology & Clinical Manifestation Prevention & Control Epidemiology
Types of Diseases caused by Strongyloides: - Same as those of  Low prevalence
1. Cutaneous Infection hookworms  Laguna has the highest
2. Pulmonary Infection prevalence
3. Intestinal Infection  100M people infected world
3 Types of Infection: wide
1) Invasion of the skin by Filariform larvae * Out of 4308 stool cultures from 6
2) Migration of larvae through the body provinces, less than 3% were found
3) Penetration of the intestinal mucosa by adult female worm to be positive. The prevalence
appears to be highest in the 7 to 14
Swollen Baby (or Belly) Syndrome – young infants develop massive Strongyloides years age group.
infections which are fatal [New Guinea]
Notes:
- Good example of facultative parasite; can exist as free-living organism (favorable conditions); reverts to parasitic existence (unfavorable conditions in
soil)
- Capable of perpetuation in man by producing many generations larvae from parthenogenetic females
- The Strongyloides larva should be distinguished from hookworm larva
- Strongyloides ratti: endemic parasite of rats; used for laboratory study (or model) and manipulation.
Morphology
ADULT
 Smallest intestinal nematode of man
 Colorless, semi-transparent with finely striated cuticles
 Slender tapering anterior end and a short conical pointed tail
 No parasitic males; parthenogenetic, requiring no male in the production of fertilized and fully embryonated eggs
 Free-living females is shorter but stouter than the parasitic female
 Males developing from filariform larvae are gradually passed out in the feces.
LARVA
Rhabditiform Larva
a. Stage that is usually passed out in the feces, characterized by a muscular elongated esophagus with a pyriform posterior bulb, a short buccal cavity and
a relatively conspicuous primordium halfway down the midgut
Filariform Larva
1. Long and delicate and are characterized by a long esophagus occupying half the length of the larvae and a forked or notched tail
EGGS/OVA
- Clear, thin-shelled and similar to those of hookworms

Strongyloides fuelleborni

o Parasite of monkeys and apes

o It causes occasional zoonotic in man in Africa and parts of Asia
o It causes “swollen baby syndrome” in infants
o Condition is serious, life-threatening characterized by diarrhea, respiratory distress and edema
o The infection is transmitted from mothers to infants through milk by breast feeding
o The condition is diagnosed by demonstration of eggs in stool
o Treatment: Thiabendazole


 Hookworms
Diagnostic Infective
Common Name Habitat Host MOT Diagnosis Treatment
Stage Stage
Necator americanus – New Ova/ Eggs L3 Larva Adult: Factors: LabDx: recovery of eggs  Albendazole
World Hookworm (Stiles, Lumen Suitability of the o Direct Fecal Smear  Mebendazole
1902) environment for o Kato-Katz
of the  Pyrantel pamoate
Small eggs or larvae o Conc. Technique
Ancylostoma duodenale –  Oxantel or
Intestine a. Brine Floatation
Old World Hookworm
Mode and extent oxantel/pyrantel
(Dubini, 1843) Technique
of fecal pollution - for individual &
b. Formalin-Ether Conc.
of the soil Technique mass treatment
Ancylostoma caninum – Dog
Hookworm (Ercolani, 1859) Sample: Stool Ferrous sulfate: for
Mode and extent iron therapy
Ancylostoma braziliense – of contact bet. Harada-Mori (Culture Method):
Cat Hookworm (De Fria, Infected soil, distinguish diff. bet. S. stercoralis;
1910) skin, or mouth when stools have stood for 12-24 hours
before the examination was done,
Ancylostoma ceylanicum –
some eggs hatched and rhabditiform
(Loose, 1911)
larvae should be differentiated
Pathology & Clinical Manifestation Prevention & Control Epidemiology
1. Pathology due to the larval stage 1. Sanitary disposal of human feces - Prevalence in PH: 5-45% depending on the geographic location and
a. Ground itch or Coolie itch 2. Wearing of shoes, slippers or boots type of rainfall
b. Pulmonary lesion or Wakana Disease 3. Health educ. on personal, family, and - Sandy loam type of soil with plenty of rain throughout the year
c. Creeping eruption or Cutaneous larva migrans community hygiene appears to be favorable for the infection
2. Pathology due to adult worms 4. Treatment of infected individuals - Human hookworms infection is greater in agricultural areas
a. Hookworm anemia 5. Mass chemotherapy - N. americanus: 96%; A. duodenale: 2%; Mixed: 2%
b. Hypoalbuminemia 6. Use of sanitary facilities
Notes:
- Human hookworms are blood sucking nematodes, attached to the mucosa of the small intestine among people living in tropical and subtropical countries
Morphology
Necator americanus
 Adult: relatively stout, cylindrical, fusiform, grayish-white
 Tendency to go against the general body curvature at the anterior end, “hook”
 Females: longer with a blunt end; Males: shorter and expanded posterior end forming fan-like bura copulatrix (copulation; characteristic of male hookworm spp)
 Both sexes have well-developed buccal capsules with the presence of semi-lunar cutting plates

Ancylostoma duodenale
 Adult: buccal capsules, 2 pairs of ventral teeth similar in size
 Follow the general curvature of the body; letter “C”
 Mouth: uses curved sharp teeth to attach to the lining of the intestine (small) sucking the blood for nourishment
Larva
Rhabditiform Larva
 First stage larve
 Feeding stage larva – bacteria and organic matter in soil and feces
 Short and stout with long and narrow buccal chamber, flask-shaped muscular or bulbous esophagus and a very small genital primordium
Filariform Larva:
 Infective stage to man
 Non-feeding stage
 Longer and slender with a pointed posterior end
 The mouth closes, the esophagus elongates and the old cuticle remains as a sheath covering larva
Eggs/ Ova
 Ovoidal thin-shelled and colorless
 Feces: already in the 4-8 celled stage
 Constipated stool: embryo develop inside the shell
 Differentiation is difficult and impractical
 Enterobius vermicularis (Linnaues, 1758)
Diagnostic Infective
Common Name Habitat Host MOT Diagnosis Treatment
Stage Stage
Pinworm or Egg associated with Small Definitiv - Hand to Mouth S&S: perianal itching, insomnia,  Albendazole
Seatworm pruritis ani Intestine e Host: - Inhalation of airborne and restlessness  Mebendazole
LabDx:
Man eggs from dust  Pyrantel
- Autoinfection from the  Graham Scoth Tape Anal Swab
Disease: pamoate
Technique – finding the
Enterobiasis anus - infection is self-
characteristic of egg
or Oxyuriasis - Handling contaminated
 Stool Exam – not preferred; limited and in the
soiled lines and night absence of reinfection,
only 5%
clothes of infected ceases without Tx
Repeated for 3-7 days
individuals - treat entire family
simultaneously
Pathology & Clinical Manifestation Prevention & Control Epidemiology
Pathogenicity of Adult Worms  Treatment of infected children - Worldwide distribution but more common in cold
1. Little pathological changes in the intestine and other members of the family regions
2. Mild catarrhal inflammation of the intestinal mucosa - Moist tropics: infants and young children are essentially
 Improved personal hygiene and
3. Caecum & Appendix: minute ulcers unclothed, it is less prevalent
4. Allergic manifestations due to absorption of metabolites cleanliness such as:
1. Cutting nails short - Not uncommon in the well-to-d- and highly educated
secreted by the worms
elite group and even in the seats of the mighty
5. Female patients: Vulvovaginitis (mucoid vaginal 2. Strict hand washing before
discharge) and salphingitis - group infection and is more common in infected families
and after eating using the
Pathogenicity of Eggs and asylums
toilet In the PH
 Adhere well on the surface of the skin; mucoid secretions 3. Washing the bed and night
causes irritation Public school children: 56%; Private school children: 29%
 Nocturnal perianal or perineal itching (pruritis ani)
dress - eggs were collected under fingernails and fingertips
Notes:
Morphology:
ADULT
- Small, whitish or brown in color
- Male: 2-5mm in length, the tail is strongly curved and a single copulatory spicule is present
- Female: 8-13mm in length, has long pointed tail; Uteri of the gravid female is distended with eggs
DIAGNOSTIC FEATURE
 Pair of lateral cuticular wing-like expansion at the anterior end known as “cephalic alae”
 Distinct or prominent esophageal bulb
OVA
- Elongated, measuring 50-60 by 20-30 microns; wherein the ventral side is flattened thus the appearance is similar to letter “D” or characteristically lopsided
There are 2 layers:
 Outer thick hyaline albuminous layer
 Inner embryonic. Lipodal layer
- The eggs are fully embryonated when laid and will mature within 6 hours after oviposition and these are already infective
- Gravid females oviposit 4,600 to 17,000 eggs per day
- Eggs are resistant to disinfectant and under cool condition and may remain viable for 13 days
 Capillaria philippinensis (Chitwood, Vasquez, Salzar, 1968)
Common
Diagnostic Stage Infective Stage Habitat Host MOT Diagnosis Treatment
Name
Pudoc Egg/Ova, Adult L3 larva Small Intermediate - Parasitologic diagnosis :  Mebendazole –
Worm & L3 Intestine Host: Small characteristic eggs, larvae or more preferred
brackish water adult in STOOL because it also
fish (Hypseleotris LabDx: attack the larva
bipartite) – Bagsit, o Direct Fecal Smear (DFS)  Albendazole
birut, bagsang, o Conc. Technique: Acid-Ether,
bagsik Formalin-Ether

Definitive Host:
Man
Pathology & Clinical Manifestation Prevention & Control Epidemiology
- Borborygmi or gurgling stomach, abdominal - Changing the eating - First recorded in N.Luzon, Thailand, Iran, Japan, Egypt, Korea, Taiwan,
pain and diarrhea habits that of eating India
- W/o tx: weight loss, dehydration, malaise, uncooked freshwater fish - Recentyly described in Compostela Valley and Zamboanga del Norte
anorexia, vomiting, anasarca, muscle wasting - Proper disposal of human (1998)
- Malabsorption of fats and sugar, protein-losing feces - Various age groups infected; peak is in males bet. 20 to 49 years old
enteropathy, low plasma levels of: K, Ca,
- Health education - Man acquire the disease by ingestion of raw fish harboring the larval stage
carotene, and TP.
- Death: massive parasitic infection due to - Proper personal hygiene - fish-bird cyle; parasite eating fish
electrolyte loss, heart failure, septicemia (sec. - Ability to infect fish-eating migratory birds suggests that this parasite may
bacterial infection) be widely distributed throughout Asia and elsewhere.
Notes:
 In 1967, an epidemic of Capillariasis in Pudoc West, Tagudin, Ilocos Sur where approx. 1,300 persons became ill and 90 persons died of infection
 First recognized in the PH in 1963 when the first human case dies of the disease in the PGH
Morphology
ADULT
 Belongs to the order Trichurida and shares with the trichurids the characteristic filariform anterior and stout posterior. However, in this parasite the tapering is gradual and less
pronounced
 Males: characterized by the presence of chitinized spicule and a long spicule sheath extending beyond the length of the worm
 2 types of Female Worms: typical female – 8 to 10 eggs in utero arranged in a single row & atypical female – 40 to 45 eggs in the utero arranged in 2 to 3 rows.

EGGS/OVA
 Eggs laid by typical female worms are pale yellow in color with a moderately thick, striated shell with flattened bipolar plugs
 Peanut-shaped and are usually in the single or 2-segmented stage of development
 Atypical females produce eggs in which are thin-shelled without polar plugs and multi-segmented or embryonated, these eggs hatch in utero into first stage larvae

NEMATODES: Tissue (Extraintestinal)

Severity depends on:
1. Number of larvae ingested
2. Immune status of the host
Majority of the infections are asymptomatic
Notes:
 Common parasite of pig
 Causes Trichinellosis, a zoonotic infection in humans
 One of the smallest nematodes
 Not found in the soil, only in tissues (muscle); no free-living stages
 The encysted cyst is lemon-shaped
 The parasite is maintained in nature by natural infection amongst animals

Morphology
- A single host serves both as the definitive and intermediate host
ADULT
 Females are twice the length of males
 They have stichosomes following a short esophagus
Males
- Absent spicule and copulatory sheath
- Identified by the conspicuous conical papillae present in the tail end
- Short lived and dies immediately after fertilization of the female within a week
Females
- Larviparous
- Have single uterus, filled with developing eggs in the posterior region but fully developed and hatched larvae in the anterior region
LARVAE
 Remain coiled inside muscle cysts; only present in striated skeletal muscle
 Inside the muscle cyst, larva continues to develop, sexually matures and differentiates
 Infective stage to man
 Remains viable for years before it is dead and eventually calcified
 In skeletal muscle: capsule surrounds the larva in a period of 3 months.
 Encysted cyst: lemon-shaped

Clinical Manifestation:
In heavy infection, 3 clinical phase (depending upon the site of lesion) are:
1. Infestation phase
- Due to invasion of the intestinal wall by the newborn larvae
- Appear 1-2 days after ingestion of undercooked pork; last about 2-3 months
2. Muscle invasion phase
 - Invasion of the larvae in the muscle
- Seen during 7-11 days of ingestion of the infected food
3. Convalescence phase
- Beginning of the encapsulation of the encysted larvae during the third week of infection
 Toxocara cati, Toxocara canis (Visceral Larva Migrans)
Common Name Diagnostic Stage Infective Stage Habitat Host MOT Diagnosis Treatment
Toxocara Larva in tissues Embryonated Small Definitive Triad: eosinophilia,  Infection: self-
canis: Dog egg with larva Intestine Host: Dogs hepatomegaly, & limited; Severe:
ascaris and Cats hyperglobulinemia need to be
Specimen: stool treated
Toxocara cati: Accidental: - examination in infected  DOC:
Cat ascaris Man patinets is not useful because Thiabendazole –
egg-laying adults are not shorten the
present course of the
disease
Examination of fecal materials
from infected pets often
supports the diagnosis
Pathology & Clinical Manifestation Prevention & Control Epidemiology
- Larval migration: hemorrhage, necrosis - Small children should be protected against contact with infected dogs When infected dogs and
and granuloma at the site and cats cats are present, the eggs
- Eosinophilia, liver damage, pulmonary - Animal under six months: dewormed with piperazine every month; are threat to human
inflammation and ocular problems Older: every two months
- Worms passes as a result of treatment should be destroyed
Notes:
- Naturally parasitic in the intestines of dogs and cats that accidentally infect humans (aberrant host) producing disease known as Visceral Larva Migrans (VLM) or
Toxocariasis
- Same life cycle for human ascariasis in dogs and cats
- Embryo is ingested by man: larvae will hatch and will not follow its normal course of development as seen in their natural host
- Larvae: penetrate the intestinal mucosa and carried in the blood stream to the liver, lungs, and other organs
- They wander for weeks/months or become dormant and they do not develop beyond migrating larval forms
 Cutaneous Larva Migrans
Notes:
Ancylostoma braziliense: Cat hookworm
- Possesses a pair of large teeth and a pair of inconspicuous median teeth in the buccal capsule
Ancylostoma caninum: Dog hookworm
- Buccal cavity is provided with three pairs of ventral teeth
- The cephalic or amphidial gland of the worm secretes an anticoagulant that delays coagulation of blood
Ancylostoma ceylanicum:
- Smallest hookworm species
- Common parasite of cats and less frequently of dogs
 Dracunculus medinensis (Linnaeus, 1758)
Diagnostic Infective
Common Name Habitat Host MOT Diagnosis Treatment
Stage Stage
Guinea Worm Third- Subcutaneou Reservoir: Source: Parasitic Dx: observation of Ancient Method: slowly
Medina stage s tissues of Man Contaminate the typical ulcer and flooding wrapping the worm on the stick
Worm larva man usually d water with ulcer with water to recover the
Surgical removal
Dragon (found in the foot or Vector: the infected discharge of larvae DOC: Niridazole
Worm the body lower limb Cyclops cyclops SeroDx: IFA, IHA, ELISA, Alternative: Metronidazole,
Fiery Serpent cavity of (Mesocyclop and western blot Thiabendazole
worm of the Cyclops) s leuckartim, Imaging: Radiologic
Israelites M. hyalinus) examination (demonstrates Anti-inflammatory & antibiotics –
for secondary bacterial infections
dead and calcified parasites)
Pathology & Clinical Manifestation Epidemiology
Pathogenesis & Pathology - Parasite causing disease; Guinea in West Africa;
-3rd stage larvae: not pathogenic, do not produce any pathological lesions in man commonly found in Medina
-Female worm: pathogenic; produces blister at site for coming out of the surface, and coming in contact with water - Russian biologist Fedstchenko (1870) discovered the
-Blister: bacteriologically sterile and contains numerous larvae and leukocytes role of cyclops as vector in transmission of disease
-Diffusable toxins: urticaria, dyspnea, vomiting, mild fever, and occasional fainting - Man acquires infection by drinking water
Clinical Manifestations contaminated with Cyclops harboring 3rd stage larva
o Infection is asymptomatic until female worm reaches the surface of the skin to ready to discharge larvae - The condition essentially is a disease of rural poor
o First Physical Sign: stinging papule at site progressively develops into a blister people
o Blister Formation: accompanied by intense burning pain, relieved by immersion of the affected part in the water - Contamination of drinking water, presence of infected
o Next few days: lesion vesiculates and the blister ruptures producing painful ulcer. Cyclops in shallow waters, poor sanitation and poor
o Worm is often visible in opening of the ulcer personal hygiene facilitate transmission of infection

Notes: - Rounded anterior end and a tapering posterior end in a form of hook-like structure
- Ancient disease - Minute triangular mouth in the anterior end
- Longest nematode (up to 1meter) - Pair of uteri, oviducts and tubules and a single unpaired vagina
Morphology - Viviparous
Adult worm
Male: First stage larva
- Difficult to demonstrate as they die immediately after fertilizing the female - Unsheated and coiled with round anterior end and a long slender filariform tail
Female: - Shows tadpole-like movement in water
- Milky-white, slender, and looks like a thick twine of thread - Short life unless taken up by the Cyclops
Angiostrongylus cantonensis (Chen, 1935)
 Common Diagnostic Infective
Habitat Host MOT Diagnosis Treatment
Name Stage Stage
Rat L3 larva Lungs of Final Host: 1. Ingestion of raw mollusk  Difficult to
Lungworm Rat Rats: Rattus rattus. Rattus containing the L3 larva diagnose since
norvegicus
, (pulmonary 2. Ingestion of raw leafy adult lay primarily
arteries) Intermediate Hosts: vegetables contaminated in the brain
Rodent Achatina fulica (giant with mucus of the  IHA, IFA, ELISA
Lungworm Japanese snail) mollusk containing L3 are frequently
Pila luzonica (kuhol) larva used serological
Parathelpusa mistio (talangka) 3. Drinking water
tests in the
Brotia asperata (suso)
contaminated with the diagnosis of
Slugs
Fresh water prawns infective larva Angiostrongyliasi
Water and vegetables 4. Ingestion of paratenic s
host such as freshwater
Accidental Host: Man prawns and crabs with L3
larva
Pathology & Clinical Manifestation Prevention & Control Epidemiology
 Incubation: 12 to 47 days
Clinical Manifestations:
 Eosinophilic meningoencephalitis
- begins with the onset of severe headache associated with neck rigidity
 Clinical and laboratory results may be negative

Notes: - Lay egg up to 15,000 eggs daily

Morphology
Adult Ova:
Male: - Elongated, ovoidal with delicate hyaline shell
- Has well-developed kidney-shaped caudal bursa First stage Larva: found in the lungs of rodent host, has a distinct small knob near the
Female: tip of the tail
- Has uterine tubules which are wound spirally around the intestine usually Third stage Larva: has two well-developed chitinous rods below its buccal cavity
described as “barber’s pole” found in mollusk
NEMATODES: Blood (Filarial Nematodes)
General Characteristics and Classification
1. Adult worms: thread-like, simple mouth which is circular or slightly A Appearance of nucleus
elongated dorsoventrally and surrounded by papillae B Presence or absence of sheath
2. Live in the lymphatics, subcutaneous tissues, CT, muscle and body C Presence of absence of caudal nuclei
cavities D Length of cephalic stage
3. Female adult worms are viviparous E Genital cell – small or large
4. Larvae: microfilaria F Excretory cell – small or large
5. Definitive Host: Humans SHEATED: Wuchereria bancrofti, Brugia malayi, Loa loa
6. Transmission: bite of arthropod (filarial worms) UNSHEATED: Onchocerca volvulus, Mansonella spp
Anatomic Landmarks
Filarials Worms Characteristics
Wuchereria bancrofti - Sheated w/o caudal nuclei
- Distinct nuclei; arranged in 2-3 rows
Brugia malayi - Sheated w/ 2 caudal nuclei
- Indistinct nuclei and confluent
Loa loa - Sheated
- Continuous caudal nuclei w/ those of the trunk
Onchocerca volvulus - Unsheated
- Nuclei free (both anterior and posterior end)
Mansonella perstans - Unsheated
- Nuclei extending up to the tip of the blunt tail
Mansonella ozzardi - Unsheated
- Tail tapers to a thin filament containing column of 4-6 ovoid nuclei
Mansonella streptocerca - Unsheated
- Posterior end: strongly bent

Periodicity – refers to the rhythmical appearance of microfilaria in the peripheral blood circulation
1. Nocturnal Periodicity – during night (10PM to 2AM)
2. Diurnal Periodicity – during daytime (10AM to 2PM)
3. Subperiodic – day and night time; Subperiodic diurnal, Subperiodic nocturnal

- Important in determining the proper time for specimen collection for laboratory identification of the parasite.
 Wuchereria bancrofti (Cobbold, 1877)
Common
Diagnostic Stage Infective Stage Habitat Host MOT Diagnosis Treatment
Name
Bancroft’ Intermediate Host: 1. Blood Diethyl
s Filarial Aedes poecilus Microscopy carbamaszine citrate
Worm Anopheles minismus flavirostris 2. QBC (DEC)
Culex quinquefasciatus 3. Urine
Microscopy
Pathology & Clinical Manifestation
Lymphatic Filariasis – caused by the juvenile & adult worms

Clinical Manifestation (depend on stages)

1. Endemic Normal – certain proportion of the population living in these areas do not show any over clinical manifestations of the disease or any mcf in their blood
even though they are exposed
2. Asymptomatic Stage – persons in this stage have mcf in their blood but do not show any clinical manifestations
3. Acute Filariasis – caused by antigens relased by female adult worms; cause no inflammatory changes; characterized by Filarial Fever, Lymphoedema,
Lymphadenitis, Adenolymphagitis
4. Chronic Filariasis – obstructive phase, takes 10-15 years to develop
5. Occult Filariasis – condition of hypersensitivity reaction of the host to microfilarial antigens; Mcf not found in the peripheral blood and the classical features of
lymphatic filariasis are absent; TROPICAL PULMONARY EOSINOPHILIA – most important manifestation of occult filariasis
6. Less Frequent Lesions – include granuloma of the spleen and other organs and the presence of adult worm in the anterior chamber of the eye

Notes:
Morphology
Adult: minute whitish and thread-like, filariform in shape with smooth surface; tapering anterior and posterior portion
Male: tail is sharply curved ventrally
Female: viviparous, longer than male
Types of Chronic Filariasis
1. Hydrocele – Most common; caused by the obstruction of the lymph vessel of the spermatic cord and exudation from the inflamed testes and epidydimis
2. Elephantiasis – caused by complex immune reaction of long duration and repeated superinfection over many years. Elephantiasis of the scrotum, legs and arms of male and
female.
3. Granuloma of the female breast – caused by the adult worms present in the lymphatic of the breast; characterized by the presence of a firm solitary mass in the breast
4. Chyluria – urine shows chyle mized with blood and occasionally with mcf; caused by the obstruction of the lymphatic vessels of the kidney and the abdomen.
5. Lymph varices -
 Brugia Malayi (Brug, 1927)
Common
Diagnostic Stage Infective Stage Habitat Host MOT Diagnosis Treatment
Name
Malayan Intermediate Same as described in Bancroft’s Same as described
Worm Host: filariasis in Bancroft’s
Mansonia bonneae filariasis
Mansonia
uniformis
Pathology & Clinical Manifestation Prevention & Control Epidemiology
Clinical Manifestation: nearly the same with
Bancroftian but with only few difference
- Common sites: legs below the knee;
- Less frequent: the arm below the elbow.
- Genital involvement at chyluria are absent
Notes:
Morphology
Adult: similar to but smaller than those of Wuchereria bancrofti

Bases for differentiation Wuchereria bancrofti (mcf) Brugia malayi (mcf)

1. Body curvature Graceful curver Angular curvature with secondary kinks
2. Appearance of nuclei Discreet and distinct Confluent and indistinct
3. Caudal nuclei Absent Present with 2 caudal nuclei
4. Cephalic space Long as broad Longer than broad
5. G cell Small Large
6. Excretory cell Small Large