PARASITOLOGY: THE NEMATODES Pathogenesis and Clinical Symptoms

 3 possible factors may contribute

to the ultimate severity of a
Morphology and Life Cycle Notes
nematode infection:
 Members of the Nematoda class 1. Number of worms present
2. Length of time the infection
3 Basic morphologic class persists
1. Eggs (Female sex cells after 3. Overall health of the host
fertilization)
2. Juvenile worms/Larvae o Depending on the individual
3. Adult Worms species involved, nematode
infections have been reported to
o Larvae - are typically long and endure up to 12 months or longer
slender. (some infections may continue for
o Sexes are separate. 12–15 years or more).
o Adult female worms are usually o Each nematode's life cycle
larger than adult males. includes the digestive system. All
o Adults equipped with complete nematodes, with one exception,
digestive and reproductive have the potential to induce
systems. digestive symptoms while
o The life cycles of the individual invading a host.
nematodes are similar but o Abdominal pain, diarrhea,
organism-specific. nausea, vomiting, fever, and
eosinophilia. Skin irritation, the
Laboratory Diagnosis formation of skin blisters, and
 Recovery of larvae, eggs, and muscle involvement.
occasional adult worms.
 The preferred specimen varies by Nematode Classification
species and may include tissue
biopsies, diseased skin ulcers, o Phylum – Nemathelminthes
stool samples, and preparations o Nematode species may be
made using adhesive tape divided into two groups, those
around the anal hole. primarily involved with the
 Serological test methods are intestinal tract, termed intestinal
available for the diagnosis. species, and those that migrate
into the tissues following initial
contact with the intestinal tract,
termed intestinal tissue species
  2.5 – 5 cm in length
 The anterior end appears
Phylum – Nemanthelminthes
colorless and contains a slender
esophagus
 The posterior end assumes a
Class – Nematoda pinkish-gray color, consisting of
the intestine and reproductive
system.
INTESTINAL SPECIES  The adult male is usually
smaller than the adult female.
 Enterobius vermicuralis  In addition to a digestive system,
 Trichuris trichuria intestinal tract, and reproductive
 Ascaris lumbricoides organs, the male possesses an
 Necator americanus easily recognizable curled tail
 Anyclostoma duodenale  The posterior end of the adult T.
 Strongloides stercoralis trichuira is large and resembles
that of a whip handle.
INTESTINAL – TISSUE SPECIES
 Trichinella spiralis
 Dracunculus medinesis

Trichuris trichiura
o Common name: Whipworm
o Commonly associated disease
and condition names:
Trichuriasis, whipworm infection
Morphology
Eggs:
 Barrel-shaped (football-shaped)
 50 – 55 um by 25 um
(micrometers)
 The undeveloped unicellular
embryo is surrounded by a
smooth shell that retains a
yellow-brown color from its
contact with the host bile
 The prominent hyaline polar plug
is visible at the end.
Adults:
 soil, the egg embryonate,
becomes infective and is ready to
Laboratory Diagnosis
initiate a new cycle.
 Specimen of choice for the
Epidemiology
recovery of T. trichiura eggs in
stool  Third most common helminth
 These eggs are most noticeable  Primarily found in warm climates
in samples that have been of the world where poor sanitation
infected and processed using the practices are common
zinc sulfate flotation method.  The person most at risk: children
 Adult worms may be visible on as well as those in psychiatric
microscopic examination of the facilities.
intestinal mucosa. Adults may
Clinical Symptoms
also be seen in areas of the
intestinal tract down to and  Asymptomatic: Patients with a
including the rectum in heavy mild whipworm infection
infections. frequently have no symptoms.
 Trichuriasis: Whipworm
Life Cycle Notes
Infection: Heavy infections of
 Ingestion of infective T. trichiura 500-5000 worms produce a wide
eggs containing larvae initiates variety of symptoms.
human infection. o Ulcerative colitis
 The larvae emerge from the eggs o Chronic dysentery
in the small intestine. o Severe Anemia
 Growth and development of the o Growth retardation
larvae occur as they migrate o Rectal prolapse
within the intestinal villi. The o Peristalsis
larvae return to the intestinal
lumen and proceed to the cecum,
o Adults: mimic those
where they complete their
inflammatory bowel
maturation
diseases
 Resulting adults take up
o Abdominal tenderness and
residence in the colon,
pain
embedding in the mucosa.
o Weight loss
 Life span of the adult worms in
untreated infections: 4-8 years o Mucoid or Bloody diarrhea
 Following copulation, the adult Treatment
female lays her undeveloped
eggs. It is this stage of the egg  Mebendazole or albendazole is
that is passed into the outside considered the treatment of
environment via the feces. choice for whipworm infections.
 Approximately 1 month outside Prevention and Control
the human body, usually in the
  Proper sanitation practice  The female possesses a
 Thorough treatment of infected blunt, rounded posterior
persons end, and a single ovary
 Educating young people about with a vulva located in the
personal cleanliness and anterior fifth of the body.
sanitation while assisting mentally
disabled people who are
institutionalized

Trichinella spiralis
o Common name: Trichina worm
o Commonly associated disease
and condition names: Trichinosis,
trichinellosis
Morphology
 Encysted Larvae: the average Laboratory Diagnosis
juvenile encysted larvae measure
 Examination of the affected
from 75-120um by 4-7 um
skeletal muscle is the method of
(micrometers)
choice for the recovery of the
 Fully developed larvae: up to a
encysted larvae.
length of 1 m. These larvae settle
 Serologic method is also
by coiling up in muscle fibers
available.
and becoming encysted.
 Other laboratory findings such as
 Biopsies of these larvae often
eosinophilia and leukocytosis
reveal a distinctive inflammatory
may also serve as indicators for
infiltrate
disease.
 Elevated serum muscle enzymes,
 Adults:
such as lactate dehydrogenase,
aldolase, and creatinine
 female measures 4 by
phosphokinase.
0.05 mm, male is smaller,
measuring 2 by 0.04 mm. Life Cycle Notes
 The male adult has a long,
slender digestive tract, two  Infection is initiated after
moderately rounded consuming uncooked
appendages, and a curved contaminated meat, primarily
posterior end. Its anterior striated muscle.
end is thin and has a small  Human digestion of the meat
mouth. releases T.spiralis larvae into the
intestine. Maturation into adult
worms occurs rapidly.
  There is no egg stage in this life perhaps a fever during the
cycle, therefore after mating, the intestinal phase of infection.
gravid adult female moves to the  As the larvae begin their
intestinal submucosa to lay her migration through the body, the
live larvae. infected person experiences a
 Infant larvae then enter the number of symptoms, particularly
bloodstream and travel to eosinophilia, pain in the pleural
striated muscle, where they area, fever, blurred vision,
encyst nurse cells. edema, and cough. Death may
 Over time, granuloma forms, also result during this phase.
which becomes calcified around  Muscular discomfort, edema,
these cells. local inflammation, overall
 The T.spiralis life cycle fails to fatigue, and weakness usually
conclude because humans are develop once the larvae settle
not the typical hosts, and the into the striated muscle and begin
cycle ends with the encystation the encystation process.
of the larvae.

Treatment
Epidemiology
 No medication is indicated if the
 T.spiralis is found worldwide,
infected person has a non-life-
particularly in members of the
threatening strain of the disease.
meat-eating population.
These patients are instructed to
 Resistant to colder regions of the
get plenty of rest, supplemented
world.
by adequate fluid intake, fever
reducers, and pain relievers.
Clinical Symptoms  Patients with severe infections
that may be life-threatening are
 Trichinosis, Trichinellosis
usually treated with Prednisone
 T. spiralis is known as the great
or Thiabendazole.
imitator because infected
 Under appropriate conditions,
patients may experience a variety
steroids may also be
of symptoms that often mimic
administered.
those of other diseases and
conditions. Prevention and Control
 The typical symptoms of a mild
 Thorough coking of meats.
infection include diarrhea along
with a very low-grade fever,
which is suggestive of the flu.
 Heavily infected patients
complain of symptoms such as
vomiting, nausea, abdominal
pain, diarrhea, headache, and
Capillaria philippinensis Pathogenesis and Clinical Manifestation
o Human infection with C.  Abdominal pain
philippinensis was first reported  Intermittent diarrhea
by Chitwood et al. in 1963 in a  Weight loss, malaise, anorexia,
29-year-old male from Northern vomiting, and edema
Luzon  Laboratory findings show severe
o Characteristically have a thin protein-losing enteropathy and
filamentous anterior end and a hypoalbuminemia; low serum,
slightly thicker and shorter potassium, sodium, and calcium;
posterior end. and high levels of
o Male worms are about 1.5-3.9 immunoglobulin E.
mm in length, while females are  Micro-ulcer in the epithelium
2.3-5.3 mm long. The male  Histologically, the intestines also
spicule is 230-300 um long and show flattened and denuded villi
has an unspined sheath. and dilated mucosal glands. The
o Female worms produced lamina propria is infiltrated with
characteristic eggs, which are plasma cells, lymphocytes,
peanut-shaped with striated macrophages, and neutrophils.
shells and flattened bipolar Diagnosis
plugs.
o These eggs, measuring 36-45  Utilizing wet mount, direct
um by 20 um, are passed in the smear, stool concentration,
feces and embryonated in the soil and egg in feces procedures.
or water.  By duodenal aspiration, the
o They must reach the water in parasites can be recovered
order to be ingested from the small intestines.
o The fish's intestines are where Treatment
the eggs develop into infectious
larvae. When fish is consumed  Patients should receive
raw, the larvae escape from the electrolyte replacement and a
intestines of the fish and grow high-protein meal in severe cases
into adult worms in the intestines with electrolyte and protein loss.
of humans.  Mebendazole or Albendazole is
o Some of these larvae are the drug choice for the treatment
retained in the gut lumen and of intestinal capillariasis
develop into adults. Epidemiology
 First recorded in Northern Luzon
in the Philippines (Pudoc West,
Tagudin, Ilocos Sur)
 Human capillariasis cases have
been subsequently reported in
 Thailand, Iran, Japan, Indonesia,
UAE, South Korea, India, Taiwan,
Egypt, and the Lao People’s
Democratic Republic.
 Uncooked tiny
freshwater/brackish water fish are
susceptible to infections.

Prevention and Control

 Improve sanitation and health
educational programs to 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.