NEMATODES

o Adult nematode is elongated, cylindrical worm, primarily bilaterally symmetrical

o Anterior end may be equipped with hooks, tooth, plates, and papillae for purpose of abrasion, attachment, and
sensory response
o Supporting body wall consists of:
à an outer hyaline, noncelluar cuticle,
à subculicular epitheliur
à a layer of muscle cells
o Alimentary tract is simple tube extending from mouth to anus.
o There is no circulatory system
o Generally, they have a complete digestive tract and a muscular pharynx that is characteristically triradiate but there is
no circulatory system.
à Mouth: Entry
à Anus: Disposal
o Equipped with complete digestive and reproductive systems
Life cycle: Egg stage > larval stage > adult stage
o They are provided with separate sexes (Dioecious) although some may be parthenogenetic
à Parthenogenetic: may or may not require male for copulation/reproduction
Female: Larger, pointed posterior, no spicule found
Male. Small, curved posterior, with spicule
o Female worms produce eggs
à Oviparous - lay immature/ unembryonated/ unsegemented eggs.
• Ascaris
à Oviviparous/ Ovoviviparous - lay embryonated/ mature eggs; lay eggs in segmented stage
• Enterobius vermicularis
à Viviparous/ Larviparous - lay larva not eggs
• Trichinella spiralis
CLASSIFICATION ACCORDING TO THE PRESENCE OF CAUDAL CHEMORECEPTORS
There are sensory organs (chemoreceptors) in the anterior and posterior ends of the worm called Amphids (cephalic
chemoreceptors) and Phasmids (caudal chemoreceptors) respectively.
Class Aphasmidia (adenophorea) : no caudal chemoreceptors
T. trichuria, T. spiralis, C. philippinensis
Class Phasmidia (Sercentiae) : with caudal chemoreceptors
A. lumbricoides, S. stercoralis, Hookworms, E. vermicularis, Filarial worms

CLASSIFICATION BASED ON HABITAT OF ADULT WORMS

Small Intestine TCASH Lymph Node/ Lymph Vessel WB
§ Trichinella spiralis adult § Wuchureria bancrofti
§ Capillaria philippinensis § Brugia malayi
§ Ascaris lumbricoides Eyes And Meninges
§ Strongyloides stercoralis
§ Agiostrongylus cantonensis
§ Hookworm
Encysted in the host muscle
Large Intestine TE
§ Trichinella spiralis larvae
§ Trichuris trichuria
§ Enterobius vermicualaris
CLASSIFICATION BASED ON MODE OF TRANSMISSION
Ingestion of Embryonated ova TAE Arthropod vectors
T. trichuria Filarial worms
A. lumbricoides Inhalation
E. vermicularis E. vermicularis
Ingestion of Larva CAT Transmammary
C. philippinensis S. stercoralis
A. cantonensis
A. duodenale
T. spiralis
Skin penetration SH
S. stercoralis
Hookworm
COMMON NAMES

COMMON NAMES
Ascaris lumbricoldes Giant intestinal roundworm
Lumbricus teres
Enterobius vermicularis Pinworm
Oxyuris vermicularis Seatworm
Social or Society worm
Trichuris trichiura Whipworm
Capillaria phillppinensis Pudoc worm
Necator americanus American hookworm American
murderer
New world hookworm
Ancylostoma duodenale Old world hookworm
ZIPAGAN | BSPH 2026
 Ancylostoma brazllense Cat hookworm
Ancylostoma caninum Dog hookworm
Strongyloldes stercorals Threadworm
Trichinella spiralls Muscle worm
Garbage worm
Wuchereria bancrofti Bancroft's filarial worm
Brugia malayi Malayan filarial worm
Loa loa Eye worm
Onchocerca volvulus Blinding worm
Dirofilaria immitis Dog/canine heartworm
Dracunculus medinensis Guinea worm
Fiery serpent of the Israelites
Medina worm
Dragon worm
Anisakls Fish and Marine mammal
roundworm
Herring's worm
Toxocara canis Dog ascarid
Toxocara cati Cat ascarid
AUTOINFECTION
S. stercoralis, H. nana, E. vermicularis, T. sollum, C.
philippinensis, C. hominis
BILE STAINED EGGS
T. trichiura, A. lumbricoides, T. solium, T. saginata
NON BILE STAINED EGGS
A. duodenale, H. nana, E. vermicularis, N. americanus
HEART-LUNG MIGRATION
A. lumbricoides, S. stercoralis, Hookworms
VISCERAL LARVAL MIGRANS
Toxocara cati, Toxocara canis
CUTANEOUS LARVAL MIGRANS
A. caninum, A. braziliense

Ascaris lumbricoides
Common Name: Giant intestinal roundworm
Most common intestinal nematode of man: occurs most frequently in the tropics
Vector of Ascaris: flies and cockroach
Member of Soil Transmitted Helminths (STH): HATS
Member of Unholy Three HAT
Member of parasites having Heart-Lung Migration : ASH
Habitat: Small Intestine
Final host: Man
Diagnostic stage: Ova found in the stool (fertilized/ unfertilized)
Infective Stage: Embryonated egg
MOT: Ingestion of embryonated eggs: embryonates in soil
If not embryonated, Ascaris lumbricoides will not cause infection
SYMPTOMS AND PATHOLOGY
Pneumonia, cough, fever, eosinophilia during larval migration
Vomiting and abdominal pain
Intestinal perforation is possible
Larva Heart-Lung Migration (ASH)
Resembling Loeffler's syndrome (eosinophilia) / Ascaris pneumonitis (pneumonia like symptoms)
Charcot Leyden crystals: Eosinophil degradation products
Adult Erratic (migrate to extraintestinal site)
Group of adult worms: Bolus
Hepatic ascariasis, migration to other tissues: kidney, appendix, and pleural cavity

Life Cycle
Adult worms live in the lumen of the small intestine. A female may produce approximately 200,000 eggs per day,
which are passed with the feces
Unfertilized eggs may be ingested but are not infective. Larvae develop to infectivity within fertile eggs after 18 days
to several weeks
Depending on the environmental conditions (optimum: moist, warm, shaded soil). After infective eggs are
swallowed,
The larvae hatch
Invade the intestinal mucosa, and are carried via the portal, then systemic circulation to the lungs.
The larvae mature further in the lungs (10 to 14 days), penetrate the alveolar walls, ascend the bronchial tree to the
throat, and are swallowed
Upon reaching the small intestine, they develop into adult worms. Between 2 and 3 months are required from
ingestion of the infective eggs to oviposition by the adult female. Adult worms can live 1 to 2 years.

LABORATORY DIAGNOSIS
Specimen of choice for the recovery of Ascaris lumbricoides eggs is stool

ZIPAGAN | BSPH 2026

 Adult worms may be recovered in several specimen types, depending on the severity of infection, including the
small intestine, gall bladder, liver and appendix
Adult worms may be present in stool, vomited, or removed from external nares ELISA is also available

TREATMENT
Several medications:
§ Mebendazole
§ Pyrantel pamoate
§ Levamisole
§ Peperazine citrate
Intestinal tract obstruction
§ combo of drug therapy and nasogastric suction, or surgery
Pulmonary discomfort
§ corticosteroids
PREVENTIVE MEASURES
§ Avoidance of using human feces as fertilizer
§ Proper sanitation and personal hygiene

Enterobius vermicularis
Also known as Oxyuris vermicularis
Common Name: Pinworm, Social worm, Society worm /seat worm
Has familial or group tendency: active transmission within the household
Habitat: Large Intestine
Final host: Man
Diagnostic stage: Embryonated Eg
Infective Stage: Embryonated egg
MOT: Inhalation, Ingestion, Autoinfection (External Autoinfection), Sexual transmission has been reported
MORPHOLOGY
Ova
Size: 50 to 60 µm by 20 to 30 µm: Average of 55 µm by 36 µm
Shape: elongated, ovoid, flattened on ventral side – “Letter D appearance”
Embryonated (oviviparous)
Tadpole-like embryo that becomes fully mature outside the host within 4 to 6 hours
Egg shell composed of 2 layers:
An outer thick hyaline albuminous shell
Inner embryonic lipoidal membrane
Rhabditiform larva
Size: 140 to 150 µm by 10 µm
Has characteristic esophageal bulb, but has no cuticular expansion on the anterior end
Adult
Anterior end with Lateral wings or Cephalic Alae (Cuticular alar expansions
Has prominent Posterior esophageal bulb
Color: Whitish or brownish
Shape: Spindle-shaped
Size: Female worms – larger than male worms (8-13 mm by 0.3-0.5 mm)
Male worms – 2-5 mm by 0.1-0.2 mm
Posterior end
Female worms – long sharp pointed enD
Male worms – ventrally curved; has a single conspicuous copulatory spicule but lacks gubernaculum

SYMPTOMS AND PATHOLOGY

Most cases are ASYMPTOMATIC
Takes 3 forms:
à Pathology at the site of attachment of the worm
• Minute ulceration and abscesses develop in the cecal mucosa (Mild catarrhal inflammation)
à Pathology due to egg deposition in the perianal region
• Pruritus or itching in the perianal region: MOST COMMON complaint resulting to scratching the area until
scarified
• Can also result to hemorrhages, eczema, and bacterial infections
à Pathology caused by migrating worms
• Vulvovaginitis and salphingitis
*Retroinfection: eggs hatch in the perianal region and the larvae migrate back into intestines
LIFE CYCLE
§ Gravid adult female Enterobius vermicularis deposit eggs on perianal folds
§ Infection occurs via self-inoculation (transferring eggs to the mouth with hands that have scratched the perianal
area) or through exposure to eggs in the environment (e.g. contaminated surfaces, clothes, bed linens, etc.)
§ Following ingestion of infective eggs, the larvae hatch in the small intestine and the adults establish themselves
in the colon, usually in the cecum

ZIPAGAN | BSPH 2026

 § The time interval from ingestion of infective eggs to oviposition by the adult females is about one month. At full
maturity adult females measure 8 to 13 mm, and adult males 2 to 5 mm; the adult life span is about two months.
Gravid females migrate nocturnally outside the anus and oviposit while crawling on the skin of the perianal area
§ The larvae contained inside the eggs develop (the eggs become infective) in 4 to 6 hours under optimal
conditions
§ Rarely, eggs may become airborne and be inhaled and swallowed. Retroinfection, or the migration of newly
hatched larvae from the anal skin back into the rectum, may occur but the frequency with which this happens
is unknown.
LABORATORY DIAGNOSIS
Most Common Helminth to Infect Man
o 5% survival in stool [worldwide]: Enterobius vemmicularis
o Perianal swab [Philippines]: Ascaris lumbricoides.
o Scotch tape swab Most common helminth parasite identified in
o Diagnostic stage: Embryonated egg temperate regions, where environmental
TREATMENT sanitation in in place. Less attention is given to
o Mebendazole pinworm infection in tropical areas, likely due
o Albendazole to the presence of the other, more clinically
significant parasites

Trichuris trichuria
Common Name: Whipworm
Habitat: Large Intestine/Colon
Final host: Man
Diagnostic stage: Ova found in stool
Infective Stage: Embryonated egg
MOT: Ingestion of Embryonated Egg (Fecal-oral)
MORPHOLOGY

Adult
Flesh colored or pinkish gray worms, slender or attenuated in the anterior
Anterior is attenuated and slender resembling a whip
Egg
Barrel-shaped (Football-shaped) with Bipolar Mucus Plug
Prominent hyaline polar plug
Resembling Japanese Lantern
SYMPTOMS AND PATHOLOGY
Diarrhea due to chronic , Hypoalbuminemia , Iron Deficiency Anemia
- Due to chronic impairment of host’s nutritional status
Anemia
- Due to ulceration of the intestine resulting from heavy worm burden Anemia is less frequent than hookworm]

Prolapse of the anus and the rectum

- Due to frequent loose bowel movement resulting to the loss of muscle tone of the anal sphincter could also resort
to bleeding thus aggravates the anemia
Appendicitis
- Due to invasion of Trichiuris

LIFE CYCLE
o The unembryonated eggs are passed with the stool
o In the soil, the eggs develop into a 2-cell stage
o An advanced cleavage stage
o Then they embryonate
o Eggs become infective in 15 to 30 days. After ingestion (soil-contaminated hands or food), the eggs hatch in the
small intestine, and release larvae
o That mature and establish themselves as adults in the colon
o The adult worms (approximately 4 cm in length) live in the cecum and ascending colon. The adult worms are fixed
in that location, with the anterior portions threaded into the mucosa. The females begin to oviposit 60 to 70 days
after infection. Female worms in the cecum shed between 3,000 and 20,000 eggs per day. The life span of the
adults is about 1 year.
TREATMENT
o Albendazole Dose
à 400 mgs single dose
o Mebendazole Dose
à 500 mgs single dose or 100 mgs twice a day for 3 days
o Oxantel-Pyrantel Dose
à 10-20 mgs per kg/body weight single dose

Capillaria philippinensis
Common Name: Pudoc worm: Pudoc disease/ Mystery disease
From Pudoc, llocos Sur
Close relative of Trichuris trichiura
Habitat: Small Intestine
ZIPAGAN | BSPH 2026
Final host: Man
Natural Host: Migratory Birds (Final Host in the environment) Intermediate Host: Freshwater fish/ Brackish water fish
Ipon (Hypselotris bipartita), Birot, Bagsang, Bagtu
Diagnostic Stage: Larva and/or Ova found in stool
Infective Stage: Larval stages found in the infected fish
MOT: Ingestion of raw undercooked fish/ seafood bearing the infective larva
MORPHOLOGY
Adult
à Delicate tiny worms
à Male with chitinized spicule
à Females usually have eggs in utero
Egg
à With bipolar mucus plugs, striated and smaller than T. trichiura egg
à Guitar, peanut-shaped
à To differentiate from Trichuris trichiura egg
• a smaller and striated
• mucus plugs are not as protruded
à Typical Egg
• immature eggs
• unembryonated eggs
• Will go to stool
• will go to fresh water where the embryonation process occur
• eaten by fish
à Atypical Egg
• segmented egg
• embryonated egg
• hatch inside the small intestine
• responsible for autoinfection (similar to S. stercoralis)
SYMPTOMS AND PATHOLOGY
o Malabsorption
o Steatorrhea
o Borborygmi: Peculiar abdominal gurgling sound
o LBM alternating with constipation (abdominal pain and diarhea)
LIFE CYCLE

o Typically, unembryonated, thick-shelled eggs are passed in the human stool

o And become embryonated in the external environment in 5—10 days
o After ingestion by freshwater fish, larvae hatch, penetrate the intestine, and migrate to the tissues
o Ingestion of raw or undercooked fish results in infection of the human host.
o The adults of Capillaria philippinensis are very small (males: 2.3 to 3.2mm; females: 2.5 to 4.3 mm) and reside in the
human small intestine, where they burrow in the mucosa

o In addition to the unembryonated, shelled eggs which pass into the environment, the females can also produce eggs
lacking shells (possessing only a vitelline membrane) which become embryonated within the female’s uterus or in the
intestine. The released larvae can re-invade the intestinal mucosa and cause internal autoinfection
o This process may lead to hyperinfection (a massive number of adult worms).

LABORATORY DIAGNOSIS
o By finding characteristic
à eggs
à larvae
à adult worms in stool

o eggs can readily be seen in a simple fecal smear

à concentration technique acid ether or formalin ether method
TREATMENT
o Mebendazole
à Dose: 200 mgs twice daily for 20 days
o Albendazole
à Dose: 400 mgs daily for 60 days
HOOKWORM
Second most common heliminthic infection reported in humans
known to have a worldwide distribution with two species known to infect humans:
à Ancylostoma duodenale: Old World Hookworm (2 pairs of teeth)
à Necator americanus: American hookwom, American murderer or New World hookworm (semilunar cutting plate)
***Ancylostoma braziliense: Cat Hookworm (2 pairs of teeth)
****Ancylostoma caninum. Dog Hookworm (3 pairs of teeth)
Habitat: Small Intestine
Final host: Man
Diagnostic Stage: Egg/Larva
Infective Stage: Filariform Larva (Sheathed)

ZIPAGAN | BSPH 2026

MOT: Skin Penetration (direct penetration) (e.g. unprotected feet
MORPHOLOGY
Adult
Hookworm N. americanus A. duodenale
Common Name Old World Hookworm New World Hookworm
American Murderer
Shape S-shaped C-shaped
Buccal Cavity Semilunar Cutting Plate 2 pairs of teeth
Copulatory Bursa Bipartite (2 digits) Tripartite (3 digits)
Barbed/ Bristle like Simple, Not Barbed

Eggs
à Same for all species (indistinguishable)
à Ovoidal, thin-shelled and colorless
à Inside is a gem cell in fragmentation: 2-8 Blastomeres
à "Morula ball" formation
Larva
L1 Rhabditiform Larva L3 Filariform Larva
1st Stage larva 2nd Stage Larva
Short and Stout Long and Slender
Open Mouth: Feeding Stage Closed mouth: Nonfeeding Stage

Long Buccal Cavity Sheathed, Pointed Tail

Short/Small Genital Primordium

SYMPTOMS AND PATHOLOGY

o Larval Penetration
à Human Hookworm
• Allergic Reaction
§ Ground itch/ Dew itch/ Water sore/ Mazza Mora
§ Severe itching at the site of larval penetration of skin
§ Erythematous popular rash
à Animal Hookworm
• Creeping eruption or Cutaneous Larva Migrans (CLM)
o Larval Migration
à Heart-Lung Migraion (ASH): pneumonitis
à Pulmonary Lesions and Hemorrhage: Wakana disease
à Pneumonia and alveolar hemorrhage, bloody sputum
o Adult
à Tissue damage at the site of attachment
à Enteritis and Pain; blood loss and anemia
à Chronic blood loss
• Iron Deficency
• Anemia Microcytic Hypochromic Anemia
à Acute gastrointestinal phase demonstrates increased eosinophilia

LIFE CYCLE
o Eggs are passed in the stool
o And under favorable conditions (moisture, warmth, shade), larvae hatch in 1 to 2 days and become free-
living in contaminated soil. These released rhabditiform larvae grow in the feces and/or the soil
o And after 5 to 10 days (and two molts) they become filariform (third-stage) larvae that are infective
o These infective larvae can survive 3 to 4 weeks in favorable environmental conditions. On contact with
the human host, typically bare feet, the larvae penetrate the skin and are carried through the blood
vessels to the heart and then to the lungs. They penetrate into the pulmonary alveoli, ascend the
bronchial tree to the pharynx, and are swallowed
o The larvae reach the jejunum of the small intestine, where they reside and mature into adults. Adult
worms live in the lumen of the small intestine, typically the distal jejunum, where they attach to the
intestinal wall with resultant blood loss by the host
o Most adult worms are eliminated in 1 to 2 years, but the longevity may reach several years.

LABORATORY DIAGNOSIS
o Primary means is by recovery of the eggs in stool samples
o Larvae may mature and hatch from the eggs in stool that has been allowed to sit at room temperature w/o
additive fixatives
o Recovery and examination of the buccal capsule is necessary to determine the specific hookworm organism
o Reverse enzyme immunoassay for specific Ige
TREATMENT
o Drugs of choice : mebendazole or pyrantel pamoate
o For asymptomatic infections: iron replacement and/or other dietary therapy (proteins, iron, vitamins)
PREVENTIVE MEASURES
ZIPAGAN | BSPH 2026
 o proper sanitation
o fecal disposal
o prompt treatment
o personal protection

Strongyloides stercoralis
Smallest nematode infecting man
Can be free-living organism
Facultative nematode
à Free living: Soil
à Parasitic (Female): Small Intestine
***Female worms are capable of Parthenogenesis/ self-fertilization
Habitat: Small Intestine
Final host: Man
Diagnostic Stage: Rhabditiform/Filarifom larva [egg signifies heavy infection]
Infective Stage: Filariform Larva (unsheathed)
MOT: Skin Penetration; Internal Autoinfection: Chronic and hyperinfection
MORPHOLOGY
Larva
Hookworm Threadworm
L1 Rhabditiform Larva
Buccal Cavity Long Short
Genital Primordium Small/ Inconspicuous Prominent/ Conspicuous
L3 Filariform Larva
Sheath Sheathed Unsheathed
Tail Pointed Notched

Eggs
à Rarely found; diagnosed as "Hookwom egg" (indistinguishable)
• slightly smaller than hookworm egg, well-developed larvae almost always contained in the egg
à Chinese Lantern Appearance
SYMPTOMS AND PATHOLOGY
o Strongyloidiasis, Cochin-China Diarrhea
o Larval Penetration: Allergic Reaction at the site of larval penetration "Larva Currens" tracks under skin from worm
migration
o Larval Migration: Heart-Lung Migration → Pneumonia (signs and symptoms resembling bronchopneumonia)
o Adult Cochin China Diarrhea, Vietnam Diarrhea (Intermittent Diarhea)
****Honeycomb appearance of the intestinal mucosa
Autoinfection (Internal): Infective larva will penetrate the intestinal mucosa

LIFE CYCLE

Free living life cycle

o Rhabditiform larvae are passed in the stool of an infected definitive host
o Develop into either infective filariform larvae (direct development) or free-living adult males and females
o That mate and produce eggs
o From which rhabditiform larvae hatch
o And eventually become infective filariform (L3) larvae
o The filariform larvae penetrate the human host skin to initiate the parasitic cycle
o This second generation of filariform larvae cannot mature into free-living adults and must find a new host to continue
the life cycle.
Parasitic cycle
o Filariform larvae in contaminated soil penetrate human skin when skin contacts soil
o And migrate to the small intestine
o It has been thought that the L3 larvae migrate via the bloodstream and lymphatics to the lungs, where they are
eventually coughed up and swallowed. However, L3 larvae appear capable of migrating to the intestine via alternate
routes (e.g. Through abdominal viscera or connective tissue). In the small intestine, the larvae molt twice and become
adult female worms
o The females live embedded in the submucosa of the small intestine and produce eggs via parthenogenesis (parasitic
males do not exist)
o Which yield rhabditiform larvae. The rhabditiform larvae can either be passed in the stool or
o Can cause autoinfection
LABORATORY DIAGNOSIS
o Diagnostic eggs, often indistinguishable from those of hookworm, may be present in stool suffering from
severe diarrhea
o Stool concentration with zinc sulfate has successfully recovered these eggs
o Rhabditiform larvae may be recovered in fresh stool samples and duodenal aspirates
o Careful screening of feces is necessary to differentiated rhabditiform larvae of hookworm from Strongyloides
o Enterotest and ELISA
o Sputum samples have yielded Strongyloides larvae in patients suffering from disseminated disease
ZIPAGAN | BSPH 2026
TREATMENT
o Thiabendazole although not always
successful Strongyloides fulleborni – SWOLLEN BODY SYNDROME
o Alternative medications include: o A piarate parasite, has been isolated from human in
albendazole and ivermectin Africa and causes a severe life- threathening condition
called “SWOLLEN BODY SYNDROME”

Trichinella spiralis
o Common name: Muscle worm, Trichinia worm
o Highest Elevation Of Eosinophils (Eosinophilia) are seen in Trichinosis
o All stages of development, including the adult and larval stages, occur within a single host
o Causes Trichinosis/Trichiniasis/Trichinellosis
o Great Imitator – mimics other diseases (Great imitator in Bacteriology or Immunology & Serology - Treponema
pallidum, causative agent of syphilis
Habitat: Small Intestine (Adult)
Encysted in striated muscle (skeletal muscle) (Larva)
Final host: Pigs and other mammals that are omnivorous or carnivorous
Man: Accidental host
Diagnostic Stage: Encysted larva (Muscle biopsy)
Infective Stage: Encysted larva
MOT: Ingestion of undercooked/ raw meat with encysted larva
MORPHOLOGY
o Larvae
à Has spear-like burrowing tip at its tapering anterior end
à Size: 80-120 µm by 5.6 µm by birth
à Encysted/Encapsulated
à settle by coiling up in muscle fibers; a striated muscle cell, known as nurse cell, surrounds the coiled larva
à Have digestive tract with underdeveloped reproductive tract
o Adults
à Rarely been seen
à Small worms; males - 0.62 to 1.58 mm by 0.025 to 0.033 mm; females - 1.26 to 3.35 mm by 0.029 to 0.038 mm
à Males have conical papillae (aids in copulation) while females have club-
shaped uterus

SYMPTOMS AND PATHOLOGY

o Intestinal phase
à Inflammation of duodenal and jejunal mucosa: malaise, nausea, diarrhea, abdominal cramps
o Stage of muscle invasion
à Fever, facial edema, muscle pain, swelling and weakness, peripheral eosinophilia
à Less common symptoms
• Headache, flushing of face, conjunctivitis, pruritus, diaphoresis, anorexia, thirst
à Damage on muscle may cause difficulty in:
• Eye movement, breathing, chewing, swallowing, speech, movement of extremities
à Myocarditis
• Appear as early as the second week, but more often after the third week
• Death from myocarditis usually occurs between fourth and eighth week of infection
• Encephalitis and meningitis may also occur at this stage
o Stage of convalescence
à End of the third week of infection where encapsulation is seen

LIFE CYCLE
o The infective encysted larvae enter the host through ingestion of raw or insufficiently cooked meat.
o The cysts are digested in the stomach, and the larvae excyst either in the stomach or in the small
intestine.
o The larvae then burrow into the subepithelium of the villi where they undergo four molts.
o Maturation takes about 2 days, and adult worms begin to mate 5 to 7 days post infection. The female
produces eggs that grow into larvae in its uterus.
o After a few days, the female worm deposits larvae in the mucosa. The larvae penetrate the mucosa, pass
through the lymphatic system into the circulation, and finally into striated muscles. In the muscles, the
larvae grow and develop.
o After about 3 weeks, they start to coil into individual cysts. Encapsulation is completed 4 to 5 weeks after
infection. The larva in the cyst remains viable for many years

LABORATORY DIAGNOSIS
Clinical diagnosis
à History of eating raw or inadequately cooked or improperly processed meat, usually pork
à History of intestinal flu or rheumatic pain
à Marked eosinophilia in blood
à Swollen eyelids or severe conjunctivitis
à ↑ muscle enzymes such as lactate dehydrogenase (LDH), aldolase, Creatine kinase (CK)
o Specific diagnosis: 4B
ZIPAGAN | BSPH 2026
 à Muscle Biopsy – free larvae or encysted larvae in skeletal muscle
à Bentonite flocculation test
• diagnostic also for Echinococcus granulosus
à Bachmann intradermal test
à Beck’s Xenodiagnosis
• Test animals include albino mice/rats
• Also applicable for Trypanosoma cruzi

TREATMENT
o No established treatment
o Thiabendazole
à Dosage: 50 mg/kg body weight
à Effect:
• May prevent the appearance of symptoms if given from the second day after ingestion of infected meat
• Greatly mitigate the illness if the drug is given between the fifth and ninth day after ingestion
à ACTH corticosteroid
• Treatment of allergic reaction
à Mebendazole
• Lethal effect
FILARIAL WORMS
Subdivided into three groups based on anatomic location at which they cause pathology (Habitats)
à Subcutaneous - Loa loa, Mansonella streptocerca, and Onchocerca volvulus
à Serous cavity (Pleural, pericardial, and peritoneal) – Mansonella spp.
à Lymphatic – Wuchereria bancrofti, Brugia malayi, and Brugia timori
Final host: Man
Diagnostic Stage: microfilariae in the blood film (except Onchocerca volvulus microfilaria – found in skin snips)
Infective Stage: L3 filariform larvae
MOT: Bite of infected Arthropod vector such as mosquito, midge, or fly
o Exhibits Periodicity
à Rhythmical pattern of vector feeding
à Time wherein blood specimens yield abundant microfilariae
• Periodic – only specific time where parasites are found in the blood
• Diurnal periodic – 10 am to 2pm
• Nocturnal periodic – 10 pm to 2 am
• Subperiodic – parasites can be found anytime in the blood but are abundant in specific time
§ Diurnal subperiodic – 10 am to 2pm
§ Nocturnal subperiodic – 10 pm to 2 am
• Nonperiodic – parasites can be found anytime in the blood in abundance
SYMPTOMS AND PATHOLOGY
o Acute Lymphatic filariasis
à Worms residing into the lymph nodes which results to swelling, lymphangitis, and lymphedema

o Elephantiasis
à Crippling condition which results from extended periods of filarial infection.
à Worms obstruct the lymphatic vessels, causing fibrosis and proliferation of dermal and connective tissue,
resulting in the wrinkled, dry appearance of an
“elephant” extremity
o Hydrocele formation
à Fluid-filled sac within the scrotum, causing enlargement of testis
à May occur when adult worms block the retroperitoneal or subdiaphragmatic lymphatic vessels
o Chyluria
à Results from lymphatic rupture and fluid entering urine
à Urine clarity: MILKY or OPAQUE
o Kokei syndrome
à Results when both Wuchereria bancrofti and Brugia malayi are present
o Calabar swelling
à Transient swelling of subcutaneous tissues
o Occult filariasis
à With pulmonary or asthmatic symptoms
à No microfilariae found in the blood
à Hidden deep in the body such as lungs
LIFE CYCLE
o Applies to all filarial worm
o The infective larval stage resides in the insect vector with the adult worm stage, which is the pathogenic form in humans.
o When the arthropod vector feeds on a human blood meal, the infective larvae are injected into the bloodstream.
o The larvae are motile and migrate to the lymphatic vessels. The infective larvae grow and develop into the adult gravid
worm in the human host over a period of months.
o The male and female adult worms mate in the definitive human host. The female worm produces large numbers of
larvae called microfilariae.

Wuchereria bancrofti
o Common name: Bancroft’s filarial worm
o MOST COMMON IDENTIFIED SPECIES of filarial worms that infect humans
o Common associated disease: Bancroft’s filariasis or elephantiasis
o Infects lower lymphatics

ZIPAGAN | BSPH 2026

Brugia malayi
o Common name: Malayan filarial worm
o Common associated disease: Malayan filariasis or elephantiasis
o Infects upper lymphatics

Cephalic space As long as wide Longer than wide

Arrangement of the Somatic cells Discrete and separate (not Numerous and overlapping
overlapping)
Rectal portion Ovoid in one end At the center
Microscopic view Sexy curves Secondary curves/Kinky curves
Terminal nuclei Absent/nuclei-free tail Two terminal nuclei
Movement Graceful/smooth Kinky/stiff appearance
Presence of Sheath Present Present

Loa loa
o Common name: African eye worm
o Common associated disease: Loiasis
Onchocerca volvulus
o Common name: Blinding filarial worm
o Common associated disease: River blindness
Mansonella ozzardi
o Common name: New world filaria
o NONPATHOGENIC

Mansonella perstan
o Common name: Perstans filaria
o Other names: Dipetalonema perstans, Acantholeinema perstans
o NONPATHOGENIC
Mansonella streptocerca
o Known for its tail as Shepherd’s Crook in appearance (in Protozoans, Shepherd’s Crook – Chilomastix mesnili)

Filarial Diseases Habitat Vector Specime Microfilaria Periodicity

worm n
W. bancrofti Lymphadenitis Lower Aedes, Blood Sheathed, nuclei Nocturnal
Chyluria lymphatics Anopheles, absent in tail periodic
Hydrocele Culex
B. malayi Malayan Upper Mansonia Blood Sheathed, tail Nocturnal
filariasis lymphatics spp., with 2 separate subperiodic
Anopheles nuclei
L. loa Fugitive Subcutaneous Chrysops Blood Sheathed, nuclei Diurnal
swelling, tissues spp., continuous up to
Calabar Tabanid fly, the tip of the tail
swelling, Deer fly,
Eosinophilia Mango fly
(30-80%)
O. volvulus River blindness, Subcutaneous Simulium Skin Unsheathed, Nonperiodic
conjunctivitis tissues spp., Blackfly snips/sha nuclei absent in
vings tail
M. ozzardi none Body cavities Culicoides Blood Unsheathed, Nonperiodic
spp. nuclei absent in
tail
M. perstans Perstans Body cavities Culicoides Blood Unsheathed, Nonperiodic
filariasis spp. nuclei up to the
tip of the tail

LABORATORY PROCEDURES
o Giemsa stained blood – Method of choice for determination of microfilariae
o Finger puncture
o Wet blood smear
à Drop of blood + 3% acetic acid (HAc) (to lyse RBCs)
à Advantage: Parasite present is alive
à Disadvantage: Temporary mount and easily dries up
o Stained thick blood film
à Same with malarial diagnosis
à Films are dehemoglobinized (lysis of RBCs) prior to staining
à 2 thick blood films and Stain with Giemsa
à Used for further study
o Capillary Tube method
à Uses heparinized capillary tube (3/4 full)
à After centrifugation, plasma, packed cell volume (hematocrit), and buffy coat (contains WBCs, platelets, and
microfilaria) are separated, both ends on a glass slide are taped and examined microscopically
o Knott’s Concentration Technique
à Done if few microfilariae are present in the blood
ZIPAGAN | BSPH 2026
 à For isolation of microfilaria
à 1 mL venous blood + 3-5% (2%) formalin acidified with acetic acid (HAc) -> centrifuge 500 x g for 1 minute,
decant the supernatant and draw the sediment -> Smear the sediment and Stain with Giemsa
§ Formalin – preserves the specimen and kills microfilaria in an outstretch manner
§ Acetic acid – lyses RBCs
o Millipore/Membrane filtration technique
à Makes use of special filter that will allow the passage of RBC but not WBC and microfilariae
TREATMENT
o Ivermectin and diethylcarbamazine
MISCELLANEOUS NEMATODES
Dirofilaria immitis

o Common name: Dog heartworm

o A very common filarial parasite of dogs
o Almost all human infections come to medical attention as solitary, peripheral nodules in the lungs (COIN
LESION APPEARANCE), or as subcutaneous nodule
Dracunculus medinensis
o LONGEST NEMATODE OF MAN up to 1 meter
o Common name: Guinea worm, FIERY SERPENT OF THE ISRAELITES, Dragon worm, Serpent worm
o Characteristics: Thick cuticle and a large uterus that fills the body cavity and contains rhabditoid larvae
o Habitat: Subcutaneous tissue (varicose veins) - Subcutaneous infection: Drancunculiasis
o Said to be part of the symbol of medicine wherein it is the snake intertwining the rod of Cauduceus
o Intermediate host: Aquatic crustaceans (Copepods) – Cyclops (Also the 1st Intermediate host in Diphyllobothrium
latum)
o Mode of transmission: ingestion of infected copepods
o NO TREATMENT; ONLY REMOVAL OF THE PARASITE
o Worms are attached to a stick and slowly retracted from the host by gradual turning of the stick and removal of the
worm
o Care must be taken when turning the stick as it may cut the worm if spinning the stick is done rapidly
Life cycle
o Humans are infected by the ingestion of freshwater from stagnant ponds containing larvae-infected copepods. The
copepods are digested in the stomach, releasing the larvae. The larvae penetrate the small intestine and migrate
through the thoracic musculature. Both adult male and female worms mature in approximately 2 to 3 months. The gravid
female develops in approximately 10 to 14 months, migrating to the lower extremities. The gravid female produces a
blister on the skin, and when the host submerges the affected area in water, the blister erupts and releases larvae into
the water.
Parastrongylus cantonensis
o Previously known as Angiostrongylus cantonensis
o Common name: Rat lungworm
o Causes CEREBRAL ANGIOSTRONGYLIASIS (Migrates to the brain and spinal cord, causing Eosinophilic
meningoencephalitis)
o Definitive host/Natural host: RATS (Rattus rattus and Rattus vorvegleus)
o Intermediate host: Mollusks – Snail
o Pila luzonica (Kuhol)
o Brotia asperata (Suso)

o Incidental host: Man

o Mode of transmission: Ingestion of intermediate host by man containing infective larvae
o Adult female worm: Barber’s pole appearance; looping of whitish uterus to the red digestive tract
o Symptoms and pathology
o Eosinophilia and symptoms of meningitis (CSF contains increased WBC plus high number of eosinophils)
o Laboratory
o ↑ Eosinophil count in CSF
Parastrongylus costaricensis
o Found primarily in the cotton rat and black rat
o Causes Abdominal Angiostrongyliasis
o Larvae create inflammatory lesions in the walls of the bowel, resulting in tissue inflammation, necrosis,
vomiting and diarrhea
o Patient may experience lower right quadrant. Abdominal pain is similar to that manifested in
appendicitis
o Mode of transmission: ingestion of salad contaminated with infected slugs or snails

Anisakis spp.
o Common name: Herring’s worm, Fish and Mammal roundworm
o Common in Japan
o Causes Herring’s disease
o Abdominal pain and Granuloma around migrating larva in the intestinal wall
o Definitive host: Whales/Dolphins
o 1st intermediate host: Copepods
o 2nd intermediate host: Smaller fishes
o 3rd intermediate host: Larger fishes (Salmon)
o Mode of transmission: ingestion of raw fish infected with larva (sashimi)
Toxocara cati and Toxocara canis
o Toxocara canis – intestinal Ascarid of dogs

ZIPAGAN | BSPH 2026

 o VISCERAL LARVA MIGRANS
o Larva will hatch but will not mature into adults
o Toxocara cati – intestinal Ascarid of cats
o Ocular Larva Migrans

ZIPAGAN | BSPH 2026