CLINICAL PARASITOLOGY LAB –  DANGER – a state or condition in

INTRODUCTION which personal injury and/or asset

damage is reasonably foreseeable.
 Also known as a “risk”, dangers
LABORATORY SAFETY
link hazards to humans,
 The goal of lab safety is to keep lab producing accidents.
workers and patients safe.  BIOSAFETY – prevention of
 UNIVERSAL PRECAUTIONS – accidental release of biological
infection control guidelines designed agent.
to protect workers from exposure to  BIOSECURITY – prevention of
diseases spread by blood and intentional release of biological
body fluids. agent.
 Assume all fluids are infectious.  Potential hazards in the clinical
 Assume that all patients are laboratory include:
infectious.  Blood
 STANDARD PRECAUTIONS –  Biological agents in blood
common sense practices used to  Chemicals
protect healthcare providers and  Physical hazards
patients from infection.
 Refers to the care of all patients
irrespective of their disease CHEMICAL LABELING
state.
 Examples include color-coding
garbage disposal,
handwashing, cleaning, and
recapping needles.
o For garbage disposal,
yellow is for infectious
while black is for dry.
o Handwashing is THE
MOST IMPORTANT PART
of SP.
o Surfaces: (1:100) diluted
bleach
o Blood: (1:10) diluted bleach

 TRANSMISSION BASED
PRECAUTIONS – used in addition to
SP when patients already have
confirmed/suspected infections.
 Each type of transmission has
recommended PPE. MICROSCOPY TERMINOLOGY
o Airborne, Droplet, and
Contact Precautions  FOCUSING – adjustment of distance
 HAZARD – a potential source of between the objective lens and the
harm. specimen; aims to produce a virtual
or floating image.
 PARFOCAL – no change has to be  Helminths are commonly found in:
made during shifting of objectives. 1.) Contaminated soil/Soil-
 FIELD OF VISION – area seen transmitted (S. stercoralis, A.
through microscope. lumbricoides, Hookworm)
 WORKING DISTANCE – distance 2.) Water (Blood flukes/Cercariae,
between the lens and microscope Schistosoma)
slide; higher magnification = shorter 3.) Undercooked/Contaminated
working distance. food (Tapeworms such as
 NUMERICAL APERTURE – the Taenia spp.)
measurement of the condenser and 4.) Insect vectors/Arthropods
objective lens’ ability to gather light’ (Filarial worms such as W.
higher magnification of objective = bancrofti)
larger numerical aperture. 5.) Wild animals (Echinococcus
 REFRACTIVE INDEX – measure of a spp.)
medium’s light-bending ability; to 6.) Human hosts (Enterobius,
obtain a clear and finely detailed Hymenolepis)
image under a microscope, a
specimen must sharply contrast with HELMINTH CLASSIFICATIONS
the medium.
 NEMATODES (Roundworms)
 Multicellular, round/cylindrical
HELMINTHS and non-segmented bodies
 Complete digestive system
MEDICAL HELMINTHOLOGY o Enterobius vermicularis
 D-shaped ova
 Study of helminths and how they o Strongyloides stercoralis
affect human health. o Hookworm
 These organisms are considered o Ascaris lumbricoides
metazoas, or multicellular
organisms.  TREMATODES (Flukes)
 Distributed worldwide; present  Multicellular, flat and non-
significant morbidity and mortality, segmented bodies
especially in developing countries.  Incomplete digestive system (no
 ANEMIA and MALNUTRITION are anus)
among the major diseases they  Bilaterally symmetrical
cause.
 Lead to weakened immunity  CESTODES (Tapeworms)
and QOL.  Multicellular, flat and segmented
bodies
HELMINTH RESERVOIRS  No digestive system
 Rely on host absorption
 Helminths inhabit different reservoirs o Echinococcus
depending on the species. o Taenia solium
 May thrive either in the
environment or require hosts
through their life cycles.
PHYLUM ASCHELMINTHES: CLASS DIGESTIVE SYSTEM
NEMATODA
 Complete, equipped with the
following:
GENERAL MORPHOLOGY  Mouth and anus
 Bilaterally symmetrical, elongated,  Buccal cavity
non-segmented and cylindrical in  Esophagus (bulb-like structures)
shape.  Pharynx (often muscular and
 Presence of pseudocoel (body observe triradiate symmetry)
cavity between body wall and  Intestines
digestive tract)  Rectum
 Lined by muscle fibers  Mouths can have spines, hooks, and
 Contains viscera and cutting plates which they use for
digestive/excretory/nervous/repr attachment and penetration.
oductive systems.
 Nematodes possess an innermost LIFE CYCLES
layer called a hypodermis and wall
musculature.  Nematodes life cycles consist of an
 Have tough protective coverings egg stage, 3-4 larval stages (L1-
called a cuticle made of chitin. L4), and an adult stage.

SEXES AND REPRODUCTION INTESTINAL NEMATODES

 Have separate sexes (male and 1.) Ascaris Lumbricoides

female), which are distinguished by  Ova can come in various forms;
size and tail shape. can be corticated, decorticated,
 FEMALES: larger, with straighter or fertilized.
tails. 2.) Trichuris Trichiura
 MALES: smaller, with more  Football/Sisig plate-shaped ova
coiled tails. 3.) Hookworm
 Female nematodes can produce  Can inhibit animal and human
offspring through different means: hosts.
 OVIPAROUS – lays eggs  Can only be differentiated
externally which hatch outside of through their larval forms.
the body (ex. A. lumbricoides) 4.) Strongyloides stercoralis
 LARVIPAROUS – bears larvae 5.) Enterobius vermicularis
instead of eggs. (ex. Trichinella 6.) Capillaria philippinensis
spiralis) TISSUE NEMATODES
 OVOVIVIPAROUS – females lay
eggs inside their own bodies, 1.) Wuchereria bancrofti
which hatch and develop inside 2.) Brugia malayi
them (ex. W. bancrofti) 3.) Parastrongylus cantonensis
 PATHENOGENETIC – asexual 4.) Trichinella spiralis
reproduction (ex. S. stercoralis, 5.) Anisakis spp.
through free-living cycle) 6.) Toxocara canis/cati
7.) Dracunculus medinensis
 8.) Other filarial worms  MORPHOLOGY: possesses a
triradiate/trilobite set of lips with a
central buccal cavity.
SOIL-TRANSMITTED HELMINTHS
 1 dorsal lip, 2 ventrolateral lips
 MAN is the only host.
 Develops in the soil.
 Transmitted via soil medium either
through:
 Ingestion of embryonated egg
o Uncooked or dirty food
o Contaminated water
o Children with soiled hands
 Skin penetration by infective
larvae
 “THE UNHOLY TRINITY”/H.A.T. –
Hookworm, Ascaris, and Trichuris Male and female adult Ascaris
lumbricoides

HABITATS IN THE HOST

 SMALL INTESTINE
 Ascaris, Hookworm,
Strongyloides
o Ascaris larvae can
migrate to different
organs such as the liver
and even the brain.
 LARGE INTESTINE
 Trichuris trichiura

ASCARIS
ASCARIS LUMBRICOIDES MALE FEMALE
Length 15-31cm 22-35cm
Common Name Giant Intestinal
Color Creamy white-pink
Roundworm
Traits  2 spicules  Pencil
Final Host Man
for holding lead
Habitat Small intestine
onto thickness
Diagnostic Stage Unfertilized/Fertilized
females  Straight
egg (seen in fecal during posterior
smear)
copulation ends
Infective Stage Embryonated egg
 Curved  Oviparous
MOT Ingestion
straight  “Genital
Portal of Entry Mouth posterior girdle”
Treatment Drug of Choice: end (constricted
Mebendazole  Smooth vagina at
Alternative: striated posterior
Albendazole cuticle 2/3rds)
DECORTICATED UNFERTILIZED EGG

 SIZE: 85-95um by 38-45um

 SHAPE: cylindrical, longer and
narrower
 EMBRYO: unembryonated;
amorphous mass of protoplasm;
smooth outer shell

CORTICATED UNFERTILIZED EGG

 SIZE: 88-94um by 39-44um
 SHAPE: longer and narrower
 EMBRYO: Irregular outer shell;
absence of fertilizing membrane;
thinner chitinous layer and
albuminous coat
 CONTENTS: coarse refractile
granules known as “Lecithin”

FERTILIZED EGG
 Has 3 main layers:
1.) Inner non-permeable, lipoidal
vitelline membrane
2.) Thick transparent middle layer
or glycogen membrane
3.) Outermost coarsely
mamillated, albuminoid layer
 CORTICATED FERTILIZED
 SIZE: 40-75um by 30-50um
 SHAPE: rounder than unfertilized
version
 EMBRYO: undeveloped unicellular
embryo with thicker chitin shell
(“ascaroside”)
 CORTICATED: presence of
mamillated albuminous material
stained brown by bile.

DECORTICATED FERTILIZED EGG

 EMBRYO: undeveloped unicellular
embryo with thicker ascaroside
 DECORTICATED: mamillated
albuminous material stained brown
by bile

ABOUT CORTICATION AND FERTILIZATION

 IF CORTICATED = irregular/bumpy outer shell
 IF DECORTICATED = smooth outer shell
 IF FERTILIZED = round shape
 IF UNFERTILIZED = oval/oblong shape

ASCARIS: PATHOLOGY AND CLINICAL MANIFESTATION

1.) Reaction to Migrating Larvae
 Pulmonary manifestations (Heart-lung migration)
 Asthmatic-like attacks
 Ascaris pneumonitis
 Loffler’s syndrome
 2.) Adults in Duodenum/Jejunum
 Feed on nutrients
3.) Wandering Adult Worm
 Erratic behavior
 Intestinal obstruction
 Acute appendicitis
 Biliary ascariasis
 Multiple abscesses
 Acute pancreatitis
 Peritonitis
 Intestinal ascariasis

ASCARIS: DIAGNOSIS
1.) Clinical Signs and Symptoms
 Vague; only confirmed by lab diagnosis.
 Diagnostic: passing out of Ascaris
2.) Gross Examination
3.) Laboratory-Stool Examination
 Direct fecal smear
 Concentration techniques (ex. Kato-Katz, Kato-Thick)
4.) Other Specialized Techniques
 Direct examination of sputum for larvae (in case of Ascaris pneumonitis)
 Serology for extraintestinal ascariasis

ASCARIS: TREATMENT, PREVENTION AND CONTROL

 Individual Infections
 Single dose of broad spectrum anthelmintics
o Albendazole (400mg as single dose)
o Mebendazole (500mg as single dose)
o Pyrantel pamoate (10mg/kg as single dose; max of 1g)

 Other Drugs
 Nitazoxanide, Ivermectin

 Community
 3x per year for 3 years
 Mass treatment for reinfection
 Selective treatment for targeted groups such as positive patients or children
 Proper disposal of fecal waste
TRICHURIS TRICHIURA

TRICHURIS
Common Name Human whipworm
Final Host Man
Habitat Large intestine (attaches at
cecum)
Female Adult Oviparous
Classification
Diagnostic Stage Egg
Infective Stage Embryonated egg
MOT Ingestion
Portal of Entry Mouth
Treatment Mebendazole
Adult Characteristics  2.5-5cm long
 Pinkish-grey in color
 Anterior end is whip-
shaped and colorless
 Slender esophagus
 Adult attaches at colon
 Causes rectal prolapse
 Released into soil as
unembryonated eggs
Egg Characteristics  Egg shape described as
barrel, Japanese
lantern, lemon,
football, or sisig plate
 Hyaline plugs/bipolar
mucus plugs found at
opposite ends of the egg
 50-55um by 25um in
size
 Shell is smooth, yellow-
brown (because of
contact with bile) and
unstriated
o Transparent inner
shell, yellowish
outer shell
 Unicellular with
undeveloped embryos
 Eggs can grow in soil
(“Advanced Cleavage
Stage”)
 Susceptible to
desiccation; moisture-
dependent
Diff. Between Male and  Females are larger than
Female males
  Males have coiled
posterior ends while
females have straight
posterior ends

TRICHURIASIS: PATHOLOGY AND CLINICAL MANIFESTATION

1.) Light Infections
 Asymptomatic
2.) Heavy/Chronic Infections
 More than 5k eggs per gram of feces
a) Trichuris dysentery syndrome (rectal prolapse)
b) Blood-streaked diarrhea (abdominal pain, nausea, vomiting, anemia)
3.) Attached on Walls of Large Intestine
4.) Rectal Prolapse
 Loss of muscle tone
 LBM
 Rectum takes cinnamon roll-like appearance
o Entry of Trichuris into rectus sigmoid area causes inflammation, turning the rectum
inside-out
5.) Invasion of Appendix
6.) Prolonged/Chronic Inflammation Leading to Anemia
 Due to lumen of appendix being filled with worms
a) Iron deficiency anemia
b) Weight loss
c) Appendicitis and granuloma formation
d) Hypoalbunemia (correlates with blood loss)
e) In children: poor appetite, wasting, stunting, and recurred intellectual/cognitive
development

TRICHURIS: DIAGNOSIS
1.) Basic Techniques
 DFS (direct fecal smear)
a) Saline
b) Fresh or preserved stool
 Concentration technique
a) Kato-Katz/Thick technique
b) FECT (formalin ether concentration technique)
2.) Other Specialized Techniques
 Examination of rectal mucosa
 a) Proctoscopy
b) Direct (if rectum is prolapsed)

TRICHURIS: PREVALENCE

 Prevalence of 80-84%
 Most infections are light to moderate (usually asymptomatic)
 Worms have long lifespans (2 years)
 Trichuris can lay 60 million eggs in 2 years
 Common among children (5-15 years old)
 More common in tropical areas

TRICHURIS: TREATMENT

 DOC: Mebendazole
 Alternatives include Albendazole and Albendazole with Ivermectin

ENTEROBIUS VERMICULARIS

ENTEROBIUS
Common Name Pinworm, Seatworm, Society
Worm
Final Host Man
Habitat Large intestine
Adult Female Oviparous
Classification
Diagnostic Stage Egg
Infective Stage Embryonated egg
MOT Ingestion, inhalation,
autoinfection, retroinfection
Portal of Entry Oral
Treatment Mebendazole
Adult  Yellowish-white in color
Characteristics  Female pinworms lay eggs in
the anus; eggs will hatch in
the perianal area
o RETROINFECTION:
larvae crawl back into
anus (migration)
o AUTOINFECTION:
ingestion of eggs from
own body (fecal-oral)
 Females can lay around 11k
eggs per day.
 Anterior Portion: contains
“cephalic alae” (AKA cuticular
alars), which act as
chemoreceptors.
  Esophagus: bulb/flask-
shaped
 Larva: tadpole-like
o Rhabditiform larvae have
NO CUTICULAR
EXPANSON on the
anterior end.
Egg  D-shaped egg (lopsided egg)
Characteristics  48-60 by 20-35um in size
(approx. 60x25um)
 Thick, double-layered shell
that can be transparent,
hyaline, or colorless.
o 1ST LAYER: albuminous;
for mechanical protection
o 2ND LAYER: lipoidal; for
chemical protection
 Embryonation: readily
infective 4-6 hours after
deposition
 Larva in Egg: L1
 Resistant to disinfectants
 Susceptible to desiccation
 Eggs can aerosolize and be
transmitted by airborne means
 “Seatworm”: easily spread
through communities
 Causes Pruritus Ani (anal
itching)
 Diagnosed through scotch
tape swabbing (before patient
bathes or during the night)
Diff. Between Male  Males have one spicule and a
and Female coiled posterior end.
 Females are larger and have
straight posterior ends.
 Males are 2-4mm by 0.3mm.
 Females are 7-14mm by
0.5mm.

ENTEROBIUS: PATHOLOGY AND CLINICAL MANIFESTATION

 Transmitted through inhalation or ingestion.

 Retroinfection and autoinfection is possible.
 Pruritus ani is caused by female migration; itching causes insomnia and
restlessness.
 ENTEROBIUS: LABORATORY DIAGNOSIS
 Basic Techniques
 Microscopic examination of perianal swab for eggs
a) Collection ideally done in the morning
b) Done by pressing tape on the perianal skin (scotch tape swabbing)
 Swellengrebel technique
o Pestle with petrolatum or petroleum jelly
 NOTE: at least 7 NEGATIVE SWABS before reporting as negative.
 Eggs
 Occasionally encountered in the urine or vaginal smears
 Adults
 Also diagnostic
 Fingernail swabbing

ENTEROBIUS: TREATMENT

 DOC: Mebendazole
 Secondary DOC: Pyrantel pamoate
 Alternatives: Albendazole
 FOR ENTIRE FAMILY: chemotherapy

HOOKWORMS

 Part of soil-transmitted helminths.

 Rhabditiform larvae: feeding, non-infective form; “open-mouth”, with stout/robust
bodies.
 Filariform larvae: thin, needle-like and infective form; “closed-mouth”.
 Favorite habitat: Sandy soil.
 Enter hosts primarily through skin penetration.
 Larvae enter blood vessels through the skin.
 Larvae then attach to the small intestine’s mucosa or jejunum to suck blood.
 All species can cause anemia.
 Diagnosed through the Harada-Mori technique (culture method).
 Differentiation of hookworms is based on their larval form and dental pattern, not
their eggs.
 When eggs are detected in a specimen, the patient is diagnosed as positive for
hookworm eggs.
 This is done since all hookworm eggs look the same.
 HOOKWORM SPECIES
HUMAN HOOKWORMS ANIMAL HOOKWORMS
Necator americanus (New World Ancylostoma braziliense (Cat
Hookworm) hookworm)
Ancylostoma duodenale (Old World Ancylostoma caninum (Dog hookworm)
Hookworm)
HOOKWORM EGGS
 Eggs have very thin hyaline shells
and contain 2-8 cell stage
blastomeres.
 Eggs are colorless, smooth, and
have bluntly rounded ends.
 Blastomeres can continually
develop in soil and become
embryonated, leading to the
emergence of larvae.

HOOKWORM LARVA
RHABDITIFORM LARVA (L1)
 Feeding stage of hookworm
 SIZE
 Newly Hatched: 270x15um
 5 Days Old: 540-700um long
 FEATURES
 Long, open buccal cavity
 Stout esophagus
 Small genital primordium

FILARIFORM LARVA (L3)

 Infective stage of hookworm
 ESOPHAGUS LENGTH: more
elongated than L1
 TAIL: pointed, used for
penetration
HOOKWORM CHARACTERISTICS
NECATOR AMERICANUS
 Semi-lunar cutting plates
 S-shaped body
 Greyish-yellow with reddish
undertones
 Copulatory bursa has bipartite
dorsal rays.
 Has a barbed spicule.

ANCYLOSTOMA DUODENALE
 2 pairs of teeth
 C-shaped body
 Pinkish or creamy grey in color
 Bell-shaped copulatory bursa with
tripartite dorsal rays.
 Has a bristle-like spicule
 Always larger than N. americanus
 Different from A. braziliense in that
their inner pair of teeth are
smaller.
 Capable of more blood loss than
N. americanus due to larger size
and presence of teeth.
 HOOKWORM CHARACTERISTICS
ANCYLOSTOMA BRAZILIENSE
 2 pairs of teeth

ANCYLOSTOMA CANINUM
 3 pairs of teeth
 Largest mouth among the
hookworms

 NOTE: animal hookworms can inhabit humans as accidental hosts but are
INCAPABLE OF MATURATION inside them.

HOOKWORM: PATHOLOGY AND CLINICAL MANIFESTATION

 Patients have elevated eosinophil levels.

 Have 3 different phases:
1.) Cutaneous phase
 “Creeping eruption”, also known as Cutaneous Larva Migrans (CLM).
 A “ground itch” or “dew itch” manifests at the site of entry due to the entry of
filariform larva.
 Redness, inflammation, and urticaria
 May last 2 weeks
2.) Pulmonary phase
 Occurs in the lungs during larval migration.
 Bronchitis, pneumonitis, and Wakana’s disease
 Diagnosed through examination of sputum.
3.) Intestinal phase
 Microcytic hypochromic anemia in chronic or heavy infections
 Iron deficiency anemia due to blood loss
4.) Other symptoms
 Exertional dyspnea
 Edema
 Albuminuria
 HOOKWORM: LABORATORY DIAGNOSIS
 Stool Examination
1) DFS
 If infection is heavy
2) Kato-Katz
 Not recommended as hookworm eggs are very thin
 Shell disintegration = false negative
3) Concentration techniques
 Ex. Flotac, FECT, zinc sulfate
 Greater specimen amounts are required
4) Harada-Mori technique
 Hatching of larva on filter paper strips, which are dipped in boiled/distilled
water or saline solution.
 Specimens are incubated for 3 days; saline solution is centrifuged and
examined after incubation.
 For species identification and differentiation from Strongyloides
5) Coproculture
6) Baermann technique
7) Molecular methods
 PCR, ELISA

HOOKWORM: TREATMENT
 DOC: Albendazole
 Alternatives include Mebendazole, Pyrantel pamoate
 For patients with severe anemia, raise hemoglobin level
 Give patient ferrous sulfate for 3 months.
 To treat CLM, use topical antihistamines.
 Main prevention method is wearing footwear to avoid skin penetration.

HOOKWORM: RELATION TO TRICHOSTRONGYLUS

 Eggs are morphologically similar to hookworm eggs.
 FINAL HOST: herbivores
 Eggs are larger than hookworm eggs.
STRONGYLOIDES STERCORALIS

STRONGYLOIDES
Common Name Threadworm
Final Host Man
Habitat Soil (Free-living)
Small intestine (Parasitic, female)
Diagnostic Stage Egg or larva in stool; typically
diagnosed through identification of
rhabditiform/filariform larva
Infective Stage Embryonated egg
MOT Ingestion
Portal of Entry Mouth
Treatment DOC: Mebendazole, Ivermectin
Egg  Ellipsoid in shape
Characteristics  50-58um by 30-34um in size
 With thin hyaline shell containing
well-developed larva
 Visually similar to a hookworm egg
 Eggs are rarely observed in stool
samples
o Eggs hatch into rhabditiform
larva very quickly
Adult/Larval  Facultative STH
Characteristics  Parthenogenetic
 Filariform larvae enter hosts
through skin penetration
 Filariform larvae can repeatedly
invade the intestinal mucosa,
leading to a honeycomb
appearance.
Diff. Between  Parasitic females are long,
Males and slender, and measure 2-3mm in
Females length.
 Free-living males can measure up
to 0.75mm long.
 Free-living females can measure
up to 1mm long.
Rhabditiform RHABDITIFORM LARVA (L1)
Characteristics  Avg. Size: 180-380um
 Short buccal cavity
 Esophagus extends to 1/3rds of
its body length
 Prominent genital primordium
 May develop into infective
filariform larva (L3); this is known
as the “direct cycle”
 Can also develop into a free-living
male or female adult worm; this is
known as the “indirect cycle”
 STRONGYLOIDES

L2 LARVA
 Longer than L1
 Short buccal canal
 Smaller esophagus
 Longer intestine

L3 LARVA
 Avg. Size: 690um
 1:1 esophagus ratio
 Posterior: forked/notched tail
 Female: colorless, semi-
transparent, finely striated cuticle
 Found in soil can enter human
host through skin penetration
 Can also be found in respiratory
specimens during autoinfection
cases

STRONGYLOIDES: VS. HOOKWORMS

STRONGYLOIDES HOOKWORM
Eggs  Less commonly found in stool  Oval, with thin shells and
specimens smooth outer surfaces
 Have segmented ova (4-8 cell  More commonly found in stool
stage blastomeres) specimens
 Seen in stool as
rhabditiform/filariform larva
instead
Size  L1 larva are slightly smaller  Larger in size
and less attenuated posteriorly
Buccal cavity  Shorter buccal cavities  Longer buccal cavities
Genital primordium  Very prominent and clearly  Smaller and less visible
visible
Motility  Highly active and move rapidly  Less active
Tail shape  Notched tails  Pointed tails
Esophagus  Extends beyond mid-body  Shorter, does not extend
beyond mid-body

STRONGYLOIDES: PATHOLOGY AND CLINICAL MANIFESTATION

 Larval Migration Phase
 Causes lobar pneumonia with hemorrhage.
 Can also be found in the brain and other viscera (“disseminated
strongyloidiasis”).
 Intestinal Phase
 “Vietnam Diarrhea” (based on war veterans)
 “Cochin-China Diarrhea” (based on origin of outbreak)
 Severe and intermittent diarrhea
 Honeycomb appearance of intestinal mucosa
 Eosinophilia
 Hyperinfection and dissemination
 Autoinfection also possible
 Local dermatitis
 “Larva Currens”
 Allergic reaction due to larval penetration
 Heart-Lung Migration
 Can cause pneumonitis
 Chronic Infection
 Strongyloidiasis may persist for many years.
 Chronic infections are usually asymptomatic.

STRONGYLOIDES: LABORATORY DIAGNOSIS

 FECT
 For larva
 Baermann technique
 For high volume of specimen
 Enterotest/Beale’s String Test
 Used to detect S. stercoralis infections.
 A patient is made to swallow a capsule attached to a nylon string; the string can
collect duodenal secretions and larva.
 Harada-Mori

STRONGYLOIDES: EPIDEMIOLOGY

 Less common than hookworms and other STHs.

 Typically target elders, AIDS patients, and immunocompromised people.
 Young Children: after contracting infection and recovering, may experience
autoinfection.
 Most cases are asymptomatic.
 However, disseminated infections and hyperinfections are more common among
the immunocompromised.

STRONGYLOIDES: TREATMENT

 No drug of choice; can be treated with Ivermectin + Albendazole.

 CAPILLARIA PHILIPPINENSIS

CAPILLARIA
Common Name Pudoc worm
Intermediate Host Glass fish;
Freshwater fish such as Bagsit,
Ipon, Birot, and Bagsang
Final Hosts Normal: Bird
Accidental: Man
Habitat Small intestine
Diagnostic Stage Ova in stool
Infective Stage L3 larva in intermediate host
MOT Ingestion of improperly cooked
fish
Portal Of Entry Mouth
Treatment DOC: Albendazole, Mebendazole
General  1st generation females are
Characteristics always larviparous (birth 2nd
gen females)
 2nd generation females are
always oviparous
 Life cycles still unsure
Egg  45um by 21um
Characteristics  Peanut/guitar shaped
o Resembles Trichuris
 Pale brown/light yellow in
color due to bile
 Typical: flattened mucus plugs
 Atypical: no mucus plugs
 Striated border
Adult  Males: 2.0-3.55mm in length
Characteristics  Females: 2.5-4.5mm in length
 Typical females can hold 8-10
eggs in a single row, while
atypical females can hold 40-45
eggs in 2-3 rows.

CAPILLARIA: PATHOLOGY AND CLINICAL MANIFESTATION

 Pudoc Disease, Intestinal Capillariasis or “Mystery Disease” (based on

assumption of “being cursed”)
 Borborygmus (or gurgling of stomach)
 DEATH may occurs if left untreated.
 Protein-losing enteropathy
 Chronic diarrhea
 Electrolyte loss
 Autoinfection can occur

CAPILLARIA: LABORATORY DIAGNOSIS

 No valid serologic testing is available for diagnosis.

 Diagnosis relies on identification/detection of eggs, larvae, or adult worms in stool
specimens or in intestinal biopsies.

CAPILLARIA: EPIDEMIOLOGY
 Highly pathogenic
 Endemic areas: Ilocos region, La Union, Pangasinan, Zambales, Cagayan, Isabela,
Compostella Valley, Zamboanga del Norte, and Mindanao (migratory birds as
reservoir)

CAPILLARIA: TREATMENT AND PREVENTION

 DOC: Mebendazole
 Alternative: Albendazole
 Electrolyte replacement and high-protein diet
 Proper preparation of fish
 Proper disposal of fecal matter

CAPILLARIA: OTHER SPECIES

 C. hepatica – liver (hepatic capillariasis)

 C. aerophila – lungs (pulmonary capillariasis)
 C. plica – urinary tract (urinary capillariasis)