NEMATODES

Nematodes

• Nonsegmented
• Cylindrical
• Tapered at both ends
• Complete digestive tract
• Separate sexes
• Females are usually larger
• Males are usually curved at
the posterior and have special
copulatory organs
INTESTINAL NEMATODES
 Ascaris lumbricoides

• Giant intestinal round worm

• Most common intestinal nematode
• Soil transmitted
 Ascaris lumbricoides

• Life Cycle
 Ascaris lumbricoides

• Morphology

Adult :
- male : 10 – 31 cm
- female : 22 – 35 cm
 Ascaris lumbricoides

• Morphology

Ova:
 Ascaris lumbricoides

• Clinical Manifestations
- allergic reactions to larval migration
- pneumonitis
- abdominal pain
- lactose intolerance
- bowel obstruction
 Ascaris lumbricoides

- erratic migration of adults may have serious

effects
- often regurgitated or passed out through the
nostrils or other body openings
- biliary obstruction
- appendicitis
- pancreatitis
 Ascaris lumbricoides

• Diagnosis
- detection of eggs in stool
 Ascaris lumbricoides

• Review

infective stage : Embryonated ova

mode of infection : Ingestion
adult habitat : Small intestines
diagnostic stage : Ova in stool
 Ascaris suum

• parasite of pigs
• Some studies suggest that it may be the same species as
Ascaris lumbricoides
 Hookworms

• 5 species
- Necator americanus
- Ancylostoma duodenale

- Ancylostoma ceylanicum*
- Ancylostoma braziliense
- Ancylostoma caninum
 Hookworms

• Soil transmitted
• Blood-sucking nematodes
 Hookworms

• Life Cycle
 Hookworms

• Necator americanus
- infects only through skin penetration

• Ancylostoma duodenale
- skin penetration, ingestion, transmammary,
and probably transplacental
 Hookworms

• Morphology

Adult:
 Hookworms

• Morphology

Ova
 Hookworms

• Morphology

Rhabditiform larvae
 Hookworms

• Morphology

Filariform larvae
 Hookworms

• Clinical Manifestations

- ground itch / dew itch

- bronchitis or pneumonitis

- abdominal pain, steatorrhea

- diarrhea with blood and mucus
- eosinophilia
 Hookworms

• Clinical Manifestations

- iron deficiency anemia

- hypoalbuminemia

- cutaneous larva migrans / creeping eruptions

 Hookworms

• Diagnosis

- demonstration of ova in stool

 Hookworms

• Review

infective stage : Filariform larva

mode of infection : Skin penetration / Ingestion
adult habitat : Small intestines
diagnostic stage : Ova in stool
 Trichuris trichiura

• Whipworm
• Soil transmitted
• Frequently observed with Ascaris
 Trichuris trichiura

• Life Cycle
 Trichuris trichiura

• Morphology

Adult:
 Trichuris trichiura

• Morphology

Ova:
 Trichuris trichiura

• Clinical Manifestations:

- petechial hemorrhages in the intestines

(increased risk of amebic dysentery)
- enterorrhagia
- blood-streaked stools
- diarrhea
- rectal prolapse
 Trichuris trichiura

• Diagnosis

- demonstration of ova in stool

 Trichuris trichiura

• Review

infective stage : Embryonated ova

mode of infection : Ingestion
adult habitat : Large intestines
diagnostic stage : Ova in stool
 Strongyloides stercoralis

• Threadworm
• Facultative parasite / zoonotic
 Strongyloides stercoralis

• Life Cycle
 Strongyloides stercoralis

• Morphology

Adult:
 Strongyloides stercoralis

• Morphology

Rhabditiform:
 Strongyloides stercoralis

• Morphology

Filariform:
 Strongyloides stercoralis

• Morphology

Ova:
 Strongyloides stercoralis

• Clinical Manifestastions

- pruritic skin papules

- larva currens
- lobar pneumonia
- alternating diarrhea & constipation
- Cochin China diarrhea
(watery & bloody intermittent diarrhea)
- dissemination in immunosuppressed patient
 Strongyloides stercoralis

• Diagnosis
- demonstration of larvae in stool
- Harada-Mori, Baermann funnel
- duodenal sampling

- larvae may be found in sputum and urine in

disseminated infection
 Strongyloides stercoralis

• Review

infective stage : Filariform larva

mode of infection : Skin penetration /
Autoinfection

adult habitat : Small intestines

diagnostic stage : rhabditiform larvae in stool
 Other Strongyloides species

• Strongyloides fulleborni
- parasite of monkeys
- eggs are passed in stool
- larvae has been found in breast milk

• S. myopotami & S. procyonis

- infects nutria and racoons
- “swamp itch”
 Enterobius vermicularis

• Pinworm
• Seatworm
• *threadworm*
• Etiologic agent of oxyuriasis / enterobiasis
 Enterobius vermicularis

• Life Cycle
 Enterobius vermicularis

• Morphology

Adult
 Enterobius vermicularis

• Morphology

Ova
 Enterobius vermicularis

• Clinical Manifestations:
- pruritus ani
- mild intestinal inflammation

- appendicitis, vaginitis, endometritis, salpingitis,

peritonitis
 Enterobius vermicularis

• Diagnosis
- ova or adult in perianal swab
- rarely in stool
- cellophane tape swab*
Enterobius vermicularis
 Enterobius vermicularis

• Review

infective stage : Embryonated ova

Larvae(retroinfection)

mode of infection : Ingestion / Inhalation

adult habitat : Large intestines
diagnostic stage : Ova or Adult
(perianal swab or stool)
 Capillaria philippinensis

• First described in 1963 from a patient in Northern

Luzon
 Capillaria philippinensis

• Life Cycle
 Capillaria philippinensis

• Morphology

Adult
 Capillaria philippinensis

• Morphology

Ova
 Capillaria philippinensis

• Clinical Manifestations:

- abdominal pain, borborygmus, diarrhea

- weight loss, malaise, anorexia, vomiting, edema

- symptoms are due to malabsorption

 Capillaria philippinensis

• Diagnosis
- demonstration of ova in stool

- coproantigen detection

- Ab detection
(crossreactive with Trichinella spiralis antigen)
 Capillaria philippinensis

• Review

infective stage : larva

mode of infection : Ingestion (via infected fish)

adult habitat : Small intestines

diagnostic stage : Ova in stool
 Trichostrongylus spp.

• Trichostrongylus orientalis
• parasites of herbivores
• Humans are accidental hosts
• Related to the hookworms
 Trichostrongylus spp.

• Life Cycle
 Trichostrongylus spp.

• Morphology
 Trichostrongylus spp.

• Clinical Manifestations:

- significant blood loss

- emaciation
 Trichostrongylus spp.

• Diagnosis

- ova in stool
 Trichostrongylus spp.

• Review

infective stage : Larva (L3, filariform)

mode of infection : Ingestion
adult habitat : Small intestines
diagnostic stage : Ova in stool
 Anisakis, Pseudoterranova, & Contracaecum

• Intestinal parasites of marine mammals

• Humans are accidental hosts
 Anisakis, Pseudoterranova, & Contracaecum

• Life Cycle
 Anisakis, Pseudoterranova, & Contracaecum

• Clinical Manifestations:
(Anisakiasis / Anisakidosis)
- inflammation of the intestinal wall
- partial ileus(intestinal obstruction) of the small
intestines
- abdominal pain, nausea, vomiting, diarrhea
 Anisakis, Pseudoterranova, & Contracaecum

• Diagnosis
- history of eating raw fish
- demonstration of worms from gastroscopy,
surgery, or due to being vomited by the patient

- organisms may be identified by the structure of

the digestive tract
Anisakis, Pseudoterranova, & Contracaecum
 Anisakis, Pseudoterranova, & Contracaecum

• Review

infective stage : Larva (L3)

mode of infection : Ingestion
(via infected fish or squid)

habitat : Intestinal wall /stomach

diagnostic stage : Larva(L3)
 Lab Exam of Stool Samples

• Direct Fecal Smear (stool wet mount)

• Iodine mount
• Kato Thick Smear
• Kato-Katz Smear
 Lab Exam of Stool Samples

• Concentration Methods:
a. floatation methods
(zinc sulfate, sheather’s sugar flotation,
FLOTAC)

b. sedimentation methods
(FECT, KOH)
 Lab Exam of Stool Samples

• Larval Hatching Methods

- Harada-Mori
- Copro Culture & Baermann Technique
- Agar culture
BLOOD & TISSUE NEMATODES
 Trichinella spiralis

• Zoonotic
• Disease of carnivores and omnivores
- T. spiralis
- T. britovi
- T. nativa
- T. nelsoni
- T. murrelli
- T. papuae
- T. pseudospiralis
 Trichinella spiralis

• Life Cycle
 Trichinella spiralis

• Morphology
 Trichinella spiralis

• Clinical Manifestations:
- diarrhea or constipation, vomiting, abdominal
cramps, malaise, nausea
- myalgia, periorbital edema, eosinophilia
- remittent fever, dyspnea, dysphagia, paralysis

- manifestations vary depending on the site of

larval invasion and encystation
 Trichinella spiralis

• Diagnosis

- demonstration of larvae in muscle biopsy

- Beck’s Xenodiagnosis
(+) result: presence of adult female in the
duodenum and/or larvae in the muscle after 14
days
 Trichinella spiralis

• Review

infective stage : Encysted larva

mode of infection : Ingestion
(via infected meat)

adult habitat : Intestines

diagnostic stage : Encysted Larva (biopsy)
 Parastrongylus cantonensis

• Rat Lungworm
• Zoonotic
 Parastrongylus cantonensis

• Life Cycle
 Parastrongylus cantonensis

• Morphology
 Parastrongylus cantonensis

• Clinical Manifestations:
 eosinophilic meningoencephalitis
- intermittent occipital or bitemporal headache
- stiff neck, weakness of the extremities, paralysis,
paresthesia, eosinophilia, confusion, incoherence,
disorientation, memory lapses, coma
 Parastrongylus cantonensis

• Diagnosis
- history of exposure
- spinal fluid eosinophilia (>10%)
- mildly elevated CSF protein
- larvae or young adults may be found in CSF

- CT scans
- Serology
 Parastrongylus cantonensis

• Review

infective stage : 3rd stage larva

mode of infection : Ingestion
(via infected snail, slug, prawn,
crab, planaria, vegetable)

site of infection* : brain

diagnostic stage : larva or young adults in CSF
 Parastrongylus costaricensis

• Found principally in Costa Rica

• Human infections are associated with slugs and
salad vegetables
 Parastrongylus costaricensis

• Adults may develop and be found in mesenteric

arteries
• May also be found in ectopic sites
• Causes thrombosis and necrosis
of tissues
• Larvae cause granuloma formation
 Lymphatic Filaria

• Wuchereria bancrofti
• Brugia malayi

• Filarial worms
• Vector-borne
 Lymphatic Filaria

• Life Cycle
 Lymphatic Filaria

• Life Cycle
 Lymphatic Filaria

• Vectors:

Wuchereria bancrofti Brugia malayi

Aedes Mansonia

Anopheles

Culex
 Lymphatic Filaria

• Morphology
(table 3.2, p.150)

Wuchereria bancrofti

Brugia malayi
 Lymphatic Filaria

• Morphology
(table 3.2, p.150)

Wuchereria bancrofti

Brugia malayi
Lymphatic Filaria
 Lymphatic Filaria

• Acute dermatolymphangioadenitis (ADLA)

• Elephantiasis
• Hydrocele

• Tropical pulmonary eosinophilia

• Milk urine
 Lymphatic Filaria

• Diagnosis

- demonstration of microfilaria in peripheral blood

• Microfilaria demonstrate periodicity

- Wuchereria is nocturnal (8pm – 4am)
- Brugia is subperiodic
 Other Filarial Worms

Organism Vector Periodicity Location of Adult

(microfilaria)

Loa loa Chrysops Diurnal Subcutaneous

(African eye worm) (Mango fly) tissue

Onchocerca Simulium Nonperiodic Subcutaneous

volvulus (Black fly, Buffalo gnat)

Mansonella Culicoides Nonperiodic Body cavities

ozzardi (Midge)
Simulium
(Black fly, Buffalo gnat)

Mansonella Culicoides Nonperiodic Mesentery

perstans (Midge)

Mansonella Culicoides Nonperiodic Subcutaneous

streptocerca (Midge)
 Loa loa

• African Eye Worm

- adults may cross over the bridge of the nose or the
eyeball
- may be immobilized with 10% cocaine
- causes subcutaneous edema (Calabar swellings)

- may be found in ectopic sites and cause a variety of

unusual clinical features
 Onchocerca volvulus

- adults encapsulates en-mass in fibrous tissue tumor-like

mass (onchocercomas)
- mal morado, erisipela de la costa, “leopard skin”
- hanging groin
- river blindness

- microfilaria may be found in skin tissue

(skin snips)

Mazzoti test
- administration of DEC provokes intense
pruritus w/in a few hours
 Mansonella spp.

• M. ozzardi
• M. streptocerca
• M. perstans

- generally asymptomatic
- adenopathy, pruritic maculopapular lesions,
arthritis, fever

- pathology is usually due to dead filariae

Differential Identification
 Differential Identification

Organism Sheath Tail Morphology Periodicity Specimen

Wuchereria bancrofti sheathed nuclei does not extend nocturnal blood

to tip
Brugia malayi sheathed 2 terminal nuclei subperiodic blood

Loa loa sheathed nuclei extend to tip / diurnal blood

continuous row
Onchocerca volvulus unsheathed pointed / tapered end nonperiodic skin

Mansonella ozzardi unsheathed nuclei does not extend nonperiodic blood, skin
to tip
Mansonella streptocerca unsheathed curved tail / nonperiodic skin, blood
shepherd’s crook

Mansonella perstans unsheathed nuclei extends to tip nonperiodic blood, skin

 Dirofilaria immitis

• Dog heartworm / Canine heartworm

 Dirofilaria immitis

• Emerging zoonotic infection

• Rare in humans
• Causes subcutaneous or pulmonary
nodules/tumors
• Symptoms are negligible to mild

• Diagnosis:
- demonstration of adults in biopsy of tumors
 Dracunculus medinensis

• Guinea worm
- found in the middle east

Manifestations:
- urticaria
- skin ulcers
- ankylosis
 Which is it?

• “fiery serpents”
• medicine
 Visceral Larva Migrans

• Caused by zoonotic ascarids

• Toxocara canis
• Toxocara cati
 Examination of Blood

• Lab Methods
Cestodes