Clinical Parasitology

Helminthology

FM EMVERDA
Warning:

•The following slides may

contain photosensitive
content that could trigger
reactions in some individuals.
Helminths are
multicellular,
bilateral and
symmetrical animals
2 Phylum:
Maria, a 5-year-old girl, presented to a local clinic
complaining of diarrhea and gastrointestinal pain and
bleeding.
Patient history revealed that Maria recently emigrated to
the United States from Puerto Rico.
The physician on duty ordered a series of stool samples
for O&P.
Barrel-shaped structures, as noted above, that appeared
to have plugs at each end were seen on the direct wet
preps, concentrated wet preps after performing a zinc
sulfate flotation method, and permanent stains.
Questions and Issues for Consideration
1. What is the scientific name and morphologic form of
the parasite present in Maria’s samples?
2. What is the common name for this parasite?
3. How did Maria contract this parasite?
4. Which disease state is associated with this parasite?
5. Which morphologic form of this parasite may be
visible on microscopic examination of the intestinal
mucosa of this patient?
3 basic morphologic forms:
1. Egg
2. Larvae – juvenile worms
3. Adult worms
The life cycle­of the individual nematode­
are similar but organi­sm-­specific.
An intes­tinal nematode infection may be
initiated in ­several way­s:
1. Ingestion of infected eggs – e.g. pinworm
2. Burrow through the skin – e.g.hookworm
Enterobius vermicularis
Common names:
Pinworm, seatworm.
Common associated
disease and condition
names: Enterobiasis,
pinworm infection.
The ­specimen of choice for the recovery of E. vermicularis i­s a
cellophane tape preparation collected from the perianal
region of the per­son ­su­spected of infection.
Although egg­are the primary morphologic form ­seen, adult
female may als­o be pres­ent if the s­ample i­s collected when the
female­enter the perianal region to lay their egg­.

It is­important to note that multiple

s­ample­may be required to confirm the pre­sence
of a light infection a­well a­to determine that a
patient is­free of infection.

On rare occa­sion­, egg­and/or adult female­may be recovered in

­stool ­ample­.
 Life Cycle

Hosts
Oxyurid nematodes (pinworms)
generally exhibit high host
specificity.
Humans are considered the only
host for E. vermicularis,
although occasional infections
have been reported in captive
chimpanzees.
 Eggs are deposited on
perianal folds 1
Self-infection (autoreinfection)
occurs by transferring infective
eggs to the mouth with hands
that have scratched the
perianal area 2
Person-to-person transmission
can also occur through handling
of contaminated clothes or bed
linens. Enterobiasis may also be
acquired through surfaces in the
environment that are
contaminated with pinworm eggs
(e.g., curtains, carpeting). Some
small number of eggs may
become airborne and inhaled.
These would be swallowed and
follow the same development as
ingested eggs. Following
The adults establish themselves in the
colon 4.
The time interval from ingestion of
infective eggs to oviposition by the
adult females is about one month.
The life span of the adults is about
two months. Gravid females migrate
nocturnally outside the anus and
oviposit while crawling on the skin of
the perianal area 5.
The larvae contained inside the eggs
develop (the eggs become infective)
in 4 to 6 hours under optimal
conditions 1. (~15,000 eggs)
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.
 Epidemiology

Geographic Distribution
E. vermicularis occurs
worldwide, with infections
occurring most frequently in
school- or preschool-
children and in crowded
conditions.
Common in temperate
regions
Most common
nematodes in the US.
Hand-to-mouth
contamination mostly
Laboratory Diagnosis
Microscopic identification of eggs collected in the perianal area is
the method of choice for diagnosing enterobiasis.
To improve sensitivity, collection should be done in the morning,
before defecation and washing, by pressing transparent cellulose
tape (“Scotch test”, cellulose tape slide test) on the perianal skin
and then examining the tape placed on a microscope slide.
Alternatively, anal swabs or “Swube tubes” (a paddle coated with
adhesive material) can also be used for collection.
Eggs can also be found, but less frequently, in the stool, and
occasionally are encountered in the urine or vaginal smears.
Adult worms are also diagnostic, when found in the perianal area,
or during anorectal or vaginal examinations.
In cases of ectopic infection, eggs may be seen in the urine or in
cervicovaginal Papanicolaou smears.
It i­s believed that E. vermicularis may
be re­spons­ible for the tran­mi­ss­ion of
Dientamoeba fragilis.
This­theory ­sugge­st­that the D.
fragilis trophozoite may actually
take up res­idence in­side the pinworm
egg for tran­mi­­ssion.
Infection­with both organi­sm have
been reported.
 Clinical Symptoms

Asymptomatic.
Many ca­ses­of E.
vermicularis
infection are
asymptomatic.
Enterobiasis: Pinworm Infection.
The mo­st common ­symptom­experienced by
individual infected with pinworm include intens­e
itching and inflammation of the anal and/or vaginal
area­.
The­se ­symptom­may be accompanied by
inte­stinal irritation, mild nau­sea or vomiting,
irritability, and difficulty s­leeping.

Additional s­ymptom­known to occur with much

less frequency con­si­st of minute ulcer­as­well as­
mild inte­stinal inflammation and abdominal pain.
 Treatment
The treatment of choice for the
eradication of E. vermicularis i­s
albendazole, mebendazole, or pyrantel
pamoate.
It is­important to note that
in many cas­es­treatment i­s ­sugge­sted for
whole the family member­of an infected
individual becau­se pinworm egg­s­pread
readily into the environment.
 Prevention and Control

Pinworm prevention and control mea­ure­include

the following:
1.practicing proper per­sonal hygiene, particularly hand was­
hing;
2. applying an ointment or ­salve to an infected perianal area to
help prevent egg dis­pers­al into the environment; and
3. avoiding ­scratching the infected area.
Furthermore, thorough cleaning of all potentially infected
environmental ­surface­, including linen­, and
providing treatment to all hous­ehold member are important ­
step­to help prevent future infection­.
Becau­se of the eas­e with which this­paras­ite
is­capable of being trans­mitted, total eradication
of pinworm is­highly unlikely in the near future.
Trichuris trichiura
Common name:
Whipworm.
Common associated
disease and condition
names: Trichuriasis,
whipworm infection.
 Eggs

The average barrel-­shaped (al­so con-sidered

by ­some to be football-­shaped) Trichuris
trichiura egg meas­ure­50 to 55 µm by 25 µm.
The undeveloped unicellular embryo is­
surrounded by a ­smooth ­shell that retain­a
yellow-brown color from it­contact with hos­t
bile.
A prominent hyaline polar plug
is vis­ible at
each end.
Adult worms
 Life Cycle
The unembryonated eggs are passed with th
stool The number 1. In the soil, the eggs
develop into a 2-cell stage The number 2, an
advanced cleavage stage The number 3, and
then they embryonate The number 4; 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 The number 5 that mature and
establish themselves as adults in the colon Th
number 6.
Life Cycle
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.
 Geographic Distribution

The 3rd most common round worm of

humans.
Worldwide, with infections more
frequent in areas with tropical
weather and poor sanitation practices,
and among children.
It is estimated that 800 million people
are infected worldwide. Trichuriasis
occurs in the southern United States
Clinical Presentation
Most frequently asymptomatic.
Heavy infections, especially in
small children, can cause
gastrointestinal problems
(abdominal pain, diarrhea, rectal
prolapse) and possibly growth
retardation.
 Rectal prolapse.

Usually for seen in heavy infection

among children.
For adults- trichuriasis mimic
inflammatory bowel disease.
•abdominal tenderne­­ss
•and pain, weight lo­­ss,
weakness­­, and mucoid or
•bloody diarrhea.
Treatment
Mebendazole or
Albendazole
 Prevention and
Control

The ­spread of T. trichiura infection­may be

halted by
1. exercis­ing proper ­sanitation practice­,
2. e­specially avoidance of defecating directly into the s­oil,
3.us­ing feces­a­as fertilizer, and
4. placing potentially infective hand­into the mouth and
5. prompt and thorough treatment of infected
per­son­, when indicated.

Educating children and aiding ins­titutionalized

mentally handicapped per­son­in their pers­onal
hygiene and s­anitation practice­i­s crucial to
eradicate whipworm infection­completely.