Blood And Tissue Nematodes  esophagus is lined with

stichosomes
At the end of this Unit, the learners
NOTE: Viviparous (gives birth to
must be able to:
larva) female lives for 30 days
and capable of producing more
•Distinguish the features of the
than 1,500 larvae in a lifetime.
following blood and tissue
nematodes
Larva
•Summarize the life cycle of each
 provided with spear-like
blood and tissue nematode
burrowing tip at it tapering
Recognize symptoms related to a
anterior end
specific parasite
Encysted Larva In Tissue Sections
TRICHINELLA SPIRALIS
 measures 80 to 120 um by 5.6
Common Name: Trichina worms,
um at birth, but reaches the
Muscle worm
size of 0.65 to 1.45 mm in
Final Host/Intermediate Host: Pig,
length and 0.026 to 0.040 mm
Rat, Man
in width after it enters a
Habitat: Adult: Small Intestines
muscle fiber
Larva: Skeletal muscle
 surrounded by a thick capsule,
Diagnostic Stage/Infective Stage:
which is ellipsoidal in shape
Encysted larva
 long axis of cyts parallels the
Mode of Transmission: Ingestion of
muscle fibers
contaminated pork
encysted larva-attaxhed directly to
->first discovered in a human
the muscle
cadaver
->italian male living in england
Life Cycle
1. Ingestion of infected animal
Morphology Male
meat with the encysted larva
 measures 0.62 to 1.58 mm by
of the parasite enables the
0.025 to 0.033 mm
larva cyst to be degraded by
 cylindrical body with slightly
digestive enzymes
curved posterior end
2. Larva will go to the intestinal
 with a pair of conspicuous
villi before it will go to the
conical papillae
circulation through the
 testes is near the posterior
superior mesenteric artery.
end of the body
3. It will then go to the heart and
skeletal muscles and encyst to
Female
cause a dead end alley
 measures 1.26 to 3.35 mm by
infection.
0.029 to 0.038 mm
4. Its development will stop and
 single ovary at the extreme
the 2nd generation of
 posterior end of the body
unembryonated eggs will be
 ovary, seminal receptacle,
passed out in feces.
coiled uterus, vagina form an
almost straight canal towards
Pathogenesis And Clinical
the vulva
Manifestation:
 uterus is filled up with semi-
The severity of symptoms depends
colled larvae
on the following:
1) LIGHT INFECTION - patients 3) CONVALESCENT PHASE- fever,
harboring up to 10 larvae; weakness, pain and other symptoms
asymptomatic start to reduce.
2) MODERATE INFECTION with 50 to NOTE: Trichinollosis is a self-limiting
500 worms; show symptoms disease.
3) SEVERE OR POTENTIALLY FATAL
with more than 1,000 to 3,000 Diagnosis
larvae; severe disease  Demonstration of larva
through muscle biopsy
worm bolus- the no. of worms  most definitive diagnostic
examination
Clinical conditions divided into three  it is done through histological
phases: examination of 0.2 to 0.5g of
1) ENTERIC PHASE-resemble those muscle tissue
of an attack of acute food poisoning,
including diarrhea or constipation, Digestion technique
vomiting. abdominal cramps, malaise  digestion of muscle samples
and nausea with pepsin and hydrochloric
2) INVASION PHASE- migrating acid
larvae resulting metabolites lead to  to determine the number of
immunological, pathological and larvae per gram of muscle to
metabolic reactions isolate larvae from molecular
characterization
- cardinal signs and symptoms of
trichinellosis: severe myalgia, NOTE: This technique is limited only
periorbital edema, eosinophilia, high to muscle larvae that are about 10 to
intermittent fever and chills, 12 days old (about 2-3 weeks post
headache, dyspnea, dysphagia and infection) because younger larvae
occasionally paralysis of the may be destroyed by digestive
extremities and splenomegaly. In enzyme.
severe cases, there may be gastric
and intestinal hemorrhages
 Laboratory tests to detect
Larval migration: eosinophilia
 Biochemical test (CK, LDH,
Heart muscle: pericardial pain, Myokinase levels and Total
tachycardia, electro diagram IgE)
abnormalities, pericardial effusion,  Serological test, Bentonite
congestive heart failure and other Flocculation test(BFT), Latex
chronic heart abnormalities. Flocculation test(LFT), IFAT,
ELISA
Neurological complications: small  Western Blot and latex
sub-acute cortical infarcts, Agglutination <1 hour:
meningitis and meningoencephalitis. Confirmation test

NOTE: Heavy infections-ocular Treatment

disturbances diplegia, deafness,  Mebendazole (5 mg/kg body
epileptiform attacks and coma may weight daily)
occur.  Albendazole (15 mg/kg body
weight daily; . Children 2
years and older 10 mg/kg
body weight)
  Analgesic and antipyretic (to are transferred from fish to
control symptoms/pain fish
reliever) 5. Fish and squid maintain L3
 Corticosteroid with larvae that are infective to
antihelminthics (to control humans and marine mammals
hypersensitivity) 6. When fish or squid containing
L3 larvae are ingested by
Prevention And Control marine mammals, the larvae
 Health Education molt twice and develop into
 Meat should be cooked at a adult worms. Adult worms
minimum of 77 C(170 F) produce eggs that are shed by
 Regular animal marine mammals
monitoring(meat inspection) 7. Humans become Incidental
 Proper disposal of suspected host through eating infected
carcasses Keeping pigs in rat- raw or uncooked seafood
free pens
NOTE: Larvae can be killed by Pathology And Clinical Manifestation
freezing and storage at -15°C for 20
days and -3°C for 6 days Anisakiasis or Anisakidosis
 larval infection with anisakis it
Anisakis may result in gastric intestinal
Common Name: Herring's worm pathology
Mode of Transmission: Ingestion of  it causes allergic reaction due
raw fish infected with larvae (e.g. to the chemicals secreted by
Sashimi) the worms

Morphology a. Hemorrhage and Inflammation -

MALE -measures 12-29 mm by 0.4 when ingested larvae invade the
mm FEMALE-measures 500-1200 sub-mucosa of the stomach or the
mm by 0.9 to 1.7 mm intestines and if deep, a tumor-like
granuloma surrounded by
NOTE: Adult female has a life span of inflammatory cells and eosinophils
12-18 months will develop

Life Cycle b. Gastric Anisakidosis -occurring 1

to 12 hours after ingestion of
infective larvae signs and symptoms:
1. Marine mammals excrete severe abdominal pain accompanied
unembryonated eggs by nausea and vomiting
2. Eggs become embryonated in
water and L2 larvae from the NOTE: Signs and symptoms may be
eggs, after the L2 larvae hatch mistaken for peptic ulcer disease,
from eggs they become free- cholecystitis or even gastroenteritis
swimming
3. Free-swimming larvae are c. Severe eosinophilic granulomatous
ingested by crustaceans and -also known as intestinal anisakidosis
they mature into L3 larvae usually mimics: appendicitis, Crohn's
4. Infected crustaceans are eaten disease (inflammatory bowels
by fish and squid. Upon the disease), intestinal obstruction or
host's death, larvae migrate to diverticulitis
the muscle tissues and
through predation, the larvae
d. Ectopic Anisakidosis-when larvae  Found in the pulmonary
have been found invading the arterioles of rats
oropharynx(tingling throat  In the Philippines, the known
syndrome), esophagus and colon. Intermediate hosts include the
following slugs and snails:
it may also cause Urticaria, asthma, Achatina fulica (Giant African
conjunctivitis and contact dermatitis Snail), Hemiplecta sagittifera,
Helicostyla macrostoma,
Diagnosis Vaginilus plebeius and
 Gastroscopic/Endoscopic Veronicella altae
Examination
 ELISA
 RAST

Treatment
 Albendazole for intestinal
anisakidosis -
 Corticosteroid for allergic
anisakidosis

Epidemiology
 Considered to be high risk for
anisakidosis are fish dishes
such as Japanese sushi and
sashimi, pickled anchovies,
slated and smoked herring
fish, and possibly fish bagoong
as well as fish kinilaw in the
Philippines
 In the Philippines, anisakis
larvae have been found in blue
mackerel scad (galunggong)
and infected eels (Palos).

Prevention And Control

 Marine fish, squid and shellfish
must be thoroughly cooked Mode of transmission:
prior to consumption a. ingestion of raw mollusk
 For raw or undercooked intermediate host infected
preparations, fish and shellfish with third-stage larva
must undergo blast freezing at b. ingestion of leafy vegetables
- 35 C for atleast 15 hours or - contaminated with mucus
20°C for 7 days. secretions of the mollusk
carrying the infective
Angiostrongylus Cantonensis stage(3rd larval stage) of the
Common Name: Rat lungworm parasite
Definitive Host: Rats c. ingestion of a paratenic host,
Intermediate Host: Mollusk such as fresh water prawn or
Infective Stage: Third stage larva crab harboring the infective
stage of the parasite
NOTE: d. drinking of contaminated
water
 e. oral-fecal route 5. It causes Eosinophilic
Meningitis, a
Morphology Male meningoencephalitis
 measures 15.5 mm long and characterized by eosinophils in
0.25-0.35 mm wide the CSF.
 Has a well-developed caudal
bursa which is kidney-shaped NOTE: A. cantonensis cannot survive
and single lobed for long in the human body

Female Pathogenesis And Clinical

 measures 18.5-33 mm long Manifestation
and 0.28-0.5 mm wide
 Have white uterine tubules
which are spirally wound  Acute, severe, intermittent
around the blood filled uterus occipital or bitemporal
and can be through the headache- most common
transparent cuticle as a  Eosinophilic
"barber's pole" pattern Meningoencephalitis- in Man
 Other symptoms includes:
Eggs/Ova Stiffness of the neck,
 measures 46-48 by 68 to 74 paresthesia, vomiting, fever,
um nausea, blurred vision or
 elongated, ovoidal with a diplopia, body and muscle
delicate hyaline shell pain, fatigue, confusion,
 unembryonated when laid into incoherence,disorientation,
the blood stream memory lapses or coma
 Complications: Intraocular
Life Cycle hemorrage and retinal
1. Eggs hatch in the lungs, and detachment
first-stage larvae are passed  Post mortem examination:
in rodents feces (A. shows leptomeningitis,
cantonensis) encephalomalacia and
2. Slugs and snails are moderate ventricular dilation
intermediate host, and after 2
molts, the larvae reach the NOTE:
infective stage(third stage)  INCUBATION PERIOD: 6 to 15
3. Humans become infected days may vary from 12-47
through food containing days
infective stage(third stage).  Eosinophils, monocytes and
Food items may include foreign body giant cells in the
undercooked snails and slugs, spinal cord or in the CSF. CSF
vegetables contaminated with usually contains 100 to 1000
snails, slugs or mollusk leukocytes per ul
secretions(slime) or infected  Charcot-Leyden crystals have
paratenic hosts(crabs, fresh been also demonstrated in the
water shrimp) meninges
4. Humans are incidental host
ONLY. Passage of larvae in Diagnosis
humans has been documented
and humans do not transmit
A. cantonensis  CT Scan, MRI
 Serological test: ELISA, PCR
Treatment
 No Specific Treatment

Prevention
 Avoid ingestion of raw or
undercooked snails and slugs,
freshwater shrimp, land crabs,
frogs, and monitor lizards or
potentially contaminated
vegetables or vegetable Juice
 Removing snails, slugs, and
rats found near houses and
gardens
 Thoroughly washing hands
and utensils after preparing
raw snails or slugs is also
recommended
 Vegetables should be
thoroughly washed if eaten
raw