CLINICAL PARASITOLOGY

LECTURE / LESSON 2

INTRODUCTION TO NEMATODA (PART I)

Nematodes c. Larviparous/Viviparous larva only, no egg stage;
parasite that bears living young instead of laying eggs
 Commonly known as the “intestinal roundworms”
 Cylindrical and have lips, teeth, and dentary plates
Pathogenesis
 These worms are either male or female
Three possible factors may contribute to the ultimate severity
 Classified as helminths
of a nematode infection:
* Members of the class Nematoda (1) Number of worms present;
* They are called roundworms because they appear round (2) Length of time of infection (length of time the
during cross section parasite is inside the host/body); and
(3) Overall health of the host
Helminths
- Parasitic worms that feed on a living host Nematoda
- Referred to as “intestinal parasites” Members of the class Nematoda may assume three basic
- Multicellular and contain internal organ systems morphologic forms:
- Share a similar morphology 1. Eggs (female sex cells after fertilization)
- Vary in size and shape
2. Juvenile worms known as larvae
- Typically long and slender
3. Adult worms
- Sexes are separate; equipped with complete digestive
and reproductive systems (don’t have circulatory system)
Nematode Classification
Kingdom: Animalia
Phylum: Nemathelminthes
Class: Nematoda
Groups: Intestinal Species and Intestinal-Tissue Species

Characteristics
1. Adult nematode is elongated, cylindrical worm, primarily
bilaterally symmetrical.
2. Multicellular; adults have complete digestive and
reproductive systems.
3. Anterior end may be equipped with cutting plates, hooks,
teeth, or papillae.
4. Supporting body wall consists of an outer hyaline
non-cellular cuticle, subcuticular epithelium and a layer of
muscle cells. Unholy Three/Trinity (3)
5. Alimentary tract is simple tube extending from mouth to  Soil-transmitted helminths
anus. There is no circulatory system.  The soil plays a major role in their development
6. Life cycle: Egg → Larva/Larvae → Adult Worms 1) Ascaris Lumbricoides
7. With two separate sexes (dioecious) 2) Trichuris Trichiura
Nematodes 3) Hookworms
Shape Elongated, cylindrical, unsegmented Ascaris Lumbricoides
Head Hooks and suckers absent. Well developed (as’kar-is/lum-bri-koy’deez)
End buccal capsule with teeth or cutting plates seen Common names: Large/Giant intestinal roundworm,
in some species Roundworm of man
Body Present and known as pseudocele. Viscera Common associated disease and condition names:
Cavity remains suspended in the pseudocele Ascariasis, Roundworm infection
Sex Separate sexes (dioecious) Epidemiology
Life Requires 1 host except Filarial worms (2 hosts)  Considered as the most common intestinal helminth
Cycle and Dracunculus (2 hosts) infection in the world, affecting approximately 1 billion
8. Provided with chemoreceptor/ sensory organs: people “disease of poverty” associated with malnutrition
- Cephalic Chemoreceptor (AMPHID) anterior end  Most susceptible to harbor in warm climates and areas of

- Caudal Chemoreceptor (PHASMID) posterior end poor sanitation

a. Oviparous lays egg unsegmented stage (unembryonated); - Human feces as fertilizer
parasite that lays eggs which hatch after leaving the body - Children defecate directly on the ground
of the host  Population most at risk children who place their

b. Ovoviviparous lays egg in segmented stage contaminated hands into their mouths
(embryonated); parasite that lays eggs which hatch before * Normally seen in people who are illiterate or uneducated
leaving the host
6
 CLINICAL PARASITOLOGY
LECTURE / LESSON 2
Morphology
Ascaris Lumbricoides ova
Unfertilized Egg: Typical Characteristics at a Glance
Parameter Description
Size 85-95 μm by 38-45 μm; size variations
possible
Shape Varies (oblong/oval)
Embryo Unembryonated; amorphous mass of
protoplasm
Shell Thin
Other features Usually corticated
*Corticated (outer part) - egg possesses an outer
mammillated, albuminous coating

Adult Worms
 Ascaris adult worms are the largest known intestinal
nematodes
 Has a so-called “polymyarian type” of somatic muscle
arrangement (many cells)
Ascaris Lumbricoides
Adults: Typical Characteristics at a Glance
Characteristics Female Adult Male Adult
Size (length) 22-35 cm Up to 30 cm
Color Creamy white Creamy white
pink tint pink tint
Other features Pencil lead Prominent
thickness incurved tail

Ascaris Lumbricoides ova

Fertilized Egg: Typical Characteristics at a Glance
Parameter Description
Size 40-75 μm by 30-50 μm
Shape Rounder than non-fertilized version (round) Adult Male
Embryo Undeveloped unicellular embryo
Shell Thick chitin
Other May be corticated or decorticated
features
*Chitin (shell) - thick nitrogen-containing polysaccharide
coating
*Decorticated - fertilized eggs lacking an outer mammillated,
albuminous coating
Adult Female

7
 CLINICAL PARASITOLOGY
LECTURE / LESSON 2
Life Cycle  Eosinophilia is present during larval migration
 The adults multiply and a number of the resulting  Intestinal irritation to the adult
undeveloped eggs (up to 250,000/day) are passed in the  Abdominal pain
feces  Moderate infections produce Lactose intolerance
 The outside environment, specifically soil, provides the (common in children)
necessary conditions for the eggs to embryonate  Heavy infections causes bowel obstruction
 Loeffler syndrome (when the larvae is in the lungs)  Complications due to extra-intestinal migration
 Invasion of bile duct through the ampulla of Vater and
enter the gallbladder of liver (Severe colicky abdominal
pain)
 Appendicitis
 Abscess
 Peritonitis - adults penetrate the intestinal wall into the
peritoneal cavity
 Fever
 Intestinal volvulus, intussusception, and obstruction
Signs and Symptoms
1. Pneumonia, cough, fever, eosinophilia (during larval
migration)
2. Vomiting and abdominal pain
3. Intestinal Perforation is possible
4. Heart to lung migration
Prevention and Control
 Avoidance of using human feces as fertilizer
 Exercising proper sanitation and personal hygiene
practices (sanitary disposal of human feces)
 Health education
Treatment: Albendazole, Mebendazole
Diagnostic Stage: Fertilized or Unfertilized egg Trichuris Trichiura
Infective Stage: Embryonated eggs (trick-yoo’ris/trick”ee-yoo’ruh)
Mode of Transmission: Ingestion of embryonated egg Common name: Whipworm
(1) Adults in small intestine Common associated disease and condition names:
(2) Unfertilized egg (will not undergo further development); Trichuriasis, Whipworm infection
Fertilized egg Epidemiology
(3) Embryonated egg with L3 (3rd stage) larva  Third most common helminth
(4) Ingestion of embryonated eggs, proceeding to the small  Found primarily in warm climates of the world where poor
intestine/intestinal wall sanitation practices are common
(5) Hatched larvae enter circulation and migrate to the 1st - Defecating directly into the soil
stop, which is the liver - Human feces as fertilizer
(6) 2nd stop is to the lungs  Children ages 5-15 years are most commonly infected
(7) Larvae are coughed and swallowed, re-entering the  In 2002, the estimated number of persons infected with
gastrointestinal tract. Maturation proceeds in the small whipworm was 1 billion
intestine Morphology
Laboratory Diagnosis Trichuris Trichiura egg
 Ascaris lumbricoides eggs - stool (specimen for recovery Eggs: Typical Characteristics at a Glance
of eggs) Parameter Description
 Adult worms - stool, vomited up, or removed from the Size 50-55 μm by 25μm
external nares (nostrils) Shape Barrel, football; hyaline polar plug at each
 Depending on the severity of infection - adult worms end (bipolar plugs)
may be recovered in small intestine, gallbladder, liver, and Embryo Unicellular; undeveloped
appendix Shell Smooth; yellow-brown color because of bile
 An enzyme-linked immunosorbent assay (ELISA) is contact
also available
Pathology
Ascariasis: Ascaris Infection
 Tissue reaction to the invading larvae
 Allergic manifestation such as lung infiltration,
asthmatic attacks, and edema of the lips
 Symptoms similar to pneumonia due to penetration of
lung capillaries

8
 CLINICAL PARASITOLOGY
LECTURE / LESSON 2
Diagnostic Stage: Unembryonated egg
Infective Stage: Embryonated eggs
Mode of Transmission: Ingestion of embryonated egg (no
heart-to-lung migration)
(1) Unembryonated eggs passed in feces
(2) 2-cell stage
(3) Advanced cleavage
(4) Embryonated eggs are ingested by host (human)
(5) Larvae hatch in small intestine
(6) Adults in cecum
Laboratory Diagnosis
 Trichuris trichiura eggs - stool (specimen recovery)
Adult Whipworm  Adult worms - visible on macroscopic examination of the
 Posterior end / back (whip handle) and anterior end / front intestinal mucosa
(whip itself)  Heavy infection - may also be seen in areas of the

Trichuris Trichiura adult intestinal tract down to and including the rectum (rectal
Adults: Typical Characteristics at a Glance prolapse)
Parameter Description  It is important to be aware that samples examined from

Size 2.5-5 cm long; males are usually smaller than patients treated for whipworm infection may reveal
females distorted eggs, showing a variety of unusual shapes
Anterior Colorless; resembles a whip handle; contains Signs and Symptoms
End a slender esophagus Trichuriasis: Whipworm Infection
Posterior Pinkish-gray; resembles whip itself; contains Conditions that a whipworm infection may stimulate vary
End digestive and reproductive systems; males with the age of the host
possess prominent curled tail  Children:
- Develop chronic dysentery
- Severe anemia
- Growth retardation
(treated children, catch-up growth usually occurs)
 Rectal Prolapse - last section of the large intestine falls
from its normal position within the pelvic area and sticks
out through the anus
 Adults:
- Abdominal tenderness and pain
- Weight loss
- Weakness
- Mucoid or bloody diarrhea
Life Cycle
 Larvae mature and establish themselves as adults in the
Prevention and Control
 Exercising proper sanitation practices
colon
 Avoidance:
 Female worms in the cecum shed between 3,000 and
20,000 eggs per day - Avoidance of defecating directly into the soil
- Using human feces as fertilizer
- Placing potentially infective hands into the mouth
***Educating children and aiding institutionalized mentally
handicapped persons in their personal hygiene and sanitation
practices is crucial to eradicate whipworm infections completely.
Treatment: Albendazole, Mebendazole
Hookworms
Species: Necator Americanus (New World Hookworm) and
Ancylostoma Duodenale (Old World Hookworm)
* Ancylostoma braziliense (cat hookworm)
* Ancylostoma caninum (dog hookworm)
Common associated disease and condition names:
Hookworm infection, Ancylostomiasis, Necatoriasis
Classification
Kingdom: Animalia
Phylum: Nematoda
Class: Secernentea
Order: Strongiloidae
Family: Ancylostomatidae
Genus: Necator/Ancylostoma
9
 CLINICAL PARASITOLOGY
LECTURE / LESSON 2
Epidemiology
 Majority of these infected individuals live in
poverty-stricken areas with poor sanitation
 Hookworm infection is most concentrated among the
world’s poorest
 Over 900 million people in tropical and subtropical
countries are affected
 Major etiology of Hookworm infection is N. Americanus
 A. Duodenale is found more in Europe and the
Mediterranean Adults: N. Americanus
Morphology Adults are small, cylindrical, fusiform, grayish-white
nematodes
Hookworm Egg: Typical Characteristics at a Glance
Parameter Description Female is larger than Male; Males possess a broad
membranous bursa with rib-like rays (posterior end) used
Size
for copulation (Males usually 5-9 mm long, Females about
Length Necator, 60-75 μm
1 cm long)
Ancylostoma, 55-60 μm
Possess a ventral pair of semilunar cutting plates in the
Width 35-40 μm
buccal capsule
Embryonic Two-, four-, or eight-cell stage
The head is curved opposite to the curvature of the body
cleavage
that appears as a hook at the anterior end
Shell Smooth, colorless
Hookworms has a “meromyarian type” of somatic muscle
arrangement where the cells are few in number (2-5 per
dorsal or ventral half)
The rhabditiform of N. Americanus & A. Duodenale are
indistinguishable but they are similar of

Hookworm Rhabditiform larva

Typical Characteristics at a Glance
Parameter Description
Size
Newly 270 by 15 μm
hatched
5 days old 540-700 μm long
Other Long buccal cavity; small genital
features primordium

Adults: A. Duodenale
Grayish white or pinkish with the head slightly bent
Slightly larger than N. Americanus
Possess well developed mouths with two pairs of curved
ventral teeth in the buccal capsule
Males (approximately 1 cm by 0.5 mm); Females are
longer and stouter
Prominent posterior copulatory bursa
Adult has a single paired Male or Female reproductive
organ

Hookworm Filariform larva

Typical Characteristics at a Glance
Parameter Description
Length of esophagus Short
Tail Pointed

10
 CLINICAL PARASITOLOGY
LECTURE / LESSON 2
Pathology
 Skin at the site of entry of the filariform larvae
 Presence of maculopapular lesions and localized
erythema, edema, and itching (ground itch or dew itch)
 Lung during larval migration
 Causes bronchitis or pneumonitis
 Hemorrhages with eosinophilic and leukocytic
infiltration
 Small intestine, the habitat of the adult worms
Life Cycle  Abdominal pain, steatorrhea, diarrhea with blood, and
 Can be found in warm, moist soil
blood eosinophilia
 A. Duodenale can infect through penetration
 Chronic infection causes microcytic hypochromic
 Female adult worms release eggs per day:
anemia due to loss of blood
- N. Americanus 9,000-10,000  Hypoalbuminemia - due to combined loss of blood,
- A. Duodenale 25,000-30,000 lymph, and protein
Diagnostic Stage: Eggs
Signs and Symptoms
Infective Stage: Filariform larvae
1. Ground itch or Dew itch
Mode of Transmission: Skin penetration
2. Pneumonia and alveolar hemorrhage, bloody sputum
3. Enteritis, pain
4. Microcytic hypochromic anemia, iron deficiency anemia
(IDA)
5. Creeping eruption / Cutaneous Larva Migrans (CLM)
6. Dyspnea, weakness, dizziness, lassitude, rapid pulse,
edema, and albuminuria
Prevention and Control
 School-based mass deworming programs have been the
most popular strategy to address the issue of hookworm
infection in children
Treatment:
 Anthelminthic medications
- Mebendazole, Pyrantel pamoate
 Infections are generally treated for 1-3 days
 Medications have few side effects
 For severe anemia, iron replacement is given

Enterobius Vermicularis
(1) Resides in the small intestine, then eggs in feces (en”tir-o’bee-us/vur-mic-yoo-lair’is)
(2) Rhabditiform larva hatches, free-living (1-2 days of Common names: Pinworm, Seatworm
development) Common associated diseases and condition names:
(3) Development to filariform larva in environment (5-10 Enterobiasis, Pinworm infection
days)
(4) Filariform larva penetrates skin Epidemiology
 Most common helminth known to cause infection in the
* Ancylostoma spp. Larvae can become developmentally
arrested and dormant in tissues. Re-activated larvae may United States
 Found worldwide, particularly in temperate and tropical
enter the small intestine
regions
* It can go to the lungs, then the larva will go to the small  More common within families with school-aged children,
intestine, then develop into adults in primary caregivers of infected children, and in
* Filariform larvae does not need open wounds to penetrate institutionalized children
(5) Adults in small intestine. Larvae exit circulation in the  Transmission: hand-to-mouth contamination,
lungs; they are then coughed up and swallowed inhalation/airborne
Laboratory Diagnosis  Eggs contaminate underwear and beddings

 Hookworm eggs - stool (specimen recovery) Morphology

 Larvae may mature and hatch from the eggs in stool that Enterobius Vermicularis egg
has been allowed to sit at room temperature, without Eggs: Typical Characteristics at a Glance
fixative added Parameter Description
 Differentiation of these larvae from those of S. Stercoralis Size 48-60 μm long, 20-35 μm wide
is crucial to ensure proper diagnosis and subsequent Shape Oval, one-side flattened
treatment Embryo Stage of development varies; may be
 Recovery and examination of buccal capsule is necessary unembryonated, embryonated, mature
to determine the specific hookworm organism (i.e., Shell Double-layered, thick, colorless
whether it is A. Duodenale or N. Americanus)

11
 CLINICAL PARASITOLOGY
LECTURE / LESSON 2
Mode of Transmission: Ingestion or Inhalation

E.Vermicularis unembryonated egg E.Vermicularis immature embryonated egg

(1) Eggs on perianal folds/region (mature within 4-6 hours)

E.Vermicularis mature embryonated egg (2) Embryonated eggs ingested by human
* Different stages of egg may be seen in the stool (3) Larvae hatch in small intestine
* Has developing larva inside (4) Adults in lumen of cecum
(5) Gravid female migrates to perianal region at night to lay
Enterobius Vermicularis adult
eggs
Adults: Typical Characteristics at a Glance
Characteristic Female Adult Male Adult Laboratory Diagnosis
 Cellophane tape preparation collected from the perianal
Length 7-14 mm 2-4 mm
Width Up to 0.5 mm ≤ 0.3 mm region of the person suspected of infection
 Eggs are the primary morphologic form seen (adult
Color Yellowish-white Yellowish-white
females may also be present)
Tail Pointed; resembles
 Multiple samples may be required to confirm the presence
pinhead
of a light infection or free of infection
* Adult males are only rarely seen
 Eggs and/or adult females may be recovered in stool
- Pointed tail uteri of gravid females are distended with eggs
samples (rare)
- Migrate in the perianal area at night and lays eggs
(4,672-16,888 eggs/day)  Best time to collect: Morning (the eggs are now hatched)

- After egg position, Female adult dies Signs and Symptoms

* Adults have “meromyarian type” of somatic arrangement 1. Asymptomatic: Many cases of E. Vermicularis infection
(few cells) are asymptomatic (mild)
2. Most common symptoms:
- Intense perianal itching (Pruritus Ani)
- Inflammation of the anal and/or vaginal areas
3. May be accompanied by: Intestinal irritation, mild nausea
or vomiting, irritability and difficulty sleeping
4. Less frequent: Minute ulcers as well as mild intestinal
inflammation and abdominal pain
Prevention and Control
 Practicing proper personal hygiene (hand washing)
* At night, the female adult goes to the perianal region where  Applying an ointment or salve to an infected perianal area
it will lay its eggs (that is why it is seen in underwear and to help prevent egg dispersal into the environment
beddings)  Avoiding scratching the infected area
Life Cycle  Cleaning of all potentially infected environmental surfaces
 Infection occurs via self-inoculation or through exposure (linens)
to eggs in the environment Treatment: Albendazole, Mebendazole, Pyrantel pamoate
 Humans are the only host of E. Vermicularis Capillaria Philippinensis
 Moderate temperature accompanied by high humidity ([kup]+[pil]+[uh]+[ree]+yah/[fi.lip.pi’nen.sis])
 Autoreinfection - hand-to-mouth contamination Common names: Pudoc worm
Diagnostic Stage: Egg Common associated disease and condition names:
Infective Stage: Embryonated egg Capillariasis

12
 CLINICAL PARASITOLOGY
LECTURE / LESSON 2
Epidemiology  Ingestion of raw or undercooked fish results in infection of
 Discovered in Northern Luzon, Pudoc West, Tagundin the human host
Ilocos Sur (29 years old, male)  The released larvae can re-invade the intestinal mucosa
 Also endemic in Thailand and cause internal autoinfection and may lead to
 Number of cases have been identified in Northern Egypt hyperinfection
recently
 One of the four Capillaria species that are known to infect
humans (Capillaria Aerophila, Capillaria Hepatica,
Capillaria Plica)
Morphology
Capillaria Philippinensis
Typical Characteristics at a Glance
Adults
Males 2.3 to 3.2 mm
Females 2.5 to 4.3 mm
Eggs
Shell Thick-shelled eggs; peanut-shaped with
striated and flattened bipolar plugs
Length Between 40 and 48 μm
Width 17 and 20 μm
Other Inconspicuous flattened bipolar plugs:
features 2-3.6 μm long and 9-12 μm wide

Male Female

Diagnostic Stage: Unembryonated eggs

Infective Stage: Larvae in raw/uncooked fish
Mode of Transmission: Ingestion of raw/uncooked fish
(1) Unembryonated, thick-shelled eggs passed in feces
(2) Eggs become embryonated in water
Adult Male Adult Female (3) Infective larvae develop in tissue of intermediate host
Length 1.5-3.9 mm 2.3-5.3 mm (4) Ingestion of raw or undercooked infected fish
Spicule is 230-300 μm Vulva is located at the (5) Adults in small intestinal mucosa
long with unspined junction of anterior (6) Females may produce two types of eggs: unembryonated
sheath and middle thirds eggs (passed in feces) and embryonated eggs lacking shells
Esophagus with May produce larvae (hatch inside definitive host)
Stichocytes or row of and re-invade the (7) Larvae re-invade small intestinal mucosa in autoinfective
secretory cells while intestinal mucosa cycle
the entire esophageal resulting in internal Definitive host - Human ; Intermediate host - Fish (raw)
structure is called autoreinfection Laboratory Diagnosis
Stichosome  Capillaria philippinensis eggs - stool (by direct smear or
Anus is subterminal May produce larva or wet mount, stool concentration methods)
eggs (oviparous,  Various larval stages of the parasites, as well as adult
larviparous) worms in the feces
 Duodenal aspiration (parasites can also be recovered from
Eggs
Peanut-shaped with striated and flattened bipolar plugs the small intestines)
 Serology - sandwich enzyme-linked immunosorbent
Size: 36-45 μm by 20 μm
assay (ELISA) - detection of coproantigen prepared from
Unembryonated eggs are passed in the feces and
stool samples of patients with capillariasis
embryonate in the soil or water (freshwater or brackish
water then ingested by fish) Signs and Symptoms
Eggs hatch in the intestine of the fish and develop into an 1. Malabsorption (C. Philippinensis and Giardia Lamblia)
infective larvae then when uncooked fish is ingested, it 2. Borborygmus (rumbling or gurgling noise of the intestine)
escapes in the fish intestines and develop into an adult 3. LBM (loose bowel movement) alternating with
worm in the human intestines constipation
4. Weight loss, malaise, anorexia, vomiting, and edema
Life Cycle
5. Protein-losing enteropathy and hypoalbuminemia

13
 CLINICAL PARASITOLOGY
LECTURE / LESSON 2
6. Malabsorption of fats and sugars, decreased excretion of Strongyloides Stercoralis
xylose Rhabditiform Larva: Typical Characteristics at a
7. Low serum potassium, sodium, and calcium with high IgE Glance
(Immunoglobulin E) Parameter Description
8. Microulcers of the epithelium but no invasion of intestinal Average size 220 by 15 μm
tissue Other Short buccal cavity; prominent genital
9. Death can occur (super/severe infection) features primordium
Prevention and Control Strongyloides Stercoralis
 Proper hygiene and disposal of fecal matter Rhabditiform Larva Comparison
 Health education
 Practice hand washing after touching or working with soil
 Teach children the importance of washing hands
 Do not eat raw or undercooked fish
Treatment:
- Mebendazole (200 mg, 2x a day for 20 days)
- Albendazole (400 mg, a day for 10 days)
- Electrolyte replacement for severe cases
vs. Hookworm Rhabditiform Larva
Strongyloides Stercolaris
(stron”ji-loy’deez/stur”kor-ray’lis)
Common name: Threadworm
Common associated disease and condition names:
Strongyloidiasis, Threadworm infection
Epidemiology
 Found predominantly in the tropical and subtropical
regions of the world (known to exist on all continents
except for Antarctica) 1. Short buccal cavity - S. Stercoralis ; Long buccal cavity -
 Experts estimate that there are between 30-100 million Hookworm
infected persons worldwide 2. Prominent genital primordium - S. Stercoralis ; Small
 Ideal atmosphere: Areas of poor sanitation, in which genital primordium - Hookworm
feces are disposed in the warm moist soil Strongyloides Stercoralis
 Those at risk for contracting threadworm are those who Filariform Larva: Typical Characteristics at a Glance
come into skin contact with contaminated soil Parameter Description
Morphology Average length 690 μm
Strongyloides Stercoralis egg Length of esophagus Long
Egg: Typical Characteristics at a Glance Tail Notched
Parameter Description Strongyloides Stercoralis
Size Average, 48 by 35 μm Filariform Larva Comparison
Typical Contains well-developed larvae
growth phase
Embryonic Two-, four-, or eight-cell stage, when
cleavage present
Shell Thin, hyaline
* The egg of S. Stercoralis is usually indistinguishable from
Hookworm (but it has features where you can distinguish it)
* S. Stercoralis egg is smaller than Hookworm
* S. Stercoralis larvae is developed, while the Hookworm is vs. Hookworm Filariform Larva
undeveloped
* Hookworms are rarely seen because they need to stand in
room temperature before developing into a larvae, unlike S.
Stercoralis, larvae are seen

1. Long esophagus, compared with that of the Hookworm,

short esophagus
2. Tail of S. Stercoralis is notched, unlike that of Hookworm,
which is pointed

14
 CLINICAL PARASITOLOGY
LECTURE / LESSON 2
Strongyloides Stercoralis (7) The filariform larvae migrate by various pathways to the
Adult Female: Typical Characteristics at a Glance small intestine where they become adults
Parameter Description (8) Parasitic adult female in small intestine
Approximate size 2 by 0.4 mm (9) Eggs deposited in intestinal mucosa. Rhabditiform larvae
Other features Colorless, transparent body; finely hatch and migrate to intestinal lumen
striated cuticle; short buccal cavity; (10) Autoinfection: Rhabditiform larvae in large intestine
long and slender esophagus become filariform, penetrate intestinal mucosa (or perianal
skin) and migrate to other organs
Laboratory Diagnosis
 Strongyloides Stercoralis eggs - stool samples (severe
diarrhea)
 Rhabditiform larvae - fresh stool samples and duodenal
aspirates
 Sputum samples have also yielded S. Stercoralis larvae in

* Only female S. Stercoralis adult is described, there is no patients suffering from disseminated disease
 Serology - ELISA
known male S. Stercoralis to exist
* Adult females S. Stercoralis are “parthenogenetic” it can Signs and Symptoms
reproduce without the male 1. Asymptomatic: Patients suffering from only a light
Life Cycle infection often remain asymptomatic
 Indirect cycle, threadworm rhabditiform larvae passed to
2. Most common symptoms: Diarrhea and abdominal pain
the outside environment and mature into non-parasitic 3. Site of larvae penetration - itchy and red. Recurring
free-living adults allergic reactions may also occur
 Autoinfection - rhabditiform larvae develop into the
4. May also exhibit urticaria accompanied by eosinophilia
filariform stage inside the intestine of the human host 5. Vomiting, constipation, weight loss, and variable anemia
 It has two cycles:
6. Malabsorption syndrome (heavy infections)
(1) Free-Living Cycle: It develops outside the host (in 7. When the larvae migrate into the lungs, patients may
the environment) develop pulmonary symptoms
(2) Parasitic Cycle: It develops inside the host 8. Immunocompromised persons (autoinfection) results in the
spread of the larvae throughout the body, increased secondary
bacterial infections, and possibly death
Prevention and Control
 Similar to those for hookworm
- Proper sanitation practices
- Prompt and thorough treatment of infected persons
 Personal protection of persons entering endemic areas:
- Covering bare feet
 Proper handling and disposal of fecal material
 Adequate protection of the skin from contaminated soil
Treatment: Ivermectin, Albendazole

Diagnostic Stage: Rhabditiform larvae

Infective Stage: Filariform larvae
Mode of Transmission: Skin penetration
(1) Rhabditiform larvae in the intestine are excreted in stool
(2) Development into free-living adult worms
(3) Eggs are produced by fertilized female worms
(4) Rhabditiform larvae hatch from embryonated eggs
(5) Rhabditiform larvae develop into filariform (L3 - 3rd
stage) larvae (It can develop both free-living adult worms - the
one that lay eggs ; filariform larvae - the one that is ingested)
(6) Infective filariform larvae penetrate the intact skin of the
definitive host

15