NEMATODES

Miguel Carlos G. Arada, RMT, ASCP (IMT), AMT, DTA, MSMT

 Nematodes
• Objectives:
 To be able to analyze the life cycle, prevalence, treatment and prevention of nematodes
that are of locally and internationally public health concerns.
 Nematodes
Topic Outline
• Introduction to Nematodes
• Enterobius vermicularis
• Trichuris trichiura
• Ascaris lumbricoides
• Hookworms
• Strongyloides stercoralis
General Characteristics
• Roundworms are unembryonated, elongated, cylidnrical in shape.
• With sensory organs known as chemoreceptors
• The sexes are separate
• Female may be
• oviparous
• viviparous
• larviparous
• Developmental stage: Egg-Larva-Adult
 General Characteristics
• 3 basic morphologic forms:
• Eggs
• Vary in size and shape
• Larvae
• Typically long and slender
• Adult
• Female worms are usually larger than the adult males
• Complete digestive and reproductive system
General Characteristics
• Digestive system
• Mouth
• located at the anterior end
• maybe equipped with hooks,teeth, plates and other structures
• Buccal Cavity
• tubular or funnel-shaped,
• Esophagus
• a muscular tube that pumps food posteriorly into the intestine
• Varies in size, shape and structures
General Characteristics
• Intestine
• a flattened tube with a wide lumen that follows a straight
course from the esophagus to the rectum
• Rectum
• Defecation occurs when the anus is dilated and the pseudocele
pressure forces the feces out
 Nematode Classification
• I.) Based on the presence or absence of caudal chemoreceptor organ
• A.) Class Enoplea (Class Adenophorea; Class Aphasmidea)
• without caudal chemoreceptor organ(phasmids)
Trichuris trichiura
Trichinella spiralis
Capillaria philippinensis
Nematode Classification
• I.) Based on the presence or absence of caudal chemoreceptor
organ
• B.) Class Rhabditea ( Class Secernentia; Class Phasmidea)
• with caudal chemoreceptor organ(phasmids)
Ascaris lumbricoides
Strongyloides stercoralis
Enterobius vermicularis
Angiostrongylus cantonensis
Filarial worms
Hookworms
Dracunculus medinensis
Nematode Classification
II.) Classification according to habitat:
• Intestinal nematodes
• Enterobius vermicularis
• Trichuris trichura
• Ascaris lumbricoides
• Necator americanus
• Ancylostoma duodenale
• Strongyloides stercoralis
• Capillaria philippinensis

• Extraintestinal nematodes
• Trichinella spiralis
• Dracunculus medinensis
• Angostringylus medinensis
• Filarial worms
Life Cycle notes
• 1. Direct (Homogonic)
• Require DH but not IH
• Homoxenous

• 2. Indirect (Heterogonic)
• Require Both DH and one or more IH
• Heteroxenous
 Nematodes
Topic Outline
• Introduction to Nematodes
• Enterobius vermicularis
• Trichuris trichiura
• Ascaris lumbricoides
• Hookworms
• Strongyloides stercoralis
 Enterobius vermicularis
COMMON NAME Pinworm, seatworm
PATHOLOGY Enterobiasis, pinworm infection
 Enterobius vermicularis
• Morphology
• Eggs
• 48-60 µm in length by 20-35 µm in width
• Characteristic appearance:
• Oval egg is flattened on one side
• Loopsided ovum or “D” shaped ovum
Enterobius vermicularis
• Adults
• 7 to 14 mm in length by up to 0.5mm wide
• Female
• Yellowish-white
• Oviposit eggs at the perianal region at night
Enterobius vermicularis life cycle
 Enterobius vermicularis
FINAL HOST Man

HABITAT Large intestine

DIAGNOSTIC STAGE Ova and adult

INFECTIVE STAGE Fully embryonated egg

MOT Ingestion and inhalation

 Enterobius vermicularis
• Life Cycle notes
• Retroinfection
• Infective pinworm eggs that migrate back into the host body
• It develops and reproduces rather than being dislodged
• Autoreinfection
• Infected individuals reinfect themselves
• Possible if an infective pinworm eggs are ingested via hand to mouth contamination
Enterobius vermicularis
Enterobiasis: Pinworm infection
• Symptoms:
• Perianal pruritus
• Difficulty in sleeping
• Intestinal irritation
• Mild nausea
• Vomiting
• Irritability
• Mild intestinal inflammation
• Abdominal pain
• Many cases are asymptomatic
 Enterobius vermicularis
• Laboratory Diagnosis
• Specimen of choice:
• Cellophane tape preparation from the perianal region
• eggs and adult may be seen
• Multiple samples may be required:
• To confirm the presence of light infection;
• To determine that a patient is free of infection
• Stool samples
• Eggs and/or adults may be recovered in rare
occassions
 Enterobius vermicularis
• Treatment
• Albendazole, mebendazole or pyrantel pamoate
• Epidemiology
• Worldwide
• Most common helminth in US
• E. vermicularis is repsonsible for the transmission of Dientamoeba fragilis
• D. Fragilis trophozoite is inside the pinworm egg.
 Enterobius vermicularis
Prevention and Control
Practice proper personal hygiene
Hand washing
Applying an ointment
Cleaning of all potentially infected environmental surfaces
 Trichuris trichiura
COMMON NAME Whipworm
DISEASE Trichuriasis , whipworm infection
 Trichuris trichiura
• Morphology
• Eggs
• Characteristic appearance:
• Barrel-shaped, foot-ball shaped, japanese lantern & lemon shaped
• A prominent hyaline polar plug is visible at each end.
• Yellowish brown due to bile contact
• 50 to 55 µm by 25 µm
 Trichuris trichiura
• Morphology
• Adults
• Anterior end
• Colorless and contains a slender esophagus
• Smaller & looks like a whip
• Posterior end
• Pinkish-gray color consiting intestine & reproductive
system
• Large & resembles a whip handle
• Adult male
• usually smaller than the adult female.
• Contains easily recognizable curled tail
Trichuris trichiura life cycle
 Trichuris trichiura
FINAL HOST Man

HABITAT Large intestine

DIAGNOSTIC STAGE Ova

INFECTIVE STAGE Fully embryonated eggs

MOT Ingestion
Trichuris trichiura
• Trichuriasis: Whipworm infection
• 500 to 5000 worms (heavy infection)
• Symptoms:
• Chronic dysentery
• Severe anemia
• Possible growth retardation
• Rectal prolapse
• Peristalsis
• Weight loss
• Weakness
• Mucoid or bloody diarrhea
• Asymptomatic
• Slight whipworm infection
 Trichuris trichiura
• Laboratory Diagnosis
• Specimen of choice: Stool
• Macroscopic examination (adult worms)
• Treatment
• Mebendazole or albendazole
 Trichuris trichiura
• Epidemiology
• 3rd most common helminth
• Found primarily in warm climates
• Prevention and Control
• Proper sanitation practices
• Avoidance of defecating directly into the soil
• Avoid using feces as fertilizers
• Educating children
 Ascaris lumbricoides
COMMON NAME Large intestinal roundworm, roundworm of man

DISEASE Ascariasis, roundworm infection

 Ascaris lumbricoides
• Morphology
• Egg shell consists of 3 layers:
• Inner
• Vitelline membrane
• Middle
• Glycogen layer
• Outermost
• Albuminous/mammilary coat
 Ascaris lumbricoides egg
UNFERTILIZED • FERTILIZED CORTICATED

INNER
x No vitelline membrane INNER ✓ vitelline membrane

MIDDLE
✓ Glycogen MIDDLE ✓ Glycogen

OUTER
✓ Refractile lecithin granules OUTER ✓ Albuminous/
mamillary
 Ascaris lumbricoides egg
FERTILIZED DECORTICATED EMBRYONATED

INNER
✓ vitelline membrane
Larvae inside
MIDDLE
✓ Glycogen

OUTER Chitin – outermost layer of

X decoritcated egg
 Ascaris lumbricoides
• Adult
• Characteristic appearance:
• terminal mouth with trilobate lips and a small
triangular buccal cavity
• cuticle with a faint longitudinal white lateral lines
• which is seen as a whitish streak along the
entire length of the body
Ascaris lumbricoides
• Male
• Adult • Seldomly reaching 30 cm in
• Female length
• 22 to 35 cm • Prominent incurved tail
• Resembles a pencil lead in
thickness
Ascaris lumbricoides life cycle
 Ascaris lumbricoides
FINAL HOST Man
HABITAT Small intestine
DIAGNOSTIC STAGE Ova, adult

INFECTIVE STAGE Fully embryonated egg

MOT ingestion
Ascaris lumbricoides Pathology
• 1.) Due to Larva: Non Human Ascariasis
• A.) Visceral Larva Migrans
• Toxocara canis
• Toxocara cati
• Ascaris suum
• B.) Ascaris Pneumonitis or Loeffler’s syndrome
Ascaris lumbricoides Pathology
• 2.) Due to Adults
• Ascariasis : Roundworm infection
• Adominal pain
• Vomiting & fever
• Diarrhea
• Malnutrition
• Complications like worm bolus
• Asymptomatic
• When a px ingest only a few eggs
 Ascaris lumbricoides
• Laboratory Diagnosis
• Specimen of choice : stool
• Ault worms may be recovered in:
• Small intestine
• Gall bladder
• Liver appendix
• ELISA
• Treatment
• Albendazole and mebendazole
 Ascaris lumbricoides
• Epidemiology
• Most common helminth infection in the world
• In addition to pinworm, may be responsible for transmitting Dientamoeba fragilis
• Prevention and Control
• Avoid using feces as fertilize
• Proper sanitation
• Personal hygienic practices
Hookworms
 Necator americanus
• Common name: New world hookworm
• Diseases: Necatoriasis
• Characteristic shape of adult is S shape
• Buccal capsule is provided with semilunar cutting
plates
• Equipped with an amphidial gland
• Tail contains a copulatory bursa and
copulatory spicule
 Ancylostoma duodenale
• Common name: Old world hookworm
• Diseases: Ancylostomiasis and miners anemia
• Characteristic shape of adult is letter C
• Adult worm has a 2 pairs of ventral teeth
• Has a pair of copulatory spicule which is bristle like
 Ancylostoma braziliense
• Common name: Cat hookworm
• Disease: Cutaneous larva migrans / creeping eruption
• Adults have a pair of teeth and a pair of inconspicuous median teeth
• Copulatory bursa is broad and long with short lateral rays
 Ancylostoma caninum
• Common name: Dog hookworm
• Disease caused: Cutaneous larva migrans/creeping eruption and eosinophilic
enteritis
• Adult worm has 3 pairs of ventral teeth
• Cephalic amphidial gland
Hookworm ova
Life cycle
Life Cycle
 Clinical symptoms
• Due to Larva
• Dermatitis: “Ground itch” or “dew itch” or “colic itch”
• Wakana disease
• Due to Adults
• Malnutrition
• Hookworm anemia
• Iron deficiency Anemia
• Laboratory Diagnosis
• DFS
• Harada – Mori technique
• Treatment
• Mebendazole
• Pyrantel pamoate
Strongyloides stercoralis
 Strongyloides stercoralis
• Common name: Threadworm
• Diseases: Strongyloidiasis and Cochin china diarrhea
• Adult contains short buccal cavity and a long esophagus
• Body of the worm is transparent with fine striated cuticle
• Ova has a characteristic Chinese lantern shape
Life cycle
• Laboratory Diagnosis
• Zinc sulfate concentration technique
• Duodenal aspirates
• Harada mori stool culture

• Treatmeant:
• Ivermectin
• Albendazole
 HOOKWORM THREADWORM
RHABDITIFORM
Buccal Cavity Long Short
Genital Inconspicuous Prominent
FILARIFORM
Sheath Present Absent
Tail Pointed Notched