Lesson 8: Nematodes Part 1 5.

Presence of sensory organs (with exceptions)

amphids (anterior) and phasmids (posterior)
6. Mostly are intestinal parasites
INTRODUCTION TO NEMATODES
Note:

 Parthenogenic: asexual reproduction in which

METAZOANS (multi-cellular organisms) the offspring develops from unfertilized eggs
 Amphids: These are the cuticular depressions
Nematoda
present on the lips surrounding the mouth in
Intestinal Ascaris lumbricoides
Capillaria philippinensis nematodes and serve as chemoreceptors.
Enterobius vermicularis  Phasmids: very useful in the grouping of the
Hookworm nematodes, neurons that were recently shown
Strongyloides stercoralis to function in modulation of chemorepulsion
Trichuris trichiura behavior (Chemorepulsion is the directional
Extraintestinal Angiostrongylus cantonensis movement of a cell away from a substance.)
Filarial worms
Trichinella spiralis
Cestoda CLASSIFICATION OF NEMATODES
Cyclophyllidea Dipylidium caninum
Echinococcus spp. A. Presence or Absence of Chemoreceptors
Hymenoplepis diminuta 1. Phasmid nematode – minute receptor organs
Hymenoplepis nana
Ex. Ascaris lumbricoides, Enterobius vermicularis,
Railientina garrisoni
Taenia saginata Hookworm, Strongyloides stercoralis,
Taenia solium Angiostrongylus cantonensis, Filarial worms
Pseudophylilidea Diphyllobotrium latum 2. Aphasmid nematode – without
Spirometra chemoreceptors
Trematoda
Clonorchis sinensis Ex: Trichuris trichiura, Trichinella spiralis,
Echinostoma ilocanum Capillaria philippinensis
Fasciola gigantica
Fasciola buski
Heterophyids B. Habitat
Opistorchis spp.
Paragonimus wetermani 1. Intestinal
Schistosoma spp
a. small intestines: Ascaris, hookworms,
Strongyloides, Capillaria
GENERAL CHARACTERISTICS OF NEMATODES b. large intestines: Trichuris, Enterobius

2. Extraintestinal
1. Elongated worms, cylindrical (round in cross a. Lymph nodes/vessels: Wuchereria and
section) Brugia
2. Not segmented b. Eyes and meninges: Angiostrongylus
3. Have a complete digestive system c. Muscles: Trichinella
4. Have separate sexes (though some maybe
parthenogenic)
C. Infective stages and Modes of Transmission NOTE:
1. Ingestion of embryonated eggs – Ascaris,
 Soil transmitted helminth infections are disease
Trichuris, Enterobius
of the poverty and may contribute to
2. Ingestion of infective larva – Capillaria,
malnutrition and impairment of cognitive
Trichinella, Angiostrongylus
performance.
3. Skin penetration of L3 – hookworms and
Strongyloides
4. Vector-borne – Wuchereria and Brugia MORPHOLOGY
5. Autoinfection – Strongyloides and
MALE FEMALE
Enterobius
10-31 cm 22-35 cm
6. Transmission through inhalation –
Ventrally curved Straight end
Enterobius and Ascaris (eggs or ova)
posterior with 2
DEVELOPMENTAL STAGES spicules

1. Egg
2. Larva
a. L1 : rhabditiform larva Trilobate lips with
b. L2 : sensory papillae
c. L3 : filariform larva
3. Adult
NOTE:

 Ascaris lumbricoides  Ascaris has been shown to produce pepsin

- Most common nematode of man inhibitor 3 (PI-3) that protects the worm from
- Occurs most frequently in the tropics digestion and phosphorylcholine that
suppresses lymphocyte proliferation.
 Common name : Giant intestinal/round worm
 Final Host : man
 Habitat : small intestine
 Diagnostic stage : fertilized and unfertilized egg Corticated, Unfertilized egg
 Infective stage : embryonated egg
 Source of ex. to inf. : soil-transmitted helminth
(along with Trichuris trichiura and hookworms)
 MOT : Ingestion Corticated, Fertilized egg
 Pathology : Ascariasis
 Diagnosis : Stool Exam, Concentration
technique
 Drug of choice : Albendazole (Mebendazole
Decorticated, Fertilized egg
and Pyrantel Pamoate)
* Ascaris suum – Ascaris of Pigs

Most vulnerable: Children who likes to play in the Embryonated egg

soil
NOTE: to the liver through portal vein  heart and
pulmonary vessels
 Unfertilized egg: longer and narrower than
fertile eggs, thin shell and irregular  Heart-lung migration
mammilated coating filled with refractile
NOTE:
granules. They may be difficult to identify.
 Fertile eggs  Female Ascaris produces about 200,000
 Corticated: outer, coarsely mammilated eggs per day. Eggs are deposited in the soil
albuminous covering and it takes about 2 to 3 weeks for the eggs
 Decorticated: w/o coarsely mammilated to develop under favorable conditions with
albuminous covering suitable temperature, moisture and
- Thick, transparent, hyaline shell with humidity.
a thick outer layer as supporting  The larvae undergo two molts to reach their
structure 3rd stage within the egg and become
- Delicate vitelline, lipoidal, inner embryonated. Only when this infective egg
membrane which is highly is swallowed can humans become infected
impermeable with Ascaris.
 Embryonated: when ingested, it will hatch on
the lumen of the small intestine and released in
PATHOLOGY
the larva
A. Due to larva
LIFE CYCLE
*Ascaris pneumonitis or Loeffler’s
Syndrome
 occurs during lung migration resulting in
allergic reactions such as lung infiltration,
asthmatic attacks and edema of the lips,
similar symptoms of pneumonia, vague
abdominal pain
 Eosinophilia is present

B. Due to adult worm

 worm bolus (accumulation that form a ball)
causing bowel obstruction
 diarrhea
Diagnostic stage:  abdominal pain

 Unfertillized egg will not undergo further Erraticity: if worm migrates to ectopic sites
development (gallbladder, hepatobilliary tree, appendix and
 Fertilized egg will further develop to become pancreas)  maybe regurgitated and vomited, may
embryonated egg escape through the nostrils or inhaled to the
trachea. Maybe due to medication, spicy-diet and
fever
Embryonated egg with L3 larva (hatch in the lumen
of the small intestine)  Larva will migrate into the
cecum or proximal colon where they penetrate the
intestinal wall  they enters the venules then go
DIAGNOSIS For children 12 – 24 months old
A. Stool Examination  Albendazole - 200 mg, single dose every 6
1. Direct Fecal Smear - less sensitive compared months. Since the preparation is 400mg, the
to Kato-Thick and Kato-Katz technique tablet is halve and can be chewed by the child
(useful for both individual or mass screening or taken with a glass of water
in schools or community)
Or
2. Kato-thick
3. Kato-katz - provides quantitative diagnosis in  Mebendazole - 500 mg, single dose every 6
terms of the intensity of helminth infection months
in eggs per gram (unit of measurement) of
For children 24 months old and above
stool, useful in monitoring the efficacy of
treatment in clinical trials  Albendazole - 400 mg, single dose every 6
 Kato-katz and Kato-thick : use cellophane to months
visualize the parasite
Or
B. Concentration Technique  Mebendazole - 500 mg, single dose every 6
1. Formalin Ether/Ethyl Acetate Concentration months
Technique (FECT)
2. Merthiolate Iodine Formaldehyde Note: If Vitamin A and deworming drug are given
Concentration technique (MIFCT) simultaneously during the GP activity, either drug
3. Brine floatation can be given first.
4. Zinc sulfate floatation technique 2. Adolescent females
 It is recommended that all adolescent
C. X-ray (extra-intestinal ascariasis  lungs) females who consult the health be given
D. CBC (demonstrate eosinophilia) anthelminthic drug
o Albendazole 400 mg once a year
Or
PREVENTION AND CONTROL o Mebendazole 500 mg once a year
1. Sanitary disposal of human feces
2. Health education 3. Pregnant women
3. Mass chemotheraphy  It is recommended that all pregnant women
4. Avoid using night soil who consult the health be given anthelminthic
5. Proper food preparation drug once in the 2nd trimester of pregnancy.
 In areas where hookworm is endemic:
 Where hookworm prevalence is 20 – 30%
o Albendazole 400 mg once in the 2nd
trimester
Integrated Helminth Control Program (DOH) Or
Targets and Doses o Mebendazole 500 mg once in the 2nd
trimester
 Where hookworm prevalence is > 50%,
1. Children aged 1 year to 12 years old repeat treatment in the 3rd trimester
4. Special groups, e.g., food handlers and MORPHOLOGY
operators, soldiers, farmers and indigenous
MALE FEMALE
people
30-45 mm 35-50 mm
 Selective deworming is the giving of
Coiled posterior with a Rounded/blunt
anthelminthic drug to an individual based on single posterior
the diagnosis of current infection. However, spicule and retractile
certain groups of people should be given sheath
deworming drugs regardless of their status
once they consult the health center.
 Attenuated anterior 3/5– slender, hairlike,
 Special groups like soldiers, farmers, food
transversed by a narrow esophagus resembling
handlers and operators, and indigenous
“string of beads” – used for attachment
people are at risk of morbidity because of
their exposure to different intestinal parasites  Robust posterior 2/5 – contains the intestines
in relation to their occupation or cultural and single set of reproductive organs
practices.
 For the clients who will be dewormed
selectively, treatment shall given be anytime
at the health centers.

 Trichuris trichiura

 Lemon shaped/barrel-shaped/football
 Common name : Whipworm shaped/ Japanese lantern with plug-like
 Final Host : man translucent polar prominences a.k.a
 Habitat : large intestine “mucoid bipolar plugs”
 Diagnostic stage : egg
 Infective stage : embryonated egg LIFE CYCLE
 Source of ex. to inf. : soil-transmitted
helminth
 MOT : Ingestion
 Pathology : Rectal prolapse, IDA, diarrhea
 Diagnosis : Stool Exam, Concentration
technique
 Drug of choice : Mebendazole (Albendazole as
alternative drug)

 Albendazole + Ivermectin better cure and egg

reduction rate than Albendazole alone

* Usually observed occurring together with Ascaris

lumbricoides
Unembryonated eggs passed in feces  2-cell PREVENTION AND CONTROL
stage  Advanced cleavage  Embryonated eggs
1. Treatment of infected individuals
are ingested (infected in 15-30 days)  eggs hatch
2. Sanitary disposal of human feces 
in the small intestine and release larva  Adult in
construction of toilets
the colon
3. Washing of hands
 The worms secrete a pore-forming protein 4. Health education (sanitation and hygiene)
called the TT47 that allows them to imbed their 5. Proper food preparation practices
entire whip-like portion into the intestinal
walls.
 Enterobius vermicularis
PATHOLOGY
1. Rectal prolapse  Common name : Pinworm, Seatworm,
- a condition in which the rectum (the Society worm*
lower end of the colon, located just  Final Host : man
above the anus) becomes stretched
 Habitat : (cecum) large intestine
out and protrudes out of the anus.
 Diagnostic stage : ova
Weakness of the anal sphincter
 Infective stage : embryonated egg
muscle is often associated with rectal
 Source of ex. to inf. : contact-borne
prolapse at this stage, resulting in
 MOT : Ingestion, inhalation
leakage of stool or mucus.
 Pathology : Enterobiasis or oxyuriasis
2. Appendicitis and granulomas due to
irritation and inflammation brought by the  Diagnosis : Scotch tape swab
worms  Drug of choice : Pyrantel pamoate
3. Blood streaked diarrheal stools, abdominal  (Mebendazole and Albendazole as
pain, tenderness, anemia and weight loss alternative)
* Familial disease
DIAGNOSIS Familial or group disease: extremely contagious
A. Stool Examination and can easily spread among members of the
1. Direct Fecal Smear family or in institutions
2. Kato-thick smear - highly recommended in NOTE:
the diagnosis of Trichuriasis.
3. Kato-katz - quantitative method used to  Can cause autoinfection and retroinfection
assess the efficacy of anthelminthic drugs in (the migration of newly hatched larvae from
terms of cure rate and egg reduction rate the anal skin back into the rectum)

 FLOTAC technique has also been shown to be

more sensitive in the diagnosis of Trichuriasis.

B. Concentration Technique
1. FECT
2. MIFCT
3. Brine floatation
4. Zinc sulfate floatation technique
MORPHOLOGY LIFE CYCLE

“Cephalic alae”

lateral wing or
cuticular alar
expansions at the
anterior end

Prominent
posterior
esophageal bulb
or “bulbus”

MALE FEMALE
2 to 5 mm 8-13 mm Eggs on perianal folds  Embryonated eggs
Curved tail and has a long pointed tail ingested by human (Self-inoculation)  Larvae
single hatch in small intestine  adults in lumen of
spicule cecum  Gravid female migrates to perianal
*rarely seen because region at night to lay eggs (Nocturnal)
they die
after copulation
PATHOLOGY
1. Mild catarrhal inflammation of the intestinal
mucosa
2. Nocturnal Pruritus ani – “perianal itching”
which may lead to secondary bacterial
infection and lack of sleep
3. Other complications: appendicitis, vaginitis,
endometritis and peritonitis.
4. Poor appetite, weight loss and abdominal
D-shaped eggs of E. vermicularis pain
 Asymmetrical, with one side flattened and DIAGNOSIS
the other side is convex
1. Graham’s scotch adhesive tape swab
 Translucent shell – triple albuminous outer
(Perianal cellulose tape swab)
layer for mechanical protection and inner
- provides the highest percentage of
embryonic lipoidal layer for chemical
positive (+) results
protection
 Ovum develops into a “tadpole-like
embryo” PREVENTION AND CONTROL
1. Personal cleanliness and hygiene are
essential
2. Hand washing
3. Boiling of linen and clothing