- Attenuated anterior three-thirds

traversed by a narrow esophagus

resembling a string of beads.
- Robust posterior two-fifths contain the
Common Name: Whipworm intestine and a single set of
reproductive organs.
- HAS THICK POSTERIOR AND LONG
AND SLENDER ANTERIOR
HOLYMYARIAN which means the
PORTION, hence the name whipworm.
arrangement of somatic cells in cross-section
Posterior is like the handle, and anterior
are small, numerous, and closely packed in a
is the whip itself.
narrow zone.

EMBRYONATED EGG = infective stage

ADULT MALE:
UNEMBRYONATED EGG = diagnostic stage
- 30 to 45 mm
One of the three nematodes that belong to the
- Coiled posterior with a single spicule
UNHOLY THREE, together with Ascaris
and retractile sheath
lumbricoides and Hookworms. It is also SOIL-
TRANSMITTED.
ADULT FEMALE:
Adult worms live on the LARGE INTESTINE –
specifically the cecum and the colon.
- Blunt posterior end
The worms secrete a pore-forming protein,
called the TT47 that allows them to imbed their
EGGS:
entire whip-like portion into the intestinal wall.
- 50 to 54 um by 23 um
Color = PINKISH GRAY
- “Lemon-shaped”
- “Football-shaped”
A female lays approximately 3,000 to 10,000
- Has plug-like translucent polar
eggs per day. Can produce about 60 million
prominences
eggs over an average lifespan of 2 years.
- Yellowish outer and transparent inner
shell
EMBRYONIC DEVELOPMENT takes place
- FERTILIZED EGGS are unsegmented
OUTSIDE the host when eggs are deposited
at oviposition.
in clayish oil. It will become embryonated
- Also called “Japanese Lantern Egg”
within 2 to 3 weeks.

In the small intestine, it undergoes 4 larval

PATHOGENESIS & MANIFESTATION
stages to become adult worm.
Petechial Hemorrhages
ANTERIOR PORTIONS – the part that imbeds
- Caused by the embedded anterior
in the intestinal mucosa.
portions of the worms, which may be
predispose to amebic dysentery.
Occurs in both temperate and tropical
countries but is more widely distributed in
Trichuris Dysentery Syndrome
warm, moist areas of the world.
- Chronic dysentery
- Rectal prolapse (common in children)
MORPHOLOGY
- Trichuriasis are often marked by
frequent blood-streaked diarrheal
Both male and female:
stools, abdominal pain and renderness,
nausea and vomiting, and weigh loss.

Notes by Neil Arnold Melabo

Enterorrhagia – intestinal bleeding

Anemia
- Strongly correlated to heavy intensity
trichuriasis.
- Blood loss range from 0.8 to 8.6 ml per
day.
- 800 worms are enough to cause
anemia to children.

Since there is no larval migration through the

lungs as in Ascaris and hookworm infections,
no lung pathology occurs.

DIAGNOSIS

1. DFS with a drop of saline solution

2. Kato Thick smear (20 to 60mg of stool)
– recommended in the diagnosis of
trichuriasis.
3. Kato-Katz technique – quantitative
method that employs egg counting to
determine the INTENSITY of infection.
4. FECT
5. FLOTAC – more sensitive

TREATMENT

1. Mebendazole (alternative)
2. Albendazole (drug of choice)
3. Ivermectin

LIFE CYCLE

1. Unembryonated eggs passed in feces,

2. 2-cell stage
3. Advanced cleavage stage (takes about
2-3 weeks for it to become infective)
4. Embryonated eggs are ingested.
5. Larvae hatch in the small intestine.
6. Larvae migrate toward the large
intestine
7. Larvae burrow into the mucosa of the
cecum and colon, where they mature
into adult worms.

Notes by Neil Arnold Melabo

 Geographic Predomina Japan, etc.
nt in
Scientific Names: Necator americanus & Philippines.
Ancylostoma duodenale Disease Necatoriasi Ancylostomias
s, is
Uncinariasi
They are soil-transmitted helminths. s
Pathogeneci Less More
They are BLOOD-SUCKING NEMATODES ty pathogenic pathogenic
that attach to the mucosa of the small Eggs per 9,000 25,000 –
intestine. day 30,000
Posterior of No spine With Spine
AVOID WALKING BAREFOOT!!! female

SMALL INTESTINE = Habitat

INFECTIVE STAGE = filariform larvae (3rd
All hookworms have the MEROMYARIAN type stage) eggs ang diagnostic stage
of somatic muscle with two to five cells
arranged per dorsal or ventral half. Characteristic of flilariform = Open mouth,
longer, and slender
Necator americanus
- New World Hookworm MOT: Skin Penetration
- Charles Wardell Stiles (identified) - Acetylcholinesterase
- Anemia (antiinflammatory)
- Glutathione-S-transferase &
Ancylostoma duodenale superoxide dismutase (inhibits ADCC)
- Old World Hookworm - Neutrophil inhibition factor (inhibits the
- Arthur Loss (described pathogenesis) endothelium-driven transmigration
- Ancylostomiasis eosinophils)

Prevalent in the TROPICS and

SUBTROPICAL countries MORPHOLOGY

QUICK COMPARISON HOOKWORM EGGS:

parameter N. A. duodenale Their eggs are difficult to distinguish.

americanu - Bluntly rounded ends
s - Thin transparent hyaline shell
Common New world Old worm - Unsegmented at oviposition
Name hookworm hookworm - A. duodenale has smaller eggs.
Buccal 1 pair of 2 pairs of - Reporting of result is “Hookworm eggs”
Capsule semilunar curved ventral
cutting teeth ADULT NECATOR AMERICANUS:
plates
Head Bends Follows the - Small, cylindrical, fusiform
Position opposite body - Grayish-white color
the body curvature - Broad, membranous caudal bursa with
curvature rib-like rays posterior FOR MALE
Bursa 2-pronged 3-pronged - Head is curved OPPOSITE to the
dorsal trays dorsal trays curvature of the body
Amount of 0.03 ml/day 0.16-0.34 - Buccal capsule has one pair of
Blood ml/day semilunar cutting plates

Notes by Neil Arnold Melabo

ADULT ANCYLOSTOMA DUODENALE MICROCYTIC HYPOCHROMIC ANEMIA –
blood picture of the disease IRON
- Slightly larger than duodenale DEFICIENCY ANEMIA (type of anemia
- Anterior end follows the curvature of the caused by hookworms)
body
- Two pairs of curved ventral teeth HYPOALBUMINEMIA – low level of albumin
- Males uses spicules to hold the female due to combined loss of blood, lymph, and
during copulation. protein.

WAKANA DISEASE – lung disease causing

RHABDITIFORM LARVAE in comparison with pneumonia
Strongyloides stercoralis
DIAGNOSIS
Parameter Strongyloides Hookworms
Buccal Short Long 1. DFS
Capsule 2. Kato-Katz
Genital Large Small 3. Concentration Method
Primordium 4. Harada Mori (culture)
5. PCR Based Detection
6. Molecular Approach (ELISA)
FILARIFORM LARVAE
TREATMENT
Necator americanus
- Conspicuous buccal spears and 1. Albendazole – drug of choice
parallel throughout their lengths 2. Mebendazole
- Conspicuous transverse striations 3. Pyrantel pamoate
present on the sheath in the tail region. 4. Iron supplementation
- Pointed tail
LIFE CYCLE
Ancylostoma duodenale
- Inconspicuous buccal spears 1. Eggs in feces
- Inconspicuous transverse striations on 2. Rhabditiform larva hatches in 1 to 2
the sheath in the tail region. days (outside)
- Notched or rounded tail 3. Development to filariform (3rd stage) in
environment after 5 to 10 days
Filariform larvae can be trapped in MORNING (outside)
DEW 4. Filariform larva penetrates skin
(infective)
When compared to strongyloides: 5. Carried through the blood vessels to
the heart
Parameter Strongyloides Hookworms 6. Lungs
Esophagus LONG SHORT 7. Penetrate into pulmonary alveoli,
Tail NOTCHED POINTED ascend to pharynx, and are swallowed
8. Larvae mature into adults in the small
PATHOGENESIS intestine

CUTANEOUS LARVAL MIGRANS = ground OTHER SPECIES

itch or dew itch
Ancylostoma braziliense – 1 pair of
LUNG EFFECTS inconspicuous median teeth
- Bronchitis
- Pneumonitis Ancylostoma caninum – 3 pairs of ventral
- Minor Hemorrhages teeth

Notes by Neil Arnold Melabo

 FREE-LIVING ADULTS (Optional):

- Male has ventrally curved tail, two

copulatory spicules and a
Common Name: Threadworm gubernaculum, and no caudal alae
- Female has muscular, double-bulbed
esophagus, straight, cylindrical
It is OVIVIPAROUS which means that its intestine.
eggs hatch before it leaves the body.
FILARIFORM LARVA
Has a FREE-LIVING RHABDITIFORM and
PARASITIC FILARIFORM - INFECTIVE STAGE
- Slender body
It can cause INTERNAL AUTOINFECTION, - Distinct cleft at the tip of the tail
along with Capillaria philippinensis - Smaller than hookworm filariform
larvae (refer to table at Hookworm sec.)
Adult females are PARTHENOGENIC which - INFECTS HUMANS BY
means that it can produce eggs even without PENETRATING THE SKIN (same sa
the male species. hookworms)
- Males can’t be parasitic due to the fact
that THEY CAN’T SURVIVE ON A PARASITIC (filariform) FEMALE:
TEMPERATURE >34 degrees C.
- Colorless, semitransparent, finely
RHABDITIFORM LARVA is seen on soil. striated cuticle
- Slender, tapering anterior end with a
It is FACULTATIVE, which means that it can short, conical, pointed tail
be free-living and parasitic. - Short buccal cavity with four indistinct
lips
Lives in the SMALL INTESTINE - Long esophagus extending to the
anterior fourth of the body
MORPHOLOGY - Vulva located one-third of the body
length from the posterior end.
EGG: - Uteri contain 8-12 segmented, thin-
shelled, transparent ova.
- Thin shelled
- Transparent PATHOGENESIS
- Segmented
- Hatch into rhabditiform larvae before COCHIN CHINA diarrhea – also known as
being excreted in feces Vitenam diarrhea is an intermittent diarrhea
(OVIVIPAROUS) with watery and bloody stools.
RHABDITIFORM LARVA: DIAGNOSIS
- DIAGNOSTIC STAGE 1. Baermann Funnel Gauze Method
- Elongated esophagus with a pyriform 2. Harada-Mori Culture – one of the most
(pear-shaped) posterior bulb successful methods.
- Short buccal cavity and large genital 3. Nutrient Agar Plate Culture
primordium (refer to table in
Hookworms sec.) TREATMENT
- May develop into free-living adults
- Can develop into filariform larvae for 1. Ivermectin
autoinfection 2. Thiabendazole
3. Albendazole

Notes by Neil Arnold Melabo

 LIFE CYCLE

THREE PATHS:

1. Rhabditiform larvae in stool

2. Develop 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
infective filariform
6. Infective filariform penetrate the intact
skin, initiating the infection.
7. Enters the circulatory system
8. Transported to the lungs and penetrate
the alveolar spaces.
9. Carried to trachea and pharynx, and the
swallowed
10. Reach the small intestine where they
become adults (only female)
11. Gravid female worm deposits eggs in
the intestinal mucosa.
12. Rhabditiform larvae hatch and migrates
to the lumen
13. Excreted in stool.
14. Can cause internal autoinfection if it
becomes a filariform larvae again.

Notes by Neil Arnold Melabo

 entire esophageal structure is called a
STICHOSOME.
- Anus is subterminal
- Filamentous at its anterior end
- Thicker and shorter posterior end
Common Name: Pudoc Worm

PATHOGENESIS
First reported by Chitwood in 1963 in a 29-
year-old male from Northern Luzon in the INTESTINAL CAPILLARIASIS – damages
Philippines. cells of intestinal wall
INTESTINAL CAPILLARIASIS, a zoonotic BORBORYGMI – stomach rumbling or
disease, is characterized by abdominal pain, gurgling.
chronic diarrhea, and GURGLING STOMACH.
ANASARCA – whole body is edematous /
Belongs to the superfamily Trichinelloida, to generalized edema
which Trichuris and Trichinella belong.
VISIBLE PERISTALTIC WAVE – you can see
SMALL INTESTINE = habitat your intestine literally move due to worm
movement.
INFECTIVE LARVAE = infective stage

UNEMBRYONATED EGG = diagnostic stage DIAGNOSIS

It can cause INTERNAL AUTOINFECTION, 1. DFS
as opposed to vermicularis that cause external 2. Concentration Method
autoinfection. 3. Intestinal Biopsies
Acquired by eating uncooked small TREATMENT
freshwater/ brackish water fish.

Freshwater Fish / Brackish Water Fish – 1. Mebendazole

INTERMEDIATE HOST 2. Albendazole
FISH-EATING BIRD – natural host LIFE CYCLE
HUMAN – incidental / definitive host 1. Unembryonated eggs, thick-shelled
eggs are passed in the human stool
MORPHOLOGY 2. Becomes embryonated in the
environment in 5 to 10 days.
EGG: 3. Ingested by freshwater fish, where the
larvae hatch, penetrate the intestine,
- FLATTENED bipolar plugs and migrate to the tissues (intermediate
- STRIATED shell host)
- Peanut-shaped 4. Ingestion of raw or undercooked fish
- Yellowish brown 5. Infective larvae matures into adult in the
small intestine
ADULTS: 6. Females may produce unembryonated
egg (passed in feces) and embryonated
- Male has unspined sheath eggs (hatch inside the definitive host)
- Vulva in females is located at the 7. Larve re-invade the small intestine,
junction of anterior and middle thirds. causing INTERNAL AUTOINFECTION
- The esophagus has rows of secretory
cells called STICHOCYTES, and the
Notes by Neil Arnold Melabo
 tightly compacted fibrils and inner
region consisting of collagen and
cysteine.
- Secretes EXCRETORY-SECRETORY
PROTEINS for survival
Common Name: Pork Worm

MALE ADULT:
It is VIVIPAROUS which means it lays larva
inside the host. - Single testis near the posterior end
- Posteriorly located cloaca is
Its habitat is the SMALL INTESTINE. EVERSIBLE
- Two conspicuous conical papillae
ENCYSTED LARVAE = infective and termed CLASPERS that is uses to hold
diagnostic stage on to the female worm during mating.
It is the SMALLEST nematode of human.
FEMALE ADULT:
Most important cause of Human Trichinellosis
- Uterus is contained in the posterior
MOT: INGESTION OF RAW OR containing developing eggs
UNDERCOOKED MEAT containing the - Anterior end contains hatching
ENCYSTED LARVAE juveniles
- Vulva for copulation is located at the
There is NO REPORTED CASES in the anterior, fifth ventral side
Philippines. - Lives for 30 days
- Capable of producing > 1,500 larvae in
It is a zoonotic infection. its lifetime.
HUMANS ARE THE DEAD-END HOST
PATHOGENESIS
IVORY WHITE in color

PHASES OF INFECTION
MORPHOLOGY
1. Enteric Phase (Incubation and
Intestinal Invasion)
LARVAE: 2. Invasion Phase (larval migration and
muscle migration) – causes
- It becomes encysted in the STRIATED eosinophilia because of the release of
MUSCLE of the host (SKELETAL histamines
MUSCLE) 3. Convalescent Phase (Encystment and
- Spear-like, burrowing anterior tip Encapsulation
- Can remain viable for years
- Reproductive organs is NOT YET ACUTE FOOD POISONING – sudden food
FULLY DEVELOPED, hence sex poisoning
determination is not possible
Considered a “GREAT IMITATOR” – mimics
ENCYSTED LARVAE: many other diseases, making diagnosis
challenging.
- NURSE CELL is a modified muscle cell
that provides home and nourishment EDEMA
for the first-stage larva
- COLLAGE CAPSULE surrounds the
larvae containing: outer region of
Notes by Neil Arnold Melabo
 DIAGNOSIS

1. Muscle Biopsy – skeletal muscle

sample

SAMPLE – Biopsied Muscle (0.2 – 0.5g)

TREATMENT

1. Albendazole
2. Mebendazole

PREVENTION

1. Freezing by storing at -15 degrees

Celsius for 20 days or -30 degrees
Celsius for 6 days.
2. Cooking meat at 77 degrees Celsius.

LIFE CYCLE

Divided into two:

1. Domestic
2. Sylvic

Focus only inside the human:

1. Ingestion of undercooked meat

containing encysted larvae
2. After exposure to gastric acid and
pepsin in the stomach, the larvae are
released from the cysts.
3. Invade the small intestine mucosa
where they develop into adult worms.
4. After 1 week, the females release
larvae that migrate to striated muscles
where they encyst.

Notes by Neil Arnold Melabo