CLINICAL PARASITOLOGY

NEMATODES
Lecture/PPT Based huehue

​ ​ CLASS NEMATODA ➢​ Almost complete digestive system

➢​ Nervous system
➔​ Multicellular parasites that appear round in ➢​ Excretory system
cross section ➢​ Reproductive system​
➔​ Belongs to Phylum Nemahelminthes
➔​ Divided into groups: 5 SUCCESSIVE FUNDAMENTAL STAGE
-​ Intestinal Nematoda
➔​ 4 larval stage (L1, L2, L3, L4)
-​ Tissue Nematoda
➔​ 1 adult stage
-​ Filariae (Blood Nematode)
➔​ L3 - infective stage (Filariform)
➔​ L4 - ecdysis
PHYLUM (NEMATHELMINTHES)
CLASS (NEMATODA)

INTESTINAL INTESTINAL FILARIAE NEMATODES GENERAL LIFE CYCLE

SPECIES -TISSUE SPECIES
EGG → LARVA → ADULT
Enterobius Trichinella spiralis Wuchereria
vermicularis bancrofti
Dracunculus
Trichuris medinensis Brugia malayi
trichuria
Loa loa
Ascaris
lumbricoides Onchocerca
volvulus
Necator
americanus

Ancylostoma
duodenale

Strongyloides
stercoralis

NEMATODES
★​ ROUNDWORMS

TYPICAL FEATURES:
-​ Cylindrical worms
-​ Elongated
-​ Bilaterally symmetrical
-​ Non - segmented

ADULT ROUNDWORMS
➔​ Possess SPECIALIZED ANTERIOR that are
capable of: ABRASION, ATTACHMENT,
SENSORY RESPONSE
➔​ Lips, hook, teeth, pilates, and papillae​

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 CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

ADULT NEMATODES HABITAT

SMALL INTESTINE LARGE INTESTINE

Ascaris lumbricoides Enterobius vermicularis

Strongyloides stercoralis Trichuris trichuria
Hookworms
Capillaria philippinensis
Trichinella spiralis

EXTRA INTESTINAL

Trichinella (larva) → muscles

Filarial worm → lymphatic tissue
Dracunculus medinensis → tissue
Angiostrongylus cantonensis → brain

PATHOGENICITY
➔​ The effects of parasitic nematodes upon the
host BUT it DEPENDS UPON THE SPECIES
and LOCATION of the species

Ascaris lumbricoides

➔​ COMMON NAME: Large Intestinal

Ascaris lumbricoides Roundworm/ roundworm of man
➔​ COMMON ASSOCIATED DISEASE: Ascariasis,
roundworm infection
➔​ Common Name: Large Intestinal
➔​ ADULT Ascaris: largest known intestinal
nematodes
➔​ INFECTIVE STAGE: embryonated egg
➔​ DIAGNOSTIC STAGE: Unfertilized egg,
fertilized egg, and adult
➔​ SIGNS & SYMPTS: abdominal pain,
pneumonitis, intestinal obstruction
➔​ MOT: Ingestion (fecal-oral)

​ ​ ​ ​ ​ ​ Isaiah 43:2 // kayanin mo yan // huehueli_MT-201

 CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

II. A. lumbricoides EPIDEMIOLOGY

➔​ 1.2 billion people infected with ascariasis

➔​ ENDEMIC TO SEA, Africa, and South America
➔​ Children 5-15 y.o. High intensity of infection
➔​ East Asia and Pacific islands - highest number
of ascariasis
In the PHILIPPINES:
➔​ Prevalence: 80-90% in high risk group
I. A. lumbricoides MORPHOLOGY ➔​ Overall prevalence:​
- 27.7% (school-age children)​
- 30.9% (pre-school)
UNFERTILIZED EGG FERTILIZED EGG

➢​ Oblong ➢​ Round LEVEL OF TRANSMISSION

➢​ 85 – 95 um by 38 – ➢​ 40 – 75 um by 30 – -​ Depends on socioeconomic factors
45 um 50 um
-​ MAIN FACTORS:
➢​ Thin shell ➢​ Transformation of
protecting the inner amorphous mass of ★​ High density of human population
amorphous mass of protoplasm into ★​ Involvement in agriculture
protoplasm undeveloped ★​ Illiteracy
➢​ Corticated (egg unicellular embryo ★​ Poor sanitation
possess an outer ➢​ Chitin (thick ★​ Poor health education in hygiene
mamillated, nitrogen-containing
albuminous polysaccharide
coating) between III. A. lumbricoides LABORATORY DIAGNOSIS
cortication and
➔​ Microscopic examination of stool sample
embryo)
➔​ DFS - less sensitive
➔​ Kato thick smear
➔​ Kato-katz technique - mass screening
FEMALE MALE ➔​ Concentration techniques - mass screening
-​ Formalin ether/ethyl acetate
➢​ Creamy white pink ➢​ Creamy white pink concentration technique FECT -
tint tint higher sensitivity
➢​ Fine striations ➢​ Fine striations on
visible on cuticle the cuticle
➢​ 22-35 cm ➢​ Up to 30 cm
➢​ Pencil lead ➢​ Prominent incurved
thickness tail

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CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

IV. A. lumbricoides CLINICAL SYMPTOMS I. T. trichuria MORPHOLOGY

➔​ ASYMPTOMATIC ➔​ Eggs – WITH PROMINENT BIPOLAR

-​ Small infection (5-10 worms) PLUGS: barrel/ football/ Japanese lantern
-​ Ingestion of eggs ➔​ Adults – WHIPLIKE (anterior – thin ;
posterior – thick)
➔​ ASCARIASIS / ROUNDWORM INFECTION
​ ​ ​ ​
➔​ Worms produce tissue damage with
migration EGGS
➔​ Secondary bacterial infection
➔​ Abdominal pain, vomiting, fever, -​ barrel-shaped/football-shaped
-​ 50 – 55 um by 25 um
distention
-​ Underdeveloped unicellular embryo
➔​ Mature worms – may entangle surrounded by a smooth shell (yellow- brown
causing obstruction in organs, may color due to bile contact)
cause death -​ Prominent hyaline polar plug at each end
➔​ Discomfort from exiting worms
(anus, mouth, nose)
* Patients may also experience pulmonary symptoms
➔​ low- grade fever
➔​ Cough
➔​ eosinophilia
➔​ pneumonia
➔​ Asthmatic reaction
V. A. lumbricoides PREVENTION & CONTROL

➔​ Avoidance of human feces as fertilizers

➔​ Exercise proper sanitation and hygiene
practices ADULTS
➔​ Provision of safe water
➔​ Regular deworming -​ 2.5 – 5 cm (males smaller than females)
➔​ WASHED (water sanitation, hygiene educ, -​ Anterior end: colorless with a slender
deworming) esophagus, smaller than posterior end
resembling a whip
➔​ STH-program
-​ Posterior end: pinkish (contains intestine and
-​ 5-10 schools representing a district reproductive system), resembles whip handle,
-​ Nutritional stats and school males possess prominent curled tail
performance - should be monitored
VI. A. lumbricoides TREATMENT

➔​ Albendazole
➔​ Mebendazole

Trichuris trichiura
➔​ COMMON NAME: whipworm
➔​ CAD: Trichuriasis, whipworm infection, rectal
prolapse
➔​ MOT: ingestion (fecal-oral)
➔​ INFECTIVE STAGE: L4 embryonated egg
➔​ DIAGNOSTIC STAGE: L1 egg

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CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

➔​ TRICHURIASIS / WHIPWORM INFECTION

-​ Heavy infection (500 - 5000 worms)
-​ Ulcerative colitis (children)
-​ Inflammatory bowel disease (adults)
-​ Abdominal tenderness and pain,
weight loss, diarrhea (mucoid or
bloody). Anemia in children
-​ Rectal prolapse

II. T. trichuria EPIDEMIOLOGY

➔​ Occurs in temperate and tropical countries,

widely distributed in warm, moist areas
➔​ 604 – 795 million infected globally
➔​ East Asia and Pacific islands = most
prevalent V. T. trichiura PREVENTION AND CONTROL
➔​ Children 5 – 15 years old = highest intensity
of infection ➔​ Avoidance of human feces as fertilizers
In the PHILIPPINES: ➔​ Exercise proper sanitation and hygiene
➔​ Overall prevalence: 8.1 – 57.1% (school-age practices
children) ; 4.5 – 55.1% (pre-school) ➔​ Provision of safe water
➔​ Co-infection with A. lumbricoides prevalence ➔​ Regular deworming
= 19.1% ➔​ WASHED (water sanitation, hygiene educ,
deworming)
III. T. trichuria LABORATORY DIAGNOSIS ➔​ STH-program
-​ 5-10 schools representing a district
➔​ Microscopic examination of stool sample
-​ Nutritional stats and school
➔​ DFS - less sensitive
performance - should be monitored
➔​ Examination of intestinal mucosa
-​
➔​ Kato thick smear
➔​ Kato-katz technique VI. T. trichuria TREATMENT
➔​ Concentration technique
-​ Zinc sulfate floatation method ➔​ Albendazole
-​ Formalin ether/ethyl acetate ➔​ Mebendazole
concentration tech. FECT - higher
sensitivity NOTE :)) to save time magbasa and memo lol
-​ FLOTAC technique
Ascaris lumbricoides, Trichuris trichiura, and Capillaria
IV. T. trichuria CLINICAL SYMPSTOMS philippinensis HAVE THE SAME prevention, control,
and treatment
➔​ ASYMPTOMATIC
-​ Slight whipworm infection

​ ​ ​ ​ ​ ​ Isaiah 43:2 // kayanin mo yan // huehueli_MT-201

CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

Capillaria philippinensis I. C. philippinensis LABORATORY DIAGNOSIS

➔​ Eggs in the species
➔​ COMMON NAME: pudoc worm, mystery
-​ Look for the characteristic of peanet
worm
shaped w/ striations: flat bipolar
➔​ CAD: intestinal capillariasis and mystery
plugs
disease
-​ DFS
➔​ MOT: ingestion of raw/ uncooked
-​ Duodenal aspiration
intermediate host
-​ ELISA
➔​ INFECTIVE STAGE: L3 larva
-​ Concentration techniques (can also
➔​ DIAGNOSTIC STAGE: eggs: peanut shaped w/
reveal eggs and adults)​
striation: FLAT bipolar plugs
➔​ INTERMEDIATE HOST: bagsang, bagsit, ipon
➔​ DEFINITIVE HOST: humans II. C. philippinensis PREVENTION AND CONTROL
➔​ Exercise proper sanitation and personal
COMMON IN: hygiene practices
Ilocos Norte​ ​ Ilocos Sur ➔​ Provision of safe water
Cagayan​​ ​ La Union ➔​ Regular deworming
Pangasinan​ ​ Zambales ➔​ Discouraged eating raw fish
Agusan del Norte​ ​ Leyte
Recently certain parts of Mindanao
III. C. philippinensis TREATMENT
➔​ Albendazole
➔​ Mebendazole
➔​ Thiabendazole
➔​
NOTE :)) to save time magbasa and memo lol

Ascaris lumbricoides, Trichuris trichiura, and Capillaria

philippinensis HAVE THE SAME prevention, control,
and treatment

REMEMBER ME huehue​
First reported by Chitwood et.al. in 1963 in a 29 y/o
male from Northern Luzon

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CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

IV. C. philippinensis MORPHOLOGY

➔​ COMMON NAME: muscle worm, garbage
worm, and pork worm
EGGS ➔​ SIGNS AND SYMPTOMS: Trichinosis, Myalgia
(Muslce pain)
1.​ 6 – 45 um by 20 um ➔​ MOT: ingestion of infected meat
2.​ peanut-shaped ➔​ DIAGNOSTIC STAGE: encysted larva = may
3.​ striated shells and flattened bipolar plugs
diagnose via MUSCLE BIOPSY stained with
eosin

V. C. philippinensis EPIDEMIOLOGY

➔​ subsequently reported in Thailand, Iran,

Japan, Indonesia, UAE, South Korea, India,
Taiwan, Egypt, and Lao People’s Democratic
republic
IN THE PHILIPPINES:
➔​ 1966 = epidemic in Pudoc West, Tagudin,
Ilocos Sur
➔​ 1967 – 1990: 2000 cases I. T. spiralis LABORATORY DIAGNOSIS
➔​ Eating freshwater fish/brackish water fish
VI. C. philippinensis CLINICAL SYMPTOMS ➔​ Muscle biopsy
➔​ Beck’s Xenodiagnosis (using albino rats)
➔​ Chemistry tests
➔​ abdominal pain & borborygmi
➔​ Serological tests – Bentonite flocculation
➔​ intermittent diarrhea (8-10 voluminous
➔​ Intradermal test – Bachmann
stool/day)
➔​ Confirmatory test – Western blot, Latex
➔​ Weight loss, malaise, anorexia, vomiting,
Agglutination
edema
➔​ Laboratory findings: hypoalbuminemia,
malabsorption of fats & sugars, low serum K+ II. T. spiralis TREATMENT
, Na + , Ca + + , high IgE
➔​ Histological findings: flattened and denuded ➔​ Thiabendazole
villi, dilated mucosal glands, lamina infiltrated ➔​ Mebendazole
with plasma cells, lymphocytes,
macrophages, and neutrophils

​ Trichinella spiralis

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 CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

III. T. spiralis PREVENTION AND CONTROL ADULT FEMALE ADULT MALE

➔​ Health education regarding pork transmission ➢​ 7 – 14 mm by 0.5 ➢​ 2 – 4 mm by <0.3

mm mm
➔​ Cook meats at 77degC
➢​ Yellowish-white ➢​ yellowish-white
➔​ Freezing of meats for storage at -15degC for ➢​ Pointed, resembles
20 days and -30degC for 6 days a pin-head tail
*smoking, salting, or drying of meat are NOT
EFFECTIVE*

​ Enterobius vermicularis

➔​ COMMON NAMES: pinworm and seatworm

➔​ CAD: Enterobiasis and pinworm infection

I. E. vermicularis MORPHOLOGY

NOTE:
EGG
L3: embryonated egg is the INFECTIVE STAGE
L1: eggs is the DIAGNOSTIC STAGE
➔​ 48 – 60 um by 20 – 30 um
➔​ Flattened one-side
➔​ Oval
II. E. vermicularis EPIDEMIOLOGY
➔​ Developing larva surrounded by a conspicuous
double-layered thick-wall colorless shell
➔​ Unembryonated (unfertilized), embryonated ➔​ Occurs in temperate and tropical countries
(fertilized egg) ➔​ Only intestinal nematode infection that
cannot be controlled through sanitary
disposal of human feces
➔​ Eggs usually contaminate beddings and
underwear
➔​ 208.8 million infected worldwide
IN THE PHILIPPINES
➔​ Overall prevalence: ​
- 29% (school-age children, private schools)
- 56% (school-age children, public schools)
➔​ Eggs found in nail clippings

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CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

III. E. vermicularis LABORATORY DIAGNOSIS ​ HOOKWORMS

Necator americanus & Ancylostoma duodenale

➔​ Cellophane tape preparation from perianal

➔​ COMMON NAME:​
region of suspected infected person -
New World Hookworm (Necator americanus)
multiple samples required
Old World Hookworm (Ancylostoma
➔​ Graham’s scotch tape swab
duodenale)
➔​ Microscopic examination
➔​ CAD: Hookworm infection, ancylostomiasis,
necatoriasis
IV. E. vermicularis CLINICAL SYMPTOMS

➔​ ASYMPTOMATIC
-​ Slight infection
➔​ ENTEROBIASIS / PINWORM INFECTION
-​ Intense itching
-​ Inflammation of anal and/or vaginal
area
-​ Intestinal irritation
-​ Mild nausea
-​ Vomiting
-​ Irritability
-​ Difficulty sleeping

I. Hookworm MORPHOLOGY

EGGS
V. E. vermicularis PREVENTION AND CONTROL
➔​ Exercise proper sanitation and personal ➢​ 60 – 75 um length (N. americanus)
hygiene practices ➢​ 55 – 60 um length (A. duodenale)
➔​ Proper handwashing ➢​ 35 – 40 um width
➔​ Application of ointment to infected area, ➢​ 2, 4, or 8-cell embryonic cleavage
➢​ thin, smooth, colorless shell
avoid scratching
➔​ Providing treatment to linens and
environmental surfaces
V. E. vermicularis TREATMENT
➔​ Albendazole
➔​ Mebendazole
➔​ Pyrantel pamoate

​ ​ ​ ​ ​ ​ Isaiah 43:2 // kayanin mo yan // huehueli_MT-201

CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

RHABDITIFORM (Immature larva, feeding stage) II. Hookworm EPIDEMIOLOGY

➢​ 15 – 270 um (newly hatched) ➔​ 576 – 740 million infected – tropical and

➢​ 540 – 700 um (actively feeding larva, 5
subtropical countries
days)
➢​ presence of long, buccal cavity/buccal ➔​ associated with anemia = 50, 000
capsule & small genital primordium (a deaths/year
precursor structure to a reproductive ➔​ A. duodenale = Europe & Southwestern Asia
system) N. americanus = tropical Africa & Americas
IN THE PHILIPPINES:
➔​ Greater in agricultural areas
➔​ Farmers, military personnel, indigenous
people, food handlers
➔​ A. ceylanicum = first human case reported in
1968 in Ilocos Norte
➔​ A. braziliense & A. caninum = “creeping
eruption” – Cutaneous Larva Migrans (CLM)

III. Hookworm LABORATORY DIAGNOSIS

FILARIFORM (Mature larva, nonfeeding stage, ➔​ Microscopic examination of stool sample

infective stage) ➔​ Direct fecal smear (DFS) – less sensitive
➔​ Examination of intestinal mucosa
➢​ Short esophagus ➔​ Kato thick smear
➢​ Pointed tail ➔​ Kato-Katz technique
➔​ Harada-Mori technique
-​ Hatching of larvae from eggs on
strips of filter paper with one end
ADULT HOOKWORM immersed in water
➔​ concentration techniques
GENERAL CHARACTERISTICS -​ Zinc sulfate floatation method
1.​ grayish-white to pink -​ Formalin ether/ethyl acetate
2.​ cuticle somewhat thick concentration technique (FECT) –
3.​ anterior end conspicuous bend, hook
higher sensitivity
4.​ female adults = 9 – 12 mm long by 0.25 –
0.50 mm wide -​ FLOTAC technique​
5.​ male adults = 5 – 10 mm long by 0.2 – 0.4
mm wide, prominent posterior IV. Hookworm CLINICAL SYMPTOMS
6.​ copulatory bursa
7.​ BUCCAL CAPSULE CHARACTERISTICS
8.​ N. americanus = cutting plates ➔​ ASYMPTOMATIC
9.​ A. duodenale = teeth -​ Slight infection
-​ Adequate diet rich in iron,
proteins, & vitamins
➔​ NECTORIASIS/ ANCYLOSTOMIASIS/
HOOKWORM INFECTION
-​ Pathology of hookworm infection
★​ The skin of the site of
entry of filariform larva

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CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

★​ Lung during larval

migration ​ Strongyloides stercoralis
★​ Small intestine
-​ Maculopapular lesions & localized ➔​ COMMON NAME: threadworm
erythema (penetrated area) ➔​ CAD: strongyloidiasis & threadworm
-​ “Ground itch” or “dew itch” - severe itching infection
especially on a dewy morning
-​ Itching, edema, erythema, and later
papulovesicular eruptions (2 weeks)
-​ Larval migration in the lungs = sore throat,
bloody sputum, wheezing, headache, mild
pneumonia with cough
-​ intestinal chronic infection (<500 eggs/g of
feces) = mild gastrointestinal symptoms,
slight anemia, & weight loss or weakness I. S. stercoralis MORPHOLOGY
-​ Intestinal acute infection = (>5000 eggs/g
of feces) = diarrhea, anorexia, edema, pain,
enteritis, epigastric discomfort EGGS

➢​ 48 by 35 um
➢​ indistinguishable from hookworm egg
➢​ developed larvae are contained
➢​ 2, 4, 8-cell
➢​ thin hyaline shell

V. Hookworm PREVENTION AND CONTROL

➔​ Protection of person entering endemic

areas (covering bare feet)
➔​ exercise proper sanitation and personal
hygiene practices
➔​ Provision of safe water
➔​ WASHED (Water, sanitation, hygiene
education, deworming) RHABDITIFORM (immature, feeding stage)
➔​ STH-control programs
-​ Parasitic monitoring of 5-10 ➢​ 220 by 15 um
schools representing a district ➢​ Short buccal cavity
➢​ Prominent genital primordium
-​ Nutritional status and school
performance – also monitored

VI. Hookworm TREATMENT

➔​ Albendazole
➔​ Mebendazole

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CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

FILARIFORM (mature larva, nonfeeding stage,

infective stage)

➢​ long, slender
➢​ 690 um in length
➢​ Long esophagus
➢​ notched tail

II. S. stercoralis EPIDEMIOLOGY

➔​ 50 – 100 million estimated infection
➔​ Soil-transmitted helminth (STH)
➔​ Autoreinfection – people remained
ADULT FEMALE
infection for more than 30 years
➢​ 2 by 0.4 mm -​ American veterans who returned
➢​ Short buccal cavity from Korean & Vietnam wars
➢​ Long & slender esophagus IN THE PHILIPPINES
➢​ Colorless & transparent ➔​ Relatively rare
➢​ Fine striated cuticle ➔​ Prevalence: 0 – 2.3%
➢​ Parthenogenetic ➔​ Frequent in male children (7 – 14 y/o)

III. S. stercoralis LABORATORY DIAGNOSIS

➔​ DFS
➔​ Enterotest
➔​ Duodenal aspiration, small bowel biopsy
➔​ Modified Harada-Mori technique
➔​ Concentration technique
-​ Baermann funnel gauze method
IV. S. stercoralis CLINICAL SYMPTOMS
➔​ ASYMPTOMATIC
-​ Light infection
➔​ STRONGYLOIDIASIS / THREADWORM
INFECTION
-​ 3 PHASES OF ACUTE INFECTION
★​ Invasion of skin by
filariform larvae
★​ Migration of larvae

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CLINICAL PARASITOLOGY
NEMATODES
Lecture/PPT Based huehue

★​ Penetration if intestinal
mucosa
NOTE :)) threadworm infection (3 phases)​

INVASION OF SKIN = erythema, pruritic to

hemorrhagic papules​

LARVAL MIGRATION = lobar pneumonia with

hemorrhage, cough,
tracheal irritation

PENETRATION OF INTESTINAL MUCOSA = diarrhea

alternating with constipation (moderate infection)​

= intractable, painless, intermittent diarrhea

(Cochin China diarrhea ) with water & bloody stool,
malabsorption syndrome

V. S. stercoralis PREVENTION AND CONTROL

➔​ Protection of person entering endemic
areas (covering bare feet)
➔​ exercise proper sanitation and personal
hygiene practices
➔​ Provision of safe water
➔​ WASHED (Water, sanitation, hygiene
education, deworming)
➔​ STH-control programs
-​ Parasitic monitoring of 5-10
schools representing a district
-​ Nutritional status and school
performance – also monitored​

VI. S. stercoralis TREATMENT

➔​ Albendazole
➔​ Thiabendazole
➔​ Ivermectin

​ ​ ​ ​ ​ ​ Isaiah 43:2 // kayanin mo yan // huehueli_MT-201