Medical Parasitology
Medical Helminthology
（蠕虫学）
Introduction
Medical helminthology （医学蠕虫学）
A discipline to study the parasitic worms that cause a
wide variety of infectious diseases, which are classified
into Nematodes or roundworms （线虫） , Trematodes or
flatworms （吸虫） , and Cestodes or tapeworms （绦虫） .
24/11/13 MEDICAL PARASITOLOGY 2
Nematode （线 虫）
Nematodes, the
numerous multicellular
animals on earth, the
number of its species is
estimated at half a million,
only few of them are the
pathogens of human and
domestic animals.
Section1 Introduction
Morphology of adult
Morphological characterestics of adult
1.Vermiform , cylindrical, bilaterally symmetrical , unsegmented;
2.Having complete digestive tract;
3. Dioecious and the female is larger than the male;
4.The body wall consist s of three layers.
Section1 Introduction
Morphology of adult
1. Body wall
The cross section of body wall
Section1 Introduction
Morphology of adult
2.Digestive system
The cross section of body wall
Section1 Introduction
Morphology of adult
2.Digestive system
The cross section of body wall
Section1 Introduction
Morphology of adult
3.Reproductive system
Section1 Introduction
Morphology of adult
3.Reproductive system
The cross section of body wall
Nematodes
Ascaris Lumbricodes Trichuris trichiura Hookworm
Enterobius vermicularis Filarial Trichinella Spiralis
Section2 Ascaris lumbricoides
Ascaris lumbricoides, is the largest of
the intestinal nematodes parasitizing
humans. It is the most common worm found
in human. It is worldwide in distribution and
most prevalent through out the tropics, sub-
tropics and more prevalent in the
countryside than in the city. The adult
worms reside in the intestinal tract of human
and cause ascariasis.
Morphology
1.Adults
Female Male
Female
Male lips
Copulatory
spicules
Female:20~35cm ;Male:15~31cm
Morphology
2. Eggs
Fertilized egg Unfertilized egg Infectious egg Decorticated egg
Unfertilized egg
Life cycle
Fertilized （2W） Embryonated （1W） Infective-stage
eggs eggs eggs
（ Embryonats live in soil for about 3 weeks ）
Ingestion
Eggs （ Develop in host for 60~75d ）
（ intestine ）
migrating Larvae
Adults
（ intestine ）
Summary of the key points for its life
cycle
1.Parasitic site: the small intestine ；
2.Infective stage: infective eggs ；
3.Mode of infection: ingesting infective eggs through food or water
contaminations ；
4.Host requirement: only definitive host without intermediate
host;
5.The larvae needs to migrate in vivo .
Pathogenesis and Symptomatolog
一、 Migrating Larvae
1. Pulmonary ascariasis
Larval migration may lead to bronchial asthma,eosinophilia( 嗜
酸粒细胞增多 ),pneumonitis （肺炎） and bronchospasm （支气管痉挛） .
The patient may have clinical symptoms of lung inflammation,
such as :cough,asthma,fever, bloody sputum.
Pathogenesis and Symptomatolog
一、 Migrating Larvae
2. Inflammation of the liver
3. Ectopic residence
The larvae can invade the brain, kidney,spleen,
thyroid,and other organs resulting in ectopic
lesion.
Pathogenesis and Symptomatolo
二、 Adult Worm
1.Malnutrition and growth retardation
Patients can have serial symptoms with no appetite, nausea,
vomiting, and intermittent periumbilical （脐周的） pain etc.
resulting in malnutrition and growth retardation.
Pathogenesis and Symptomatolo
二、 Adult Worm
2.Allergic reactions
Ascaris allergen was absorbed and the presentation in
an allergic patient can be skin pruritus( 搔痒症 ),
urticaria( 荨麻疹 ), angioedema( 血管性水肿 ) and
conjunctivitis( 结膜炎 ).
Pathogenesis and Symptomatolo
urticaria( 荨麻疹 )
Urticaria is a kind of skin rash with red, raised, itchy bumps.
Pathogenesis and Symptomatolog
Angioedema( 血管性水肿 )
Angioedema is a condition in which small blood vessels leak fluid
into the tissues, causing swelling.
Pathogenesis and Symptomatolog
Conjunctivitis( 结膜炎 )
Conjunctivitis is also known as pink eye, is inflammation of the outermos
t layer of the white part of the eye and the inner surface of the eyelid.It
makes the eye appear pink or reddish. There may also be pain, burning,
scratchiness, or itchiness.
Pathogenesis and Symptomatolog
二、 Adult Worm
3. Syndrome of ascariasis
(Due to Ascaris drilling characteristics)
When parasitic environment changes, such as in high body
temperature, gastrointestinal disorder, eating spicy food and
improper anthelmintic treatment often can stimulate its activity. An
ascaris easily drill into the pipelines generally opening to the
intestinal wall, such as bile duct, pancreatic duct and the appendix,
etc.
Pathogenesis and Symptomatolo
二、 Adult Worm
3. Syndrome of ascariasis
Bilary ascariasis （胆道蛔虫病）
It’s the most common
syndrome with the presence
of abdominal pain ,gallstone,
gallbladder rupture or liver
abscess.
Pathogenesis and Symptomatolo
二、 Adult Worm
3. Syndrome of ascariasis
Intestinal obstruction （肠梗阻）
Large numbers of adults cause mechanical obstruction of the intestine
when worms get entangled with each other to form abolus.
Pathogenesis and Symptomatolo
二、 Adult Worm
3. Syndrome of ascariasis
Intestinal perforation( 肠穿孔）
The Ascaris could penetratethe ulcers of alimentary canal .
Pathogenesis and Symptomatolo
18 Ascarids penetrate through navel of a 5-year old child
Patent discharging worms
Laboratory Diagnosis
1.Finding characteristic eggs in the faeces
Saline direct smear method （ check 3 slices ： 95% ）
2.Identifying the worm after being expelled by
anthelminthic treatment.
3.Checking larva in the sputum of host.
Epidemiolog
y
1. Infective agents: patients and carriers whose faeces
contain fertilized ascarid eggs.
2 . Route of transmission ： Taking in foods and water
contaminated by infectious stage of ascarid eggs .
3. Susceptible population ： all the people, particular
in kids.
Factors of extensive transmission
1. Releasing large amount eggs ~240000 eggs daily for
a female worm.
2. The eggs with strong resistance towards the
external environment (remain viable for up to 6 years in
mild climates).
3. Life cycle is simple.
It does not need the intermediate host, eggs directly
Factors of extensive transmission
4. Improper management for feces ：
Indiscriminate defecation and human excrement fertilizing before
being harmless treated will result in contaminating soil ,water and
vegetables.
5.Bad hygienic behaviour and insanitation facility
Without washing their hands before meals; drinking or eating
contaminated water and vegetables .
Prevention and Treatment
1.Active treatment of patents and carriers by
use of Albendazole ； Mebendazole
2.Strengthen the management and decontamination
of human faeces.
3. Education of children and population for their
knowledge on parasitic transmission to improve
personal hygienic behaviour.
Trichuris Trichiura
Adults:
Its shape likes
horsewhip 。 The anterior
part in 3/5 is slim; The 2/5
of posterior shows thick 。
♀ ： 35-55 ㎜ in length,
End is round and straight;
♂ ： 30-45 ㎜ , Tail curl with
Female Male
a copulatory spicule.
Eggs
egg shape likes spindle in
polar plug
yellow brown ;
50~54×22~23μm;
shell Egg shell is thick with
ovum transparent polar plugs, containing
a fertilized egg-cell 。
Life cycle
5000~10000/d 3~5w
Adults Eggs infectious eggs
（ cecum) soil
oral
Larva Drill into the intestinal mucosa, 10d later , the Larva
larvae come back to the intestinal lumen
（ intestine ）
The complete life cycle is 1~3 months, the adult life is 3~5
years.
Life cycle
Summary of Life cycle key
points
1.Parasitic sites: cecum ；
2.Infective stage: infective eggs ；
3.Mode of infection: ingesting infective eggs through
contaminated food or water ；
4.Without intermediate host for its life-cycle;
5.There is not a larvae migrating in vivo ；
6. Parasite food: blood, tissue fluid.
Pathogenesis and Symptomatolo
1.Inflammation of the digestive tract
Attachment of adult worms to
the colonic mucosa and their
subsequent feeding activities
produce localized ulceration
and hemorrhage.
Damage to the intestinal
mucosa may induces nausea
Whipworm reside in cecum
,abdominal pain and diarrhea
.
Pathogenesis and Symptomatolo
2.Anemia :
A child may harbor 800 worms or more ,the entire
colonic mucosa is parasitized,with significant mucosal
damage,blood loss (0.005ml blood per worm per day)
and anemia.
Pathogenesis and Symptomatolo
3.Prolapse of rectum
The shear force of the fecal stream
on the bodies of the worms may
produce prolapse of the colonic
or rectal mucosa through the
anus,particularly when the host
is straining at defecation or
during childbirth .
Laboratory Diagnosis
1.Find characteristic eggs in the feces
Direct smear method;
Precipitation concentration method ;
Saturated saline flotation method (recommend this method). The egg is
small and easy to leak, It is should be more than three times continuous
fecal examinations.
Epidemiology
It distribute worldwidely;
The infection rate was 4.63%,8~13 million people infected in
China (in 2004);
Averagely high up to 31.35% in Hainan province of China.
The prevalence amongst children are higher than that infection
amongst adults, and it often coexists with Ascaris.
Prevention and Treatment
1. Man is the only infectious source. Principle
treatment is the same as the methods for Ascaris
Albendazole ； Mebendazole
2.Strengthen the management and decontamination of
human feces.
Assignments
1. Describe the factors that lead an extensive
transmission of Ascaris?
2. Describe the whipworm life cycle and its
differences from Ascaris.
The end
That’s all for today.
Thanks for your attention,
and see you late!
