Microbiology Chapter

15:
NEMATODES
PREPARED BY: MA. CAZANDRA MORA-HERIA
 GENERAL CHARACTERISTICS
• Nematodes or roundworms are unsegmented,
bilaterally symmetrical worms with elongated,
cylindrical bodies.
• Three stages-embryonated egg or ova, larva, and
adult worms
• The body covering is called the cuticle.
• These parasites have separate sexes, with the
female worm being larger than the male worm.
 GENERAL CHARACTERISTICS
• Complete digestive system, a simple nervous system, an
excretory system, and a reproductive system.
• Sensory organ called amphid, which is usually located in the
anterior end of the head region of the worms.
• Pair of caudal chemoreceptors called phasmids
• Ascaris, Enterobius, and Trichuris MOT is embryonated ova
• Necator, Ancylostoma, and Strongyloides MOT is skin
penetration
• C. philippinerisis MOT is ingestion of undercooked or raw
infected fish
 INTESTINAL NEMATODES

Enterobius vermicularis Pinworm or Sit worm

Trichuris trichiura Whipworm
Ascaris lumbricoides Large Intestinal roundworm
Ancylostoma duodenale Old World hookworm
Necator americanus New World hookworm
Strongyloides stercoralis Threadworm
Capillaria philippinensis Pudoc worm
 BLOOD & TISSUE NEMATODES

Trichinella spiralis Muscle worm

Wuchereria bancrofti/ Brugia malayi Filarial worms
CASE STUDY

A 32-year-old female presented with intermittent abdominal

discomfort and weight loss, reporting recent travel to an area with
poor sanitation. Stool microscopy spherical, golden-brown, and
have a thick, mamillated shell. The patient was successfully treated
with a single dose of albendazole, with complete resolution of
symptoms at follow-up.
 Ascaris lumbicoides
- Adult worm: Creamy white outer covering
- MOT: Ingestion of contaminated food and water with feces
Characteristic containing embryonated egg
- Egg small intestine (Larva)  Liver  Lungs (Larva in
sputum)  Small intestine (Adult worm)
- Most common helminth infection; in warm climates and
Epidemiology poor sanitation; affects young children
- Night soils
Diagnostics - Fecalysis
- Proper disposal of human feces
Prevention and - Health education
Control - Avoid night soils
- Mass chemotherapy
Ascaris lumbircoides

DOC:
Albendazole and
Pyrantel Pamoate
 Ascaris lumbricoides- Disease
- Majority of patients are asymptomatic
- Symptoms larval migration  Loeffler’s syndrome
Ascariasis
(eosinophilia, allergic reaction manifesting as asthma
attack) in the Lungs
CASE STUDY

A 6-year-old patient presented with complaints of perianal itching,

particularly at night. Microscopic examination of the patient's stool
and perianal scotch tape swab revealed the characteristic eggs
which are oval, flattened on one side, and have a transparent shell
containing an embryonated larva. The diagnosis was confirmed,
and the patient was treated with anthelmintic therapy, leading to
resolution of symptoms.
 Enterobius vermicularis
- Eggs are oval and flat on the other side
- Adult worm are yellowish- white in color
Characteristic - Eggs (small intestines)  Larva (Large intestines)
- (+) Retroinfection and autoinfection
-Worldwide infection especially in temperate region
Epidemiology -At risk host: Children and caretaker; institutionalized
people; crowded areas
Diagnostics - Scotch tape or cellophane tape mtd (adult or egg)
- Treatment of household (group infection)
Prevention and - Clipping of nails
Control - Washing beddings
Enterobius vermicularis

DOC:
Albendazole
Mebendazole
Pyrantel Pamoate
 Enterobius vermicularis - Disease
- Majority of patients are asymptomatic
Enterobiasis - Symptoms pruritus ani at night  sleep deprivation
CASE STUDY

A 32-year-old female presented with chronic abdominal discomfort,

bloating, and intermittent diarrhea, after traveling to a rural area
with poor sanitation. Stool microscopy revealed characteristic egg,
which are barrel-shaped with bipolar plugs. The patient was
treated with mebendazole, and after one month, her symptoms
significantly improved, with repeat stool examination showing no
further egg presence.
 Trichuris trichiura
- Eggs are barrel shaped or football shape with prominent
hyaline plug
- Adult worm’s anterior end is colorless (resembles a whip)
while the posterior end is pink (resembles a handle of a
Characteristic whip)
- Male adult: curve tail
- MOT: Ingestion of contaminated food and water
- Larva (small intestine)  Adult (large intestine)
- 3rd most common roundworm affecting human
Epidemiology - Same with Ascaris using night soils
Diagnostics - Fecalysis
Prevention and - Health education; proper sanitation avoidance of human
Control feces as fertilizer
Trichuris trichiura

DOC:
Mebendazole
Albendazole
 Trichuris trichiura - Disease
- Majority of patients are asymptomatic
- Heavy Infection In Children Is Like Ulcerative Colitis:
chronic dysentery (bloody, mucoid diarrhea), severe
anemia and growth retardation
Trichuriasis -
(+) Rectal prolapse and hyperperistalsis
- Heavy Infection In Adult Is Like Irritable bowel
syndrome: abdominal pain and tenderness, weakness
and dysentery
CASE STUDY

A 28-year-old female presented with pruritic skin lesions and

gastrointestinal discomfort. Microscopic analysis of a fresh stool
sample also identified characteristic larvae, with their typical "J"
shape and the presence of a short buccal cavity. The patient was
treated with albendazole, and symptoms improved within a week,
with follow-up stool tests showing no further larvae or eggs.
 Ancylostoma duodenale/ Necator Americanus
- Both have 4 stages: Egg, Rhabditiform larvae, Filariform
larvae, Adults
- Rhabditiform larva: immature, actively feeding, buccal
cavity or capsule
- Filariform larva: non-feeding, infective larva, distinct
pointed tail
Characteristic - N. americano- buccal capsule with pair of cutting plates
- A. duodenale- buccal capsule with teeth
- MOT: Skin penetration of filariform larva
- Larval migration (Lungs)  Adult (Small intestines)
 Ancylostoma duodenale/ Necator Americanus

Epidemiology - Worldwide infection especially in the tropics

- Fecalysis  thin-shelled
- (+) Occult Blood
Diagnostics - (+) larva in the sputum
- PBS  microcytic, hypochromic anemia
- Similar to those of Ascaris
Prevention - Wearing shoes or protective footwear
and Control
Ancylostoma duodenale/ Necator Americanus

DOC:
Mebendazole
Pyrantel pamoate
 Ancylostoma duodenale/ Necator Americanus - Disease
- “Ground itch” – Pruritic papule or vesicle from
Hookworm migration of filariform larva
Infection - IDA  microcytic, hypochromic anemia
CASE STUDY

A 50-year-old male with a history of immunosuppression

presented with abdominal pain, diarrhea, and a history of recent
travel to an endemic region. Stool examination revealed larvae
and adult female worms, which were characterized by their
slender, thread-like appearance, measuring 2-3 mm in length.
The patient was treated with ivermectin, leading to the resolution
of symptoms and complete clearance of the parasite in follow-up
stool tests.
 Strongyloides stercoralis
- Both have 4 stages: Egg, Rhabditiform larvae, Filariform
larvae, Adults
- Rhabditiform larva: immature, actively feeding, buccal
cavity or capsule, passed out in feces
- Filariform larva: non-feeding, infective larva, longer
Characteristic esophagus distinct notched tail
- 2 life cycles: (1) Human host (2) Free living
- (+) Autoinfection
- (+) Ground itch
 Strongyloides stercoralis
- Worldwide infection especially in the tropics,
Epidemiology subtropics, warm and temperate areas
- 3-day Fecalysis  rhabditiform larvae
- Larva in sputum
Diagnostics - Duodenal aspirate
- CBC  massive eosinophilia
- Similar to those of Hookworm
Prevention
and Control
Strongyloides stercoralis

DOC:
Mebendazole
Thiabendazole
CASE STUDY

A 35-year-old male from a coastal village presented with chronic

diarrhea, abdominal pain, and significant weight loss after
regularly consuming raw freshwater fish. Stool examination
revealed numerous peanut-shaped eggs with striated shells and
flattened bipolar plugs. The patient responded well to
albendazole treatment.
 Capillaria philippinensis
- 1st described in the Philippines (1993)
Characteristic
- Natural host: Migratory birds (unembryonated egg)
- Freshwater fish (embryonated egg)
- (+) Autoinfection
- Endemic to Philippines (Ilocos Region, Zambales And
Epidemiology Southern Leyte)
- (+) Malabsorption syndrome
Diagnostics - Fecalysis
Prevention and - Health education; proper cooking of food
Control
Capillaria philippinensis

DOC:
Albendazole
Mebendazole

Chemotherapy for 20 days

High protein diet
 Capillaria philippinensis- Disease

- Abdominal pain, gurgling stomach

(borborygmus) and chronic diarrhea
- Chronic diarrhea: weight loss, anorexia,
Capillariasis malabsorption of fat, carbohydrates, protein
and electrolyte abnormalities
CASE STUDY

A 32-year-old woman presented with muscle pain,

periorbital edema, and fever following consumption of
undercooked pork. Serologic testing and muscle biopsy
encysted larvae in muscle tissue.
 Trichinella spiralis
- 2 morphologic stages: Larva and adult
Characteristic - (+) Nurse cells
- Mating in the small intestine
- Europe an US
Epidemiology - MOT: Eating raw meat
Diagnostics -
- Encysted larva in skeletal muscle
Eosinophilia, elevated LDH, Aldolase, Creatinine
Prevention - Health education and properly cooked food
and Control - Freezing meat
Trichinella spiralis

DOC:
Thiabendazole
Corticosteroids
Supportive
 Trichinella spiralis - Disease
- 3 Phases
- Enteric Phase:
Diarrhea, vomiting and abdominal pain
- Invasion Phase:
Trichinosis/
Periorbital and fascial edema, conjunctivitis, fever,
Trichinellosis
muscles, muscle (pain), splinter hemorrhage,
peripheral eosinophilia
- Convalescent Phase
- Rare causes: Heart failure and respiratory paralysis
CASE STUDY

A 45-year-old male from a tropical region presented with

chronic limb swelling and nocturnal fever. Blood smear
collected at night revealed microfilariae characterized by a
sheath and nuclei that do not extend to the tip of the tail.
The adult worms reside in lymphatic vessels, and the eggs are
not laid freely but develop into sheathed microfilariae, which
circulate in peripheral blood.
 Wuchereria bancrofti / Brugia malayi
- 2 morphologic stages: adult worm and larvae
(microfilariae)
- Male adult is the size of female
Characteristic - Mosquito borne parasite
- (+) Sheath
- Exhibits periodicity (feeding time of the mosquito and
their migration)  Nocturnal, diurnal, sub-periodic
- Majority of infection is from Brugia malayi
- B. malayi vector: Culex (urban areas), Anopheles
Epidemiology (Philippines), Aedes and Mansonia
- Manifestation is forming obstruction of lymphatic vessels:
edema of he legs
 Wuchereria bancrofti / Brugia malayi
- Giemsa-stained peripheral blood smear 
Diagnostics microfilariae
- Time of collection is at 9 pm and 4 am
Wuchereria bancrofti / Brugia malayi

DOC:
Diethylcarbamazine
Mebendazole +
albendazole
 Wuchereria bancrofti / Brugia malayi - Disease
Asymptomatic - Thousands microfilariae in PBS and adult worm
stage in lymphatic system w/o manifestations
- Lymphadenitis in genitalia (Bancroft's) and in
extremities (Brugia)
Acute Stage of - Recurrent attacks: epididymitis, orchitis,
Infection retrograde lymphangitis
- Calabar swelling
- Adenolymphangitis
- (+) Elephantiasis
Chronic Filariasis -
(+) Hydrocele
Thank you!!