Intestinal

nematodes

Omokhua Gabriella
UNIBEN
OUTLINE
• GENERAL CHARACTERISTICS OF NEMATODES
• INFECTIVE STAGE/MODE OF TRANSMISION
• LIFE CYCLE OF INTESTINAL NEMATODES
• CLINICAL FEATURES
• LAB DIAGNOSIS
• TREATMENT
GENERAL CHARACTERISTICS OF
NEMATODES
• They are unsegmented, elongated and cylindrical.
• They have separate sexes with separate appearances.
• They have a tough protective covering or cuticle.
• They have a complete digestive tract with both oral and anal
openings.
• Majority of nematodes are free living few are parasites of
humans, plants or animals.
• The nematodes are generally light cream-white colored.
• Their life cycle includes: egg, larvae and adult.
• Intestinal nematodes
• Intestinal nematodes with tissue stage
• A. Ascaris lumbricoides
• B. Hookworms
• C. Strongyloides stercoralis
• Intestinal nematodes without tissue stage
• A. Enterobius vermicularis
• B. Trichuris trichuira.
INTESTINAL NEMATODES WITH
TISSUE STAGE
• ASCARIS LUMBRICOIDES
• These are common roundworms infecting more than 700 million people
worldwide.
• Morphology:
• Male adult worm measures 15-20 cm in length. The posterior end is curved
ventrally.
• The female worm measures 20-40 cm in length. Its posterior end is straight.
• Infective stage and modes of infection:
• The egg containing larva when ingested with contaminated raw vegetables
causes ascariasis.
Life cycle:

• Ingested eggs hatch in the duodenum.

• The larvae penetrate the intestinal wall and circulate in the blood.
• From the heart they migrate to the lungs, ascend to the trachea,
descend to the esophagus and finally reach the small intestine to
become adult.
• The female pass immature eggs which pass to the soil and mature in 2
weeks
Clinical features

• Adult worms in the intestine cause abdominal pain and may cause
intestinal obstruction especially in children.
• Larvae in the lungs may cause inflammation of the lungs (Loeffler’s
syndrome) – pneumonia-like symptom
Ova of Ascaris lumbricoides
Laboratory Diagnosis
• Examination of stool for eggs by
direct saline smear method.
• Demonstration of adult worms
in stool

Treatment
• Mebendazole
• Albendazole
 HOOK WORMS
• There are two species of hookworm:
• Ancylostoma duodenale
• Necator americanus
• The adults are found in the small intestines of man.
• Mixed infection is common.
• Both of the species are found in Ethiopia, but N. americanus is more
common.
• Ancylostoma duodenale:
• Distribution: This species is found in the northern part of the world including
China, Japan, Europe, North Africa and Ethiopia.
• Necator americanus
• Distribution: This species, so called American hookworm, is found in
predominantly the tropics.
LIFE CYCLE
• Infective stage and methods of infection:
• The filariform larva infects by skin penetration.
• Adult male and female worms live in the small intestine
• The female lays eggs which contain immature embryo
• When the eggs pass in the stool to the soil and under favorable
conditions of temperature, moisture and oxygen, they hatch into
larvae, which molt twice and become infective.
• When the filariform larvae penetrate the skin, they circulate in the
blood, reach the lungs, ascend to the trachea, descend to esophagus
to reach the small intestine and become adults
• Pathogenecity
• Adult worms in the intestine feed on blood causing iron deficiency
anemia.
• The larvae may cause inflammation of the lungs.
Ovum of hook worm
• Diagnosis: Examination of stool
by direct saline/Iodine smear to
detect the eggs
• Treatment :Mebendazole
STRONGYLOIDES STERCORALIS

• The worms may be present as parasitic in the host or free living in the
soil.
• Infection: follows skin penetration by filariform larvae.
Life cycle

• Adult male and female worms live in the small intestine.

• After fertilization, the female penetrates the mucosa of the small intestine and
lay eggs in the submucosa.
• The eggs hatch and the larvae penetrate the mucosa back to the lumen.
• If the environmental conditions are favorable, the larvae will come out with the stool to
the soil. They transform into adults, which lay eggs, and hatching larvae get transformed
to adults and so on.
• If the environmental conditions are not favorable, the larvae in the stool will moult and
transform into infective filariform larvae, which pierce the intestine (auto-infection).
• Larvae penetrating the skin from the soil or by autoinfection are carried by the
blood to the lungs, ascend to the trachea, descend to the esophagus and
mature in the small intestine
• Clinical presentation
• The patient complains of mucoid diarrhea.
• Larvae in the lungs may cause pneumonia.
• Disseminated strongyloidiasis:
• Multiplicity of symptoms are present due to the injury of other organs by the
migrating larvae. Organs such as liver, heart adrenals, pancreas, kidneys, and
CNS, etc. may be affected. This is usually seen in immunocompromized
individuals.
Rhabidiform larva of Strongyloides stercoralis

• Diagnosis - Detection of
rhabditiform larvae of
strongyloides in stool.

• Treatment: Thiabendazole
INTESTINAL NEMATODES
WITHOUT TISSUE STAGE
• ENTEROBIUS VERMICULARIS (PIN WORM OR THREAD WORM)
• Enterobius vermicularis is a small white worm with thread-like appearance.
• The worm causes enterobiasis. Infection is common in children.
• Morphology
• Male: The male measures 5 cm in length.
• Female: The female measures 13 cm in length. The posterior end is straight.
• Infective stage
• Infection is by ingestion of eggs containing larvae with contaminated raw vegetables.
• Mode of infection
• By direct infection from a patient (Fecal-oral route).
• Autoinfection: the eggs are infective as soon as they are passed by the female worm. If the hands of
the patient get contaminated with these eggs, he/she will infect him/herself again and again.
• •
Life cycle

• Adult worm lives in the large intestine.

• After fertilization, the male dies and the female moves out through
the anus to pass its eggs on the peri-anal skin at night. The egg
contains larva.
• When the eggs are swallowed, they hatch in the small intestine and
the larvae migrate to the large intestine to become adult
Clinical presentation

• The migration of the worms causes allergic reactions around the anus
and during night it causes nocturnal itching (pruritus ani) and
enuresis.
• The worms may obstruct the appendix causing appendicitis.
Laboratory diagnosis
ovum of Enterobius vermicularis

• Peri-anal swab: The peri-anal region is

swabbed with a piece of adhesive tape
(cellotape) hold over a tongue depressor.
• The adhesive tape is placed on a glass
slide and examined for eggs.
• The swab should be done in the early
morning before bathing and defecation.
• Eggs in stool: Examination of the stool by
direct saline smear to detect the egg:
this is positive in about 5% of cases
because the eggs are glued to the peri-
anal skin.
• Treatment:Mebendazole
TRICHURIS TRICHIURA (WHIP
WORM)
• Infective stage and mode of infection
• Infection is by ingestion of eggs containing larvae with contaminated raw
vegetables.
• Life cycle:
• Ingested eggs hatch in the small intestine and the larvae migrate to
the large intestine to become adult.
• After mating, the female lays immature eggs, which pass with the
stool to the soil and mature in 2 weeks
• Symptoms
• The patient complains of dysentery (blood and mucus in stool
together with tenesmus).
• Rectal prolapse is also possible.
Laboratory diagnosis
ova of Trichuris
trichiura
• Finding of characteristic eggs.
The egg of trichuris is barrel-
shaped,
• The shell is thick with a one
mucoid plug at each pole.

• Treatment: Mebendazole
 Prevention and control of intestinal
nematodal infections
•Surveillance and Monitoring
•Regular surveys to track prevalence and intensity.
•Monitoring drug efficacy and resistance.

•Health Education
•Community awareness on transmission and prevention.
•School-based programs combining deworming + hygiene education.

•Personal Hygiene
•Handwashing with soap before meals/after defecation.
•Washing fruits/vegetables; safe food handling.
•Wearing footwear to prevent hookworm infection.

•Chemotherapy (Mass Drug Administration – MDA)

•Periodic deworming with albendazole or mebendazole.
•Target groups: school children, preschool children, women of reproductive age.

•Sanitation and Environmental Control

•Use of toilets/latrines to prevent soil contamination.
•Safe water supply and proper waste disposal.
Exercise
• List the general characteristics of nematodes
• What are soil transmitted nematodes, give examples
• What are intestinal nematodes, give examples
• discuss the soil transmitted nematodes
• discuss intestinal nematodal infections
• List the neglected tropical nematodal infections
• Discuss the infective stages and mode of transmission of intestinal nematodes
• Discuss the life cycle of intestinal nematodes
• Discuss the laboratory diagnosis of nematodal infections
• Discuss the treatment, prevention and control of nematodal infections