COURSE: CLINICAL PARASITOLOGY

TOPIC: Nematodes

Helminths Adult worms:

- Multicellular and it contains internal ➢ The adult female worms are usually
organ systems. larger than the adult males.
➢ The adults are equipped with complete
Nematodes
digestive and reproductive systems.
- Commonly known as the intestinal
roundworms.
The life cycles of the individual nematodes are

similar but organism-specific.

MORPHOLOGY AND LIFE CYCLE NOTES
(GENERAL) E.g. Pinworms MOT: Ingestion of infected eggs
transmits the disease.
Nematodes
Hook worm MOT: Burrow through the skin of the
➢ Class: Nematoda (multicellular parasites
foot and make way into the intestinal tract.
that appear round in cross section).

Three basic morphologic forms:

1. Fertilized adult female nematodes lay
1.) Eggs (female sex cells after fertilization)
their eggs in the intestine. (The eggs
2.) Juvenile worms (Larvae)
may be passed into the stool)
3.) Adult worms
2. Outside the body: larvae located inside
Egg stage: the eggs require warm moist soil and 2

➢ Eggs vary in size and shape. to 4 weeks for continued development.

3. The developed egg is then ready for
Larvae:
infection into a new host and the cycle is
➢ In the appropriate environment, repeated.
developing larvae located inside
In two of the nematode life cycles, Trichinella
fertilized eggs emerge and continue to
and Dracunculus, tissue becomes involved,
mature.
serving as the primary residence of the
➢ Larvae are typically long and slender.
organisms.
➢ The growing larvae complete the
maturation process, resulting in the Primary residence of the organism: Trichinella

emergence of adult worms. and Dracunculus

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Most members of the nematode group have the PATHOGENESIS AND CLINICAL SYMPTOMS
ability to exist independent of a host (i.e., they (GENERAL)
are freeliving).
Three possible factors may contribute to the
ultimate severity of a nematode infection:

1. The number of worms present

2. The length of time the infection persists
3. The overall health of the host

Infections with nematodes have been known to

LABORATORY DIAGNOSIS (GENERAL) last for up to 12 months or longer (some

infections may last 10 to 15 years or more),
The laboratory diagnosis of nematodes may be
depending on the specific species involved.
accomplished by:
The occurrence of reinfections and/or
➢ Recovery of eggs, larvae, and occasional
autoinfection’s may increase the infection time
adult worms
up to several years and beyond
Specimen of Choice (It varies by species):
Some infections persist indefinitely. (It will
➢ Cellophane tape preparation (Around continue for ever or until someone decides to
anal opening) change it or end it)
➢ Stool samples
In most cases, an infection of a small number of
➢ Tissue biopsies
worms in a relatively healthy individual may
➢ Infected skin ulcers
remain asymptomatic or cause minimal
Note: Serologic test methods are available for discomfort.
the diagnosis of select nema tode organisms.
Patients who have a heavy worm burden,
particularly if combined with other health
problems, are probably more likely to
experience severe symptoms and/or
complications.

The life cycle of each of the nematodes involves

the intestinal tract.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

With one exception, all the nematodes may ofthis text and to maintain taxonomic
cause intestinal infection symptoms at some consistency, Nematoda is considered as a class
point during their invasion of the host. just like all of the helminth groups covered in this
text.
These typically include :

• Abdominal pain
• Diarrhea Two groups of Nematode species:
• Nausea
➢ Intestinal species ( involved with the
• Vomiting
intestinal tract)
• Fever ➢ Intestinal-Tissue species (migrate into
• Eosinophilia the tissues following initial contact with
• Skin irritation the intestinal tract)
• The formation of skin blisters
• Muscle involvement
1.) Enterobius vermicularis (E.
vermicularis)

Common names: Pinworm, seatworm,

threadworm

Common associated disease and condition

names: Enterobiasis, pinworm infection.

NEMATODE CLASSIFICATION

Enteros “Bowel” and bios “life”

Vermicularis latin “small worm”

Infective stage: Embryonated eggs

Recent investigation of current taxonomy

classification terms revealed that the placement
of the term Nematoda varies by source, listing it
as a phylum, order, or class. For the purposes

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

MORPHOLOGY

Eggs:

Cellulose-tape preparation

The egg may be seen at various stages of

development.

Oval

Flattened on one side (D-shaped). Thick walled,

double-layered, colorless shell, may contain
MORPHOLOGY
larva.
Adults:
Unembryonated = Unfertilized egg

Embryonated= Fertilized egg

The yellowish-white females are equipped with

primitive organ systems, including a digestive
tract, intestinal tract, and reproductive
structures.

MAG-ISA, ALVIN JAMES R.

 COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Adult female possesses a clear, pointed tail that

resembles a pinhead—hence, the common
name pinworm.
Female
Male adult worms are typically smaller than
female adulty worms. Eggs

Adult female: small, white, slender, pointed tail,

resembles a pinhead

Adult male: (Rarely seen), same w/ female but

smaller w/ wide, curled/curved tail

Male Posterior

Anterior
Posterior (Female)

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Laboratory Diagnosis Life cycle notes

Specimen of choice: Cellophane tape

preparation (collected from the perianal region
of the person suspected of infection).

Perianal swab- cellophane/scotch tape prep /

“swube” tubes w/ paddle

Time of Collection: Early morning before bathing

(Because this is the time when we can acquire
the eggs and the eggs can be washed off)

Adult females may also be present if the sample

Humans- Only known host of E. Vermicularis (or
is collected when the females enter the perianal
captive chimpanzees)
region to lay their eggs.
1. Pinworm infection, which is usually self
Multiple samples are required (Confirmation of
limiting, is initiated following the
presence of a light infection)
ingestion of the infective eggs.
Eggs and/or adult females may be recovered in 2. The eggs migrate through the digestive
stool samples (rare) tract into the small intestine, where

Ingestion of infective eggs to oviposition they hatch and release young larvae.
(nocturnal) of female worm- takes 1 months 3. The resulting larvae continue to grow
Oviposition- To oviposit means to lay eggs and mature, ultimately transforming

Adult life span- 2 months into adult worms.

4. The adult worms reside in the colon.
Following mating of select worms
(copulation), including roundworms, the
resulting pregnant (gravid) female worm
migrates outside the body to the
perianal region, where she may deposit
up to 15,000 eggs.
5. Following 4 to 6 hours incubation, the
Swube tubes w/ paddle (By: BD)
developing eggs achieve infective

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

status. These infective eggs may then eggs are ingested via hand-to-mouth
become dislodged from the body, caused contamination.
at least in part by intense scratching of
the anal area by the infected person.
6. Once apart from the host, the infective Epidemiology

eggs may take up residence in a number Found worldwide particularly in temperate

of locations, including dust, sandboxes, areas.
linens, and clothing.
Enterobius vermicularis is the most common
7. The eggs may become airborne.
helminth known to cause infection in the United
8. The infective eggs may survive for a few
States (White children).
days up to several weeks under suitable
environmental conditions. The ideal It is believed that E. vermicularis may be
surroundings for thriving infective eggs responsible for the transmission of
consist of a moderate temperature Dientamoeba fragilis. (The D. fragilis trophozoite
accompanied by high humidity. may actually take up residence inside the
9. Ingestion of these infective eggs initiates pinworm egg for transmission.)
a new cycle.

Copulation- the act of engaging in sexual

Clinical symptoms
intercourse.
1.) Asmyptomatic
Gravid- pregnant; carrying eggs or young.
- Many cases of E. vermicularis infection
MOT: ingestion, inhalation, and autoinfection are asymptomatic.
(retroinfection and reinfection/retrofection) 2.) Enterobiasis: Pinworm Infection

Enterobiasis or oxyuriasis- “puritus ani” Most common symptoms:

(intense chronic itching affecting peri-anal skin.)
Intense itching (puritus ani) and inflammation of
Retroinfection/reinfection- defined in Pinworm- the anal and/or vaginal areas.
specific terms as infective pinworm eggs that
These symptoms may be accompanied by:
migrate back into the host body, develop and
Intestinal irritation, mild nausea or vomiting,
reproduce rather than becoming dislodged.
irritability, and difficulty sleeping.
Autoreinfection- Infected individuals that
reinfect themselves. If an infective pinworm

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Additional symptoms: much less frequency

consist of minute ulcers as well as mild intestinal
inflammation and abdominal pain.

Treatment

➢ Albendazole
➢ Mebendazole
➢ Pyrantel pamoate

Prevention and Control 2.) Trichuris trichiura (T. trichiura)

➢ Practicing proper personal hygiene Common name: Whipworm

(hand washing)
Common associated disease and condition
➢ Applying an ointment or salve to an
names: Trichuriasis, whipworm infection.
infected perianal area to help prevent
egg dispersal into the environment.
➢ Avoiding scratching the infected area.
Infective stage: Embryonated egg
➢ Thorough cleaning of all potentially
infected environmental surfaces (linens) Morphology

➢ Providing treatment to all household Egg:

members are important steps to help
prevent future infections.

➢ Barrel-shaped
➢ Football-sha[ed w/ prominent hyaline
bi-polar plug, “Japanese latern” ova

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

The undeveloped unicellular embryo is Adults:

surrounded by a smooth shell that retains a
yellow-brown color from its contact with host
bile.

Posterior end large, like whip handle, anterior

end is slender

Adult male is smaller than adult female

Male- smaller than female, curled tail (spicule)

Atypical T. trichiura eggs

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY Spicule/retractile sheath
TOPIC: Nematodes

Spicule

Spicule: use in copulation

Spicule/retractile sheath: retractile organ and

apparently capable of considerable expansion
and contraction, since the sheath in retracted
position is much narrower than when extruded.

Laboratory diagnosis

Specimen of choice (recovery of eggs): Stool

Zinc Sulfate Flotation method (Eggs are more

prominent)

Adult worms may be visible on macroscopic

examination of the intestinal mucosa.

Adult worms may also be seen in areas of the

intestinal tract down to and including the rectum
(Heavy infections).

MOT: ingestion of embryonated ova (soil)-

infective stage

Eggs- Direct fecal smear, kat-katz, kato thick,

Formalin ethyl acetate concentration technique

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

➢ Anemia 2. The larvae emerge from the eggs in the

➢ Tenesmus (frequent urge to go to the
small intestine. Growth and
bathroom without being able to go)
➢ Rectal prolapse (when part of the large development of the larvae occur as they
intestine's lowest section, the rectum, migrate within the intestinal villi.
slips outside the muscular opening at
3. The larvae return to the intestinal lumen
the end of the digestive tract known as
the anus) and proceed to the cecum, where they
complete their maturation.
4. The resulting adults take up residence in
the colon, embedding in the mucosa.
The life span of the adult worms in
untreated infections may be from 4 to 8
years.
5. Following copulation, the adult female
lays her undeveloped eggs. It is this stage
of egg that is passed into the outside
Life Cycle Notes environment via the feces.
6. Following approximately 1 month
outside the human body, usually in the
soil, the eggs embryonate, become
infective, and are ready to initiate a new
cycle.

Epidemiology

T. trichiura third most common helminth

Found primarily in warm climates of the world

where poor sanitation practices are common,
such as defecating directly into the soil or using
1. Ingestion of infective T. trichiura eggs human feces as a fertilizer (Night soil).
containing larvae initiates human
infection.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Areas of the United States that have been known Infected adults:
to harbor whipworm include the warm humid
➢ Inflammatory bowel disease
South, particularly in rural settings.
➢ Abdominal tenderness and pain
Persons most at risk for contracting whipworm ➢ Weight loss
infections include children as well as those in ➢ Weakness
psychiatric facilities. ➢ Mucoid or bloody diarrhea

Infections with both Trichuris and Ascaris,

another intestinal nematode are known to occur.
Treatment
This is likely caused at least in part because the
human port of entry, which serves as the mode ➢ Albendazole

of organism transmission, is identical for both ➢ Mebendazole

parasites.

Prevention and control

Clinical symptoms Exercising proper sanitation practices: especially

1.) Asymptomatic avoidance of defecating directly into the soil,

2.) Trichuriasis: Whipworm Infection using feces as a fertilizer, and placing potentially
infective hands into the mouth and prompt and
500-5000 worms (Heavy infection)
thorough treatment of infected persons, when
indicated.

Infected children: Educating children and aiding institutionalized

mentally handicapped persons in their personal
Resembling ulcerative colitis
hygiene and sanitation
As few as 200 worms may cause a child to
develop chronic dysentery, severe anemia, and
possibly growth retardation.

➢ Catch-up growth (treated childrens)

➢ Rectal prolapse and peristalsis
(Common)

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Egg is usually corticated (i.e., the egg possesses

an outer mammillated, albuminous coating).

3. Ascaris lumbricoides (A. lumbricoides)

Common names: Large intestinal roundworm,

roundworm of man.

Common associated disease and condition

names: Ascariasis, roundworm infection.

“Lumbricus terrestis” – Common earthworm

Largest known (and most common) intestinal

nematodes

Ascaris derived from pigs (A. suum) may also

infect humans.

Morphology

Unfertilized Eggs:

Thin shell protects the inner amorphous mass of

protoplasm.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Fertilized eggs:

Fertilized A. lumbricoides egg is more rounded

than the unfertilized egg.

Fertilization of the egg transforms the

amorphous mass of protoplasm into an
undeveloped unicellular embryo.

FERTILIZATION OF THE EGG

Undeveloped
Amorphous mass of
unicellular
protoplasm
embryo

Chitin/shell- Thick nitrogen-containing

polysaccharide coating;

Chitin/shell is sandwiched in between the

embryo and mammillated albuminous material
(corticated).

Both layers protect the embryo from the

outside environment.

Decorticated fertilized egg- Eggs lacking an outer

mammillated, albuminous coating (May also be
present)

The chitin shell is less evident in corticated eggs

than in those that have lost their outer
albuminous coating.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Laboratory diagnosis

Adults:

Fine striations are visible on the cuticle

Cuticle- A surface covering present on adult

nematodes

Male- curved (spicule)

Female- straight

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Life Cycle Notes

Laboratory diagnosis

Specimen of Choice (Recovery of eggs): Stool 2 months

(DFS)

Kato-katz & kato thick

liver, heart, and lungs,
hatched larvae enter
circulation and
Concentrate - Formalin-ethyl acetate migrate to lungs)

sedimentation technique

ELISA

Adult worms can be recovered in: small

intestine, gallbladder, liver, and appendix (It
depends on the severity)

Adult worms may also be present in: stool,

vomited up, or removed from the external nares,
1. Infection begins following the ingestion
where they may attempt to escape.
of infected eggs that contain viable
Loeffler syndrome- Pulmonary ascariasis, larvae.
eosinophilia
2. Once inside the small intestine, the
larvae emerge from the eggs.
3. The larvae then complete a liver-lung
migration by first entering the blood via
penetration through the intestinal wall.
4. The first stop on this journey is the liver.
5. From there, the larvae continue via the
bloodstream to the second stop, the
lung.
6. Once inside the lung, the larvae burrow
their way through the capillaries into the
alveoli.
7. Migration into the bronchioles then
follows.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

8. From here, the larvae are transferred United states- most susceptible to harbor Ascaris
through coughing into the pharynx, resemble those for Trichuris— warm climates
where they are swallowed and returned and areas of poor sanitation, particularly where
to the intestine. human feces is used as a fertilizer (Night soil) and
9. Maturation of the larvae occurs, where children defecate directly on the ground.
resulting in adult worms, which take up
Childrens who place their contaminated hands
residence in the small intestine.
into their mouths (Most risk of contacting this
10. The adults multiply and a number of the
parasite).
resulting undeveloped eggs (up to
250,000/day) are passed in the feces Source of infection:

11. The outside environment, specifically Children’s toys to the soil itself
soil, provides the necessary conditions
Vegetables are grown using contaminated
for the eggs to embryonate.
human feces as fertilizer.
12. Infective eggs may remain viable in soil,
fecal matter, sewage, or water for years. Water (Rare)

Note: Eggs may even survive in 10% formalin May be responsible for the transmission of
fixative used in stool processing. Dientamoeba fragilis (not proven).

13. The longevity of these eggs is partly

because they are not easily destroyed by
Clinical symptoms
chemicals.
14. The resulting embryonated eggs are the 1.) Asymptomatic

infective stage for a new host and, when Patients infected with a small number of worms
consumed by a human host, initiate a (5 to 10)
new cycle.
These patients usually ingest only a few eggs
Epidemiology
They may only learn of their infection if they
Ascariasis is considered as the most common happen to notice an adult worm in their freshly
intestinal helminth infection in the world, passed feces or if they submit a stool for a
affecting approximately 1 billion people. routine parasite examination.

Ranks second in frequency in the United States,

the first being pinworm infection.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

2.) Ascariasis: Roundworm Infection Asthmatic reaction (due to presence of worm)

which is allergic in nature may also occur
May be infected with only a single worm.

a worm may produce tissue damage as it

migrates through the host. Treatment

Secondary bacterial infection may also occur ➢ Albendazole

following worm perforation out of the intestine. ➢ Mebenazole

Prevention and Control

Symptoms of patients that is infected with many ➢ Avoidance of using human feces as
worms: fertilizer
➢ Exercising proper sanitation
➢ Vague abdominal pain
➢ Personal hygiene practices
➢ Vomiting, fever
➢ Distention

Mature worms may entangle themselves into a

mass that may ultimately obstruct the intestine,
appendix, liver, or bile duct.

Discomfort from adult worms exiting the body

through the anus, mouth, or nose may occur.

Heavily infected children who do not practice

good eating habits may develop protein
malnutrition.

Pulmonary symptoms may also occur (When

worms migrate to the lungs)

➢ Low-grade fever
➢ Cough
➢ Eosinophilia
➢ Pneumonia

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

HOOKWORMS Primary differences of the two organisms:

1.) Necator americanus (N. americanus) 1. Geographic distribution varies slightly

with each organism
Common Name: New World hookworm.
2. Importantly for identification purposes,
the adult worms of each have minor

2.) Ancylostoma duodenale (A. duodenale) morphologic differences. The egg and
larva stages, however, are basically
Common Name: Old World hookworm.
indistinguishable.

Morphology
3.) Ancylostoma ceylanicum (A.
Eggs:
ceylanicum)

- Cause creeping eruptions

4.) Ancylostoma braziliense(A. braziliense)

- Cause creeping eruptions

INFECTIVE STAGE: Filariform larvae

Common associated disease and condition

names: Hookworm infection, ancylostomiasis, Only difference between the eggs of N.

necatoriasis. Americanus and those of A. Duodenale is size.

The term hookworm refers to two organisms: N. Americanus is longer than of A. Duodenale

Necator americanus and Ancylostoma Eggs recovered in freshly passed stool may be
duodenale. unsegmented or show a visible embryonic
cleavage, usually at the two-, four-, or eight-cell
stage.

Thin, smooth, colorless shell- Provides

protection for the developing worm

The size ranges of these two organisms are so

close and the other characteristics are identical,
recovered eggs are considered as

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

indistinguishable and are usually reported as reproductive system consisting of a clump of cells
hookworm eggs. in an ovoid formation)

Rhabditiform Larvae:

Filariform Larvae:

The actively feeding larva will, at a minimum,

double in length, ranging from 540 to 700 μm,
when it is only 5 days old.

Presence of a long oral cavity known as a buccal

cavity or buccal capsule and a small genital The infective, nonfeeding filariform larva

primordium (i.e., a precursor structure to a emerges after the rhabditiform larva completes
its second molt.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Two notable characteristics: Adults:

1.) This slender larva has a shorter

esophagus than that of Strongyloides
stercoralis.
2.) The hookworm filariform larva has a
distinct pointed tail.

Anterior end typically forms a conspicuous bend,

referred to as a hook—hence, the name
hookworm.

The hook is usually much more pronounced in

the N. americanus adult than in that of A.
duodenale.

Adult males are smaller than adult female

Adult male: Equipped with Copulatory bursa

Copulatory bursa: Prominent, posterior,

umbrella-like structure that aids in copulation.

Buccal capsule
N. americanus A. duodenale A. ceylanicum
➢ Pair of ➢ Consists of ➢ Large outer
cutting actual teeth ventral teeth
plates ➢ Four and smaller
hooklike inner teeth
teeth ➢ One pair

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Laboratory Diagnosis Rhabditiform larvae: 1st stage; actively feeding,

long buccal cavity; small genital primordium
Specimen of choice: Stool
Filariform larvae (L3): Infective; non-feeding
Stool culture: Harada mori method larva emerges after the rhabditiform complete
demonstrates L3 to differentiate Necator from its 2nd molt, Pointed tail; short esophagus
Ancylostoma

MOT: skin penetration of filariform larva 1. Humans contract hookworm when third-
stage filariform larvae penetrate through
Miner’s anemia & Tropical anemia
the skin, particularly into areas such as
Urticarial dermal reaction (”ground itch”)
associated with filariform (L3) larvae penetration unprotected feet.
2. Once inside the body, the filariform
Gastrointestinal/pulmonary disturbances and
eosinophilia (Wakana syndrome) by per-oral larvae migrate to the lymphatics and
infection blood system.
Larvae may mature and hatch from the eggs in 3. The blood carries the larvae to the lungs,
stool that has been allowed to sit at room where they penetrate the capillaries and
temperature, without fixative added. enter the alveoli.

Recovery and examination of the buccal capsule 4. Migration of the larvae continues into

is necessary to determine the specific hookworm the bronchioles, where they are coughed

organism. up to the pharynx, subsequently

swallowed, and deposited into the
Life Cycle Notes
intestine.
5. Maturation of the larvae into adult
hookworms occurs in the intestine. The
resulting adults live and multiply in the
small intestine. Adult females lay 10,000
to 20,000 eggs/day.
6. Many of the resulting eggs are passed
into the outside environment via the
feces.
7. Within 24 to 48 hours and under
appropriate conditions— warm, moist
soil—first-stage rhabditiform larvae
emerge from the eggs.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

8. The larvae continue to develop by Although historically a parasite of the Old World,
molting twice. Third-stage infective A. duodenale has been transported to other
filariform larvae result and are ready to areas of the globe via modern world travel.
begin a new cycle. (Europe, China, Africa, South America, and the
Caribbean.)

Epidemiology
Clinical Symptoms
25% of the world’s population is infected with
hookworm (Estimation). 1.) Asymptomatic Hookworm Infection

High in warm areas in which the inhabitants Light hookworm infection (Do not exhibit clinical
practice poor sanitation practices, especially symptoms)
with regard to proper fecal treatment and
Adequate diet rich in iron, protein, and other
disposal.
vitamins helps maintain this asymptomatic state.
Trichuris, and Ascaris are possible because all
2.) Hookworm Disease: Ancylostomiasis,
three organisms require the same soil conditions
Necatoriasis.
to remain viable.
Ground itch (intense allergic itching at the site of
Unholy three parasites (WHO):
hookworm penetration) of patients who are
➢ Ascaris lumbricoides repeatedly infected.
➢ Hookworm ( Ancylostoma duodenale
Larvae migration to the lungs: sore throat,
and Necator americanus )
bloody sputum, wheezing, headache, and mild
➢ Trichuris trichiura
pneumonia with cough.
Note: These 3 are soil-transmitted helminths
Symptoms associated with the intestinal phase
(STH)
of hookworm disease (Depends on the number
Persons at risk for contracting hookworm in of worms present)
these areas are those who walk barefoot in feces
contaminated soil.
Chronic infections:
N. americanus is primarily found in North and
South America. Also known to exist in China, Light worm burden (<500 eggs/g of feces)

India, and Africa (Due to international travel). Most common form seen

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Symptoms: Prevention and Control

➢ Vague mild gastrointestinal symptoms ➢ Similar to those for A. lumbricoides.

➢ Slight anemia ➢ Proper sanitation practices (appropriate
➢ Weight loss or weakness fecal disposal)
➢ Prompt and thorough treatment of
infected persons
Acute infections: ➢ Personal protection of persons entering

>5000 eggs/g of feces known endemic areas, such as covering

bare feet
Symptoms:

➢ Diarrhea
➢ Anorexia Notes of Interest and New Trends

➢ Edema Advent of indoor plumbing (said by some to be

➢ Pain contributed in decrease of hookworm infection)
➢ Enteritis
United States known to have sandy soil.
➢ Epigastric discomfort
Infections in those regions were contracted by
Adult hookworms compete with the human host individuals who walked barefoot to and from
for nutrients as they feed, infected patients may the outhouse.
develop a microcytic hypochromic iron
Incidence of hookworm among soldiers during
deficiency, weakness, and hypoproteinemia.
World War II was high (majority of them have no
Enormous loss of blood (Mortality) clinical symptoms).

Research has been conducted using a reverse

Treatment enzyme immunoassay for specific

immunoglobulin E (IgE) in patients with known
➢ Mebendazole
hookworm infections.
➢ Pyrantel pamoate

Iron replacement and/or other dietary therapy

(including proteins, iron, and other vitamins)
[Especially for patients with asymptomatic
hookworm infection]

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Two other species of hookworms known to infect

humans accidentally:

ACCIDENTAL PARASITES

1.) Ancylostoma braziliense

- Canine & Feline

in humans, causes cutaneous larva migrans, or

creeping eruptions.

2.) Ancylostoma caninum

When they infect humans, these organisms are

unable to complete their life cycle, infecting the
subcutaneous or skeletal tissues.

Human infection with either of these organisms

may produce a condition known as cutaneous 5.) Strongyloides stercoralis (S. stercoralis)

larva migrans. Common Name: Threadworm

Symptoms: Common associated disease and condition

Skin lesions and intense itching, which may lead names: Strongyloidiasis, threadworm infection.

to a secondary bacterial infection.

Lesions resemble creeping worms through the Infective stage: Infective filariform larvae
skin.
Morphology
Treatment of choice: Thiabendazole
Eggs:
Prevention of infection and control: avoidance
of skin contact with dog and cat feces.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

“Chinese lantern” ova Rhabditiform Larvae:

The eggs are considered indistinguishable from

those of hookworm

Two features to identify S. stercoralis egg:

1.) Typical S. stercoralis egg measures only

Difference between S. stercoralis and
slightly smaller than hookworm eggs,
hookworms Rhabditiform Larvae
averaging 48 by 35 μm.
2.) Unlike hookworm, well developed larvae S. stercoralis hookworms

are almost always contained in the S. ➢ Short buccal ➢ Long buccal

stercoralis eggs. cavity cavity

➢ Prominent ➢ Small genital
The eggs of both organisms are similar in that
genital primordium
when present, the two-, four-, or eight-cell stage
primordium
of embryonic cleavage is surrounded by a thin
Rhabditiform larvae of S. stercoralis resemble
hyaline shell.
those of hookworm but can be distinguished by
the shorter buccal capsul and larger genital
primordium

Esophageal bulb is observed.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

The long, slender, nonfeeding filariform larva

results from the molting of the rhabditiform
form.

Difference between the hookworm:

1. Long esophagus, compared with that of

the hookworm
2. Tail of S. stercoralis is notched, unlike
that of S. stercoralis hookworm, which is
pointed.

Filariform Larvae:

Notched
tail

MAG-ISA, ALVIN JAMES R.

 COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Adult Female:

Adult Developing
female eggs

Probably because no adult male S. stercoralis is Adult

known to exist, the adult female is considered as female
parthenogenic, because there are no obvious
morphologic structures to indicate that a male is
not required for fertilization. (THIS IS PROBABLY
OUTDATED BECAUSE THERE ARE KNOWN
ADULT MALE IN OTHER SOURCES) Developing
eggs
Male: Presence of spicule

Laboratory Diagnosis:

Adult Eggs: (Severe diarrhea): Zinc sulfate flotation

male
technique. FECT

Larvae: Baermann funnel mtd. Harada-mori filter

Spicule paper tech.

Koga agar plate culture method- Most sensitive

coprological mtd. (CDC)
Adult
male ELISA, PCR
Spicule
Rhabditiform larva (Stool, duodenal aspirates)-
Enterotest
Rhabditform
larvae

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Sputum samples have also yielded S. stercoralis life cycle rhabditiform larvae in the threadworm
larvae in patients suffering from disseminated are usually passed in the feces.
disease.
Eggs are only occasionally found in such samples.
Larvae have higher recovery rate in concentrated
These rhabditiform larvae develop directly into
specimens than flotation techniques.
the third-stage infective filariform larvae in
S. fuelleborni- primates warm, moist soil.

Cochin-china diarrhea (Vietnam) The remaining phases of the threadworm life

cycle basically mimic those of the hookworm life
cycle.
Life Cycle Notes
1. In the indirect cycle, threadworm
rhabditiform larvae are passed into the
outside environment (soil) and mature
into free-living adults that are
nonparasitic.
2. These adult females produce eggs that
develop into rhabditiform larvae.
3. These larvae mature and transform into
the filariform stage, at which time they
may initiate a new indirect cycle or
become the infective stage for a human
host and begin a direct cycle.

AUTOINFECTION
Three possible routes of threadworms:
1. Autoinfection occurs when the
1. Direct rhabditiform larvae develop into the
2. Indirect filariform stage inside the intestine of
3. Autoinfection the human host.
2. The resulting infective larvae may then
Unlike in the hookworm life cycle, in which eggs
enter the lymphatic system or
are the primary morphologic form seen in feces,
bloodstream and initiate a new cycle of
infection.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Epidemiology ➢ Recurring allergic reactions may also

occur
Strongyloides is found predominantly in the
➢ Pulmonary symptoms (When larvae
tropical and subtropical regions of the world.
migrate into the lungs)
Areas of poor sanitation, in which feces are ➢ Immunocompromised persons often
disposed in the warm moist soil, provide a suffer from severe autoinfections that
wonderful atmosphere for the organism to exist, may result in the spread of the larvae
especially when participating in the indirect cycle throughout the body, increased
of reproduction. secondary bacterial infections, and

Those at risk for contracting threadworm are possibly death.

those who come into skin contact with

contaminated soil.
Treatment
Persons living in institutions in which sanitation
Ivermectin with albendazole as an alternative.
may be poor, such as psychiatric facilities, are
also at risk.

Clinical Symptoms Prevention and Control

1.) Asymptomatic Similar for hookworm

- Light infections In addition to proper handling and disposal of

fecal material and adequate protection of the
2.) Strongyloidiasis: Threadworm Infection
skin from contaminated soil, prompt and
➢ Diarrhea
thorough treatment of infected persons is
➢ Abdominal pain
essential, especially to stop or prevent
➢ Urticaria accompanied by eosinophilia
autoinfections.
➢ Vomiting
➢ Constipation
➢ Weight loss
➢ Variable anemia
➢ Malabsorption syndrome (heavy
infections)
➢ Site of larvae penetration may become
itchy and red

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

These larvae settle by coiling up in muscle fibers

and becoming encysted. Biopsies of these larvae
often reveal a distinctive inflammatory infiltrate
in response to the presence of the larvae.

A striated muscle cell, known as a nurse cell,

surrounds the coiled larva.

Intestinal-tissue species

1.) Trichinella spiralis (T. spiralis)

Common name: Trichina worm

Common associated disease and condition

names: Trichinosis, trichinellosis.

Infective stage: First stage of larva (L1)

Morphology

Encysted Larvae:

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Adults: Laboratory Diagnosis

Zoonosis

Based on history & clinical symptoms

Method of choice: Examination of the affected

skeletal muscle for the recovery of the encysted
larvae.

Eosinophilia and leukocytosis may also serve as

indicators for disease.

Muscle biopsy- definitive diagnostic exam

Male adult is smaller than female adult. Elevated serum muscle enzyme levels

Male adult characteristically possesses a thin Blood chem exams- (Increased creatine,
anterior end equipped with a small mouth, long phosphokinase, lactate dehydrogenase and
and slender digestive tract, and curved posterior myokinase levels) – evidence of muscle damage
end with two somewhat rounded appendages.
Serological test- (Bentonite flocullation test,
ELISA)

Beck’s xenodiagnoses albino rats

Life Cycle Notes

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

1. Human infection with T. spiralis is the May be found in a number of different animals,
result of accidental human infection with
including the pig, deer, bear, walrus, and rat.
a parasite whose normal host is an
animal (zoonosis). T. spiralis is resistant to colder regions of the
2. Infection is initiated after consuming
undercooked contaminated meat, world as compared with most parasites studied
primarily striated muscle. thus far.
3. Human digestion of the meat releases T.
spiralis larvae into the intestine. It is presumed that the feeding of contaminated
4. Maturation into adult worms occurs
pork scraps to hogs accounts for a major mode of
rapidly.
5. Mating occurs and the gravid adult T. spiralis transmission.
female migrates to the intestinal
submucosa to lay her live larvae because
there is no egg stage in this life cycle. Clinical Symptoms
6. The infant larvae then enter the
bloodstream and travel to striated 1.) Trichinosis, Trichinellosis
muscle, where they encyst nurse cells.
Light infections:
7. Over time, a granuloma forms, which
becomes calcified around these cells. ➢ Diarrhea
8. Because humans are not the traditional ➢ Slight fever, suggestive of the flu.
hosts, completion of the T. spiralis life
Heavy infections:
cycle does not occur and the cycle ceases
with the encystation of the larvae. ➢ Vomiting
➢ Nausea
➢ Abdominal pain
From the discussion: ➢ Diarrhea
➢ Headache
Mating occurs and the gravid adult female
➢ Fever during the intestinal phase of
migrates to the intestinal sub-mucosa to lay live infection.
larvae (viviparous) because there is no egg stage As the larvae begin their migration through the
in this life cycle. Larvae then enter the blood body, infected persons experience a number of
symptoms:
stream and travel to striated muscle. Granuloma
➢ Eosinophilia
forms, larvae eventually die & calcify in the
➢ Pain in the pleural area
human muscles (dead-end cycle) ➢ Fever
➢ Blurred vision
➢ Edema
Epidemiology ➢ Cough
➢ Death may also result during this phase.
T. spiralis is found worldwide, particularly in Muscular discomfort
members of the meat-eating population. ➢ Local inflammation
➢ Overall fatigue

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

➢ Weakness usually develop once the avoidance of feeding pork scraps to hogs is also
larvae settle into the striated muscle and necessary to break the T. spiralis life cycle.
begin the encystation process.

The striated muscle of the face and limbs, as well

as that of other parts of the body, may become
infected.

Treatment

No medications are indicated if the infected

person has a non–life-threatening strain of the
disease.

Patients are instructed to get plenty of rest,

supplemented by adequate fluid intake, fever
reducers, and pain relievers.

Severe infections: Prednisone

➢ Thiabendazole

2.) Dracunculus medinensis (D. medinensis)

Prevention and Control Common name: Guinea worm

Thorough cooking of meats, especially from Common associated disease and condition
animals known to harbor T. spiralis, is paramount names: Dracunculosis, dracunculiasis, guinea
to the eradication of this parasite. worm infection.

It has been determined that proper storage of Medina worm, Dragon worm, fiery serpent worm
these meats, at below-zero temperatures (i.e., of the Israelites. (“Little dragon from medina”)
−15° C [59° F] for 20 days or −30° C [86° F] for 6
Infective stage: L3 larva in crustacean copepods
days) will greatly decrease the viability of the
water fleas (Cyclops)- intermediate host
organism.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Induced rupture of the infected ulcers by

Morphology immersing in cool water reveals the first-stage

Larvae: larvae.

Life Cycle Notes

Two larval stages:

1. Diagnostic stage (First stage /

rhabditiform larvae)

2. Third stage larvae

- Which reside in an intermediate host, have not

been well described.

Adults: 1. Ingestion of drinking water

contaminated with infected copepods
(freshwater fleas) initiates human
infection.
2. These copepods contain infective D.
medinensis third-stage larvae, which
upon human ingestion emerge into the

Considered as one of the largest adult intestine.

nematodes 3. The larvae mature into adult worms,

penetrate the intestinal wall, and
Male adult is smaller than Female adult.
proceed to connective tissues or body
cavities.
4. Following mating, the gravid female
Laboratory Diagnosis
worms migrate into the subcutaneous
Observing the infective ulcers: to check the tissue, especially in the skin of the
emergence of worms.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

extremities, where they lay live first- First-stage D. medinensis larvae escape from the
stage larvae. ulcers of infected persons who come into contact
5. On release of all their larvae, the adult with this water.
females may escape from the body at
Ponds, human-made water holes, and standing
the larvae deposit site or migrate back
water may also serve as sources of infection.
into deeper tissues, where they
eventually become absorbed. Reservoir host: such as dogs

6. The fate of the adult males is unknown. Like humans, these animals become infected via
An infected ulcer results at the site of the contaminated drinking water.
larvae deposit.
7. Under appropriate conditions, such as
contact with cool freshwater, the ulcer Clinical Symptoms
ruptures and releases the larvae into the
1.) Guinea Worm Infection: Dracunculosis,
water. Dracunculiasis.
8. Copepods living in the water consume Symptoms associated with allergic reactions as
the first-stage larvae, serving as its migration of the organism occurs.
intermediate host.
Secondary bacterial infections may also develop,
9. Maturation of the larvae into their third-
some of which may cause disability or even
stage infective form then occurs.
death.
10. Ingestion of the infected copepod begins
the cycle again. Once the gravid female settles into the
subcutaneous tissues and lays her larvae, a
painful ulcer develops at the site.
Epidemiology
Unsuccessful attempts to remove an entire adult
Found in parts of Africa, India, Asia, Pakistan, and female worm may result in a partial worm being
the Middle East. left at the site and subsequent toxic reactions in

Copepods reside in fresh water, located the ulcer.

particularly in areas called step wells, from which Allergic reactions and nodule formation may
people obtain drinking water and bathe. develop on the death and calcification of an adult
worm.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

Treatment Prevention and Control

Use of properly treated water for consumption

No specific medicines available

Boiling water suspected of contamination

successful treatment typically consists of total
worm removal. Prohibiting the practice of drinking and bathing
in the same water

Five steps of removal: Ceasing the practice of allowing standing water

to be ingested are all logical guinea worm
1. This step consists of placing the affected
prevention and control measures.
body part, in the form of a blister, in cool
water. Contact with the water creates an Copepods may be removed from suspected
environment of interest to the water is to filter it using a finely meshed filter.
underlying adult worm.
Educate the entire population in endemic areas,
2. In this step, the adult worm breaks
the religious practices of some people in these
through the blister and is eager to
areas lead to water contamination.
explore the outside world.
3. It is important at this juncture to clean
the resulting wound thoroughly. Notes of Interest and New Trends
4. Manual extraction of the entire worm by History of D. medinensis dates back to biblical
winding it around a stick or a similar item times.
that creates tension constitutes this
Guinea worms were suspected of being the
step.
“fiery serpents” responsible for a plague that
5. Once the worm is removed, this step is
affected the Israelites who lived by the Red Sea.
performed, which consists of applying
topical antibiotics to the wound site as a This organism was also described by Egyptian

protective measure against the priests, the Greeks, and the Romans.

emergence of secondary bacterial

infections.

MAG-ISA, ALVIN JAMES R.

COURSE: CLINICAL PARASITOLOGY
TOPIC: Nematodes

MAG-ISA, ALVIN JAMES R.