Introduction to Nematodes

and
Ascaris lumbricoides

Dr. Sulaiman Lakoh

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 Objectives
• To understand what nematodes are
• To be able to classify nematodes
• To know the epidemiology of nematodes
• To learn about the parasitology of Ascaris
lumbricoides

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 Introduction to nematodes
• Among the commonest of all parasites
• Responsible for diseases of major importance in
humans
• Non-segmented roundworms
• Belongs to the Phylum Nemathelminthes, Class
Nematoda

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 Introduction to nematodes
• The sexes are usually separate (Dioecious)
• Male which is smaller than the female
commonly has a curved posterior end

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 Epidemiology of nematodes
• Approximately 0.807 to 1.221 billion humans
have ascariasis
• About 604 to 795 million have trichuriasis
• About 567 to 740 million have hookworm
infections

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 Morphology of nematodes
• Cylindrical and slender
• Bilaterally symmetrical
• Sex-differentiated
• Celomic cavity: protocoele
• The supporting body wall consists of cuticle layer,
syncytial layer (subcutical layer) and longitudinal
muscular layer
• The alimentary tract is a simple tube extending from
the mouth to the anus

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 Morphology of nematodes

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 Morphology of nematodes

• No circulatory system
• The reproductive system is in tubular
form with dioecious (sex- Digestive system

differentiation):
– Male: testis, vas deferens, seminal
vesicle, ejaculatory duct, cloaca male reproductive system

and spicule
– Female: ovary, oviduct, seminal
receptacle, uterus, ovejector and female reproductive system

vagina
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 Physiology of nematodes
• The methods of obtaining food may be classified as
– Sucking with ingestion of blood (Ancylostoma)
– Ingestion of lysed tissues and blood (Trichuris)
– Feeding on the intestinal contents (Ascaris)
– Ingestion of nourishment from the body fluids (filarial worms)
• Metabolism: mainly aerobic metabolism, and most species
need free-living periods for larvae, which are capable of
withstanding a wide range of environmental condition
• During larval development, nematodes pass through several
molts or ecdysis, both inside and outside the host

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 Life cycle of nematodes
• Geo-helminths
– Only one host: the larvae pass from host to host
directly or after a free-living existence
– Transmission to a new host depends upon
• the ingestion of the mature infectious eggs
with larvae (Ascaris, Pinworm)
• the penetration of the skin or mucous
membranes by the larvae (Hookworm)

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 Life cycle of nematodes
• Bio-helminths
– Have an intermediate host
– Transmission to a new definitive host is
intermediated by the arthropod--- (filarial worm)

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Common medical nematodes species

• Intestinal lumen residing nematodes:

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 General Introduction
• Common saying “round worm of man”
• The largest of the intestinal nematodes parasitizing
humans
• 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

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 Morphology of Ascaris
• Adult:
– Cylindrical in shape
– Creamy-white or pinkish in color
– The female averages 20-35cm in length, the largest
49cm
– The male is smaller, averaging 15-31cm in length, has a
typical curled tail with a pair sickle like copulatory spines
– On the tip of the head there are three lips, arranged as a
Chinese word “ 品 ”

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 Morphology of Ascaris
– Male has a single reproductive tubule
– The female has two reproductive tubules and the vulva is
ventrally located at the posterior part of the anterior 1/3
of the body

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 Adult worm of A. lumbricoides
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 Other characteristics
• Infective stage: eggs
• Route of transmission: oral
• Gastrointestinal location: Jejunal lumen
• Incubation period: 60-75 days
• Logevity: 1 year
• Fecundity: 240,000 eggs per worm/per day
• Diagnostic stage: eggs in the stool

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 Life cycle

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 Life cycle of Ascaris

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 Clinical features: lung phase
• Irritating non productive cough
• Burning substernal discomfort
• Dyspnea
• Blood-tinged sputum
• Fever
• Eosinophillia
• Loefler’s syndrome

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 Clinical features: Intestinal phase
• Mostly asymptomatic
• Abdominal pain
• Bowel obstruction, intussusception, volvulus
• Biliary colic, cholecystitis, cholangitis,
pancreatitis, intrahepatic abscesses

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 Diagnosis
• Microscopic detection of Ascaris eggs in fecal
or sputum samples
• Passage of adult worm
• Abdominal x rays, abdominal ultrasound and
ERCP
• Full blood count: eosinophillia

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 Treatment
• Mebendazole 100 mg twice a day or 500 mg
once
• Albendazole 400mg stat
• Ivernmectin
• Pyrantel pamoate
• Nitazoxanide

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 Treatment
• Supportive care: IV fluids, nasogastric tubes
for partial obstruction
• Surgical removal of the worms

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