HELMINTHS

Human and Microbial Interaction

Unit VI

By
Muhammad Iqbal
Lecturer
KMU

Microbiology
 OBJECTIVES

• At the end, the learners will be able to:

• Define key terms
• Discuss general characteristics of helminths
• Give their classification
• Identify helminthic diseases
• Discuss preventive measures

M. Iqbal
 Classification

Helminths

Phylum: Nemathelminthes (Round) Phylum: Platyhelminthes (flat)

Class: Nematoda Class: Cestoda & Trematoda

M. Iqbal
 General Features of Nematodes
Nematodes (Nema= thread) are commonly known as
Round worms. They include pinworms or thread
worms, Hookworms, Whipworms.
Shape: unsegmented, Round, elongated and tapered
at both ends. Hooks and suckers are absent.
Size: from 5 mm to 30 cm in length.
Digestive system: complete alimentary tract present.
Sex: dioecious, means male and female are separate.
Males are smaller than females.
Reproduction: Mostly are oviparous but some are
viviparous.
Life cycle: Almost monogenetic; may take about 60
days to complete their life cycle.
M. Iqbal
 Habitat
Regarding habitat there are two groups of
Nematodes:
1. Intestinal, and 2. Tissue or somatic Nematodes
1. Intestinal Nematodes:
a. Small Intestinal Nematodes:
e.g: Ascaris lumricoides (Round worm)
Ancyclostoma duodenale (hookworm)
Necator americanus (hookworm)
b. Large Intestinal Nematodes:
e.g: Enteroboius vermicularis (pinworm)
Trichuris trichiura (whipworm)
Infective stage: either fertilized egg or larva
 Roundworms
Different species like Ascaris lumbricoid, etc are found.
Gk. Askaris=intestinal worm
► Size: Males 15-30 cm and females from 20-40 cm in
length
► Habitat: Small intestine
► Transmission: by ingestion of fertilized eggs via food
and water
► S/S
• GIT disturbance, N/V, Colic pain, anorexia,
malnutrition, paleness, intestinal obstruction in heavy
infection, fever, liver abscess, pancreatitis and
Loeffler’s syndrome due to their migration (ectopic
infection).
Most infections (about 85%) are mild and symptomless.
M. Iqbal
► Diagnosis:
• The presence of adult worms in faeces or vomitus
• Microscopic stool examination for eggs and larvae
• Sputum microscopic examination
• Blood examination for Eosinophilia

► Treatment
1. Pharmacologic Treatment:
• Mebendazole and pyrantel pamoate are drugs of
choice. Other drugs are piperazine, albendazole,
and Thiabendazole.
2. Surgery:
Is necessary in case of intestinal obstruction.
Note: Ascariasis in pregnancy should be treated
after 1st trimester.
M. Iqbal
 Pinworms
• Pinworm or threadworm is a common name. They
include different species like Enterobius vermicularis.
► Size: Small and can be seen with naked eyes.
Males range from 2-5 mm and females from 8-12
mm in length.
► Habitat: The adult worms remain attached to
caecum, appendix and in ilium, ascending colon as
well.
► Transmission: by Ingestion or inhalation of
fertilized eggs.
• Female comes down and lays eggs in perianal area
during night which causes itching and irritation. M. Iqbal
 Pinworm cont…
► S/S: perianal itching and irritation,
pruritus ani.
►Laboratory Diagnosis:
• Graham sticky tape method for eggs on
perianal area.
• Microscopic stool examination
► Treatment: Mebendazole, pyrantel
pamoate and should be repeated after two
weeks
M. Iqbal
 Whipworms
• Whipworm (whip shaped) is a common name.
They include different species like Trichuris
trichiura, etc.
► Size: Males range from 3-4 cm and females
from 4-5 cm in length.
• Females lay 2,000 to 6,000 eggs /day
► Habitat: Large intestine, caecum, appendex
► Transmission: Ingestion of food and water
contaminated with fertilized eggs.
M. Iqbal
 Whipworm cont…

► S/S: Abdominal pain, distention, mucous or

bloody diarrhea, anorexia, weight loss,
eosinophilia, anemia.
► Laboratory Diagnoisis: Microscopic stool
examination.
► Treatment: Albendazole or Mebendazole

M. Iqbal
HOOKWORM

M. Iqbal
Hookworms

M. Iqbal
 Hookworm
• Hookworm is a common name. different
species are like Ancyclostoma duodenale
(Gk. Anchylos=hooked), Necator americanus
(Necator=murderer means American
murderer),etc. Apart from anthrophilic, there
are zoophilic species also.
► Habitat: duodenum and jejunum and ileum.
► Size: Male 10 mm and female 15 mm.
► Transmission: The entrance of rhabditiform
(rod shaped) larva through the skin of bare
footed man waking on contaminated soil.
M. Iqbal
 Hookworm cont…
► S/S: severe itching at penetration site known
as ground itch or ancylostoma dermatitis
which lasts for 2-4 weeks. Loeffler’s
syndrome, anemia as they suck blood and
there secretions also contain anticoagulant
which leads to blood loss.
► Laboratory diagnosis: Stool examination,
Stool occult blood, CBC.
► Treatment: Mebendazole or albendazole

M. Iqbal
 2. Tissue or Somatic Nematodes
Somatic nematodes are filarial worms (Latin, filum
means ‘thread’).
General features:
• Size: 2-10 cm in length
• Habitat: Lymphatic vessels, blood vessels,
lungs, and subcutaneous tissues
• Life cycle: They are digenetic, blood sucking
insect.
• Vector: Filarial worms are transmitted by
various species of mosquitoes like Anopheles,
Aedes, and Culex. M. Iqbal
• Microfilaria: The adult females are
viviparous and give birth to larvae called
microfilaria. The vectors transmit
microfilaria into human blood.

M. Iqbal
 Lymphatic Filariasis
• Three filarial worms are responsible for
lymphatic filariasis. They are Wucheria
bancrofti, Brugia malayi, Brugia timori. The
most common is Wucheria bancrofti which is
responsible for 90 % of infections. It causes
elephantiasis.
• Wucheria bancrofti
• Habitat: lymph nodes and lymph vessels
• Size: male 2-4 cm x 0.1 mm
female 8-10 cm x 0.2 mm
M. Iqbal
They affect different tissues as:
a. Lymphatic vessels as lymphatic filariasis
caused by, for example, Brugia malayi
b. Subcutaneous tissues (e.g Loa loa)
c. Conjunctiva (e.g Loa loa)
d. Lungs (e.g Trichinella spiralis)

Transmission:
Somatic nematodes are mostly transmitted to
man in the form of larvae by mosquito bite.
M. Iqbal
 Lymphatic Filariasis

Elephantiasis of the leg A female Anopheles mosquito

(source: WHO) taking a blood meal
 Platyhelminthes
(Tapeworms)

Platyhelminthes are classified into

Cestodes and Trematodes
M. Iqbal
 Platyhelminthes

Cestodes Trematodes
1. Tape-like, segmented 1. Leaf-like, unsegmented
2. Monocious /Hermaphrodite 2. Monocious except schistosomes
3. Suckers often with hook 3. Suckers but no hook
4. Alimentary canal absent 4. Alimentary canal present but
incomplete

M. Iqbal
 Cestodes
Gk. Kestos=ribbon, means tape-like
► General Features:
• Shape: dorsoventrally flattened.
• Habitat: Intestine and other body tissues.
• Size: ranges from 1 cm to 15 meters.
• Body structure: Consists of
a) scolex: containing suckers (organs of
attachment)
b) neck: (germinal centre from which new
proglottids or segments keep generating)
M. Iqbal
 Cestodes general features cont…
c) Strobila: Trunk or body of tapeworm
• Proglottid: three types ---immature, mature, gravid.
Each mature proglottid contains both male and
female reproductive organs
• Digestive system: No digestive system
• Sex: hermaphrodites
• Life cycle: Digenetic, using intermediate and
definitive host.
They cause both intestinal as well as systemic
infections
There are different species of cestodes.
M. Iqbal
 Taenia saginata (beef tapeworm)
• Distribution: Worldwide
• Size: usually 5-10 meters but may exceed
even 20 meters. It is white in color.
• Habitat: Adult tapeworms live in the small
intestine of man attached to the mucosa by
scolex.
• Life span: It may live for about 10 years.
• Proglottids: The strobila (trunk) consists of
1000-2000 proglottids (segments). Each
segment has opening to discharge fertilized
eggs.
M. Iqbal
 Cont….
• Testes: 300-400 in each mature proglottid
• Ovaries: Two in number. Each segment
contains about 80,000 eggs.
• Life cycle: It requires two hosts to complete its
life cycle.
• Intermediate host: Cattle (cow or buffalow)
harbours larval stage
• Definitve host: Man who harbours adult worm.
• Transmission: Ingestion of cysticercus cyst
larvae by man in raw or undercooked meat of
cattle or contaminated food or water.
M. Iqbal
• Development in man: the larvae cysticerci
grow into adult in man. They discharge
fertilized eggs through human faeces. The
eggs are viable upto 8 weeks in soil and are
infective for cattle only.
• Development in cattle: The cattle ingest the
eggs during grazing. The eggs pass from
intestine into muscles via blood circulation. In
muscles,the eggs develop into larvae called
cysticercus bovis. This larva is ingested by
man in raw or undercooked beef.
M. Iqbal
• S/S: Nausea, abdominal discomfort, pain,
indigestion, diarrhea alternating with
constipation.
• Diagnosis: Microscopic stool examination
for segments and eggs
• Treatment: Praziquantel or Niclosamide

M. Iqbal
 Taenia solium (pork tapeworm)
• Size: 2-3 meters in length.
• Habitat: Small intestine.
• Life span: upto 25 years
• Transmission: Ingestion of cysticerci by
man (definitive host) in raw or undercooked
pork.
• Proglottids: 800-900
• Intermediate host: pig
• Defenitive host: man
M. Iqbal
• Life cycle is similar to that of T. saginatta.
• Transmission is same with that of T. saginatta
• It causes both intestinal as well as systemic
infections
• S/S:
• In Intestinal taeniasis there is abdominal
discomfort and pain.
• Systemic infections include subcutaneous
tissues, skeletal muscles and brain infection
M. Iqbal
►Diagnosis
a) For Intestinal taeniasis:
• Microscopic stool examination
b) Tissue cysticercosis (tissues affected by
cysticercus larvae is called cysticercosis) is
diagnosed by:
• Radiography, biopsy
• CT scan, MRI
• Treatment:
• Same as T. saginatta infection
• For cysticercosis, prazequantel and
albendazole are effective.
M. Iqbal
 Other systemic/tissue cestodes
They ineter body tissues in larval forms.
Examples are:
• Echinococcus granulosus (dog tapeworm)
causes hydated disease
• Echinicoccus multilocularis (rodent tapeworm)
causes alveolar and hydated disease
- Hydatid disease occurs when the larval
stages of these organisms are ingested
- The larvae may develop in man and cause
lesions in several organs, e.g. liver, brain
M. Iqbal
 Trematodes
• Trematodes have suckers with a hole (Gk. Trema,
hole; edios, appearance) appears in the middle of
suckers, and hence are called trematodes.
• General characteristics:
• Leaf-shaped
• Unsegmented
• Size is 1 mm to several cm
• Found in intestine, liver, lung, blood vessels
• They are mostly hermaphrodites
• Either monogenetic or digenetic
• Their infective larvae are cercaria, metacercaria and
miracidium. M. Iqbal
• They are named according to the organs
they infect like liver fluke, lung fluke, etc.

Liver fluke Lung fluke

 Prevention

• Education
• Safe disposal of faeces
• Avoid contact with contaminated soil
• Good personal hygiene
• Adequate sanitation
• Avoid bare footed walking
• Control measures for mosquitoes and flies

M. Iqbal
 References
• Textbook of Medical Parasitology by
P.Chakabrty
• Tortora, microbiology, ed 10th

M. Iqbal
• Annelid worms such as leeches all have an anterior (oral) sucker
formed from the first six segments of their body, which is used to
connect to a host for feeding. It also releases an anaesthetic to
prevent the host from feeling pain while it sucks blood. They use a
combination of mucus and suction (caused by concentric muscles in
those six segments) to stay attached and secrete an anti-clotting
enzyme, hirudin, into the host's blood stream. The medicinal leech (
Hirudo medicinalis) has two suckers, one at each end, called the 
anterior and posterior sucker. The posterior is mainly used for 
leverage while the anterior sucker, consisting of the jaw and teeth, is
where the feeding takes place.[12] During locomotion directional
movement of the body is done by successive attachment and
detachment of the oral sucker and the acetabulum.[2]

M. Iqbal
• A medicinal leech with its oral sucker

M. Iqbal
 Schistosoma (blood fluke)
• Morphology
• Adult schistosomes share all the fundamental features of
the digenea. They have a basic bilateral symmetry, oral
and ventral suckers, a body covering of a syncytial 
tegument, a blind-ending digestive system consisting of 
mouth, oesophagusand bifurcated caeca; the area
between the tegument and alimentary canal filled with a
loose network of mesoderm cells, and an excretory or
osmoregulatory system based on flame cells. Adult
worms tend to be 10–20 mm (0.4–0.8 in) long and
use globins from their hosts' hemoglobin for their own
circulatory system.
M. Iqbal
 Schistosoma
• Schistosoma indicum
• Schistosoma datta
• Schistosoma japonicum

M. Iqbal