Helminthic

infections
Group 9
 GROUP MEMBERS
• AH/PAS/21/0061
• AH/PAS/22/0121
• AH/PAS/21/0065
• AH/PAS/21/0015
• AH/PAS/21/0068
• AH/PAS/22/0020
• AH/PAS/21/0043
• AH/PAS/22/0115
• AH/PAS/22/0026
OUTLINE
1. Definition 8. Diagnosis and
2. Epidemiology Examination
3. Virulence factors 10.Some common helminthic
4. Pathophysiology infections
5. Risk factors 11.Prevention
6. Classification
DEFINITION
• Helminthic infection refers to an infestation of
the body by parasitic worms known as
helminths.
• Helminths (from the Greek helmins, meaning
worm) include three groups of parasitic worm
, large multicellular organisms with complex
tissues and organs.
• Three in particular – ascariasis, hookworm
and trichuriasis
• Helminths are the largest internal human
parasite. They reproduce sexually, generating
millions of eggs or larvae.
• Nematodes and trematodes have a mouth
and intestinal tract, while cestodes absorb
nutrients directly through the outer tegument.
 EPIDEMIOLOGY
• Helminthic infections are widespread globally, with the highest burden
observed in tropical and subtropical regions, particularly areas with
inadequate sanitation, poor hygiene practices and limited access to
clean water.
• The World Health Organization (WHO) estimates that over one billion
people worldwide are infected with at least one helmintic species.
• Three in particular – ascariasis, hookworm and trichuriasis – are
included in a list of 13 ‘neglected tropical diseases’, which the WHO
has identified as causing major disability among the poorest people in
the world.
PATHOPHYSIOLOGY
The pathophysiology of helminthic infections involves various stages of the worm's life cycle, the host's
immune response, and the resulting tissue damage and systemic effects.

 Transmission: Helminthic infections typically occur through the ingestion of contaminated food or water,
contact with infected soil, or the bite of an infected insect. The larvae or eggs of the helminths enter the
host's body through the oral or dermal route.
 Invasion and Migration: Once inside the body, the helminth larvae hatch or mature into adult worms. The
adult worms may reside in the gastrointestinal tract, lungs, liver, or other tissues depending on the
specific helminth species. They have various mechanisms to attach to the host's tissues, such as hooks,
suckers, or burrowing.
 Local Tissue Damage: The presence of helminths in the host's tissues can cause mechanical damage and
inflammation. As the worms move through tissues, they may rupture blood vessels, obstruct ducts, or
cause ulceration. This can lead to symptoms such as abdominal pain, diarrhea, or cough, depending on
the site of infection.
 Nutritional Competition: Helminths require nutrients to survive and reproduce. They can compete with
the host for essential nutrients, causing malnutrition and depletion of vital resources necessary for the
host's growth and development. This can lead to weight loss, stunted growth, and developmental delays,
especially in children.
.

 Immunological Response: The presence of helminths triggers an immune response in the host. Initially, the
host's immune system responds with an innate immune response, characterized by the activation of various
immune cells and the release of inflammatory mediators. Subsequently, an adaptive immune response
involving T cells, B cells, and antibodies is initiated.
 Immune Modulation: Helminths have evolved sophisticated mechanisms to evade the host's immune
response. They can release molecules that suppress or modulate the host's immune system, preventing it
from effectively eliminating the infection. This immune modulation may result in a chronic or persistent
infection.
 Hypersensitivity Reactions: Some individuals may develop hypersensitivity reactions to helminthic antigens.
These reactions can manifest as allergic responses, including eosinophilia, urticaria (hives),
bronchoconstriction, or angioedema.
 Systemic Effects: In chronic or disseminated helminthic infections, the systemic effects can be significant. The
chronic immune response, tissue damage, and malnutrition can lead to generalized symptoms such as
fatigue, weakness, anemia, and impaired cognitive function.
 General virulence factors
• Helminths, or parasitic worms, are multicellular organisms that can infect humans and
other animals. They possess various virulence factors that allow them to establish and
maintain an infection within their hosts. Here are some general virulence factors of
helminths:
 Adhesive Structures: Helminths may possess specialized structures, such as suckers,
hooks, or spines, that allow them to attach to host tissues and avoid being expelled.
These structures enable them to establish a firm foothold within the host's body.
 Immune Evasion: Helminths have evolved mechanisms to evade or modulate the host
immune response. They can release molecules that suppress or manipulate immune
cells, dampening the immune system's ability to eliminate the parasites effectively.
 Tissue Damage: As helminths migrate through host tissues, they can cause physical
damage, leading to tissue disruption, inflammation, and associated pathology. For
example, the movement of larvae or adult worms within organs can induce
mechanical injury, granuloma formation, or fibrosis.
.
 Nutrient Acquisition: Helminths have developed sophisticated mechanisms to
acquire nutrients from the host. They can secrete proteases, lipases, and other
enzymes that break down host tissues and molecules, facilitating the absorption of
nutrients by the parasites.
 Anticoagulant and Antithrombotic Activity: Some helminths produce molecules with
anticoagulant and antithrombotic properties. These factors prevent blood clotting
and facilitate the survival of the parasites in the host's bloodstream or tissues,
where they might encounter the coagulation system.
 Immunosuppressive Molecules: Helminths can secrete immunosuppressive
molecules that inhibit the host's immune response. These molecules can modulate
the production or function of cytokines, antibodies, or immune cells, compromising
the ability of the immune system to eliminate the parasites.
 Immunomodulation: Helminths are known to alter the host immune response in a
way that promotes their survival. They release molecules that can skew the immune
system towards a regulatory or anti-inflammatory state. This modulation helps them
avoid excessive immune-mediated damage and increases their chances of
persistence within the host.
RISK FACTORS
The risk factors of helminthic infection can vary depending on the specific type of
worm and the mode of transmission, but some general risk factors include;
 Poor sanitation
 Lack of access to clean water
 Poor personal hygiene
 Eating raw or uncooked food
 Walking barefooted
 Close contact with infected individuals or animals
 Living in or visiting endemic areas
 Immunosuppressed
 Age
 Malnutrition
classification
• Helmenthic infections, also known as worm infections,
are caused by various parasitic worms that belong to
the phylum Platyhelminthes (flatworms) and the
phylum Nematoda (roundworms). These infections are
classified based on the type of worm involved, as well
as the location in the body where the worms reside.
Here are some common classifications of helminthic
infections:
 Nematodes ( grouped into intestinal nematode
infections and tissue nematode infection )
Cestodes infection (tapeworm)
.
Diagnosis of helminthic infections
The diagnosis of a helminthic infection typically involves a combination of clinical
assessment, medical history, and laboratory tests. Here are some common methods used
to diagnose helminthic infections:
Stool Examination: A stool sample is collected and examined under a microscope to
detect the presence of worm eggs, larvae, or adult worms. This method is commonly
used to diagnose intestinal helminths like roundworms, hookworms, and whipworms.
Blood Tests: Blood samples may be taken to check for specific antibodies or antigens
associated with certain helminthic infections. For example, the enzyme-linked
immunosorbent assay (ELISA) can be used to detect antibodies against filarial worms or
schistosomes.
Serological Tests: Serological tests involve checking for the presence of specific
antibodies in the blood to indicate a helminthic infection. These tests can be useful for
diagnosing certain types of parasitic infections, such as echinococcosis or trichinellosis.
Imaging Techniques: In some cases, imaging
techniques like ultrasound, computed tomography
(CT), or magnetic resonance imaging (MRI) may be
used to visualize the organs affected by helminthic
infections. These imaging tests are particularly
helpful for diagnosing infections caused by large
worms or assessing the extent of organ damage.
Biopsy: In certain situations, a tissue sample may be
taken through a biopsy to examine it under a
microscope for the presence of worm larvae or eggs.
This method is commonly used for diagnosing
tissue-dwelling helminths like filarial worms
or liver flukes.
 Nematodes
Human infections can be divided into:
Tissue-dwelling worms, including the filarial worms
and the Guinea worm Dracunculus medinensis.
Human intestinal worms, including the human
hookworms, the common roundworm (Ascaris
lumbricoides) and Strongyloides stercoralis, which are
the most common helminthic parasites of humans.
The adult worms live in the human gut and do not
usually invade tissues, but many species have a
complex life cycle involving a migratory larval stage.
Zoonotic nematodes, which accidentally infect
Tissue dwelling worms
FILARIASIS
Filariasis is a parasitic disease caused by infection with thread-like filarial worms.
These nematodes belong to the superfamily Filarioidea . The adult worms are
long and thread-like, ranging from 2 cm to 50 cm in length; females are generally
much larger than males. Larval stages are inoculated into humans by various
species of biting flies (each specific to a particular parasite).
The adult worms that develop from these larvae mate, producing millions of
offspring (microfilariae), which migrate in the blood or skin. These are ingested
by feeding flies, in which the remainder of the life cycle takes place. Disease,
which may be caused either by the adult worms or by microfilariae, is caused by
the host immune response to the parasite and is characterized by massive
eosinophilia. Adult worms are long-lived (10–15 years) and re-infection is
common, so that disease tends to be chronic and progressive.
Diseases caused by the filarial worms
 Clinical features
Many individuals with filariasis may remain asymptomatic,
especially in the early stages of infection.
Acute manisfestations include acute inflammatory reaction
known as filarial fever : fever, lymphadenitis, lymphangitis,
pain and swelling
Chronic manisfestation include; lymphedema, elephantiasis
and hydrocele
Others include; skin rashes, itching
Occasionally, the predominant features of filarial infection
are pulmonary. Microfilariae become trapped in the
pulmonary capillaries, generating an intense local allergic
diagnosis
• The clinical picture in established disease is usually
diagnostic, although similar lymphatic damage may
occasionally be caused by silicates absorbed through
the feet from volcanic soil (podoconiosis).
Parasitological diagnosis has traditionally relied on
detecting microfilariae in blood films or skin snips, but
rapid and sensitive near-patient antigen detection
tests are now available.
 management
• Diethylcarbamazine (DEC) kills both adult worms and
microfilariae. Serious allergic responses may occur as the
parasites are killed and particular care is needed when
using DEC in areas endemic for loiasis. Mass treatment
programmes using combinations of DEC, ivermectin and
albendazole to target various helminthic infections are
used in many parts of the world; the exact regimens
depend on local situations. Over 500 million people have
already received such treatment. There is currently much
interest in using doxycycline to kill the symbiotic
Wolbachia bacteria, without which the adult worm will
 onchocerciasis
• Onchocerciasis (river blindness) affects 37 million people
worldwide, of whom 250 000 are blind and 500 000
visually impaired; most of these are in West and Central
Africa, with small foci in the Yemen, and in Central and
South America. It is the result of infection with
Onchocerca volvulus. Infection is transmitted by day-
biting flies of the genus Simulium
pathogenesis
• Infection occurs when larvae are inoculated into humans by the bite of an
infected fly. The worms mature in 2–4 months and can live for more than
15 years. Adult worms, which can reach lengths of 50 cm (although they
are <0.5 mm in diameter), live in the subcutaneous tissues. They may
form fibrotic nodules, especially over bony prominences and sites of
trauma.
• Huge numbers of microfilariae are distributed in the skin and may invade
the eyes.
• Live microfilariae cause relatively little harm, but dead parasites may
cause severe allergic reactions, with hyaline necrosis and loss of tissue
collagen and elastin. In the eye, a similar process causes conjunctivitis,
sclerosing keratitis, uveitis and secondary glaucoma
Clinical features
Symptoms usually start about a year after infection. Initially, there is
generalized pruritus, with urticaria and fleeting oedema.
Subcutaneous nodules (which can be detected by ultrasound) start to
appear, and in dark-skinned individuals, there is hypo- and
hyperpigmentation from excoriation and inflammatory changes.
Over time, more chronic inflammatory changes appear, with roughened,
inelastic skin. Superficial lymph nodes become enlarged and, in the
groin, may hang down in loose folds of skin (‘hanging groin’).
Eye disease, which is associated with chronic heavy infection, usually
first manifests as itching and conjunctival irritation. This gradually
progresses to more extensive eye disease and eventually to blindness.
 diagnosis
In endemic areas, the diagnosis can often be made clinically,
especially if supported by finding eosinophilia on a blood film.
In order to identify parasites, skin snips taken from the iliac
crest or shoulder are placed in saline under a cover slip. After
4 hours, microscopy will show microfilariae wriggling free on
the slide.

MANAGEMENT
Ivermectin, in a single dose of 150 µg/kg, kills microfilariae
and prevents their return for 6–12 months.
HUMAN INTESTINAL NEMATODES
Adult intestinal nematodes (also sometimes referred
to as soil-transmitted helminths, or geohelminths) live
in the human gut.
 There are two main types of life cycle, both usually
including a soil-based stage. In some species,
infection is spread by ingestion of eggs (which often
require a period of maturation in the environment); in
others, the eggs hatch in the soil and larvae penetrate
directly through the skin of a new host.
Strongyloides is unusual, in that it is the only
nematode that is able to complete its life cycle in
Ascariasis (roundworm infection)
Ascaris lumbricoides is a pale yellow worm, 20–35 cm in
length. It is found worldwide but is particularly common
in poor rural communities, where there is heavy fecal
contamination of the immediate environment.
 Larvae hatch and penetrate the duodenum, migrating
through the tissues to the lungs before being
expectorated and swallowed. The adult worms live in the
small intestine. Ova are deposited in faeces and require
a 2–4-month maturation in the soil before they are
infective
Infection is usually asymptomatic, although heavy
DRUGS USED FOR TREATING HUMAN INTESTINAL NEMATODE
HOOKWORM

• Hookworms are parasitic nematodes (roundworms) that infect the intestines

of their hosts. The two primary species that infect humans are Ancylostoma
duodenale and Necator americanus.
PATHOGENESIS
• Blood Loss: Hookworms attach to the intestinal mucosa and ingest blood,
leading to iron-deficiency anemia.
• Nutrient Absorption: The presence of hookworms impairs nutrient
absorption, contributing to malnutrition.
• Immune Response: Infection can elicit an immune response, characterized
by increased eosinophils and IgE antibodies.
 SYMPTOMS
• Acute: Itching and localized rash (at the site of skin penetration), abdominal pain, diarrhea.
• Chronic: Anemia, protein deficiency, malnutrition, fatigue, and in severe cases, cognitive
impairment in children due to chronic blood loss.

Prevention and Treatment:

• Sanitation: Improved sanitation and proper disposal of human waste.
• Footwear: Wearing shoes to prevent larvae from penetrating the skin.
• Medication: Anthelmintics such as albendazole and mebendazole are effective treatments.
 TREMATODES
• Trematodes, commonly known as flukes, are parasitic flatworms belonging to the class
Trematoda.
• They infect various tissues in their hosts, including the intestines, liver, lungs, and blood
vessels.
Types Of Tramatodes
• 1. Liver Flukes: Fasciola hepatica and Clonorchis sinensis.
• 2. Intestinal Flukes: Fasciolopsis buski.
• 3. Blood Flukes: Schistosoma species.
• 4. Lung Flukes: Paragonimus species.
 SYMPTOMS
• Acute: Fever, abdominal pain, diarrhea, eosinophilia (high levels of eosinophils in the
blood).
• Chronic: Liver cirrhosis, bile duct obstruction (for liver flukes), intestinal blockage,
respiratory symptoms (for lung flukes), and blood vessel damage (for blood flukes).

Prevention and Treatment:

• Sanitation: Access to clean water and proper sanitation.
• Food Safety: Proper cooking of food and avoiding consumption of raw or undercooked
aquatic plants, fish, and crustaceans.
• Medication: Praziquantel is commonly used to treat trematode infections.
 Schistosomiasis
There are three species of schistosome that commonly cause
disease in humans: Schistosoma mansoni, S. haematobium and
S. japonicum. And S. mekongi .
Schistosomiasis is largely a disease of the rural poor but has also
been associated with major development projects, such as dams
and irrigation schemes.
Chronic infection causes significant morbidity and, after malaria,
it has the most socioeconomic impact of any parasitic disease.
 pathophysiology
 Eggs are passed in the urine or faeces of an infected person and hatch in fresh water to
release the miracidia. These ciliated organisms penetrate the tissue of the intermediate
host, a species of water snail specific to each species of schistosome.
 After multiplying in the snail, large numbers of fork-tailed cercariae are released back into
the water, where they can survive for 2–3 days.
 During this time, the cercariae can penetrate the skin or mucous membranes of the
definitive host, humans. Transforming into schistosomulae, they pass through the lungs
before reaching the portal vein, where they mature into adult worms (the male is about 20
mm long and the female a little larger).
 . Worms pair in the portal vein before migrating to their final destination: mesenteric veins in
the case of S. mansoni and S. japonicum, and the vesicular plexus for S. haematobium.
 The pathology of schistosome infection varies with species and stage of infection. In the
early stages, there may be local and systemic allergic reactions to the migrating parasites
 Clinical features
 Cercarial penetration of the skin may cause local dermatitis (‘swimmer’s
itch’). After a symptom-free period of 3–4 weeks, systemic allergic
features may develop, including fever, rash, myalgia and pneumonitis
(Katayama fever).
 These allergic phenomena are common in non-immune travellers but
are rarely seen in local populations, who are usually exposed to infection
from early childhood onwards.
 If infection is sufficiently heavy, symptoms from egg deposition may start
to appear 2–3 months after infection.
 diagnosis
 Schistosomiasis is suggested by relevant symptoms following fresh-water exposure in an endemic
area.
 In the early allergic stages, the diagnosis can only be made clinically. When egg deposition has
started, the characteristic eggs (with a terminal spine in the case of S. haematobium and a lateral
spine in the other species) can be detected on microscopy.
 In S. haematobium infection, the best specimen for examination is a filtered midday urine sample.
Parasites may also be found in semen and in rectal snip preparations. S. mansoni and S.
japonicum eggs can usually be found in faeces or in a rectal snip.
 Serological tests are available and may be useful in the diagnosis of travellers returning from
endemic areas, although the test may not become positive for 12 weeks after infection; a
parasitological diagnosis should always be made, if possible.
 In chronic disease, X-rays, ultrasound examinations and endoscopy may show abnormalities of
the bowel or urinary tract, although these are non-specific. Liver biopsy may show the
characteristic periportal fibrosis.
 management
The aim of treatment in endemic areas is to decrease the
worm load and therefore minimize the chronic effects of egg
deposition.
The most widely used is praziquantel, which is effective
against all species of schistosome, well tolerated and
reasonably cheap.
Prevention of helminthic infections
Maintain personal hygiene
Drink clean water
Practice safe food handling
Avoid eating raw or uncooked food
Maintain proper sanitation
Education on proper waste management
Avoid walking barefooted
Avoid contact with contaminated soil
Avoid swimming in contaminated water
Regular deworming
REFERENCES
Harrison, T. R. (2022). Harrison's Principles of Internal
Medicine. (20th ed.). McGraw-Hill.
Kumar, P., & Clark, M. (2020). Kumar and Clark's
Clinical Medicine. (10th ed.). Elsevier.
Davidson, S. (2018). Davidson's Principles and
Practice of Medicine. (23rd ed.). Elsevier