Trichinella spiralis

Common name: Trichina worm

Disease caused: Trichinosis, Trichiniasis
Smallest nematode parasitic to humans
Female viviparous/larviparous are capable
producing 1500 larvae.

of

LARVAE
-

PATHOLOGY

Has spear-like burrowing anterior

80-100 m
900-1300 m x 35-40 m

LIFE CYCLE
-

infection. Carnivorous/omnivorous animals, such as

pigs or bears, feed on infected rodents or meat from
other animals. Different animal hosts are implicated in
the life cycle of the different species of Trichinella.
Humans are accidentally infected when eating
improperly processed meat of these carnivorous
animals (or eating food contaminated with such meat).

Encysted larvae in pig muscle

Mode of transmission (MOT): ingestion of
improperly cooked pork
Infected flesh is digested by gastric juice
Adults in the duodenum
Larviparous female burrows into mucosa and
deposit larvae.
Encyst in striated muscle
Dead end cycle

Incubation and intestinal invasion:

-

Diarrhea
Constipation
Vomiting
Abdominal cramps
Nausea

Larval migration and muscle invasion:

-

Fever
Pain and swelling
Weakness
Splenomegaly
Gastric and intestinal hemorrhages

Encystment and encapsulation:

-

Fever
Weakness
Pain

DIAGNOSIS
-

Muscle biopsy
Serological ELISA

TREATMENT
-

Thiabendazole: 1st week of infection

Mebendazole: larvicidal

PREVENTION AND CONTROL

-

Focus on the infected pigs

Cook meat 77C or 177F
Freezing: -15C for 20 days/ -30C for 6 days
Smoking (steaming), salting (preserving) or drying
is not effective.

Trichinellosis is acquired by ingesting meat containing

cysts (encysted larvae)

of Trichinella. After exposure

to gastric acid and pepsin, the larvae are released

from the cysts and invade the small bowel mucosa
where they develop into adult worms
(female 2.2
mm in length, males 1.2 mm; life span in the small
bowel: 4 weeks). After 1 week, the females release
larvae

that migrate to the striated muscles where

they encyst . Trichinella pseudospiralis, however,

does not encyst. Encystment is completed in 4 to 5
weeks and the encysted larvae may remain viable for
several years. Ingestion of the encysted larvae
perpetuates the cycle. Rats and rodents are primarily
responsible for maintaining the endemicity of this

Capillaria philippinensis
-

Severe diarrheal syndromes in humans

Pathogenic to humans
Intestinal capillariasis

EPIDEMIOLOGY
-

In 1962, a healthy young man from Luzon PH

(Tagudin) fell ill.
Post-mortem examination revealed capillariasis
infection
He was the first documented casualty of human
intestinal capillariasis.
Epidemic during 1967-1968 where 1200 individuals
were infected
Common in children having a history of pica
Capillaria spp. parasitize many classes of
organisms although 4 species have been found in
humans:
C. philippinensis (intestinal capillariasis)
C. plica (urinary capillariasis)
C. aerophila (pulmonary capillariasis)
C. hepatica (hepatic capillariasis)

MORPHOLOGY
-

Adult: small, slender nematode

Female is larger than male:
Male: 2-6 mm
Female: 3-6 mm

Unique feature
-

EGGS: ovoid/peanut-shaped, operculated with

flattened bipolar plugs, broad shoulders and a
striated shell

Typically, unembryonated eggs are passed in the

human

stool

and

become

embryonated

in

the

external environment ; after ingestion by freshwater

fish, larvae hatch, penetrate the intestine, and migrate
to the tissues

. Ingestion of raw or undercooked fish

results in infection of the human host

. The adults
of Capillaria philippinensis (males: 2.3 to 3.2 mm;
females: 2.5 to 4.3 mm) reside in the human small
intestine, where they burrow in the mucosa
. The
females deposit unembryonated eggs. Some of these
become embryonated in the intestine, and release
larvae that can cause autoinfection. This leads to
LIFE CYCLE
-

Host: humans
Intermediate host: freshwater and brackish
water fish
Role of intermediate host: site where the parasite
only develops before becoming infectious to the
primary host
Embryonation occurs in water only.
Unembryonated egg cannot be infectious.
Only embryonated egg is capable of infecting
humans because of its capacity to form larvae.
Prevalent in coastal areas
After embryonation, C. philippinensis egg is
ingested by the fish.
The infective intermediate host (fish) is ingested by
humans, goes to the systemic circulation, and the
cycle repeats.
OR, accidental host (birds) will ingest the fish.

hyperinfection (a massive number of adult worms)

.Capillaria philippinesis is currently considered a
parasite of fish eating birds, which seem to be the
natural definitive host

CLINICAL FEATURES
-

Associated malaise (due to

anorexia, nausea and vomiting
Advanced disease shows:
Cachexia (loss of weight)
Diminished reflexes
Dehydration

lack

of

protein),

DIAGNOSIS
-

C. philippinensis can be fatal in severely infected

individuals which may result in severe diseases
with a high mortality when untreated.
Early diagnosis is very important.

LABORATORY DIAGNOSIS

1.
-

2.
-

Stool analysis
Stools are bulky with elevated fecal fat content and
an average daily stool weight of 1200 g (versus
controls of 170 g).
Protein loss in the stools may be 15 times that seen
in controls.
Not a routine test in the lab, but can be done.
Egg
Still under stool analysis
Diagnostic characteristic
Length: 40 m x 20 m

Trichuris trichiura egg

Wuchereria bancrofti

Capillaria
philippinensis egg

Difference: shape of bipolar plugs

TREATMENT
-

(Add. Info) The reason why parasitic infections are

still prevalent in provinces is that the indigenous
people perceive sickness as a curse and reject
medicine.

Hospitalization
Intake of fluids and electrolytes (especially, K
replacement)
High-protein diet
Antidiarrheal agents

Bancrofts filariasis
A blood and lymphatic dweller. The infection results
to elephantiasis (severe and disfiguring).
Vectors: Culex, Aedes and Anopheles mosquito

DIAGNOSIS
-

Detection and identification of microfilaria in

stained blood smear (lymphatic vessels).
Best seen at night after 10 PM (nocturnal)
(Add. Info) Mosquito carrying dengue is often seen
during the morning.

MORPHOLOGY

SPECIFIC TREATMENT
-

Drug of choice: Albendazole

Treatment of choice: 200 mg
Effective against eggs, larvae, and adult worms
Alternative drug: Mebendazole
Dosage: 200 mg
Pediatric dose is the same

PREVENTION
-

Prevention of ingestion of raw fish

(Add. Info) To prevent infections by parasites with
vectors, eliminate the vector first.

FILIARIASIS (Filarial Worms)

GENERAL LIFE CYCLE
-

Human infection is acquired when infective larvae

enter the skin at the arthropods feeding site.
Larval migration takes place in tissue.
Adults are in various tissue (according to species)
They mature to produce microfilariae

LYMPHATIC FILARIASIS
-

Habitats the lymphatic system:

Wuchereria bancrofti
Brugia malayi
Transmitted by mosquito that results to deformity
and disability
Adults seen in the lymphatic vessels

Nuclei are well-separated yet numerous in the

body.
Body of microfilaria has sweeping curves.
Tail tapers to a point with no nuclei present.
The sheath is typically stains pale pink with
Giemsa.
Sheath extends beyond the tip of the tail, but the
nuclei do not.

LIFE CYCLE OF W. bancrofti

-

During a blood meal, uninfected mosquito

introduces 3rd stage filarial larvae (L3 larvae) on
the skin of human host, where they penetrate into
the bite wound.

Vector can also be infected when it sucked blood

from an infected human.

A blood and lymphatic dweller. The infection can

cause elephantiasis, but it is not disfiguring or
common like W. bancrofti.
Vectors: Mansonia, Anopheles and Aedes
Diagnosis of microfilaria in stained blood smear

MORPHOLOGY

The head space is twice as long as it is broad.

Tail tapers around to 2 nuclei that appear to be
connected by a fine thread.
Nuclei in body appear crowded.
Sheath stains pink-red with Giemsa stain and body
is closely folded in an angular fashion.

During a blood meal, an infected mosquito introduces

third-stage filarial larvae onto the skin of the human
host, where they penetrate into the bite wound
.
They develop in adults that commonly reside in the
lymphatics . The female worms measure 80 to 100
mm in length and 0.24 to 0.30 mm in diameter, while
the males measure about 40 mm by .1 mm. Adults
produce microfilariae measuring 244 to 296 m by 7.5
to 10 m, which are sheathed and have nocturnal
periodicity, except the South Pacific microfilariae which
have the absence of marked periodicity. The
microfilariae migrate into lymph and blood channels
moving actively through lymph and blood
. A
mosquito ingests the microfilariae during a blood
meal . After ingestion, the microfilariae lose their
sheaths and some of them work their way through the
wall of the proventriculus and cardiac portion of the
mosquito's midgut and reach the thoracic muscles
.
There the microfilariae develop into first-stage
larvae

and subsequently into third-stage infective

larvae

. The third-stage infective larvae migrate

through the hemocoel to the mosquito's prosbocis

and can infect another human when the mosquito
takes a blood meal
Brugia malayi

LIFECYLE

2.
-

Allows more efficient detection of parasite

Cannot have an optimal review of the morphology
Thin blood smear
Can view the morphology
Consists of blood spread in a layer with a
decreasing thickness toward feathery edge
In feathered stage, the cells should be monolayer,
not touching one another.

The typical vector for Brugia malayi filariasis are

mosquito species from the genera Mansonia andAedes.
During a blood meal, an infected mosquito introduces
third-stage filarial larvae onto the skin of the human
host, where they penetrate into the bite wound .
They develop into adults that commonly reside in the
lymphatics . The adult worms resemble those
of Wuchereria bancrofti but are smaller. Female worms
measure 43 to 55 mm in length by 130 to 170 m in
width, and males measure 13 to 23 mm in length by
70 to 80 m in width. Adults produce microfilariae,
measuring 177 to 230 m in length and 5 to 7 m in
width, which are sheathed and have nocturnal
periodicity. The microfilariae migrate into lymph and
enter the blood stream reaching the peripheral
blood

3.
-

Immunochomatographic diagnostic test

Kit containing antibodies against the parasite
In vitro immunodiagnostic test used to detect W.
bancrofti antigen in the blood.
During an infection, there are antigens and
antibodies present.
It employs an antibody specific for W. bancrofti.
(Add. Info) Advantage of antigen detection: can see
early infection since antibodies are still not
present.

. A mosquito ingests the microfilariae during a

blood meal . After ingestion, the microfilariae lose

their sheaths and work their way through the wall of
the proventriculus and cardiac portion of the midgut to
reach the thoracic muscles

. There the microfilariae

develop into first-stage larvae

and subsequently

into third-stage larvae . The third-stage larvae

migrate through the hemocoel to the mosquito's
prosbocis

and can infect another human when the

mosquito takes a blood meal

MODE OF
PERIOD
-

TRANSMISSION

AND

INCUBATION

Lymphatic filariasis: transmitted by the bite of the

vector (infected mosquito) which harbors L3 larvae

L1
1-3 hours
L2
3-4 days
L3
5-6 days
DIAGNOSTIC METHOD
1.
-

Thick blood smear

Consists of thick layer of lysed/dehemoglobinized
RBC

LYMPHATIC FILARIASIS CLINICAL MANIFESTATION

-

Elephantiasis hydrocele (accumulation of fluid)

Penis

LYMPHATIC FILARIASIS MANAGEMENT BY WHO

The elimination strategy has 2 components:
1.
2.

To stop the spread of infection by interrupting

transmission: kill the vectors!
To alleviate the suffering of affected population:
control morbidity.

NATIONAL FILARIASIS ELIMINATION PROGRAM

-

Legs

1.
-

2.
-

Breast

Selective treatment
For infected individuals
Drug: diethylcarbamazine citrate
Dosage: 6 mg/Kg body weight in 3 divided doses
for 12 consecutive days casually given after
meals
Mass treatment
Drugs are given to all population in endemic area
(2 y.o. and above).
Diethylcarbamazine citrate + albendazole
400 mg
Singe dose given anually
Prophylaxis for immunity