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I.

S MoT Lung Diagnostic Host Nutrition saturated female


Migration Stage salt sol’n lays
S Stercoralis Rhabditoid
 larva
A duodenale biting w/ E float 25000-
penetration of
filariform larva
filariform larva Man
toothlike G 30000

into intact skin


 Egg
structures;
G
ingestion of
blood S
N americanus  9000
A braziliense cats and
A caninum dogs
A duodenale N americanus
Size adults are larger&thicker smaller&more Slender
Anterior end bends in the same direction as the body opposite direction to body curvature
curvature
Buccal Capsule has 6 teeth has 4 cutting plates
Copulatory Bursa no of rays-13 no of rays-14
dorsal ray-tripartite dorsal ray-bipartite
has 2 separate spicules, long&bristle lke has 2 spicules fused at the tip forming a
delicate barb
Posterior end of female spine is present no spine
Pathogenicity more pathogenic less pathogenic
Habitat
Life cycle 5-7 years 4-20 years
Reproduction 24000-30000 9000
Nutrition 0.2mL of blood per worm/day 0.03mL of blood per worm/day

Necator Americanus
FILARIFORM
 Differs from A duodenale
 larger and fatter head
 Less obvious esopohageal spears
 Larger&more posterior genital primordium
 Narrow esophaguss
 Intestine has no apparent constriction at the esophageal junction

Destroys Larva
 Drying
 Direct sunlight
 Urine
 Disinfectants

Larva mature best


 Shaded localities
 Sandy soil
 Humus covered w/ vegetation

Common sites of entry


 The skin bet toes
 Dorsum of the feet
 Inner side of the sole
o Larva can penetrate any part of the skin w/c is sufficiently thin
 Gardeners&miners-skin of the hand
 Accidental drinking of H2O contaminated with filariform larva but is uncommon

Creeping Eruption
 Filariform larva will wander about through skin in aimless manner for several weeks; will produce an itchy papule along the path transversed by
the larva

Rhabditoid Larva
-indistuingishable from that of A duodenale

Angiostrongylus Cantonensis
Life Cycle:
Ingestion of 3rd stage larva in molluscan Ih by rats(or man)Infective larva migrates to brainMature in 4 weeksMigrate to pulmonary
arteriesMale and female worms copulateFemales lay eggsHatch in the lungsLarva migrate to tracheaswallowedintestinelarva(1st
stage)passed out w/ fecesinfect molluscan IHbecomes 3rd stage in 2 weeks
Enterobius Vermicularis
Life Cycle:
Ingestion of embryonated eggegg hatches in the duodenumlarva moves down to cecumdevelops into adultfemale and male worms
copulatemale diesgravid female migrates down the colonrectumgoes out of anus in the eveningoviposited In the perianal skin

Nocturnal Migration:
=governed by: maturation of the ova and the need for O2 for the final development of the larva
=shows a periodicity of 3-7 weeks

1. Adult=oral end lacks a true buccal capsule; provided w/ 3 lips and dorsoventral bladder-like expansions of the cuticula called cephalic alae.

Male=2-5mmX0.1-0.2mm;post. end strongly curved ventrad


=has a single conspicuous copulatory spicule but lacks a gubernaculum
=has a greatly reduced bursa designated as caudal alae.

Female=9-13mmX0.3-0.5mm
=tail portion (1/3 of entire length) is sharply pointed
=vagina is relatively long, extends posteriad from vulva before it joins the paired genital organs(uteri, oviducts,&ovarian tubules)
Gravid female=uteri are tremendously distended’ entire body is passed with eggs’ lay a mean of 11105 ova/day

2. Eggs=50-60uX20-30u
=elongate-ovoidal, distinctly compressed laterally
=flattened on one side (D or inverted D appearance)
=shell is relatively thick&colorless
=embryonated when laid
=infective within 6 hrs after deposited

Female: pinworm
Male: Seatworm
Pathogenesis&Symptomatology
1. Pruritus ani-severe itching;results from gravid females migrating from anus to the perianal&perineal skin
2. Appendicitis(2%)*not sure maybe 12?
3. Mild Eosinophilia(4-12)
4. more frequent infection in young persons (11-20yo)
3X more in women than men
5. vaginitis in girls=gravid females migrate up the vagina;mucoid vaginal discharges

Lab Diagnosis:
=finding the adult worms&ova
1. Adult worms=may be seen in feces(after enemas)
=mau be seen in periana; region

*place adult worm in vinegar/alcohol&bring to lab


2. *in book

Swabbing the perianal area:


=requires repeated examination

1. Scotch adhesive tape swab


*in book
-swab is made of nonadhesive cellophane
2. Wet pestle method of Schüffner and Swellengrebel
=perianal skin is massaged w/ moistened, rough ground glass pestle (to dislodge the ova bet the folds of skin&break up the clusters of eggs

Ascaris Lumbricoides
Morphology:
1. Adult=flesh-colored,cylindrical, tapering at anterior&posterior ends
=has lateral lines(a pair of whitish streaks along entire length of body)
=has 3 lips: a broad dorsal 1&a pair of ventrolateral ones and all are..

*didn’t get to copy continuation

Male: has lateral lines (a pair with whitish streaks along the entire body)
=terminal mouth has three lips with fine denticulates
=buccal cavity is triangular
=cloaca is subterminal
=2 copulatory spicules protruding
=no gunernaculum

Female=longer and stouter than male


=20-35cmX3-6mm
=vulva is situated midventrally near the junction of the anterior&middle 3rd of the body
=Genital girdle(vulvar waist)-a distinct groove around the body at the level of the vulva; to facilitate mating
=vagina-branches to form double genital tubules;
=uterus may contain 27M eggs at 1 time
=daily egg laying capacity: 200,000 eggs/worm

2. Eggs
a. Fertilized egg
=45-75uX35-50u; round/oval in shape
=brownish in color(bile stained)
=contains a conspicuous blastomere(unsegmented)
=there is a velar crescentic area(semilunar space)at each pole-separates cell/embryo from the shell
=has 3-layered shell:innermost vitelline membrane, a thick chorionic layer and albuminoid layer with mammilations. This outer coat is sometimes lost
(decorticated egg)
=floats in saturated solution of common salt
b. Unfertilized egg
=88-94uX39-44u;narrower&elongate;brownish in color(bile stained)
=a mass of disorganized, highly refractile granules
=vitelline membrane is absent
=thinner shell: inner chorionic&outer irregular coating of albumin (mammilated or decorticated)
=does not float in salt solution

*life Cycle&MoI in book

Lab Diagnosis
1. Finding larvae in sputum/gastric washings:
Clinical evidence of ascaris pnumonitis (early stage of infex’n)

*Loeffler’s Syndrome
-allergic reaction cause by larva in lungs
-patient may have asthma,urticaria, eosinophilia,coughing,moderate fever

Sputum: 3rd stage larvae, eosinophils, Charchot Leyden crystals


2. Stool exam-ova are easily detected by direct mx exam (NSS prep) or concentration by floatation method *ZnSO4
*(-)results may be due to presence of all males or worms still immature
3. Identify adult worms-may pass out spontaneously in the stoo or vomited or escape throught the nose
4. Barium Swallow (radiographic study w/ barium sulfate)
=adult worms either take BaSO4 or not.
A cantonensis E vermicularis A lumbricoides
Infective Stage man/rat: 3rd stage larva embryonated egg containing 1 stage larva embryonated egg w/ 3rd stage larva
st

Definitive Host domestic rats Man


Egg hatches in duodenum stomach&upper small intestine
Diagnostic Stage larva&young adult worms
Nocturnal Migration 
Reproduction 11105 200000
Lung Migration  
Habitat fave: jejunum

VISCERAL LARVA MIGRANS


-a syndrome typically found in young children; produced when nematode larvae gain entry to extraintestinal viscera of the unnatural(paratenic) host,
or under unsuitable condition, in the natural host, resulting in phagocytic attack on the larvae, isolating them in granulomatous lesions in the tissues

Phagocytic cells will come and attack larva-forming granuloma-to prevent migration of larva (toxopara granuloma)

Etiologic agents:
Toxocara canis=usual cause
Toxocara cati=less common
Rare causes: A. lumbricoides
S. stercoralis
A. caninum
A. braziliense
Toxocara canis
Common name: the dog ascarid
Morphology: male=4-6cm long
Female=6.5-10cm long
=have the char. ascarid lips
=distinct cervical alae are much longer than broad

Eggs=85X75u;subglobose&pitted superficially
=dark brown&unembryonated when laid

Toxocara carti
Common name: The cat ascarid
Morphology: Male=4-6cm long
Female=4-12 cm long
=have the cha. ascarid lips; a pair of broad, lateral cervical alae

Eggs=65X70u;subglobose
=thin shelled&delicately pitted

Etiology:
Eggs w/ 2nd stage larvae→ingested by incompatible (unnatural) host→eggs hatch in small intestine→larvae penetrate intestinal wall→mesenteric
venules or lymphatics→extraintestinal organs(liver,lungs,brain,eye,etc)→larvae are attacked by host cell reacation→granulomatous formation→block
further migration

-In unnatural host=larvae do not grow and molt


-Capsulated larvae=viable for weeks or months

Diagnosis:
1. clinical picture=depending on ectopic foci
in brain: headache, epilepsy
in lungs: cough
in liver:jaundice,enlargement
2. biopsy=esp liver(most common site of toxicara granuloma)
3. serology=hemagglutination test
=microprecipitation test

Prevention:
1. periodic deworming of household dogs&cats
2. prevent children from eating dirt(may be contaminated w/ Toxocara mature eggs