NEMATODES

► Commonly known as Roundworms

► unsegmented terrestrial, freshwater, or marine worms
► almost worldwide in distribution
► abundant in the surface layers of soils (geohelminths)
► cylindrical, tapering animals with simple bodies
► They consist an interior gut and a muscular outer wall,
separated by a fluid-filled cavity called a pseudocoel
► The outer wall secretes an elastic cuticle that is molted four
times during the animal's lifetime
► Species range in size from microscopic to about 10 cm (about
4 in) long
► Most species have separate sexes (dioecious), but a few are
hermaphroditic
► fertilization is internal
Ascaris lumbricoides – giant intestinal roundworms
- causes Ascariasis, the most prevalent form of
parasitism in the Philippines
- Transmission by ingestion of mature embryonated
eggs
- Usually asymptomatic in mild infestation
- S/Sx: colicky periumbilical pain, malnutrition and
acute intestinal obstruction can occur in massive
infestations
- Stressful conditions (fever, illness, drugs) can
stimulate worms to migrate causing:
 biliary obstruction
 Gut wall perforation
 acute appendicitis
- Dx: stool exam (ova or worms)
CBC (eosinophilia)
Treatment: Mebendazole, Pyrantel Pamoate, Piperazine
citrate
Ascaris lumbricoides (adult)
Ascaris lumbricoides, fertilized egg. Note that the
egg is covered with a thick shell that appears
lumpy (bumpy) or mammillated; approximate
size = 65 µm in length.
A "decorticated," fertilized, Ascaris lumbricoides
Trichuris trichiura – whipworm
- Causes trichuriasis
- Eggs w/ bipolar mucus plugs also known as football
egg or Japanese lantern egg
- Life cycle:
 Unsegmented ova – soil
 Full embryonated ova – small intestines
 Larvae – cecum
 Adults – colon
 Light infections – asymptomatic
 Heavy infections – chronic or recurrent diarrhea w/ foul, black
tarry or bloody stools, anemia, undernutrition, rectal prolapse
(rectum becomes edematous)
- Dx: proctoscopy
stool exam (ova)
CBC (eosinophilia, hypochromic microcyitc
anemia)
- Treatment: Mebendazole
Trichuris trichiura(whipworm)
Strongyloides stercoralis – causes Cochin China diarrhea
- Man is the primary host
- Transmitted by skin contact (walking barefoot in soil
contaminated by human feces), consumption of
contaminated food
- Life cycle:
 Free living adults and Rhabditiform larva – soil
 Filariform larva – soil
 Penetrate skin – “ground itch”
 Enter blood vessels
 Lungs – pneumonitis
 Intestines – asymptomatic
 Adult – abdominal pain, vomiting, diarrhea, steatorrhea,
melena (ulceration), anemia
 Eggs – hatch in the mucosa
 Rhabditiform larva – stools
- Dx: stool exam (rhabditiform larva)
CBC (eosinophilia)
- Treatment: Thiabendazole
Strongyloides stercoralis
First stage larva (Strongyloides stercoralis )
Third stage larva (Strongyloides stercoralis)
Hookworm infections
 Necator americanus: New World hookworm or American
Hookworm
 Ancylostoma duodenale: Old world hookworm
- Causes Ancylostomiasis, Uncinariasis, Necaturiasis
- Life cycle:
 Ova – soil
 Rhabditiform larva –
 Filariform larva
 penetrate skin of feet – “ground itch”
 Cutaneous venules – “creeping eruptions” or “cutaneous larval
migrans”
 Lungs – cough or wheezing
 Trachea
 Swallowed
 Adults
 Small intestines – epigastric pain, nausea, hypochromic
microcytic anemia, chronic malnutrition w/ hypoproteinemia
 Copulate
 Gravid females lay eggs w/c pass out of stools
- Dx: stool exam (ova, larva, adults)
CBC (eosinophilia, hypochromic microcytic
anemia)
Adult (anterior teeth)
filariform larva
EMBRYONATED EGG
filariform larva
EMBRYONATED EGG
Enterobius vermicularis – pinworm or
seatworm
- Causes Enterobiasis or Oxuriasis
- S/Sx: pruritus ani, vulvovagianitis,
salpingitis
- Dx: perianal cellulose tape swab
(Scotch tape method)
- Treatment: Pyrantel pamoate,
Mebendazole
ADULT
Capillaria philippinensis – Pudoc worm
- Causes capillariasis, Pudoc disease or
mystery disease
- S/Sx: borborygmy, abdominal pain,
diarrhea, anorexia, nausea and
vomiting, hypotension, cachexia,
death due to cardiac failure
- Intermediate host is Ipon or bagsang
- Endemic in Pudoc. Tagudin, Ilocos Sur,
Bangar, La Union
- Dx: stool exam (ova)
- Treatment: Mebendazole
Capillaria philippinensis
Capillaria philippinensis
Filariasis
 Wuchereria bancrofti – Bancroft’s filarial worm
- Transmitted by a Culex, Anopheles or Aedes mosquito
 Brugia malayi – Malayan filarial worms
- Transmitted by a Mansonia mosquito
- Causes Filariasis or Elephantiasis
- S/Sx: most infections are asymptomatic,
lymphangitis, hydrocoele of the scrotum and
legs
- Dx: microfilariae in a fresh blood film
adult worms in tissue specimens
obtained at biopsy
- Treatment: Diethylcarbamazine (DEC) or
Hetrazone
Wuchereria bancrofti