NEMATODES • Unholy Trinity

• Members of the class Nematoda - Hookworm

• Multicellular parasites - Ascaris lumbricoides
• Roundworms - Appear round in cross-sections. - Trichuris Trichiura

MORPHOLOGIC FORMS Strongyloides stercoralis

• Eggs - Female sex cells after fertilization • Common Name: Threadworm
• Larvae - Juvenile worms, long, and slender • Common associated disease and condition names:
• Adult Worms - Completely matured, reproductive - Strongyloidiasis
organ, complete digestive tract. - Threadworm infection
» Female - Larger than Adult Male Worms
MODE OF TRANSMISSION
GROUPINGS BASED ON HABITAT 1. Ascaris, Trichuris
• Intestinal - small and large intestines - Ingestion of Embryonated eggs ONLY
• Tissue 2. Hookworm, Strongyloides
- Skin penetration of Larvae
• Body Wall - Consists of three layers.
» Outer Cuticle - Cortical layer, Middle RISK FACTORS
Homogenous layer, inner fibrous layer • Inadequate sanitary facilities
» Hypodermis - Four longitudinal cords • Inadequate supply of potable water
» Musculature - For movement • Indiscriminate defecation
• Digestive Tract • Poor hygiene (Food and Personal)
- Complete Digestive tract • Poor health seeking behaviors
- Mouth – anterior, anus (posterior) • Overcrowding
- Muscular Esophagus
• Excretory System Ascaris lumbricoides
- Two Lateral Canals • Common names:
- Excretory pores - Large/Giant Intestinal Roundworm
• Reproductive System - Roundworm of man
- Separate sexes • Diseases
- Copulatory spicules - Ascariasis, Roundworm infection
• Nervous System – for stimuli of adult worms • Mode of Transmission
• Metabolism - Ingestion of embryonated eggs
- Carbohydrates • Habitat
- Glycogen - Small intestine
» Most common intestinal nematode
LABORATORY DIAGNOSIS
• Recovery of: Ascaris lumbricoides: ADULT
- Eggs
- Larvae FEMALE
- Adult Worms • 22 - 35 cm
• Specimens: • Creamy white w/pink tint
- Stool samples • Fine striations on the cuticle
- Tissue biopsies • Pencil lead thickness
- Infected Skin Ulcers • Paired reproductive organs
- Cellophane Tape Preparations • Anterior End
- Mouth, 3 lips
PATHOGENESIS AND CLINICAL SYMPTOMS • Posterior 2/3
• Severity of a nematode infections: - Paired reproductive organs
- The number of worms present
- The length of time the infection persists. MALE
- The overall health of the hosts • Up to 30 cm
• Slender
• Abdominal pain, diarrhea, nausea, vomiting, fever, • Fine striations on the cuticle
and eosinophilia, skin irritation, the formation of • Prominent incurved tail
skin blisters, and muscle involvement may also • Spicules
occur. • Single, long, slender tortuous tubules
• Anterior end
SOIL TRANSMITTED HELMINTHS - Mouth, 3 Lips
• STH aka Geo-helminths - part of worm’s
development takes place in the soil.

RINGO, NICOLLE S. | BSMT 1

 Ascaris lumbricoides: EGGS » 2nd Most Common Soil-Transmitted
Helminths (STH)
UNFERTILIZED EGG
• 85-95 um by 38-45 um STH: Trichuris trichiura: ADULT
• Longer and narrower • Much smaller than roundworm
• Thin Shell • Anterior
• Unembryonated, Amorphous mass of protoplasm - Colorless
• Corticated - Resembles whip handle
- Heavy albuminous coating - Three-fifths: Slender Esophagus
- Irregular mammilations • Posterior
- Refractile Granules - Pinkish gray
- Two fifths: Intestine and single set of
reproductive organ
FERTILIZED EGG
• 40 to 75 𝜇m by 30 to 50 𝜇m
• More rounded MALE
• Undeveloped unicellular embryo • Smaller than female: 30 - 45 mm
• Thick chitin shell • Prominent curled tail/ coiled posterior end.
• Corticated • Single spicule and retractile sheath
- Contains coarse mamillated covering
• Decorticated FEMALE
- Absence/Loss of Mamillated covering • 30-50 mm
• Blunt posterior end
FULLY EMBRYONATED EGG • Lays 3,000 to 10,000 eggs per day.
• Infective Stage
• 2-3 weeks for eggs to be fully embryonated. Trichuris trichiura: EGG
• Can survive moist environment for months to 2 • 50-55 by 25 um
years. • Barrer or football-shaped
• Pair polar plugs
DIAGNOSIS • Undeveloped unicellular embryo
• Diagnostic stage • Yellowish outer and transparent inner shell
- Eggs • 2 - 3 Weeks → Embryonated
- Adult Worms → Erratic Migration
• Specimen DIAGNOSIS
- Stool • Diagnostic stage
• Diagnostic Methods - Eggs
- Direct Fecal Smear (DFS) - Adult Worms → RECTAL PROLAPSE
- Kato-thick → Qualitative • Specimen
- Kato-katz → Quantitative - Stool
- Formalin-Ether Concentration Technique (FECT) • Diagnostic Methods
- Direct Fecal Smear (DFS)
TREATMENT, PREVENTION, AND CONTROL - Kato-thick → Qualitative
• Treatment - Kato-katz → Quantitative
- Albendazole ]→ SINGLE DOSE - Formalin-Ether Concentration Technique (FECT)
- Mebendazole - Zinc Sulfate flotation
• Prevention and Control
- Sanitary Disposal of Human Feces TREATMENT, PREVENTION, AND CONTROL
- Health Education (Personal, Family, Community • Treatment
Hygiene) - Albendazole ]→ SINGLE DOSE
- Mass Drug Administration - Mebendazole
• Prevention and Control
Trichuris trichiura - Sanitary Disposal of Human Feces
• Common Name - Health Education (Personal, Family, Community
- Whipworm Hygiene)
• Diseases - Mass Drug Administration
- Trichuriasis, Whipform infection
• Mode of Transmission HOOKWORM
- Ingestion of Embryonated Eggs • Mode of Transmission
• Habitat - Skin penetration of infective larvae
- Intestine - Habitat
- Attached to the mucosa of small intestine

RINGO, NICOLLE S. | BSMT 2

 - Factors for Transmission • Germinal mass
- Appropriate temperature • Embryonic cleavage
- Rainfall • 2-4 or 8 cell stage
- Loose Sandy and Loamy soil • Develops in the soil
- Direct defecation into the soil • Hatches
- Barefoot practice • Releases parasitic larvae
• 24-48 hours
Necator americanus
• Common Name HOOKWORM RHABDITIFORM LARVAE
- New World Hookworm • Free living and non-parasitic stage
• Disease • Newly hatched
- Hookworm infection, Necatoriasis • 15 by 270 um
• Buccal capsule has ventral sucking plates/disk • 5 Days
• 540 to 700 𝜇m
Necator americanus: ADULTS • Long buccal canal and muscular esophagus
• Small, Cylindrical grayish white to pink • Survive in the soil
• Hook anterior end - Conspicuous • Thin shelled
• Attenuated anteriorly • Has no capacity to enter the skin
• Ventral and dorsal semilunar cutting plates • Inconspicuous genital primordium
(sucking plate)
HOOKWORM FILARIFORM LARVAE
• Male • Infective Stage
- 5-10 mm long, 0.2-4 mm • Non-feeding stage
- Long and slender spicules fused at the tip • Penetrates the skin
- Prominent copulatory bursa • Pointed tail
• Striated sheath
• Female • Closed mouth
- 9-12 mm long, 0.25 - 5 mm diameter • Short esophagus
- Wider and longer
DIAGNOSIS
Ancylostoma duodenale • Diagnostic stage
• Common Name - Eggs
- Old World Hookworm - Adult Worms → RECTAL PROLAPSE
• Disease • Specimen
- Hookworm infection, Ancylostomiasis - Stool
• Buccal capsule has 2 pairs of cutting teeth • Diagnostic Methods
- Direct Fecal Smear (DFS)
Ancylostoma duodenale: ADULTS - Kato-thick → Qualitative
• Slightly larger than N. americanus - Kato-katz → Quantitative
• Ventral cutting teeth - Formalin-Ether Concentration Technique (FECT)
• Single paired reproductive organ - Zinc Sulfate flotation
• Head has same curvature of the body - Harada-mori
- Molecular assay, Serologic Assay
• Male
- 5-10 mm long, 0.2 - 4 mm TREATMENT, PREVENTION, AND CONTROL
- Posterior extends to bursa • Treatment
- Have a pair of testis - Albendazole ]→ SINGLE DOSE
- A pair of spicules - Mebendazole
• Prevention and Control
• Female - Sanitary Disposal of Human Feces
- 9-12 mm long, 0.25-5 mm diameter - Health Education (Personal, Family, Community
- Wider and longer Hygiene)
- Two ovarian tubules coiled back and forth over - Mass Drug Administration
the intestine
Enterobius vermicularis
HOOKWORM EGGS • Common Name
• Smooth and colorless - Pin worm, Seatworm
• Necator - 60-75 um • Diseases
• Ancylostoma - 55-60 um - Enteroiasis, Oxyuriasis
• Thin shelled • Mode of Transmission

RINGO, NICOLLE S. | BSMT 3

 - Ingestion and Inhalation of Embryonated eggs
(deposited in perianal region)
• Habitat
- Cecum, Portions of small and large intestines

Enterobius vermicularis: ADULT

• Cephalic alae
• Posterior esophageal bulb

• Female
- 8 to 13 mm by 0.4 mm
- Long pointed tail
- Uterus
- Distended with eggs
- Perianal region
- 15k eggs
• Male
- 2 to 5 mm by 0.1 to 0.2 mm
- Curved tail
- Single spicule
- RARELY SEEN

Enterobius vermicularis: EGGS

• Asymmetrical
• Colorless
• One side flat
• One side Convex
• Elongate to Oval, D shaped
• Translucent shell
- Outer triple albuminous covering
• Embryo
- Stages Vary
- Tadpole like embryo
- Matures within 4-6 hours

DIAGNOSIS
• Diagnostic Stage
- Eggs
- Adults
• Specimen
- CELLULOSE TAPE
- Stool
• Diagnostic methods
- Microscopic examination
- Graham’s scotch adhesive tape swab (perianal
cellulose tape swab)
• Supplies and Materials
- Gloves
- Slides
- Mask
- Cellulose tape, Scotch tape
- Tongue depressor REFERENCES
• Time of Collection
- Early morning Far Eastern University PowerPoint presentation
- When patient has slept for hours
Zeibig, Elizabeth A. Clinical Parasitology: A Practical Approach. 2nd
Edition 2013

Notes from the discussion by:

Mx. Katherine Balboa

RINGO, NICOLLE S. | BSMT 4