FOOD- BORNE NEMATODES

- Can be transmitted primarily through ingestion.

SOURCES PARASITES
Crabs, shrimp Gnathostoma
Fish (Freshwater) Capillaria
Fish ( Marine fish) Anisakis, Gnathostoma, Pseudoterranova
Fruits, Vegetables Angiostrongylus, Ascaris
Pork Trichinella
Slugs, Snails Angiostrongylus
Squid Anisakis
Water Ascaris, Gnathostoma
Frogs, snakes Gnathostoma
Bear, cougar, horse, Trichinella
walrus, wild boar

Three Types of Food Chain

FOOD CHAIN PARASITE EXAMPLE
DESCRIPTION
Farm to- Fork Meat- borne parasites Trchinella (most common
occurring in livestock in undercooked pork)
Forest to - Fork Meat- borned parasites Trichinella
occurring in wildlife
Freshwater/Ocean/ Fish-borne parasites Anisakis
Pond to- Fork

ANGIOSTRONGYLUS (Angiostrongyliasis)
- A metastrongyloid parasites ( that occurs in the lungs of mammals)
- It’s normal for rodents to have this parasite
- Zoonotic infection
Angiostrongylus Angiostrongylus
(Parastrongylus) cantonensis (Parastrongylus) costaricensis

Common Name Rat lungworm --

Disease - Angiostrongyliasis - Angiostrongyliasis
(Angiostrongylus (Angiostrongylus
infection) infection), except
 Australia)
- Eosinophilic meningitis - Eosinophilic gastroenteritis
(neural anstrongyliasis), (abdominal/ intestinal
occasionally ocular disease angiostrongyliasis
( ocular angiostronyliasis)
Definitive Host Several rat species; - Hispid cotton rat
- Black rat/ House rat/ Roof (Sigmodon hispidus)-
rat/Ship rat (Rattus rattus) MAIN
- Brown rat/ Norway rat - Black rat (Rattus rattus)
(Rattus norvegicus) - Pygmy rice rat
- Hispid cotton rat (Oligoryzomys fulvescens)
(Sigmodon hispidus) - Short- tailed cane
mouse/Short tailed
zygodonts (Zygodontomys
brevicauda)
Intermediate Host Gastropod (Slug & snail) Gastropod (slugs);
- Achatina spp. -Linacidae family
- Biomphilaria - Veronicellidae family
- Bulinus spp.
- Lynnaeca spp.
- Pomacea snails

In the Philippines;
- Achatina fulica (Giant
African snail)
- Helicostyla macrostoma
- Hemiplecta sagitifera
- Vaginilus plebeius
- Veronicella altae
Aberrant/Accidental hostl / Humans, birds, wild & domestic Humans, non-human primates,
Dead end host mammals other mammals (opossum,
raccoons)
Distribution Predominant in Southeast Asia, Caribbean, Latin America
tropical Pacific Islands, seen also
in Africa, Australia. Caribbean,
Hawaii, & Southern US
Specimen Brain tissue, CSF Intestinal tissue section

Laboratory Diagnosis Abnormal CSF: Finding of eggs, larvae, or adult in

- Elevated pressure tissue section through
- (+) protein biopsy/surgery
- (+) leukocyte
- Eosinophilia
- Rarely: (+) parasite larvae
Molecular Diagnosis CSF real- time PCR Tissue conventional PCR, then
DNA sequencing analysis ( no
specific molecular test available)
Treatment None ( Supportive treatment only) None, but may require surgery
Prevention & Control - Health Education -Health education
- Avoid consumption of raw/ - Avoid consumption of raw/
undercooked slugs, snails, undercooked slugs of
 freshwater shrimps, land contaminated vegetables/
crabs, frogs. Monitor vegetables juices
lizards (transport hosts), or - Remove slugs, snails, and rats
contaminated vegetables/ near gardens and houses
vegetables juices - Thoroughly wash hands and
- Remove slugs, snails, and utensils after preparing slugs
rats near gardens and -Thoroughly ras vegetables if
houses eaten raw
- Thoroughly rats vegetables
if eaten raw

LIFE CYCLE OF ANGIOSTRONGYLUS CANTONENSIS

LIFE CYCLE COSTARICENSIS

• Angiostrongylua costaricensis adult worms (female).: Note the “barber’s pole” appearance of the
parasite that is made up of the dark red intestine tract filled with blood intertwined with a pair of the
white genital tract.
• Angiostrongylus cantonensis adult worm (male) with the posterior end showing a small bursa and two
copulatory spicules

TRICHINELLA (extra-intestinal nematode)

- Resides in smooth muscle
- An aphasmid worm (Adenophorea) (phasmid- sensory organ located in the posterior portion of
nematodes)
 - 3 aphasmids nematodes (Capillaria, Trichuris, Trichinella) and Hymenolepis nana (cestode)

SPECIES SOURCE DISTRIBUTION

Trichinella spiralis Carnivorous & omnivorous Worldwide
animals ( Pigs= primary reservoir)
Trichinella pseudospiralis Bird & mammals Worldwide
Trichinella britovi Carnovorous animals Europe, Western Asia
Trichinella nativa Artic bears
Trichinella nelsoni African predators & Scavengers
Trichinella papuae Wild & domesticated pigs Papua New Guinea, Thailand

TRICHINELLA SPIRALIS
Common Name Garbage worm, Pork worm, Trichina worm, Muscle
worm
Disease Trichinellosis/Trichinosis, Neurotrichinellosis
Definitive/ Intermediate & Reservoir host Pigs, rats
Aberrant host Humans
Mode of Transmission Ingestion of muscle tissue infected with encysted
larvae—infective stage (consumption of
undercooked pork)
Habitat Small intestine ( adults)
Striated muscle ( Larvae)
Pig/humans- small intestine (dito magiging adult)
In animals (pigs), the highest concentration of larvae
is found in the diaphragm & tongue (but also present
in many skeletal muscles)
Manner of reproduction Viviparous (releases larvae in the intestinal mucosa)

• Male dies after fertilizing the female

• Female dies after 16 weeks (after discharging
the larvae)
Clinical manifestation • Trichinellosis can be
asymptomatic/symptomatic
- Diarrhea, facial edema, fever, headache,
myalgia

- Neurotrichinellosis (sequelae/ consequence of

severe infection) encephalopathy,
neuromuscular disturbance, ocular
involvement – causing inflammation

NOTE: Symptoms depends on number of

parasites

10 larvae- asymptomatic
50-500 larvae- (moderate infection) = symptomatic
1000-3000 larvae ( severe infection)
 Phases of disease
- Enteric phase- incubation and intestinal
invasion

Invasion period- time between exposure and

occurrence of clinical manifestation

- Invasion phase= larval migration & muscle

invasion
- Convalescent phase= encysment &
encapsulation

Cell encysted larvae capsule- Nurse cell

Diagnosis Muscle biopsy ( demonstration of larvae in
histological examination (0.2-0.5 grams od muscle
tissue)- most definitive.

Muscle diagnosis technique using hydrochloric acid

& pepsin- to determine the number of larvae per
gram muscle

Disadvantage- Younger larvae may be digested hence

used to digest 10-12 days old muscle larvae ( 2-3
weeks post infection)

Serology:
- ELISA
- Western blot
- Latex agglutination test = rapid test

Molecular techniques

Non-specific teats
- Eosinophilia (CBC)
- Increased muscle enzymes ( CK, LDH,
myokinase)
- Increased total serum IgE

Algorithm (in belizario)

LIFE CYCLE OF TRICHINELLA SPIRALIS

TYPES OF LIFE CYCLE

Urban life cycle Poorly cooked pork eaten by man
Sylvatic life cycle Predators and scavengers become hosts of the parasite
Marine life cycle Polar bears, seals, walruses, and whales become hosts
of the parasite

ADULT

- One of the smallest nematodes in humans

- Penis if T. spiralis is called claspers
 - The male bears a pair of conspicuous papillae (claspers) that it uses to hold on the female worm during
mating
LARVA
- 80 um x 7.8um diameter
- Encysted larva (infective stage): 1mm length x 36um diameter
NOTE: Encystation only occurs in striated muscle (not in other tissues as they generate and are absorbed
calcification

- Life span (encysted 5-10 years years, or up to 40 years

- Calcification of infected muscle cell + larvae: 6-12 months post infective

TREATMENT
- Mebendazole- 5mg/kg body weight daily for 10-15 15 days
- Albendazole- 15mg/kg body weight daily in 2 dividend doses for 10-15 days
-Children greater than 2 years old: 10mg/kg body weight daily in 2 dividend doses for 10-15
days
- Thiabendazole- has adverse drug reactions (no longer recommended)
- Supportive treatment (analgesics, ------, corticosteroids- To control symptoms (e.g., corticosteroids= to control
hypersensitivity from larvae, from myositis, and vasculitis

PREVENTION AND TREATMENT

- Health education
- Adequate cooking of meat
- Freezing or storing at -15 degree Celsius for 20 days or -30C for 6 d days
NOTE: Salting. Smoking or drying of meat does not kill the larvae
- Regular animal monitoring (meat inspection, detection of circulating antibodies)
- Keeping of pigs in rat-free pens
- Proper disposal of suspected carcasses (preventing pigs from eating raw meat & ofal (intestine, internal
organs – waste feeding)
ASCARIDOID NEMATODES (ANISAKIS)
-inhabit the stomach of marine mammals

Disease Anisakiasis (Anisakidosis, Cod (fish) worm disease,

herring (fish) worm disease, seal (mammal) worm
disease)
Etiology Anisakis simplex complex:
- Anisakis simplex sensa stricto
- Anisakis berlandi (=Anisakis simplex C)
- Anisakis pegreffii

BOLD : most common in humans

Pseudoterranova decipiens complex

- Pseudoterranova decipiens sensa stricto
- Pseudoterranova azarasi
- Pseudoterranova cattani

Contracecum oscalatum complex

Common name Codworm (Pseudoterranova decipiens),

Herring worm (Anisakis simplex), sealworm
Transmission Ingestion of raw/poorly cooked saltwater fish/ squid
Definitive host Marine mammals, ingest infected fish with L3 larva ;
Larvae develop into adults after 2 moulting, then
reside in the stomach. Eggs produced are passed out in
the feces of these marine mammals

Anisakis simplex
Cetaceans (dolphins, whales porpoises)

Pseudoterranova decipiens
Pinnipeds (seals, sea lions, walrus)

Costracecum oscalatum complex

- Bearded seal (Erignathus barbatus)
- Gray seal (Halichoerus grypus)
First intermediate host Euphasid crustaceans (Euphasids/krill- ingest free-
swimming L2 larvae that later mature t
Second intermediate host/ paratenic host/ extension Marine fish (predatory fish) e.g cod, herring,
host- complicates the life cycle mackerel, sculpin & squid- ingest crustaceans with L#
(dito nakukuha ng tao yung infected larvae) larvae. Larvae then migrate from the intestines to the
tissues of the peritoneal cavity and grow up to 3 cm in
length
Habitat L3 larvae- resides in the hemecoel of crustaceans (1st
IH) & Mesentery and muscle tissue of marine fish (2nd
IH)
 Adults= stomach of marine mammals (definitive host)

In humans. L3 larvae penetrate the stomach and the

intestines
Distribution Worldwide

Anisakis simplex complex:

- Deep sea & coastal environment in the Alaskan
coast, Atlantic Basin & Pacific ocean, (Northen
hemisphere)

Anisakis pegreffii
- Southern hemisphere

Pseudoterranova decipiens complex & Contracecum

oscalatum complex

- Cold water, coastal environments (Arctic,

Northern Atlantic, South Atlantic ocean, Japan,
Southern Chile)
Clinical Manifestations - Acute abdominal symptoms with hours after
ingestion of larvae >> can be mistaken for
appendicitis, food poisoning peptic ulcer
- Sometimes, larvae are coughed up
- Larvae in the intestines >> severe eosinophilic
reaction in 1-2 weeks after infection causing
symptoms mimicking Crohn’s disease and
intestinal perforation (rare)

*Anisakis has “boring tooth” that can perforate the

intestinal mucosa

-Tissue damage can cause longer lasting symptoms

- can cause “anaphylactic reaction”= severe/immediate
hypersensitivity reaction / allergy ( the parasite has
proteins that can cause reaction when humans touched/
ate the fish harboring L3 larva of anisakis.

- Antigens present in fish muscle after the larvae

were killed (after freezing) can cause allergic
reactions (severe anaphylaxis) in some
individuals
- Ectopic infection = * in human beings, the
usual habitat of L3 larvae is the stomach and
the intestine (small & large) but thet can
migrate to unusual/ ectopic sites as
well)**possible but rare: esophagus,
mesentery, peritoneal cavity, tongue
Laboratory diagnosis - Demonstration & removal of larvae through
gastroscopic examination ( upper endoscopy)
- Histopathologic examination of tissue sections
 taken thru biopsy of surgery

Prevention and Control -

Cooking at > + 63C (> +145F)
-
Freezing at </= -20C (< - 4F) for 7 days
-
Freezing at </= -35C (</= -31F) until solid
then storing at the same temperature for >/= 15
hours or at -20C for 24 hours
NOTE: parasite larvae may resist pickling, salting, or
smoking
Treatment - Endoscopic removal of parasite larvae =
curative
• In other books, anisakiasis is self -limiting - Albendazole (?) 400mg PO bid x 6-21 days
disease

*infective stage of the parasite to the human being is the L3 larva, while the infective stage of
the parasite to the 2nd intermediate host is also the L3 larva also to the 1st intermediate host

MORPHOLOGY (L3 Larva)

- Three bi-lobed lips (1 dorsal,2 subventral)

- Has a boring tooth ventral to the mouth
- Has an excretory pore between the ventrolateral lips
- May reach a length of 50mm & diameter of 1-2mm
Three major parts: (1) anterior/ cephalic end, (2) ventricular area, and (3) posterior/caudal end

*cone shaped mucron- anisakis simplex complex

esophagus(yellowed)
Red( ventriculus/ventricular appendix)

intestine- yellow
CAPILLARIA (=PARACAPILLARIA)

Capillaria philippinensis Capillaria hepaticum (=Calodium

hepaticum)
Common name Pudoc worm/ Mystery worm ---
Disease Intestinal capillariasis (Mystery Hepatic capillariasis
disease following its discovery
during an epidemic in Pudoc West,
Tagudin, Ilocos sur in 1966
Transmission Ingestion of infected small Ingestion of fecal matter of infected
freshwater fish animals

Infection leads to diarrhea and Infection leads to hepatitis

emaciation
Definitive host Fish- eating birds (bitterns, egrets, Rodents (rats)- reservoir host
herons) – natural definitive host Domestic & Wild carnivores
(e.g., cats, dogs, foxes)
Humans- incidental host
Lagomorphs
Primates
Swine
Humans- incidental host

Intermediate host Freshwater or brackish water fish: --

- Hypseleotris bipartita
(natural source in Ilocos
Sur)
- Ambassis miops (bagsang)
- Chonophorus
melanocephalus (biyayang
bato, bukto)
- Eleotris melanosome (birut)
- Poecilla reticulata (guppy)
- Scyoopterus spp. (ipon)
Distribution Philippines (especially Worldwide (all inhabited
NorthernLuzon) &Thailand ; also, continents, except Australia)
in other East & Southeast Asian
countries, northern Egypt *parasite of wild animals*
Clinical Presentation Abdominal/gastrointestinal disease Rare in humans
that can be serious if not treated
- Acute-subacute hepatitis
Protein-losing enteropathy resulting with peripheral leukocytosis
to cachexia, cardiomyopathy, & eosinophilia.
severe emaciation & death Hepatomegaly,
persistentfever ( up to
Case fetality rate => 10% +40C)
- Granuloma formation &
 liver necrosis due to the
deposition of eggs in the
liver
- Heavy infection may lead to
fatal liver dysfunction

Diagnosis Demonstration of adult, larvae, Demonstration of adult, and/or

and/ eggs (35-45um length x 20- eggs 5—50um length x50-35um
25um width) in stool/intestinal width) in biopsy or autopsy
biopsies specimens

*stool *spurious infection- makikita mo

*histopath- intestinal tissue ang sa stool
(biopsy)
= adult Hepatica ay mas Malaki ng konti
kesa sa philippinensis pero pareho
lang ng morphology= peanut
shaped and may bipolar plugs, may
cell sa loob

NOTE; (+) eggs in stool

specimens= spurious infection due
to the ingestion of infected liver
from infected animals

NOTE: Capillaria philippinensis/hepatica eggs may resemble Trichuris spp. Eggs

Capillaria philippinensis/hepatica Trichuris spp.

Ellipsoidal (ovoid); peanut- shaped Barrel- shaped
Has striated shell No striated shell
Has smooth (flattened) poles Has protruding poles (more prominent polar plugs)
Has broader shoulders
AUTOINFECTION- CESH (Capillaria, Enterobius, Strongyloides, Hymenolepi)
PREVENTION & CONTROL

- Avoidance of eating uncooked fish

- Control of rodents (for capillaria hepatica)
- Improve hygiene (not eating, drinking, or bathing in water where humans defecate; ensuring
sanitary disposal of human feces & away from water sources shared by human population)

Treatment
Drug-of-Choice Adult dose Pediatric dose
Albendazole 400mg PO daily x10 days 400mg PO daily x 10 days
Mebendazole 200mg PO bid x10 days 200mh bid x20 days
GNATHOSTOMA (causes Gnathostomiasis)
Species of Gnathostoma infecting humans
SPECIES SOURCE DISTRIBUTION
Gnathostoma spinigerum (most Domestic & wild cats & dogs China, India, Japan, SEA
common)
Gnathostoma doloresi Wild boars (swine) Central & Eastern Europe
Gnathostoma hispidium Domestic & wild pigs (swine) Asia, Australia, Europe
Gnathostoma nipponicum Weasels

Others:
Gnathostoma binucleatum Cats & dogs
Gnathostoma malaysiae Freshwater shrimp (?) Myanmar

Three species reported in the Philippines:

- Gnathostoma spinigerum
- G. hispidium
- G. doloresi

Disease Gnathostomiasis

Cutaneous larva migrans (rate of larval migration in

subcutaneous tissue = 1cm/hour )

Visceral larva migrans /visceral gnathostomiasis/larva

migrans profundus (affecting the ears, eyes (ocular
gnathostomiasis >> vision loss). Lungs,
gastrointestinal &genitourinary systems, & rarely but
fatally, the CNS >> neurognathostomiais >>
eosinophilic meningitis, myeloencephalitis)
MOT Primary MOT:
- Consumption of raw/ improperly cooked
infected fish and/or paratenic host
Alternative MOT
- Drinking water with infected with copepods
(1st IH)
- Penetration of the skin from infected meat
(food hunters)
Definitive Host Cats, dogs, leopards, lions, minks, opossums, otters,
pigs, racoons, tigers, weasels, wild boars

Cats, dogs= G. spinigerum

Pigs= G. hispidium

Habitat= stomach

First Intermediate host Copepods (Cylops, Cyclops serrulatus)

Second intermediate host Freshwater fish
 - Glossogbius giurus (tank goby)
- Ophicephalus striatus (= Channa striata)
(dalag, striped snakehead)
- Therapon argenteus (=Mesopristes argenteus)
(silver grunter, silver terapon ; silver
trumpeter)
Paratenic host Water snake/ South Asian bockadam/ New Guinea
bockadam/Dog-faced water snake (Hurria rynchops=
Cerberus rynchops)

Boie’s wart frog, Ricefield frog, Asian grass frog

(Fejervarya limnocharis= Rana limnocharis)
GNATHOSTOMA:MORPHOLOGY
Egg Oval, 67-70 x 38-40 um
One mucoid plug (minsan 2)
Contains 1-4 cells
Unembryonated when passed in stool

Gnathostoma spinigerum eggs with polar knob

Larva (diagnostic stage)

L3- 8 rows
Adult

nondendated- single pointed

(larva)

Adult – Tridentated cuticulas spines