HELMINTHS

Ascaris lumbricoides - INTESTINAL PHASE

intestinal nematode o adult worms will cause acute intestinal
obstruction and malabsorption syndrome
CLASS: Nematoda (roundworms) resulting in nutrient deficiencies –
malnutrition
CHARACTERISTICS - WANDERING WORMS
- “giant roundworm” o due to erratic behavior of adult worms →
- most common and largest nematode
hepatobiliary ascariasis, pancreatitis,
- soil-transmitted helminth
appendicitis
- habitat: small intestine, soil
**if they go to the bile duct, it will mimic the gall
BASIC MORPHOLOGY stones
egg: oval shaped with a thick chitin shell
adult worm: white, elongated, cylindrical with “lateral DIAGNOSIS
lines” on each side • Direct Fecal Smear
o (+) egg
LIFE CYCLE • Kato-Katz Technique
IS: embryonated egg • Direct Visualization of Adult Worm
DS: egg & adult worm
DH: man Ancylostoma duodenale & Necator americanus
IH: none intestinal nematode
MOT: fecal-oral
CLASS: Nematoda (roundworms)
ingestion of food or water contaminated with fecal
material that contains ascaris embryonated egg → CHARACTERISTICS
stomach (survives gastric acidity) and reaches - “hookworm”
duodenum → small intestine → excystation occurs → - soil-transmitted, blood-sucking helminth
larva is released and penetrates intestinal wall → - habitat: small intestine, soil
reaches blood circulation → liver via portal circulation
→ right side heart → pulmonary vessels → grow and BASIC MORPHOLOGY
develop in the lung tissues resulting in immune egg: thin wall and colorless with at least 4-8
response → larva is cough out and swallowed again blastomeres
→ develop into adult worms in the small intestine → adult worms: small, cylindrical with characteristic
these adults continue to reproduce and lay eggs, and mouths
these eggs / adult worms are seen in stool o A. duodenale – 2 pairs of ventral teeth
o N. americanus – cutting plates
**every bowel movement of the patient, it carries the
egg LIFE CYCLE
**the eggs in the soil will go cell division – mitosis, IS: filariform larva
then it becomes embryonated DS: egg
**erratic parasites / wanderers – they will go DH: man
wherever they want to go IH: none
MOT: larval penetration
DISEASE
Ascariasis filariform larva
- major damage occurs during larval migration - found in the soil and will penetrate an intact skin
- LUNG PHASE (foot most of the time)
o Loeffler’s Syndrome (hypersensitivity - will stay in the foot for few days
pneumonitis) → will migrate to the nearest blood vessel → will be
▪ infection of the lungs caused by parasitic carried by the blood towards the inferior vena cava →
infections right side of the heart → pulmonary vessels → lung
▪ you may find the larva inside the alveoli – tissues resulting in immune response → larva is cough
empty sac in the lungs out and swallowed again → will enter the GIT →
- matures small intestine → adult worm attach mucosa

YTAC, VENICE ANN BSN – 1G

of SI and feed on lymph & plasma → will migrate in ingestion of food or water contaminated with fecal
the large intestine → they go sexual reproduction → material containing embryonated egg → in the SI, one
eggs → passed in feces → egg hatches on soil and is of the bipolar end will open → larva leaves the egg →
called rhabditiform larva → matures to filariform larva enters the mucosal crypts in the SI → transform
larva to adult worm → adult worms attached to the cecum
→ eggs passed out in feces and reaches the soil
**YOU DON’T NEED AN OPEN WOUND
DISEASE
DISEASE Trichuriasis or Whipworm Infection
Hookworm Infection - diarrhea
- major damage is due to blood loss at attachment - increased peristalsis → rectal prolapse
site o urge is always there
- CUTANEOUS PHASE o will sometimes cause the perineal muscles to
o penetration of filariform larva to the skin → weaken (due to constant straining) which
ground itch and/or cutaneous larva migrans results to rectal prolapse
(creeping eruption wherein larva cannot pass - no lung migration phase
below stratum germinativum and stays there - does NOT cause significant anemia
for a short while)
o will give a characteristic of rash DIAGNOSIS
- LUNG PHASE • Direct Fecal Smear
o lung migration of filariform larva → Loeffler’s o (+) egg
Syndrome (hypersensitivity pneumonitis) • Kato-Katz Technique
- INTESTINAL PHASE
o up to 200mL of blood may be lost per day → MANAGEMENT & PREVENTION
anemia → weakness, pallor, malnutrition • deworming

DIAGNOSIS Enterobius vermicularis

• Direct Fecal Smear intestinal nematode
o (+) egg
• Kato-Katz Technique CLASS: Nematoda (roundworms)

Trichuris trichiura CHARACTERISTICS

intestinal nematode - “pinworm”
- soil-transmitted helminth
CLASS: Nematoda (roundworms) - habitat: large intestine, soil

CHARACTERISTICS BASIC MORPHOLOGY

- “whipworm” egg: D-shaped ovum with thin colorless cell wall
- soil-transmitted helminth adult worm: round body with lateral wings or cephalic
- habitat: large intestine, soil alae (seen in the head)

BASIC MORPHOLOGY LIFE CYCLE

egg: barrel-shaped with bipolar mucus plugs – during IS: embryonated egg
the hatching process, it will be removed, and the larva DS: eggs on perianal folds
will exit **it doesn’t break DH: man
adult worm: anterior 2/3 is narrower and since it’s IH: none
very narrow, it will penetrate the wall of large MOT: fecal-oral, inhalation of eggs, retroinfection –
intestine **head is very thin and tail will just stay autoinfection
outside
ingestion of food or water contaminated with fecal
LIFE CYCLE material containing embryonated egg or inhalation of
IS: embryonated egg embryonated egg → larvae hatch in SI → adult
DS: unembryonated egg worms develop in SI → moves to perianal skin to lay
DH: man eggs at night → female dies after oviposition → eggs
IH: none laid on perianal area mature within 6 hours →
MOT: fecal-oral contaminates feces or the hand when scratched
YTAC, VENICE ANN BSN – 1G
eggs will either: HUMAN SOIL
1. be carried together with the feces to the external filariform larva → SI → filariform larva → can
environment, maybe exposed to the soil, develop into adult be excreted together
undergoes cell division… worms → sexual with the feces → once it
2. hatch (morning) → larva will exit, goes back to reproduction → eggs reaches the soil, the
the rest of the large intestine → enters small are deposited in the larva will mature into
intestine for maturity → will go back to the large lining of the SI → the adult worms → sexual
intestine → male dies → female will travel and eggs will hatch after reproduction → eggs →
lays eggs → female dies… few days → larva will will hatch and the larva
▪ process is called retroinfection (form of exit the SI → larva is is called rhabditiform
autoinfection – the host is the source of the called rhabditiform larva → will mature into
infection) larva → develop/mature filariform larva
into filariform larva
**oviposition – laying of the eggs (happens during the (infective stage) → look
night) this process is very itchy for the nearest blood
vessels → (starts
DISEASE another cycle of
Enterobiasis infection) – another
- pruritus ani (itchy anus) example of
- risk for autoinfection autoinfection
DIAGNOSIS
DISEASE
• Cellulose Tape Preparation – Graham Scotch Tape Strongyloidiasis
o (+) eggs - CUTANEOUS PHASE
Strongyloides stercoralis o ground itch/larva currens
intestinal nematode o migration is faster than other larvae
- LUNG PHASE
CLASS: Nematoda (roundworms) o Loeffler’s Syndrome
- INTESTINAL PHASE
CHARACTERISTICS o diarrhea
- “threadworm” (thin as a thread) o intestinal ulceration
- soil-transmitted helminth o duodenitis
- only helminth that causes greater pathology in - DISSEMINATED STRONGYLOIDES (in
AIDS patients/immunocompromised patients immunocompromised)
- habitat: small intestine, soil
DIAGNOSIS
BASIC MORPHOLOGY • Harada-Mori Culture
egg: ellipsoid, thin-walled o (+) rhabditiform larva
adult worm: long (2-3 mm), slender, pointed tail • STOOL!

LIFE CYCLE Wuchereria bancrofti

IS: filariform larva tissue nematode
DS: rhabditiform larva
DH: man CLASS: Nematoda (roundworms)
IH: none
MOT: skin penetration by filariform CHARACTERISTICS
- mosquito-borne roundworm that primarily affects
human lymphatic system
- habitat: blood – microfilaria, lymphatic system –
adult worm

BASIC MORPHOLOGY
microfilaria: transparent with blunt head and pointed
tail (diagnostic stage)
adult worm: creamy white, long, hair like with both
ends tapering (M = curved, F = straight)
YTAC, VENICE ANN BSN – 1G
LIFE CYCLE
IS: L3 larva (3rd stage larva)
DS: microfilaria
DH: man
IH: Female Anopheles Mosquito
MOT: bite of an infected mosquito

infected Female Anopheles Mosquito bites man and

releases L3 larva just beneath the skin → larva
penetrates on its own into the deeper portions →
reaches lymphatics → regional lymph nodes (axillary
and inguinal in most commonly affected) → after 5-18
months, L3 larva become adult worms → M&F worms
reproduce → female lays microfilaria (no eggs!) →
lymphs → will drain by the right lymphatic
duct/thoracic duct → subclavian vein → systemic
circulation → mosquito ingests the microfilaria during
the blood meal → further development of the larva
in the mosquito into L3 larva

**microfilaria → L1 → L3

DISEASE
Filariasis / Elephantiasis
- presence of adult worm in lymph nodes and
lymphatics → lymphadenitis – adult worms will
obstruct the lymph nodes
- lymph nodes become inflamed and enlarged
- with chronic course, nodes and vessels may
contain dead worms surrounded by fibrotic and
calcified tissue → mechanical blocking of lumen
by dead worms → lymphedema

DIAGNOSIS
• Giemsa Stained Blood Smear
o (+) microfilaria

YTAC, VENICE ANN BSN – 1G

 Schistosoma species Urinary Schistosomiasis (S. haematobium)
trematode (flukes) – flat not segmented - same plus painless hematuria
- associated with squamous cell carcinoma of the
CHARACTERISTICS bladder
- “oriental fluke”; “blood flukes”
- areas of endemicity: Sorsogon, Samar, Leyte, **can cause bladder cancer
Oriental Mindoro, Bohol, all of Mindanao except
Misamis Oriental DIAGNOSIS
- Fecalysis / Kato-Katz Technique
S. japonicum o (+) parasite eggs
eggs: small lateral spine (‘knob’) - Urine Microscopy
endemicity: Southeast Asia - Circumoval Precipitin Test (COPT)
lay eggs: blood vessels supplying the small intestine o detects circumoval Schistosoma antigen
and liver
MGT & PREVENTION
S. mansoni - wear boots
Eggs: large, prominent lateral spine - avoid going to areas that are endemic
Endemicity: Africa & South America - avoid exposure to fresh water areas
Lay eggs: blood vessels supplying the large intestine - proper sewage disposal
- environmental sanitation
S. haematobium
Eggs: large terminal spine PARTS OF TAPEWORM
Endemicity: African regions Scolex
Lay eggs: blood vessels supplying the urinary bladder - head of the tapeworm
- may contain suckers & rostellum
LIFE CYCLE - the most regenerative part of the parasite
IS: cercariae Proglottids
DS: egg - segments below the neck
DH: man - the farther the proglottids from the neck, the
IH: Oncomelania quadrasi (snail) mature it is
MOT: skin penetration by cercariae **mas duol sa neck = immature
Gravid proglottids
cercariae (fresh water areas – lakes, farms…) → - distal
penetrates an intact skin (shed their tail, only head - pregnant proglottids – carries the egg
remains) → schistosomula / schistosomulae → blood
→ portal of circulation (liver)→ becomes adult worms **tapeworms are hermaphrodites – they have male &
→ migrate into their respective organs → sexual female reproductive organs (doesn’t need a sexual
reproduction → lay eggs into the blood vessels → partner)
eggs passed out in the feces and reaches the water **forms the scolex/head first → neck
where oncomelania quadrasi is → hatch to miracidia
→ penetrates snail tissue → develops into mother Taenia species
sporocysts, then give rise to daughter sporocysts → cestode (tapeworms) – flat and segmented
develop into cercariae → freshwater
T. solium
DISEASE
Intestinal Schistosomiasis (S. japonicum & S. mansoni) CHARACTERISTICS
- cercarial dermatitis (swimmer’s itch) - “pig tapeworm”
- Katayama fever (Japan)
o systemic hypersensitivity BASIC MORPHOLOGY
o liver & spleen enlargement cyst: fluid-filled vesicle with invaginated scolex
- liver granulomas adult: ribbonlike, tapelike segmented varying in size
o lead to obstruction, hepatomegaly, and portal with four suckers and circle of hooks arranged around
hypertension a rostellum
- MCC of death gravid proglottids: have 5-10 primary uterine
o exsanguination from ruptured esophageal branches
varices
YTAC, VENICE ANN BSN – 1G
 T. saginata Diphyllobothrium latum
cestode (tapeworm) – flat and segmented
CHARACTERISTICS
- “beef tapeworm” CHARACTERISTICS
- “fish tapeworm”
BASIC MORPHOLOGY - longest of the tapeworms
adult: ribbonlike, tapelike segmented varying in size
with four suckers but no hooklets/rostellum BASIC MORPHOLOGY
gravid proglottids: 15-25 primary uterine branches scolex: two elongated sucking grooves
proglottids: wider > long
LIFE CYCLE (T. species)
IS: cysticerci LIFE CYCLE
DS: gravid proglottids & egg IS: plerocercoid larvae
DH: man DS: gravid proglottids and egg
IH: pig (solium); cattle (saginata) DH: man
MOT: ingestion of cysticerci in undercooked pork or IH: (1) copepod; (2) fish
beef MOT: ingestion of plerocercoid larvae in undercooked
fish
cysticerci (muscles of pigs and cows) → will mature in
SI → adult worms attach to the mucosa of the SI by plerocercoid larva is ingested → will mature in SI →
means of its scolex (will suck the nutrients) → sexual adult worms attach to the mucosa of the SI by means
reproduction → gravid proglottids + eggs will detach of its scolex (will suck the nutrients) → sexual
and crawl out of anus → some of the eggs are reproduction → gravid proglottids + eggs will detach
discharged with the feces → soil → pig/cow ingests and crawl out of anus → some of the eggs are
the feces → further development in the SI of the discharged with the feces → freshwater → coracidia
animals → eggs will hatch → will develop and be → crustacean (copepod) – 1st intermediate host
called oncosphere → penetrates the intestinal walls o coracidia will develop into procercoid larva
of the animals → will be carried by the blood → → small fish – 2nd intermediate host
striated muscles → cysticerci o procercoid larva will develop into
**CYSTICERCI – the only stage that can cause plerocercoid larva
infection → bigger fish (salmon, trout, freshwater fish…) –
serves as the paratenic host
DISEASE o plerocercoid larva remains as is
Taeniasis
- mild intestinal symptoms DISEASE
- obstruction on vital organs by larva Diphyllobothriasis
Neurocysticercosis (T. solium) - mild intestinal symptoms
- if it reaches the brain - Vitamin B12 deficiency -> megaloblastic anemia
- T. solium cysts causes seizures, obstructive - Malnutrition
hydrocephalus
**NOT life threatening DIAGNOSIS
• Direct Fecal Smear
DIAGNOSIS o (+) proglottids
• Direct Fecal Smear o (+) egg
o (+) proglottids
o (+) egg
• MRI
o for neurocysticercosis

YTAC, VENICE ANN BSN – 1G