[PARASITOLOGY: PHASMID NEMATODES 2 DR.

AYOCHOK]
(...Continuation of STRONGYLOIDIASIS)

Epidemiology
Brazil and Columbia
Mental hospitals, prisons
More in adults
Philippines: male children and adolescents
Zoonotic: wild or domestic
o Raccoon, sheep, cattle, goat, dogs,
cats

Pathology and Symptomatology

Majority: benign, eosinophilia
Types of disease:
o Cutaneous due to larval migration
o Pulmonary due to larval migration
o Intestinal
a. Cutaneous lesions
Pruritus, erythema
Highly sensitized: migrate in skin, with
no lung migration
Larva currens (racing larva): linear
urticarial lesion
o Sudden onset
o Zone of progression: red,
tender, raised
o Older zone: wider, less red
o 12-48h course, then disappear
without desquamation or
pigmentation
b. Pulmonary lesions
Haemorrhages, cellular infiltration in
alveoli and bronchioles
Intensity of host tissue reaction
o Proportional to sensitization of
host to worm products
Pneumonia: severe reaction
o Delay in passage of worm
through lung parenchyma
o Autoinfection: larvae in sputum
o Seen as nodular infiltrates in
xray
Chronic bronchitis or asthma
symptoms
o Eggs, rhabditoid larvae in
sputum
c. Intestinal
Heavy infection: sloughing of large
patches of mucosa
Usually little damage
Abdominal pain, diarrhea

Malabsorption: concomitant
malnutrition
Chronic: gastritis to ulceration
(filariform larvae)
Granulomatous hepatitis (eggs)
Increased WBC, eosinophilia 5075%

Hyperinfection
Impaired balance between the hosts
immune mechanisms and parasites
reproduction
Protein-calorie malnutrition
Lepromatous leprosy
Cancer
Cirrhosis
Severe burns
Hypogammaglobulinemia
Absent peripheral eosinophilia poor
prognosis
Larvae into filariform stage in intestine >
lung migration > re-enter intestine >
parasitic adult females
o Numerous adult females
Ulceration and necrosis of small and large
intestines, perforation
Lung migration: pneumonitis
o Dyspnea, cyanosis, cough,
hemoptysis
o Respiratory distress
o Nodular infiltrates on x-ray
CNS: lethargy, coma
o Meningitis, brain infarct/abscess
Septicemia
o Intestinal bacteria in blood carried
by migrating larvae
Prognosis: poor
Diagnosis
Continued diarrhea, pain, peripheral
eosinophilia
Demonstration of parasite in feces
(rhabditoid or filariform larvae), sputum
(egg, rhabditoid, or filariform larvae),
gastric aspirate (egg, rhabditoid, or
filariform larvae), biopsy(all stages)
Serology: ELISA, indirect HA
Radiology: suggestive of Crohns Disease
o Coarsening of folds of duodenum
o Absent normal mucosal pattern
Treatment
Acute and chronic strongyloidiasis
o DOC: Ivermectin 200g/kg PO x 12d

[PARASITOLOGY: PHASMID NEMATODES 2 DR.

AYOCHOK]
Alternative: Albendazole 400 mg
PO bid x 7d
Hyperinfection/dissemination
o Ivermectin 200 g/kg/d PO until
stool and/or sputum exams are (-)
for 2 wks
Prognosis
o Good in chronic intestinal, larva
currens
o Poor in hyperinfection and absent
eosinophilia
o

1 . Ancylostoma duodenale
Old world hookworm

Morphology
Adults: stout, cylindrical, slightly
constricted anteriorly with characteristic
cervical curvature
o Pinkish or creamy gray
o Tough cuticle
o A pair of lateral cervical papillae
behind circumesophageal nerve
ring

HOOKWORMS

Order Strongylida

Introduction
Common features:
o Female: complex ovejector,
sphincter developed
o Male: caudal bursa, pair of spicules
o Claviform esophagus
o H-shaped excretory system
o Stoma without lips, with 6 lips or
with corona radiata
Bursate nematodes (phasmid)
4 superfamilies:
1. Ancylostomatoidea: Ancylostoma
and Necator
2. Strongyloidea
3. Trichostrongyloidea
4. Metastrongyloidea
2 most common hookworms of man:
a) Ancylostoma duodenale
Old world hookworm
Ventral cutting teeth
Development in lungs of
final host not essential
Filariform larva adult
(intestine)
b) Necator americanus
New world hookworm,
American Murderer
More serious in the
Philippines
Ventral cutting plates
Larval development in lungs
essential
Skin penetration

Males: 8-11 mm long x 0.4-0.5 mm

(shorter)
o Posterior body extended into
campanulate bursa supported by
fleshy rays
o 1 testis proceeds anteriad, winds
back and forth, turns posteriad as a
tubule
o Expands as seminal vesicle then as
muscular ejaculatory ducts
o 1 pair bristle-like copulatory spicule
regulated by muscles(retracted if
unused)
Females: 10-13 mm long x 0.6 mm
o Conoid posterior end with
subterminal anal opening
o Vulva midventral
o 2 ovaries (1 anterior, 1 posterior)
continuous at distal ends with
oviducts, then to seminal
receptacle
o To muscular ovejector to transverse
vagina to vulva
Buccal capsule
o Outer articulated portion, inner
fused portion
o Ventral/ upper: 2 fused teeth, outer
tooth larger, inner tooth with
median process
o Dorsal/lower: dental plate with
median cleft
Excretory system: carrying cell,
suspensory cell, pair of tubules from
buccal capsule to subcaudal area
o Drain to excretory canal
Notetakers:
Jackie Te
Diana Bandong

[PARASITOLOGY: PHASMID NEMATODES 2 DR.

AYOCHOK]

Rhabditiform Comparison

L: Filariform (L3) hookworm larva in a wet mount; R: Hookworm rhabditiform larva (wet preparation)

Highly magnified histologic section showing

hookworm (Ancylostoma sp) attached to the
intestine.

[PARASITOLOGY: PHASMID NEMATODES 2 DR.

AYOCHOK]

Ancylostoma
mouth

Ancylostoma duodenale

duodenale

[PARASITOLOGY: PHASMID NEMATODES 2 DR.

AYOCHOK]

Ancylostoma duodenale male (posterior

bursa)

Ancylostoma duodenale male

copulatory y