NEMATODES

Maricelle D. Manlutac, RMT, MPH, MLS (ASCPi)

Faculty
Nematodes/ Roundworms
 Adult: elongated, cylindrical, bilaterally symmetrical

 Anterior end: hooks, teeth, cutting plates, and papillae

 Complete digestive tract, No circulatory system

 Alimentary tract: tube extending from mouth to anus

 Supporting body wall:

a. Outer hyaline non-cellular cuticle
b. Subcuticular epithelium
c. Layer of muscles

 Dioecious- separate sexes

Adult Nematode

 Male adult is smaller than

female

 Male has dorsally curved

posterior while the posterior
end of female adult is not
sharply curved
Chemoreceptors
A. Amphids head cephalic chemoreceptors

B. Phasmids tail caudal chemoreceptors

Types of Females:

A. Oviparous- lays eggs that develop outside the

maternal body

B. Larviparous- give birth to a larva

C. Parthenogenetic- parasite that do not need male

 Life Cycle

EGG **LARVA ADULT

A. B. C.
 Nemathelminthes

Nematoda

Intestinal Species Intestinal-Tissue Species

 Ascaris lumbricoides  Trichinella spiralis
 Strongyloides stercolaris  Dracunculus medinensis
 Human Hookworms

 Trichuris trichiura **Blood Nematodes

 Enterobius vermicularis  Wuchereria bancrofti
 Brugia malayi
Groups according to presence of
Caudal structure:
Aphasmids Phasmids
a) Small intestine
a) Small intestine
 Ascaris lumbricoides
 Trichinella spiralis  Strongyloides stercoralis
 Capillaria philippinensis  Human hookworms

b) Large intestine
 Enterobius vermicularis
a) Large intestine
c) Blood and Tissue
 Trichuris trichiura  Wuchereria bancrofti
 Brugia malayi
 Loa loa
 Onchocerca volvulus
 Mansonella ozzardi

d) Larva migrans
 Animal Hookworm-A. braziliense &A. caninum
 Ascarid worms- T. cati & T. canis (dog Ascaris)
Ascaris lumbricoides

 CN: Giant intestinal roundworm

 Habitat: Small intestine

 FH: Man

 IS: Embryonated Ova

 DS: Egg/ Ova

 MOT: Ingestion
Ascaris lumbricoides: Eggs
Infertile Fertile
 88- 94 µm by 39- 44 µm  45- 70 µm by 35-50 µm

 Longer and narrower  Outer coarsely mammilated

albuminous covering
 Thinner shell **decorticated
 Irregular mammilated coating  Thick, transparent, hyaline
filled with refractile granules shell

 Delicate vitelline, lipoidal inner

membrane
Ascaris lumbricoides: Eggs
A. B.

 Corticated Fertilized  Decorticated Fertilized

C. D.

 Corticated Unfertilized  Corticated Unfertilized

Ascaris lumbricoides:
Fertilized Corticated Egg
Ascaris lumbricoides: Adult

 Appear as white, cream, or

pinkish yellow when fresh
 Large size
 Male: 10- 31 cm
 Female: 22-35 cm

 Head is provided with 3 lips, and a

triangular buccal cavity (Trilabiate)
 Males have ventrally curved
posterior end with two spicules
Ascaris lumbricoides: Female
Ascaris lumbricoides: Male
Ascaris lumbricoides
Ascaris lumbricoides

 Lab Dx: Stool Exam

A. DFS

B. Concentration
 Sedimentation- AECT, FECT
 Flotation- Brine flotation, Zinc sulphate (1.18) , Sugar flotation

C. Kato thick and Kato-Katz

 Pathology:
 Larval migration- eosinophilia, Ascaris pneumonia (Loeffler’s Syndrome)
 Mass of Adult worms- Obstruction, appendicitis
Ascaris lumbricoides: Pathology

 Lung infiltration

 Intestinal perforation and

obstruction

 Bowel obstruction

 Asthmatic attacks

 Abdominal pain
Epidemiology
 Ascariasis occurs in all ages, but
is most prevalent among children
5-9 age group

 Incidence is approximately same

for both sexes

 High risk groups includes public

school elementary children
Treatment and Prevention
 Albendazole, Mebendazole, and Pyrantel pamoate

 Mass drug administration

 Implement STH program (WASHED / WOW)

Trichuris trichiura

 CN: Whipworm

 Habitat: Large intestine

 FH: Man

 IS: Embryonated Ova

 DS: Egg/ Ova

 MOT: Ingestion
 Trichuris trichiura: Egg

 Bipolar mucus plug

 Barrel shape

Football shaped

 Japanese lantern shape

 Bile stained yellowish outer and

transparent inner shell

 3,000 to 10, 000 eggs produced

per day by a female adult
 Trichuris trichiura: Adult
 Attenuated whip-like anterior
traversed by a narrow
esophagus resembling a
string of beads

 More robust, thick and fleshy

posterior containing the
intestines and a single set of
reproductive organs

 Approx 30-50 mm

 Male has a coiled posterior

with a single spicule and
retractile sheath
Trichuris trichiura
 Lab Dx: Stool Exam

A. DFS

B. Concentration
 Sedimentation- AECT, FECT
 Flotation- Brine flotation, Zinc sulphate, Sugar flotation

C. Kato thick and Kato-Katz

 Pathology:
 Diarrhea, Dysentery, Abdominal discomfort, IDA
 Rectal prolapse
Trichuris trichiura: Pathology

 Dysentery

 Tenesmus-feeling of
constantly needing to
pass stools

 Anemia- pore forming

protein TT47 which
allows the whip-like
portion to imbed in the
intestinal wall

 Rectal prolapse
 Enterobius vermicularis

 CN: Seatworm/Pinworm/ Society Worm

 Habitat: Large intestine

 FH: Man

 IS: Embryonated Ova

 DS: Egg/ Ova

 MOT: Ingestion/ Inhalation/ Autoinfection /Retroinfection

Enterobius vermicularis: Egg

 Asymmetrical eggs with

one side flattened and
the other is convex

 “D-shaped”

 Tadpole like embryo

 Enterobius vermicularis: Female

 Migrate down the

intestinal tract and exit
through the anus to
deposit eggs on the
perianal skin usually at
night

 Dies after egg deposition

Enterobius vermicularis: Male
 Death occurs after
copulation
Enterobius vermicularis

 Lab Dx: **Stool Exam- NOT recommended

 Best: Perianal Swabbing: Cellulose/ Scotch Tape Swab

 Pathology:
 Intense nocturnal pruritus ani
 Secondary bacterial infection
 Insomnia
 Extra intestinal Enterobiasis
 “Mother’s Complex”
Perianal Cellulose Tape Swab

 Preferably done in the

morning before bathing and
defecation

 Repeated examinations is
recommended

 Need formal consent

Treatment and Prevention
 Mebendazole, Albendazole, or Pyrantel pamoate

 Good personal hygiene

 Fingernails should be cut short

 Proper hand washing

 Sharing of underwear, clothes, and blankets should

be discouraged
“Unholy Three”
Hookworms

Human Hookworms Animal Hookworms

 Necator americanus  Ancylostoma braziliense

 2 pairs of ventral teeth (outer
 Ancylostoma duodenale
pair is conspicuous and
other pair is less prominent)

 Ancylostoma caninum
 3 pairs of ventral teeth
Point of Difference Necator americanus Ancylostoma duodenale

1. Position of the head Anterior and strongly Anterior end continuous in

relaxed dorsally the same curve as the body

2. Buccal capsule 1 conspicuous dorsal 2 pairs of ventral teeth

pair of semilunar cutting
plates

3. Copulatory bursa Small with 2 prolonged Large with three prolonged

dorsal rays (Bipartite) dorsal rays (Tripartite)

4. Copulatory spicules Barbed / arrow head Simple/plain

5. Vuvla Anterior half of the body Posterior half of the body

Human Hookworm
Necator americanus Ancylostoma duodenale
 New World Hookworm  Old World Hookworm

 S- shaped  C- shaped

 Semilunar cutting plates  Two pairs of teeth

 Bipartite  Tripartite
Hookworms: Egg
Lab Dx

 DFS – heavy infection

 Kato thick and Kato katz technique

 Concentration technique

 Harada- Mori culture technique

 Culture method from a positive stool sample and allows release of
rhabditiform larvae
 Collection of larvae from eggs hatched on strips of filter paper with
one end immersed in water
Hookworms: Pathology
 Cutaneous: Ground / Dew itch (Mazza
Mora or Water sore) - severe itching

 Pulmonary: Pneumoniae (Wakana’s

disease) and alveolar haemorrhage

 Adult intestinal phase: Microcytic

Hypochromic Anemia
Strongyloides stercoralis

CN: Threadworm

Adult female: Parthenogenesis

Facultative Nematode which exist in two forms:

a. Homogenic- parasitic generation (Filariform)

b. Heterogonic- free-living generation (Rhabditiform)

Pathology: Cochin China Diarrhea/ Vietnam Diarrhea

 weight loss, abdominal pain, eosinophilia
 Intestinal mucosa- Honey comb appearance
Lab Dx
 Baermann funnel gauze

 Harada- Mori filter paper

culture technique

 Duodenal aspiration
(Beale’s string test)
Common Features:
Hookworms and Strongyloides stercoralis

 Habitat: Small intestine

 FH: Man

 MOT: Skin penetration

 IS: Filariform larva

 **Egg- difficult to distinguish

 Rhabditiform Stage

Hookworms Strongyloides stercoralis

Buccal Cavity: Long, equal to the Short, equal to ½ of

width of the body the body

Genital Primordium: Small or inconspicuous Prominent or Conspicuous

Esophagus: Deep and flask shape Club-shaped and muscular

 Filariform Stage

Hookworms Strongyloides stercoralis

Sheath: (+) Sheathed (-) Unsheathed

Tail: Pointed Notched/Forked

Capillaria philippinensis

 CN: Pudoc Worm / Mystery worm

 Habitat: Small intestine

 FH: Man/ Other vertebrate host

 IH: Glass fishes/ Brackish water fish (Bagsang, bagsit,

birot, ipon)

 DS: Ova/ Larva/ Adult

 IS: Larva in the IH

 MOT: Ingestion
 Eggs
Capillaria philippinensis Trichiuris trichiura

 Size Smaller Bigger

 Shell Striated Non-striated

 Shape Peanut; Barrel shaped;

Guitar shaped Japanese lantern

 Mucus plugs Flattened Prominent

Capillaria philippinensis: Egg
Capillaria philippinensis
Male
Female
A. Atypical Female
**Egg
 Sheated spicule
 Thin shell, non-striated
 Embryonated
 40-45 eggs/2-3rows
 Autoinfection

B. Typical Female
**Egg

 Has bipolar mucus plug

 Indented, striated
 Guitar/ peanut shaped
 8-10 eggs/single row
Capillaria philippinensis: Adult
Capillaria philippinensis
 Lab Dx:

1. DFS
2. AECT/FECT
3. Duodenal aspirate
4. Serologic tests

 Pathology
 Abdominal pain
 Diarrhea
 Malabsorption
 Borborygmi
Treatment and Prevention
 Mebendazole

 Electrolyte replacement

 High protein diet

 Improve sanitation and health education

Trichinella spiralis

 “Great Imitator”

 CN: Muscle worm/ Trichina worm

 DS/IS: Encysted Larva

 FH/IH: Pig, rat, man

 Habitat of Adult Small Intestine (subepithelial villi)

 Habitat of Larvae Encysted in skeletal Muscles

 MOT: Ingestion of meat with encysted larva

Trichinella spiralis: Encysted Larva
Trichinella spiralis: Adult
Male Female
 0.62 to 1.58 mm by 0.025 to  1.26 to 3.35 mm by 0.029 to
0.033 mm 0.038 mm
 With conical papillae  Club shaped uterus

 Larviparous / Viviparous
Trichinella spiralis: Lab Dx
1. Muscle Biopsy

2. Immuno Test

a. Bentonite Flocculation Test

b. Bachman Returns – intradermal test

c. Xenodiagnostic Test- BECK’S Test (Albino rats/ mice)

Trichinella spiralis: Pathology
 Intestine
 Nausea, vomiting, diarrhea, edema, and inflammation

 Larva migration
 Fever and eosinophilia

 Muscle
 Edema and pain at the site of encystation

 Local
 Retinal haemorrhage and rash
Treatment and Prevention
 Mebendazole or Albendazole

 Health education

 Food handling and thorough cooking

 Freezing to kill larvae