PARASITOLOGY LECTURE 3 - Nematodes • in the US frequency is greatest in the Appalachian

Notes from lecture, Zeibig (’97) and Murray (’98) Mountains and surrounding areas in the east, west and
USTMED ’07 Sec C – AsM south
III. Morphology
OUTLINE IN THE STUDY OF PARASITE
Unfertilized Egg
I. Nomenclature and synonyms
II. Geographic distribution
III. Morphology
IV. Life cycle
V. Pathology in the host
VI. Clinical symptomatology
VII. Laboratory diagnosis
VIII. Treatment
IX. Preventive measures

GENERALITIES decorticated unfertilized

egg
• helminths are multicellular and contain internal organ
systems
• nematodes are commonly known as the intestinal
roundworms

Morphology and Life Cycle Notes

- members of the class nematoda may assume three basic

morphologic forms: egg, larvae, and adult worms
- eggs vary in size and shape unfertilized egg
- the developing larvae located inside fertilized eggs Fertilized Egg
emerge and continue to mature; they are typically long
and slender
- sexes are separate
- the adult female worms are usually larger than the adult
males
- the adults are equipped with complete digestive and
reproductive systems
- life cycles of the nematodes are similar yet organism
specific
- infection may be initiated in one of two primary ways:
1. ingestion of the infected eggs
2. by burrowing through the skin of the foot
- the adult worms reside in the intestine where they
concentrate on obtaining nutrition and reproduction
- adult females lay eggs in the intestine
- eggs may be passed into the stool; once outside the
body, the larvae inside the eggs warm, moist soil and 2-4
weeks to mature

Laboratory Diagnosis

- through recovery of eggs, larvae and occasional adult very corticated mature egg mature egg
worms
- the specimens of choice vary by species and include
cellophane tape preparations taken around the anal
opening, stool, tissue biopsies and infected skin ulcers
- ELISA is available for the diagnosis of select nematode
organisms

Pathogenesis and Clinical Symptoms

- the following factors may contribute to the ultimate

severity of a nematode infection
1. the number of worms present
2. the length of time the infection persists
3. overall health of the host corticated mature egg
- with one exception, all of the nematodes may cause Adults
intestinal infection symptoms at some point during their
invasion of the host
- symptoms include: abdominal pain, diarrhea, nausea,
vomiting, fever and eosinophilia
- other symptoms: skin irritation, formation of blisters,
muscle involvement

ASCARIS LUMBRICOIDES

I. Nomenclature and synonyms

• Ascaris lumbricoides (as’kar-is/lum-bri-koy’deez)

• Common names: Large Intestinal Roundworm,
Roundworm of Man

II. Geographic distribution adult male

• most common intestinal helminth infection in the world

• susceptible are warm climates and areas of poor
sanitations
 accompanied by eosinophilia and O2 desaturation
• a tangled bolus of worms in the intestines may cause
obstruction, perforation and occlusion of the appendix

VI. Clinical symptomatology

adult female • Asymptomatic : patients infected with a small number

IV. Life cycle of worms (5-10) will often remain asymptomatic
• Ascaris/Roundwrom infection : patients who develop
1. infection begins following the ingestion of symptomatic ascariasis may be infected with as few as a
infected eggs that contain viable larvae single worm
2. inside the small intestine the larvae emerge o Intestinal phase
from the eggs
 may produce tissue damage;
secondary bacterial infection may
occur following worm perforation
 Px infected w/ many worms may
exhibit vague abdominal pain,
vomiting, fever and distention
 Discomfort from adult worms exiting
the body through anus, mouth or
nose may occur
 Protein malnutrition
o Pulmonary phase
 Low-grade fever
 Cough
 Eosinophilia
 Pneumonia
 Asthmatic reaction

VII. Laboratory diagnosis

• specimen of choice for the recovery of Ascaris

lumbricoides eggs is stool
• adult worms may be recovered in several specimen
types, depending on the severity of infection, including
the small intestine, gall bladder, liver and appendix
• adult worms may be present in stool, womited, or
removed from external nares
• ELISA is also available

VIII. Treatment

• several medications:
o mebendazole
3. the larvae complete a liver-lung migration by o pyrantel pamoate
first entering the blood via penetration o levamisole
through the intestinal wall o peperazine citrate
4. first “stop” is the liver • intestinal tract obstruction
5. continues through the blood stream to second o combo of drug therapy and nasogastric
“stop,” the lung suction, or surgery
6. once inside the lung, the larvae burrow their • pulmonary discomfort
way through capillaries into the alveoli o corticosteroids
7. migration to bronchioles IX. Preventive measures
8. larvae are transferred through coughing into
the pharynx • Avoidance of using human feces as fertilizer
9. are swallowed and returned to the intestines • Proper sanitation and personal hygiene
• adult worms take up residence in the small intestine
• adults multiply and a number of resulting undeveloped
eggs (up to 250,000/day) are passed in the feces HOOKWORM
• soil provides the necessary conditions for the eggs to
embryonate NECATOR AMERICANUS/ANCYLOSTOMA DUODENALE
• infective eggs remain viable for years
• eggs are not easily destroyed by chemicals
GENERALITIES
• Infective stage: embryonated eggs
• “hookworm” refers to Necator americanus and
V. Pathology in the host Ancyclostoma duodenale
• 2 primary differences between the two organisms
• a worm can migrate into the bile duct and liver and o geographic distribution
damage tissue o adult worms of each have minor morphologic
differences
• because the worm has a tough, flexible body, it can o eggs, larvae stages are indistinguishable
occasionally perforate the intestine, creating peritonitis
with secondary bacterial infection
• the adult worms do not attach to the intestinal mucosa I. Nomenclature and synonyms
but depend on constant motion to maintain their
position w/in the bowel lumen
• Necator americanus (ne-kay’tur/ah’merr”i-kay’nus)
• migration of worms to the lungs can produce
pneumonitis resembling an asthmatic attack • Common name: New World Hookworm
• migration can occur in response to fever, drugs other
than those used to treat ascariasis and some anesthetics • Ancylostoma duodenale (an”si’los’tuh’muh/dew”o-de-
• pulmonary involvement is related to the degree of nay’lee)
hypersensitivity induced by previous infections and the • Common name: Old World Hookworm
intensity of the current exposure and may be
 II. Geographic distribution/Epidemiology Hookworm filariform larva

• nearly ¼ of the world population is infected w/ Adults

hookworm
• frequency of hookworm is high in warm areas where the
inhabitants practice poor sanitation practices
• mixed infections w/ any combo of hookworm, Trichuris
and Ascaris is possible because all organisms require the
same soil conditions
• Necator is primarily found in North and South America
o Also exist in China, India and Africa
• Ancylostoma is a parasite of the Old World
o Found in Europe, China, Africa, South America
and Caribbean

III. Morphology

Eggs

Necator americanus adult male

Hookworm egg
400x

Necator americanus buccal capsule

Hookworm egg
Rhabditiform Larvae

Ancyclostoma duodenale adult female

IV. Life cycle

Hookworm rhabditiform larva

Hookworm rhabditiform larva 400x close up of buccal cavity

Filariform Larvae

short esophagus

1. humans contract hookworm when third-stage

filariform larvae penetrate through the skin,
particularly into areas such as unprotected
Pointed tail
feet
 2. inside the body, the filariform larvae migrate • drugs of choice : mebendazole or pyrantel pamoate
to the lymphatics and blood system
• for asymptomatic infections : iron replacement and/or
3. blood carries the larvae to the lungs where other dietary therapy (proteins, iron, vitamins)
they penetrate capillaries and enter alveoli
4. migration of larvae continues into the IX. Preventive measures
bronchioles where they are coughed into the
pharynx, swallowed and deposited into the • similar to those of Ascaris
intestines
• proper sanitation, fecal disposal
• maturation occurs in the intestine
• prompt treatment
• adults live and multiply in the S.I.
• personal protection
• females lay 10,000 to 20,000 eggs per day
• eggs are passed into the outside environment via feces
• first-stage rhabditiform larvae emerge from eggs w/in STRONGYLOIDES STERCORALIS
24-48 hrs in warm, moist soil
• larvae continue to develop by molting two times I. Nomenclature and synonyms
• Infective stage: third-stage filariform larvae
• Strongyloides stercoralis (stron”ji-loy’deez/stur”kor-
V. Pathology in the host ray’lis)
• Common name: Threadworm
• human phase of hookworm life cycle is initiated when a
filariform (infective form) larva penetrates intact skin II. Geographic distribution
• egg laying is initiated 4 to 8 weeks after the initial
exposure and can persist for 5 years • found predominantly in tropics and subtropics
• on contact w/ soil, the rhabditiform (noninfective) larva III. Morphology
are released from the eggs
• the rhabditiform larva develop into filariform w/in 2 Eggs
weeks
• both species have mouthparts designed for sucking blood
from injured intestinal tissue
• A. duodenale has chitinous teeth
• N. americanus has shearing chitinous plates

VI. Clinical symptomatology

Rhabditiform Larvae
• Asymptomatic Hookworm infection: does not exhibit
clinical symptoms
• Hookworm Disease/Ancylostomiasis/Necatoriasis :
patients who are repeatedly infected may develop
intense allergic itching at the site of hookworm
penetration known as ground itch; other symptoms:
 Sore throat rhabditiform larva 400x
 Bloody sputum
 Wheezing
 Headache
 Mild pneumonia w/ cough
o Intestinal phase
 Symptoms depend on # of worms
present
 Chronic infections (light worm
burden ~500 eggs/g feces)
• Vague mild GI symptoms Strongyloides stercoralis rhabditiform larva
• Slight anemia
• Weight loss or weakness Strongyloides stercoralis
 Acute infections (greater than 5000 rhabditiform larva, close-up of
eggs/g feces) anterior end showing a typical
• Diarrhea short buccal cavity
• Anorexia
• Edema
• Pain Filariform Larvae
• Enteritis
• Epigastric discomfort
• Patients may develop a
microcytic hypochromic
iron deficiency
• Weakness
• Hypoproteinemia
• Mortality due to blood loss

VII. Laboratory diagnosis

• primary means is by recovery of the eggs in stool

samples
• larvae may mature and hatch from the eggs in stool that
has been allowed to sit at room temperature w/o
additive fixatives
• recovery and examination of the buccal capsule is Strongyloides stercoralis filariform larva
necessary to determine the specific hookworm organism Adult
• reverse enzyme immunoassay for specific IgE

VIII. Treatment

IV. Life cycle
• unlike in the hookworm life cycle, where eggs are the
primary morphologic form seen in feces, in the
threadworm life cycle rhabditiform larvae are usually
passed in the feces
• eggs are only occasionally found
• the rhabditiform larvae develop directly into the third-
stage infective filariform larvae (in soil)
• remaining phases of the threadworm life cycle mimic
those of the hookworm
• there are 3 possible routes threadworms may take in
their life cycles:
o direct
 a skin-penetrating larvae enters the
circulation and follows the
pulmonary course
 adults develop in the small intestine
 adult females burrow into the
mucosa of the duodenum, and
reproduce parthogenetically
 @ female produces about 1 dozen
eggs/day
 eggs hatch w/in the mucosa and
releaserhabditiform larvae into the
lumen of the bowel
 rhabditiform larvae are
distinguished from hookworms by:
• short buccal capsule
• large genital primordium
 rhabditiform larvae are passed into
the stool and may either:
• develop into filariform and
continue the direct cycle
• develop into free-living
adult worms and initiate
indirect cycle
o indirect
 Rhabditiform larvae are passed into
the outside environment (soil) and
mature into free-living adults that
are nonparasitic
 Adult females produce eggs that
develop into the rhabditiform larvae
 Larvae mature and transform into
the filariform at w/c time they may
either initiate a new indirect cycle
or become infective
 Several generations of this
nonparasitic existence may occur
before new larvae become skin-
penetrating
o Autoinfection
 Occurs when the rhabditiform larvae
develop into the filariform stage
inside the intestine of the host
 Penetrate the intestinal or perianal
skin and follow the course through
the circulation and pulmonary
structures-coughed-swallowed
(become adults)
 The larvae may then enter the
lymphatics or blood stream
 Persist for years and can lead to
hyperinfection and massive or
disseminated, fatal infection
• S. stercoralis differs from the life cycle of hookworms in
three aspects:
1. eggs hatch into larvae in the intestine before
they are passed in feces
2. larvae can mature into filariform in the
intestines and cause autoinfection
3. a free-living, nonparasitic cycle can be
established outside the human host
V. Pathology in the host
• Heavy worm loads may involve the biliary and
pancreatic ducts, the entire small bowel and colon
o Causes inflammation and ulceration leading to
epigastric pain and tenderness, vomiting,
diarrhea and malabsorption
• Symptoms mimicking peptic ulcer disease coupled w/
peripheral eosinophilia
• Individuals w/ chronic strongyloidiasis are at risk of
developing severe, life-threatening hyperinfection
syndrome if the host-parasite balance is disturbed by
any drug or illness that compromises the immune status
• Hyperinfection syndrome:
o Seen in individuals immunocompromised by
malignancies and those undergoing
corticosteroid therapy
o Also observed in Px who have undergone solid
organ transplantation and in malnourished
people
o Intestinal symptoms: diarrhea, malabsorption,
and electrolyte abnormalities
o Fatal complications: bacterial sepsis,
meningitis, peritonitis and endocarditis
• Loss of cellular immune function may be associated w/
the conversion of rhabditiform larvae to filariform
larvae, followed by dissemination of the larvae via the
circulation to virtually any organ
• Extraintestinal infection involves the lung and includes
bronchospasm, diffuse infiltrates and cavitation
• Widespread dissemination that involves the abdominal
lymph nodes, liver, spleen, kidneys, pancreas, thyroid,
heart, brain and meninges
VI. Clinical symptomatology
• Asymptomatic: patients infected w/ only a light
infection often remain asymptomatic
o Usually seen in intestinal infections
• Strongyloidiases/Threadworm infection:
o Most common symptoms include diarrhea and
abdominal pain
o Also exhibit urticaria accompanied by
eosinophilia
o Additional intestinal symptoms may occur such
as vomiting, constipation, weight loss, and
variable anemia
o Malabsorption syndrome for Px w/ heavy
infection
o Site of larvae penetration may become itchy
and red
o Recurring allergic reactions
o When larvae migrate to the lungs, Px may
develop pulmonary symptoms
 o Pneumonitis from migrating larvae
o Immunocompromised persons
 Severe autoinfections lead to spread
of larvae throughout the body
 Increased secondary bacterial
infections
 Death

VII. Laboratory diagnosis

• diagnostic eggs, often indistinguishable from those of

hookworm, may be present in stool samples from
patients suffering from severe diarrhea
• stool concentration with zinc sulfate has successfully
recovered these eggs
• rhabditiform larvae may be recovered in fresh stool
samples and duodenal aspirates
• careful screening of feces is necessary to differentiated
rhabditiform larvae of hookworm from Strongyloides
• Enterotest and ELISA -fin-
• Sputum samples have yielded Strongyloides larvae in
patients suffering from disseminated disease audsmartinez@gmail.com
ustmedc3@yahoogroups.com
VIII. Treatment

• Thiabendazole although not always successful

• Alternative medications include: albendazole and
ivermectin

IX. Preventive measures

• same as hookworm
• proper handling and disposal of fecal material and
adequate protection of the skin from contaminated soil

GNATHOSTOMA SPINEGERUM (SPINIGERUM)

* can’t find any chapter or topic that discusses this parasite. The closest was in
reference to the Copepods of the phylum Arthropoda…

GENERALITIES
• The arthropods are the largest of the animal phyla
• Phylum Arthropoda comprises invertebrate animals w/ a
segmented body, several pairs of jointed appendages,
bilateral symmetry, and a rigid, chitinous exoskeleton
that is molted periodically as the animal grows
• Arthropods develop from eg to adult by a process known
as metamorphosis
• They pass through several distinct morphological stages
including egg, larvae, pupa and adult
• 5 important classes
o Chilopoda
o Pentastomida
o Crustacea
 Copepods
 Decapods (crabs, crayfish)
o Arachnida
o Insecta

Copepods
• are small, simple aquatic organisms
• lack a carapace, have one pair of maxillae, and have 5
pairs of biramous swimming legs
• are intermediate host in the life cycle of several human
parasites including:
o Dracunculus medinensis
o Diphyllobothrium latum
o Gnathostoma spinigerum
o Spirometra species
• Epidemiology
o Worldwide distribution
o Serve as intermediate hosts for helminthic
diseases in the US and Canada
o Human infections result from ingesting water
contaminated with copepods or from eating
the raw or insufficiently cooked flesh of
infected fish