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ASCARIS LUMBRICOIDES
Giant intestinal round worm
Ascariasis intestinal
Loefflers syndrome pulmonary
Cosmopolitan; endemic in the tropics
and subtropics
1.3B infected; 73% in Asia exposed
Prevalent: 5 9 yrs old m=f
Areas of poor sanitation; crowded; feces
used as fertilizer
A. lumbricoides
Adult:
Male 10-31cm; female 22-35cm
Smooth finely striated cuticle
Conical anterior/posterior extremeties
Ventrally curved posterior end of male
with 2 spicules
Paired reproductive organs in female;
single in male
A. lumbricoides
Egg:
a.
Morphology
Female
Male
20-40 cm
15-30 cm
Fertilized Egg
Broadly ovoidal with thick shell
Vitelline membrane
Albuminous coat
75 cm
Unfertilized egg.
Prominent mamillations
of outer layer.
Fertilized egg.
The embryo can be distinguished
inside the egg
Pathology:
Immune reaction of host
Mechanical effects of adult worms
Effects of adult worms on the host
nutrition
Clinical presentation:
1. migrating larvae: lungs: Loefflers pneumonitis;
Loefflers syndrome transient pulmonary
symptoms accompanied by eosinophilia
Nutritional impairment
Growth impairment
3. allergic response
4. complications: Obstruction
Intussusceptions
Ectopic migration
Laboratory Diagnosis:
Stool examination
Direct fecal smear
Kato technique / cellophane thick method
Kato Katz technique or Modified Kato
technique
Ancillary methods
CBC
Chest X-ray
Treatment:
Supportive
Specific
Albendazole: 400mg single dose
Mebendazole: 500mg single dose
Pyrantel palmoate: 10mg/kg (max. 1gm
- Piperazine citrate: 150mg/kg initially,
followed by
65mg/kg at 12hrs
intervals for erratic worm migration
Enterobius vermicularis
A.k.a pinworm, seatworm or society
worm
Cosmopolitan distribution
An urban disease of children in
crowded environment.
Adults may get it from their children.
MORPHOLOGY
Cephalic alae
8-13 mm
2-5 mm
Lop-sided/ Plano-convex/
D-shaped
Colorless shell
50-60 m
LIFE CYCLE
Symptoms
Enterobiasis is relatively innocuous and
rarely produces serious lesions.
The most common symptom is perianal,
perineal and vaginal irritation caused by the
female migration.
The itching results in insomnia and
restlessness.
In some cases gastrointestinal symptoms
(pain, nausea, vomiting, etc.) may develop.
Diagnosis
Diagnosis is made by finding the
adult worm or eggs in the perianal
area, particularly at night.
Scotch tape or a pinworm paddle is
used to obtain eggs.
TRICHURIS TRICHIURA
WHIPWORM
Epidemiology
A tropical disease of children (5 to 15
yrs) in rural Asia (65% of the 500-700
million cases).
Morphology
The female organism is 50 mm long with a
slender anterior (100 micrometer diameter)
and a thicker (500 micrometers diameter)
posterior end.
The male is smaller and has a coiled
posterior end.
The Trichuris eggs are lemon or football
shaped and have terminal plugs at both
ends.
Whip-like
Barrel shaped
Two polar plugs
Yellow brown external layer
Clinical Presentation
Asymptomatic
Classical trichuriasis with dysentery
syndrome
Chronic trichuriasis ( >1 year)
Growth stunting; malnutrition
Rectal prolapse
Tenesmus
Geophagia
Finger clubbing (anemia; substance
secreted by parasite)
Chronic bloody mucoid stools
Abdominal pain
Pathology:
Anterior portions of the worms
embedded in the mucosa
Resembles ulcerative colitis
Allergy
Laboratory Diagnosis:
Stool examination:
Direct fecal smear
Kato cellophane thick smear
Kato-katz technique: egg
counting to determine cure rate,
egg reduction rate and intensity
of infection
Stool concentration ( acid ether;
formalin ether)
Treatment:
Albendazole: 400 mg single dose
Mebendazole: 500 mg single dose
* 100 mg bid for 3 days
Pyrantel palmoate
HOOKWORMS
Ancylostoma duodenale: OLD world
Necator americanus: NEW world
A. duodenale: Europe; Southwestern Asia
N. americanus: Africa, America
Hookworm infection/ disease
Cosmopolitan, tropical and subtropical
areas
900 million infected
50,000 deaths annually due to anemia
Morphology:
Adult:
N. americanus : 9-11mm x 0.35mm
: small, cylindrical, fusiform, grayish
: buccal capsule has a ventral pair of
Cutting plate
A.duodenale
: buccal capsule has two pairs of
curved ventral teeth
: bigger than N. americanus
Female
Male
Closed mouth
Filiform esophagus
sheathed
Pointed ends
Hookworm filariform larvae
(Infective stage)
Life Cycle
Clinical Presentation:
Cutaneous: ground itch dew itch
Creeping eruption (CLM)
Skin entry of filariform larvae
Pulmonary: Loefflers syndrome
Larval lung infection
Intestinal infection:
Acute heavy
Chronic hookworm
Hookworm Disease
Microcytic, hypochromic anemia from
hookworm infection (+)stool
examination
A. duodenale: 0.2ml blood/worm/day
N.americanus: 0.03 ml/blood/worm/day
Laboratory Diagnosis:
A. Stool examination
Direct fecal smear: low yield
Concentration technique;
Zinc Sulfate Centrifugal Floatation
Formalin-Ether Method
B. Stool Culture:
Harada Mori: culture method allowing
hatching of larva from eggs on strips
of filter paper with one end immersed
in water
Treatment:
Mebendazle: 100mg bid x 3days or
500-600mg single dose
Albendazole: 400 mg single dose
Pyrantel palmoate
Thiabendazole
STRONGYLOIDES
STERCORALIS
A.k.a Threadworm
Cochin-China diarrhea
Prevalent in tropical and subtropical
areas with poor sanitation.
Morphology
Has a free-living (rhabditiform) and
parasitic (filariform) form.
The rhabditiform is the feeding larval
stage
The filariform larva is the non feeding
and infective stage
Broadly fusiform
Pointed and curved tail
with 2 spicules
Rhabditiform larva
Life cycle
Autoinfection cycle
Rhabditiform larva
in the small intestine
Filariform larva
Penetrates skin
in perianal area
(External)
Penetrates the
small intestine
(Internal)
Pathology
A. Cutaneous stage:
Erythematous, serpinginous, pruritic
skin (creeping eruptions)
Larva currens if multiple
B. Larval form
Pneumonitis
C. Adult:
Honey-comb lesions of the
intestine
Diarrhea and abdominal pain
Laboratory Diagnosis
Stool examination
DFS has low yield (50 eggs/day)
Culture: sand/charcoal technique;
Baermans technique; Harada-Mori culture
Body fluids
Duodenal aspirate: Enterotest
Sputum; urine; ascitic fluid; CSF
CBC: hypereosinophilia
Treatment:
Abendazole: as drug of choice 400mg
for 3 days
Thiabendazole: 25 mg/kg in 3 divided
doses daily for 3 days
Capillaria philippinensis
Distribution: Philippines & Thailand
Host: Marine mammals- definitive host
fish: ingest eggs >
infective larva in muscles (in 3-4 wks)
Transmission: Ingestion of raw or
undercooked fish
Capillaria philippinensis
Capillaria philippinensis
Capillaria philippinensis
Pathogenesis & Clinical Diease
- adult: burrow in the jejunum wall
- inflammation & villi atrophy
> pain, diarrhea, malabsorption
Capillaria philippinensis
Diagnosis
- eggs in feces
Traetment
- Mebendazole: drug of choice
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