Introduction to helminth

Helminth means worm. Their motile activity is acc

oplished by wriggling movement. The helminth of med
ical importance belong to 3 classes: Nematoda, Trema
toda and Cestoda.

Geohelminths refer to the helminths which complet

e their life cycles not requiring the processes of the de
velopment in intermediate hosts. They have only one
host and a simple life cycle, such as ascarid, hookwor
m, pinworm and etc.

Biohelminths refer to those that have to undergo th

e development in intermediate hosts to complete their
life cycle , such as filaria, liver fluke, pork tapeworm a
nd so on.

Characteristics of Class Nematod

a
1. Body is non-segmented and cylindrical i
n shape.
2. Two sexes are separated. is larger with
a straight tail and a double set of reproduc
tive organs. is smaller with a curled tail
and a single set of reproductive organs.
3. With a complete digestive tract.
4. The body cavity is a protocoele.
5. Life cycle: infective stage is embryonated
egg or larva3.

Ascaris Lumbri
coides
Ascaris lumbricoides , common saying roun
d worm of man, is the largest of the intestin
al nematodes parasitizing humans. It is the
most common worm found in human. It is wo
rldwide in distribution and most prevalent th
rough out the tropics, sub-tropics and more p
revalent in the countryside than in the city

Morphology
Adult:
cylindrical in shape,
creamy-white or pinkish in color.
female : 20-35cm max
49cm. male : 15-31cm
more slender than the female.
The typical curled tail with a pair sickle like copulator
y spines. On the tip of the head there are three lips, c
omplete digestive tract.
Reproductive organs : tubular.
male has a single reproductive tubule.
female has two reproductive tubules and the vulva is
ventrally located at the posterior part of the anterior
1/3 of the body.

Adult worm of A. lumbricoides

The lips of Ascaris lumbricoides

The three lips are seen at the anterior end. The

margin of each lip is lined with minute teeth which are
not visible at this magnification.

Ascaris lumbricoides Lips

Copulatory spines of male

Egg:
5 aspects: size, color, shape, shell an
d content.
1. Fertilized eggs:
broad oval, brown, size 60 45m. shell is thicker a
nd consists of ascaroside, chitinous layer, fertilizing
membrane and mammillated albuminous coat staine
d brown by bile. The content is a fertilized ovum. Th
ere is a new-moon(crescent) shaped clear space at t
he each end inside the shell.

2. Unfertilized egg: Longer and slender

than a fertilized egg. The chitinous laye

r and albuminous coat are thinner than
those of the fertilized eggs without asc
aroside and fertilizing membrane. The
content is made of many refractable gr
anules various in size.

3. Decorticated eggs: Both fertilized an

d unfertilized eggs sometimes may lac
k their outer albuminous coats and are
colorless.

Fertilized egg of A. lumbricoides

Fertilized Ascaris Egg

A fertilized Ascaris egg,
still at the unicellular s
tage, as they are when
passed in stool. Eggs
are this stage when pa
ssed in thewhen passe
d in stool. Eggs are no
rmally at this stage wh
en passed in the stool

Fertilized Ascaris Egg

The ova begin fission

Embryonated Eggs of Ascaris

Freshly Passed Ascaris Eggs From fa

eces

The eggs may appear from light to dark b

rown in color.

Egg containing a larva, which will be

infective if ingested.

Unfertilized egg

The chitinous layer and albuminous coat are thinne

r than those of the fertilized eggs without ascarosid
e and fertilizing membrane. The content is made of
many refractable granules various in size.

Unfertilized egg

Unfertilized and Fertilized Eggs

Life Cycle
1.
2.
3.
4.
5.

Site of inhabitation: small intestine

Infetive stage: embryonated eggs
Route of infection: by mouth
No intermediate and reservoir hosts
Life span of the adult: about 1 year

Pathogenesis
There are two phase in ascariasis:
1. The blood-lung migration phase of the larva
e: During the migration through the lungs, the l
arvae may cause a pneumonia. The symptoms o
f the pneumonia are low fever, cough, blood-tin
ged sputum, asthma. Large numbers of worms
may give rise to allergic symptoms. Eosionophili
a is generally present. These clinical manifestati
on is also called Loefflers syndrome.

2. The intestinal phase of the adults.

The presence of a few adult worms in the lumen o
f the small intestine usually produces no symptom
s, but may give rise to vague abdominal pains or i
ntermittent colic, especially in children. A heavy w
orm burden can result in malnutrition. More serio
us manifestations have been observed. Wandering
adults may block the appendical lumen or the co
mmon bile duct and even perforate the intestinal
wall. Thus complications of ascariasis, such as int
estinal obstruction, appendicitis, biliary ascariasis,
perforation of the intestine, cholecystitis, pancreat
itis and peritonitis, etc., may occur, in which biliar
y ascariasis is the most common complication.

A large mass of Ascaris

biliary ascariasis

Intestinal obstruction

Diagnosis
Worm / Eggs
1. Ascaris pneumonitis: Examination of
s
putum for Ascaris larvae is sometimes succ
essful.
2. Intestinal ascariasis: Feces are examined
for the ascaris eggs.
Direct fecal film:
simple and effective.
The eggs are easily found using this way due to
a large number of the female oviposition, appr
oximately 240,000 eggs per worm per day. So
this method is the first choice.

Epidemiology
World wide distribution, very common in Indonesi
a.
Factors favoring the spread of the transmissi
on:
1. Simple life cycle.
2. Enormous egg production ( 240,000 eggs/ day/ female ).
3. These eggs are highly resistant to ordinary disinfectants
(due to the ascroside). The eggs may remain viable for
several years.
4. Social customs and living habits.
5. Disposal of feces is unsuitable.

Prevention and Treatment

1.Treatment to ascariasis: Mebendazole,
Albendazole, Pirantel Pamoat and Le
vamizole are effective.
2. Sanitary disposal of feces.
3. Hygienic habits such as cleaning of hand
s before meals.
4. Health education.

Trichuris Trichiura
(Whipworm)
Morphology:
Adult: The worm looks like a buggy whip, the anterior 3/5 i
s slender and the posterior 2/5 is thick. It is pinkish gray
in color. The female worm is 3-5 cm in length and has a lo
ng slender esophageal region. The male is smaller than th
e female and has a curved tail. The reproductive organs o
f male and female are all double tubule.
Egg: It is barrel or spindle in shape and 50 x 20m in size.
It is brownish and has a translucent polar plug at either e
nds. The content of the egg is an undeveloped cell

Adults of T. trichiura

Eggs of
T. trichiura
under the
high power

Life Cycle:
Site of inhabitation: cecum
Infective stage: embryonic egg
Infectve mode and route: passively
swallowed by the mouth
Without intermediate host and reservoir
host
The life span of the adult is about 35years.

Pathogenesis:

Light infection: Asymptomatic

Middle infection: Clinical manifestations ar
e usually abdominal pain, anorexia, di
arrhea, constipation .
Heavy infection: Bloody diarrhea, emaciati
on, prolapse of the anus may occur.

Diagnosis:

Discover the eggs in feces by

saturated brine flotation met
hod or direct fecal smear.

Treatment and preventio

n:
Same as those of ascariasis
Take Mebendazole 3 days for a
treatment course and repeat next
week