Parasitology

What is
Parasitology ??
 Parasitology

Parasitic Helminthes Arthropods Molluscs

Protozoa (worms)
Relationship between organisms
• Symbiosis: relationship between two dissimilar
organisms that are adapted to living together

• Mutualism: 2 organisms of different species live

closely together with each organism deriving some
benefits from the association

• Commensalism: one organism benefits but the

other neither benefits nor is harmed in the
relationship

• Parasitism: one organism is harmed and the other

benefits
 Helminth
• Morphology
• Distribution
• Life cycle
• Pathogenesis/clinical manifestation
• Laboratory diagnosis
• Prevention and control
• etc
 Pathogenesis and clinical
symptoms
3 possible factors may contribute to the severity of
a nematode infection

1. The number of worms present

2. The length of time the infection persists
Infections have been known to last up to 12 months or
longer (15 years for onchocerciasis)

3. The overall health of the host

 Symptoms
• Symptoms of nematode infection
may include:
–Abdominal pain
–nausea
–vomiting
–fever
–eosinophilia
 Control and prevention
• Parasitic diseases involve
– individuals
– the communities in which we live
– large geographical areas
Control programmes should involve all these
individual groups.
 Individuals
• 1. individuals
(a) education: education and methods of personal
hygiene,
– precautions against exposure, etc

(b) chemotherapy: may be employed in the parasitized

individuals
– to eradicate the infection and to relieve the suffering
of the patient
– to prevent transmission to other members of the
community.
 Community
• 2. Community:
– public health service should help the communities to
get safe drinking water
– provision of good sanitary and sewerage disposal,
methods directed against vectors and molluscs
intermediate hosts.
– to break the life cycle of the disease to reduce hazards
of the individuals and group exposure.
• Community mass chemotherapy:
– to prevent the vectors from acquiring and transmitting
the disease, eg. filariasis and malaria.
 Helminths and helminthic
infections
• There are 3 main groups of worms of
medical importance

1. Nematodes (round worm)

2. Trematodes (flukes)
3. Cestodes (tape worms)
 Nematodes (round worm)
• Unsegmented
• possess mouth
• Oesophagus and anus
• In general sexes are separate
• Reproduction is by oviparous and laviparous.
• Infection is by
– ingestion of eggs
– penetration of larvae through surface
– arthropod vector
– ingestion of encysted larvae
 Examples of nematodes

• Ascaris, hookworms, etc

• Wuchereria bancrofti
• Onchocerca volvulus
• Dracunculus medinensis
• etc
 Trematodes (flukes)
• Unsegmented
• leaf-like or cylindrical in shape
• generally hermaphroditic
• reproduction is digenetic-
– oviparous or multiplication within the larval worms.
• Infection is mainly
– by the larval stages entering intestinal tract
– and sometimes through skin.
• Except for blood fluke, trematodes have male
and female reproductive organs in the same
individual (hermaphroditic).
 Cestodes (Tape worms)
• Segmented
• possess scolex
• neck and proglottids
• They are hermaphroditic
• Reproduction is
– by oviparous or sometimes multiplication
within the larval form
• Infection is generally by ingestion of
encysted larvae
Cestodes of medical importance
• Taenia solium -Pork tapeworm
• Taenia solium - Cysticercosis
• Taenia saginata - Beef tapeworm
• Diphyllobothrium latum -Fish tapeworm
• Hymenolepis nana -Dwarf tapeworm
• Hymenolepis diminuta -Rat tapeworm
• Echinococcus granulosus -Unilocular hydatid cyst
• Echinococcus multilocularis –Alveolar hydatid cyst
 Intestinal nematodes
• Intestinal nematodes are among the most common and
widely distributed parasites of human.

• Most of the common nematode parasites of intestinal tract

of humans have direct life cycle in which transmission to
man occurs without intermediate host.

• Ascaris, hookworm, and whipworm are parasitic worms

known as Soil transmitted helminth (STH)

• Examples of intestinal nematodes are

– Ascaris lumbricoides
– Trichuris trichiura
– Strongyloides stercoralis, etc
 Ascaris lumbricoides
• Ascaris lumbricoides is the largest roundworm
parasitizing the human intestine.
• Adult females are about 20-35cm long and the
males about 15-30cm long.
• It is the most common human helminthic
infection.
• Distributed Worldwide.
• Has the highest prevalence in tropical and
subtropical regions, and in areas with
inadequate sanitation.
• About 807 million–1.2 billion people are
infected at a time
 Life Cycle
• Adult worms live in the lumen of the small
intestine.

• A female may produce approximately 200,000

eggs per day, which are passed with the feces.

• Unfertilized eggs may be ingested but are not

infective.

• Fertile eggs embryonate and become infective

after 18 days to several weeks, depending on
the environmental conditions (optimum: moist,
warm, shaded soil).
• After infective eggs are swallowed, the larvae hatch,
invade the intestinal mucosa, and are carried via the
portal, then systemic circulation to the lungs.

• The larvae mature further in the lungs (10 to 14 days),

penetrate the alveolar walls, ascend the bronchial tree to
the throat, and are swallowed.
• Upon reaching the small intestine, they
develop into adult worms.

• Between 2 and 3 months are required

from ingestion of the infective eggs to
oviposition by the adult female.

• Adult worms can live 1 to 2 years.

Life cycle of Ascaris lumbricoides
 Clinical manifestations
• Adult worms usually cause no acute
symptoms.

• Infections may cause stunted growth

• Migrating adult worms may cause symptomatic
occlusion of the biliary tract.

• During the lung phase of larval migration,

pulmonary symptoms such as
– cough, dyspnea, hemoptysis (coughing of blood),
eosinophilic pneumonitis - Loeffler s syndrome can
occur

Sensitive people may also develop asthma

attack
Adult roundworms migrating in the liver

Larvae migrating in the lung

 Laboratory Diagnosis
• Microscopic identification of eggs in the
stool.
• The recommended procedure is as
follows:
– Collect a stool specimen.
– Fix the specimen in 10% formalin.
– Concentrate using the formalin–ethyl acetate
sedimentation technique.
Examine a wet mount of the sediment.
 Unfertilized egg
Fertilized Ascaris egg mammillations of outer layer

Unfertilized egg with

no outer mammillated layer
Please read on Kato-katz test
• Larvae can be identified in sputum or gastric aspirate
during the pulmonary migration phase

• Adult worms are occasionally passed in the stool or

through the mouth or nose and are recognizable by their
macroscopic characteristics.

• Humans can also be infected by pig roundworm (Ascaris

suum).

• Ascaris lumbricoides (human roundworm) and Ascaris

suum (pig roundworm) are indistinguishable.

• It is unknown how many people worldwide are infected

with Ascaris suum.
Adult worm
 Prevention and control
Avoid ingesting soil that may be contaminated with human
or pig feces, including where human fecal matter (“night
soil”), wastewater, or pig manure is used to fertilize crops.
• Wash your hands with soap and water before handling
food.

• Wash your hands with soap and water after touching or

handling pigs, cleaning pig pens, or handling pig
manure.
• Teach children the importance of washing hands to
prevent infection.

• Supervise children around pigs, ensuring that they do

not put unwashed hands in their mouths.

• Wash, peel, or cook all raw vegetables and fruits before

eating, particularly those that have been grown in soil
that has been fertilized with manure.

• Transmission of Ascaris lumbricoides infection to others

in a community setting can be prevented by:
– Not defecating outdoors.
– Effective sewage disposal systems.
• Mass treatment of school children in
endemic areas
 Treatment
• There are many anti-helminthic drugs
• Eg.
– Melbendazole (vermox®): 100mg orally twice
daily for 3 days
– Albendazole (zentel®): A single dose of
200mg for children under 2 years and 400mg
for adults
– They are “over the counter” (OTC) drugs
– The drugs are effective and appear to have
mild or no side effects.
 Trichuris trichiura
(Whip worm)
• T. trichiura is common in areas where sanitation is poor.

• In endemic areas, small children often develop heavy

infection by eating contaminated soil.

• It is also prevalent among children of school going age.

• There are no intermediate hosts for T. trichiura so

human infections are acquired by ingesting the infective
stage derived from the human feces in contaminated
food, water and soil.
 Morphology
• The adult female is between 30 and 35 cm
long.
• The anterior end is thin and thread-like
and the posterior end is club-shaped
• The male is thin and thread-like at the
anterior end and the posterior end is coiled
in.
• The shape of the adult worm is whip-like,
hence, the name whipworm.
Adult males and females
 The egg
• The eggs of the whipworm are
unsegmented.
• When passed out, they have a thick brown
smooth shell.
• It has a clear knob or translucent knob on
each end.
• This gives the ova a "tea-tray"
appearance.
Life cycle of Trichuris
 Life cycle
• The unembryonated eggs are passed with the
stool.

• In the soil, the eggs develop into a 2-cell stage, an

advanced cleavage stage, and then they
embryonate

• Eggs become infective in 15 to 30 days.

• After ingesting contaminated soil through hands,

water or food, the eggs hatch in the small intestine,
and release larvae that mature and establish
themselves as adults in the colon.
• The adult worms (approximately 4 cm in length) live
in the cecum and ascending colon.

• The adult worms are fixed in that location, with the

anterior portions threaded into the mucosa.
•
• The females begin to oviposit 60 to 70 days after
infection.

• Female worms in the cecum shed between 3,000

and 20,000 eggs per day.

• The life span of the adults is about 1 year.

Life cycle of Trichuris
 Clinical manifestations
• Attachment of the adult worm to the colonic mucosa and
the subsequent feeding activities cause localized
ulcerations and hemorrhage.

• Ulcers may provide opportunity for the entry of enteric

bacteria and bacteremia may occur.
• With moderate worm load, damage to the
intestinal mucosa may induce nausea,
abdominal pains and bloody mucoid
diarrhea.

• In heavy infection, the colonic mucosa

may be damaged leading to blood loss,
anaemia, and bloody mucoid diarrhea.
• In children, heavy infection may cause
anal prolapse

– especially when the host strains during

defecation.

– The prolapse is due to edema of rectum,

produced by the number of worms embedded
in that area
• Appendicitis, brought about by blockage of
the lumen of the appendix by worms has
been frequently reported.
 Laboratory diagnosis
• Microscopic identification of whipworm
eggs in feces.
• A concentration method is useful in the
case of light infection.
• Look for double shelled, unsegmented ova
with 2 polar bodies.
 Prevention and control
• All infected persons should be treated
• Provision of adequate toilet facilities
• Proper environmental sanitation and
hygiene
• Proper disposal of human feces.
– Where it is to be used as manure, it should be
sterilized.
 Treatment
• Albendazole is the drug of choice in trichuriasis:
– An oral dose of 400mg per day for 3 days is recommended for
adults and 200mg for children under 2 years of age.

• Melbendazole (vermox®):
– 100mg orally twice daily for 3 days
– 500mg once
 Hookworm

• Hookworms belong to 2 genera.

– Necator
– Ancylostoma.
• The 2 species that infect man are
– Necator americanus
– Ancylostoma duodenale
 Epidemiology
• The second most common human helminthic infection
after ascariasis.
• They are mostly found in areas with moist, warm and
humid climate.
• Both N. americanus and A. duodenale are found in
Africa, Asia and the Americas.
• N. americanus predominates in the Americas and
Australia, while only A. duodenale is found in the Middle
East, Africa and southern Europe
• N. americanus is believed to have been introduced to
America through slave trade because N. americanus is a
native hookworm of Africa, South of the Sahara
 Morphology
• The adult worms are cylindrical and grayish white.
• Females (1cm) are larger than males.
• The most prominent difference between the 2 is in the
buccal cavity.
– N. americanus has ventral semilunar cutting plates
and
– and A. duodenale has 4 ventral teeth.
• Female A. duodenale produces about 10 000- 20 000
eggs per day
• N. americanus produces about 5 000-10 000 per day.
Necator: head
ventral semilunar cutting plates

Ancylostoma- Head

4 ventral teeth
 Ova
• The shape is oval with thin shell and it is
transparent.
• There is a clear space between the
embryo and the shell
• They are usually at 4-8-celled stage when
released
• The eggs from the 2 species are
indistinguishable from each other.
 Larval form
• They have 2 larval stages
– 1. Rhabditiform larvae
– 2. Filariform larvae

• The newly hatched first stage rhabditiform larva

that develops within the eggs is long, has a thick
wall, and narrow buccal cavity.

• The muscular eosophagus is flask-shaped and

occupies the anterior one-third of the body.

• Slender third-stage filariform larvae are 500-700

um long.
• The mouth is closed, and the elongated
eosophagus occupies one-third of the body.

• The tail is sharply pointed.

• Rhabditiform larvae of the 2 species cannot be

differentiated.

• But the filariform larvae of N. americanus have

dark, prominent spears and a striated cuticle
seen more clearly at the posterior end.
– These features are not found in A. duodenale.
Hookworm rhabditiform larva (wet preparation).
Hookworm filariform larva (wet preparation)
 Life cycle
• The life cycle is the same for both.
• Both the male and the female live attached to the
mucosa of the small intestine.
• They feed, develop and grow to maturity and mate to
produce eggs.
• The eggs are passed in the stool, and under favorable
conditions (moisture, warmth, shade), larvae hatch in 1
to 2 days.
• The released rhabditiform larvae grow in the feces
and/or in the soil, and after 5 to 10 days (after two molts)
become filariform (third-stage) larvae that are infective.
• These infective larvae can survive 3 to 4 weeks in
favorable environmental conditions.
• On contact with the human host, the larvae
penetrate the skin and are carried through the
veins to the heart and then to the lungs.

• They penetrate into the pulmonary alveoli,

ascend the bronchial tree to the pharynx, and are
swallowed.

• The larvae reach the small intestine, where they

reside and mature into adults.

• Adult worms live in the lumen of the small

intestine, where they attach to the intestinal wall
with resultant blood loss by the host.
• Most adult worms are eliminated in 1 to 2 years,
but can last for several years.

• Some A. duodenale larvae, following penetration

of the host skin, can become dormant in the
intestine or muscle.

• In addition, infection by A. duodenale may also

occur by the oral route.

• N. americanus, however, requires a trans-

pulmonary migration phase.
 Clinical manifestations
• At the site of the infection of the filariform
larvae, there is hypersensitivity reaction
characterized by itching (ground itch).

• In the intestine, the essential damage

caused by adult hookworm infection is
hemorrhage from the intestinal wall.

• In general blood loss is proportional to the

number of adult hookworm infection
• Iron deficiency anemia caused by the blood
loss at the site of intestinal attachment of the
adult worms is the most common symptom,
and can be accompanied by cardiac
complications due to acute anemia.
• Gastrointestinal and nutritional/metabolic
symptoms can also occur.

• During migration through the lungs,

respiratory symptoms such as cough and
pneumonitis can occur.

Larvae of hookworm in the lungs

• A. duodenale 3rd stage larvae infect
humans both by oral route and through
skin.

• When infection with A. duodenale occurs

by oral route, the early migrations of the
larvae cause a syndrome known as
Wakana disease.

• This is characterized by
– nausea, vomiting, pharangeal irritation,
cough, dyspnea, and hoarseness.
 Lab diagnosis
• Microscopic identification of eggs in the stool is the most
common method for diagnosing hookworm infection.
– Collect a stool specimen.
– Fix the specimen in 10% formalin.
– Concentrate using the formalin–ethyl acetate
sedimentation technique.
– Examine a wet mount of the sediment.
• Where concentration methods are not available, a direct
wet mount method can be done.
• Examination of the eggs cannot distinguish between N.
americanus and A. duodenale.
Control and prevention
 Control and prevention
• Treatment of all infected people.
• Provision of adequate toilet facilities and
proper disposal of human excreta.
• Provision of good balance diet for people
living in hookworm endemic areas.
• Health education and proper agricultural
practices.
• People must wear shoes.
 Treatment
• Albendazole is the drug of choice in hookworm infection:
– A single oral dose of 400mg is recommended for adults and
200mg for children under 2 years of age.

• Melbendazole (vermox®):
– 100mg orally twice daily for 3 days
– 500mg once

• In severe infections, 200mg ferrous sulfate 3 times daily

for 2-4 weeks should be administered.
 Cutaneous larva migrans

• Cutanous larva migran (creeping eruption)

is a dermatitis caused by
– larvae of Ancylostoma branziliense, the cat
and dog hookworm.
• They penetrate human skin and migrate in
the subcutaneous tissue.
• Ancylostoma caninum and other species
of hookworms can also cause this
infection.
• The third-stage hookworm larvae which can
penetrate unbroken human skin are found in the
soil contaminated with excreta from infected
animals

• As the larvae invade the skin, a tingling

sensation may be felt at the site of involvement.

• Proteolytic enzymes present in the larval

secretions may cause an inflammatory reaction
associated with the intense pruritus as the lesion
progresses.
 Symptoms /pathogenesis
• At the site of penetration by Ancylostoma larva,
– an erythematous pruritic papule usually develops within a few hours.
• This intensifies over the next few days, and develops into
a slightly raised erythematous serpiginous tract that
usually progresses at the rate of 1-2cm /day.
• Skin lesions may be single or numerous in massively
infected persons.
• The most frequent areas of skin involvement are the feet,
hands, buttocks, and genital areas.
• Lesions may become secondarily infected from
scratching.
• The larvae cannot reach the intestine to complete their life
cycle in their unnatural human host.
– However, they may migrate to the lungs where they produce
pulmonary infiltrates
 Control and prevention

• It is an occupational hazard for

– construction workers, plumbers, etc.

• Children who go barefoot or play in backyards can be

affected.
• Anyone who has skin contact with damp soil
contaminated with the excreta of infected dogs or cats is
subject to infection.

• Control of human infections is dependent on periodic

examination of dogs and cats for intestinal parasites,
appropriate treatment, and sanitary disposal of animal
excreta.
 Treatment

• Albendazole:
– 400mg orally for 3 days is the treatment of
choice.
• Ivermectin:
– 200ug/kg body weight daily for 1-2 days
 Strongyloides stercoralis
(Threadworm)
• Strongyloides infection like hookworm infection is
common in warm, humid and tropical environment where
people walk bare-footed

• Strongyloides stercoralis infection is almost similar to

that of hookworm under the same conditions.

• S. stercoralis resembles hookworm in morphology and

epidemiology but differ in the life cycle.

• The eggs of the S. stercoralis hatch into larvae in the

intestine before they pass out in the feces so eggs are
never seen in the feces-laviparous.
• The adult worm looks like a thread so it is
called threadworm.

• It has 2 larval stages: rhabditiform larval

stage and filariform stage.

• The rhabditiform has a short buccal cavity

and a prominent germinal primordium.

• The infective stage is the 3rd stage

filariform larvae.
Strongyloides stercoralis-Larva
Distribution of strongyloidiasis
• S. stercoralis has 3 types of life cycle.

1. Direct
2. Indirect
3. Autoinfection.
 Life cycle
• Both male and female live threaded in the
mucosa of the small intestine.

• The female lays eggs and the eggs hatch

into the first rhabditiform larvae

• The larvae migrate to the lumen of the

large intestine where they are passed out
into the environment
 Direct life cycle
• In the direct development, the 1st stage released into the
environment feed in the soil, grow and molt to reach the
3rd stage filariform larvae (infective stage).

• When the infective filariform larvae in the contaminated

soil come in contact with man, they penetrate the human
skin, especially between the toes.

• They enter the circulation and follow the pulmonary

course and are transported to the lungs where they
penetrate the alveolar spaces.

• They are coughed up and swallowed, and the adult

develop in the small intestine.
• The adult females burrow into the mucosa of the
duodenum and reproduce parthenogenetically.

• Each female produces about a dozen eggs each day

which hatch into rhabditiform larvae in the lumen of the
bowel.

• The rhabditiform larvae are passed in the stool and may

either continue the direct cycle by developing into
infective filariform larvae or develop into free-living adult
worms and initiate the indirect cycle.
 Indirect life cycle

• In the indirect development, the larvae in

the soil develop into free-living adults that
produce eggs and larvae several times.

• Several generations of these nonparasitic

existence may occur before new larvae
become skin penetrating parasites.
 Autoinfection
• In the autoinfection, rhabditiform larvae in the intestine
do not pass out with feces but become filariform larvae in
the lumen of the bowel.

• These larvae penetrate the intestinal and peri-anal skin

and follow the course through the circulation and
pulmonary structures, are coughed up and then
swallowed.

• They then become adults and produce more larvae in

the intestine.

• The cycle can continue for years and this can lead to
hyper-infection and can be fatal.
Life cycle of Strongyloides stercoralis
 Clinical manifestations
• When the infective larvae from the soil penetrate
the skin in large numbers, they may cause
pruritus or ground itch.
• Pneumonitis can result from larval lung invasion.
• In heavy infection, damage to the intestines may
be severe, with edema, inflammation, and
increased secretion of mucus.
• Epigastric pain, mucous diarrhea, and
eosinophilia may occur.
• Autoinfection may increase worm burden of
the intestine, leading to severe ulceration of
the mucosa

• Depending on the number of worms in the small

intestine, they may cause malabsorption and
obstruction leading to
– fatty diarrhea
– abdominal pain
– and weight loss.
 Lab diagnosis
• Several methods such as
• Microscopic identification of larvae (rhabditiform and
occasionally filariform) in the stool or duodenal fluid.
– Examination of serial samples may be necessary,
because stool examination is relatively insensitive.

– The stool can be examined in wet mounts or

concentration method can be used

• Culture in agar plates

• Larvae may be detected in sputum from patients with

disseminated strongyloidiasis.
Strongyloides stercoralis-Larva
Larvae of Hookworm and
Strongyloides
 Prevention and control
• All infected patients should be treated to
prevent autoinfection and potential
dissemination of the parasite
• Education
• Proper sanitation
 Treatment
• The drug of choice for the treatment of uncomplicated
strongyloidiasis is ivermectin.
• 200ug/kg body weight daily for 2 days

• Ivermectin does not kill the Strongyloides larvae only but also the
adult worms, so repeat dosaging may be necessary to properly
eradicate the infection.

• Other drugs that are effective are albendazole and thiabendazol

(400mg/kg twice daily for 2 days).

• All patients who are at risk of disseminated strongyloidiasis

should be treated.
 Enterobius vermicularis
(Pin worm)
• The pin worm is a small white worm which can affect
anybody.
• It is found in perianal region or vagina of infected children.
• It is found in families where several children sleep together
in one bed or people in institutionized centres.

• Pin worm is transmitted from hand-to-mouth after

– scratching the peri-anal region
– by handling contaminated bedding and night clothing
– by inhaling eggs in airborne dust

• The eggs usually contain mature larvae when passed out

and become infective in less than 6 hours.
• Exposure to the infection can occur in 3 main
ways.
1. Auto-infection by fecal –oral route.
The infected person may scratch the infected area
(perianal) with the fingers, pick the infective ova and
transmit it to himself through the mouth.
2. People sleeping in the same bed or room.
One person may infect fomites such as towels, bed
sheets, etc
3. Eggs that become airborne can be inhaled or
swallowed by many people.
 Morphology
• Ova
– The eggs are elongated with thick and
colourless shell.
– They have a colourless double shell
– an inner membrane and outer albuminous
membrane which causes the eggs to stick
together or to fomites, bedsheets, perianal
region of the infected person.
 Adult worm
• The adult female is about 8-13mm in
length and the male is 2-5mm.
• The adult male is smaller in size than the
female.
• It is cream in colour and has a pointed tail.
• The posterior end of the male is coiled.
 Life cycle
• The adult male and female live attached to the mucosa
of the colon.

• After mating the male dies, becomes calcified and

reabsorbed in the stool and passed out.

• The gravid female migrates out to the perianal area of

the skin of the infected person during the night when the
patient is asleep or in the day when the patient is
resting.

• It deposits a large number of eggs at the perianal area

of the host.
• One female may lay 20 000 eggs.

• The time interval from ingestion of

infective eggs to oviposition by the adult
females is about one month.

• The life span of the adults is about two

months.

• The larvae contained inside the eggs

develop to become infective in 4 to 6
hours under optimal conditions.
• Retroinfection, or the migration of newly hatched larvae
from the anal skin back into the rectum, may occur.

• Self-infection also occurs by transferring infective eggs

to the mouth with hands that have scratched the perianal
area.

• Person-to-person transmission can also occur through

handling of contaminated clothes or bed linens.

• Enterobiasis may also be acquired through surfaces in

the environment that are contaminated with pinworm
eggs (e.g., curtains, carpets, etc).
• Some small number of eggs may become
airborne and inhaled.

• These would be swallowed and follow the

same development as ingested eggs.

• Following ingestion of infective eggs, the

larvae hatch in the small intestine and the
adults establish themselves in the colon.
Life cycle of Enterobius vermicularis
 Clinical manifestations
• It is normally asymptomatic.

• Patients who are allergic to the secretions of the

migrating worms may experience pruritus
(severe itching) of the perianal area.

• This symptom is severe in the night during the

migration of the gravid female adult worm to lay
eggs.
• In severe infection, the intense itching,
scratching, excoriation and bacterial infection
may occur.

• In female patients, the adult worms may enter

the genital tract causing vaginitis,
granulomatosis, endometritis and salpingitis
(infection of the fallopian tube).

• The worm may carry bacteria into the urinary

tract causing bacterial infection of the urinary
tract.

• Some physicians also believe that pinworms can

cause appendicitis
 Lab diagnosis
• The ova of the E. vermicularis are normally not found in
the stool.

• Microscopic identification of eggs collected in the perianal

area is the method of choice for diagnosis.

• This must be done in the morning before defecation and

washing
– by pressing transparent adhesive tape ("Scotch test", cellulose-
tape slide test) on the perianal skin and then examine the tape
placed on a slide.

• Alternatively, anal swabs (a paddle coated with adhesive

material) can also be used.
• Eggs may be found, but less frequently, in
the stool, and occasionally are
encountered in the urine or vaginal
smears.

• Adult worms are also diagnostic, when

found in the perianal area, or during
anorectal or vaginal examinations.
 Control and prevention
• Observation of good personal hygiene
• Clipping of fingernails of children
• Proper washing of bed clothes.
• Children in large families should be
provided with separate beds and sleeping
clothes
 Treatment
• The condition can be treated with
– Albendazole: a single oral dose of 400mg
– Pyrantel pamoate: a single oral dose of 11mg/kg body
weight.

• Taking a second dose of medication two weeks

after the first will usually kill any pinworms that
might have hatched in the meantime, before they
are able to produce new eggs.