HELMINTHOLOGY

NEMATODA PLATYHELMINTHES
(ROUNDWORMS) (FLATWORMS)

Phasmidia Aphasmidia Flukes (Trematoda) Tapeworms

(Secernentea) (Adenophorea) (Cestodea)

Ascaris lumbrocoides Capilaria philippinensis Schistosoma spp. Diphyllobothrium latum

Enterobius Trichenella spiralis Clonorchis sinensis Taenia sagiinata
vermicularis Trichuris trichiura Opistorchis felineus Taena solium
Hookworms Fasciola hepatica Dipylidium caninum
Strongyloides Fasciola gigantica Hymenolepis diminuta
stercoralis Paragonimus Hymenolepis nana
Filarial worms westermani Echinococcus
Angiostrongylus Fasciolopsis buski granulosus
cantonensis Heterophyes
Anisakis spp. heterophyes
Metagonimus
yokogawai

NEMATODES CESTODES TREMATODES

Round worms Tape worms Flukes

●​ Unsegmented ●​ Segmented (Proglottids - ●​ Unsegmented

●​ Posses mouth, ‘strobila’ chain of ●​ Leaf-like or cylindrical
esophagus, and anus proglottids) ●​ Hermaphroditic
●​ Separate sexes ●​ Possess scolex, neck, ○​ Schistosoma
●​ Reproduction and proglottids ●​ Reproduction
○​ Oviparous ●​ Hermaphroditic ○​ Oviparous
○​ Larviparous ●​ Reproductive ○​ Multiplication
■​ Trichinella ○​ Oviparous within larval forms
■​ Microfilaria ○​ Sometimes ●​ Infection mainly by larval
●​ Infection by multiplication stages entering intestinal
○​ Ingestion of eggs within larval forms tract, sometimes through
○​ Penetration larvae ●​ Infection by incysted skin
through surfaces larvae
○​ Arthropod vector
○​ Ingestion of
encysted larvae

I.​ PHYLUM NEMATODA (ROUNDWORMS OR NEMATODES)

●​ Elongated, cylindrical with bilateral symmetry, unsegmented
●​ Complete digestive tract, muscular pharynx (triradiate), no circulatory system, separate sexes
(but some parthenogenetic)
●​ Sensory organs: anterior (amphids) and posterior (phasmids)

A.​ CLASS ADENOPHOREA (APHASMIDIA) - LACKS OF PHASMIDS

Nematodes Trichuris trichiura Trichinella Capillaria Capilaria hepatica

spiralis philippinensis

Other name Whipworm Trichina worm Pudoc worm Capillary liver worm

Egg Lemon-shaped, Egg: none Peanut-shaped, Lemon-shaped;

barrel-shaped, guitar-shaped; pitted golf ball
Japanese lantern; Larva: Coiled, with flattened appearance of outer
Spear-like tip bipolar plugs shell
with bipolar hyaline
 plugs Encysted in nurse
cells of striated
Yellow - brown color muscle

Adult worm A: attenuated and L: body consisting Small Resembles T.

whip-like, of esophagus filled trichiura
esophagus with stichosomes Males have
resembles string of sheathed spicule
beads (stichocytes) A: slender, with
small orbicular
P: more robust; nonpapillated
coiled (M) & bluntly mouth
rounded (F)
P: ventrally curved
Heavy infections of with 2 caudal alae
500 to 5000 worms (M) & bluntly
rounded (F)
Adult lays 100,000
egg/day

Reproductio Oviparus Viviparous Oviparous (typical) Oviparous

n
Viviparous
(atypical)

IS & DS IS: embryonated egg IS: encysted larva IS: larva in fish IS: embryonated
egg
DS: encysted larva DS:
(muscles) unembryonated DS: egg (liver
egg in feces biopsy)
 DS: unembryonated
egg in feces

Disease Trichuriasis Trichinellasis Intestinal Hepatic capilariasis

capillariasis
Trichinosis

Pathogenes Abdominal pain and Stage 1: Intestinal ”Mystery disease” Resembles

is; Clinical tenderness invasion infectious hepatitis
Manifestatio Intestinal
ns Weight loss Stage 2: Larval malabsorption
migration (in
Weakness muscles) Borborygmus

Mucoid or bloody Stage 3:

diarrhea Convalescence -
period of recovery
Ulcerative colitis

Severe anemia

Growth retardation

Peristalsis -
inflammation of
intestinal wall

Dysentery - due to
lacerations of
pin-fashion
attachment causing
bleeding

Rectal prolapse -
occurs among
children; high
number of worms in
the rectum leading
to edema; extruding
rectum outside of
anus

Dx Direct microscopy Muscle biopsy (for Direct microscopy Liver biopsy *if
(feces) encysted larva) (feces) found in feces:
spurious infection
Zinc Sulfate Beck’s (paratenic host)
Flotation Method xenodiagnoses
(albino rats)
Man (final host)
Bachman
MOT: Ingestion intradermal test -
injection of Ag
from larvae

Others Coinfection with A. Autoheteroxenous *autoinfection

lumbricoides *dead - end
infection First to discover in
3rd most common the Philippines
helminths (Pudoc, Ilocos
 Sur)

Treatment Mebendazole Rest

Adequate fluid
Albendazole intake
Fever reducers
Pain relievers

*Thiabendazole

Dioctophyme renale
●​ “Giant kidney worm”
●​ Egg: barrel-shaped, thick pitted gold ball appearance of shell
●​ Adult: blood-red cylindrical, bursa is bell-shaped with spicule
●​ Intermediate host: earthworms
●​ Paratenic host: fish and frogs
●​ Incidental host: man
●​ Pathogenesis: destruction of kidney tissues
●​ Diagnosis: urine
 A.​ CLASS SECERNENTIA (PHASMIDIA) - HAS PHASMIDS

Ascaris lumbricoides Enterobius Toxocara canis Toxocara cati

vermicularis

Other Giant intestinal Pinworm Dog ascaria Cat ascaria

name roundworm
Seatworm Dog roundworm Cat roundworm
-largest intestinal
nematode *autoinfection
-most common
nematode infection in
man

Egg Fertilized: golden Thick-walled, coiled Resembles Ascaris egg, but is larger
brown with 3 layer: larva inside D-shaped with thinner shell
-​ inner lipoidal or oval with one side
vitelline flattened, persimmon
membrane seed-like
-​ middle
transplant Colorless
glycogen
membrane
-​ outer coarsely
mammilated

Fully embryonated egg

when laid; matured
within 4 - 6 hours after
oviposition of gravid
female
 Unfertilized: longer and
narrower, no glycogen
membrane

Decorticated: no outer
albuminous layer

Adult Trilobate lips DT, IT, RO Resembles Ascaris, but smaller

Cephalic alae - Body is bent ventrally

movement and anchor
(anterior) ”Bow” cervical ”Arrowhead”
alae cervical alae
Esophageal bulb -
feeding and digestion

A: rarely seen because

it dies easily after
copulation

F: clear, pointed tail

resembles pinhead;
lays ~15,000 eggs a
day
IS & DS IS: embryonated egg IS: embryonated egg IS: embryonated egg

DS: unembrynated egg DS: embryonated egg DS: larva (affected tissue)
in feces (perianal area)

Disease Ascariasis Enterobiasis Toxocariasis

Oxyuriasis

Pathog ”Sandbox” infection S/Sx Visceral larva migrans (VLM)

enesis; ●​ Pruritus ani
Clinical Ascaris pneumonitis ●​ Insomia Ocular larva migrans
Manifes ●​ Restlessness
tations Loeffler’s syndrome -
increase of eosinophils Habitat: large
accumulated in lungs intestines
in due to parasitic
infection MOT:
Ingestion
Pot belly
Inhalation
-larval migration (can
be erratic - in other Retroinfection - newly
organs) hatched larvae migrate
back into the host

Autoinfection -
hand-to-mouth
transmission

Co-infection of
Dientamoeba fragilis

Diagnos Direct microscopy in Perianal swab Serology

is feces (Graham’s scotch tape
method)
Sputum sample (larva)

X-ray (Ascaris bolus)

Treatme Albendazole Mebendazole

nt
Mebendazole Albendazole

Pyrantel pamoate

Gnathostoma spinigerum
●​ Rust-colored, cephalic bulb, four rows of hook on bulb
●​ Ingestion of infective larvae in fish, birds, snakes
●​ Pathogenesis
○​ Gnathostomiasis
○​ VLM-like syndrome
○​ CNS involvement (eosinophilic myeloencephalitis)
●​ Diagnosis: tissue biopsy

Angiostrongylus cantonensis
●​ “Rat lung worm”
●​ Barber’s pole appearance
●​ Ingestion of infective larvae in snails and prawns
●​ Pathogenesis
○​ Eye invasion
○​ Eosinophilic meningoencephalitis

HOOKWORM Necator Ancylostoma Ancylostoma Ancylostoma

species americanus duodenale caninum braziliense

Other name New World Old World Dog hookworm Cat hookworm
hookworm hookworm

American Germ of Laziness

Murderer

Egg Oval Identical to Similar to Necator, but somewhat

Necator smaller
2-8 cell stage
Adult Head is sharply Head is slightly Similar to A. duodenale
bent, forming bent
hook shaped at
anterior end Female: longer
and stouter

Buccal capsule 1 median tooth 2 ventral pairs of 3 ventral pairs of 2 ventral pairs of
fused teeth teeth unfused teeth
pair of semilunar
cutting plates

Copulatory bursa Shape: longer S: short and S: large, S: as broad as

than broad broad flame-shaped long

Dorsal rays: deep R: shallow cleft, R: long and R: stunted

cleft, tips bipartite tips tripartite slender

2 spicules: fused 2 spicules:

and barbed unfused and not
barbed

IS & DS IS: filariform larva IS: filariform larva Ectoparasite (skin Ectoparasite (skin
only) only)
DS:
unembryonated
egg in feces

DS:
unembryonated
egg in feces
Disease Skin penetration Skin penetration Cutaneous larva migrans

Pathogenesis Ground itch Ingestion Creeping eruptions/ Serpiginous

tunnels
Clinical Coolie itch Wakana
Manifestations syndrome
Dew itch -​ pharyngeal
irritation
Loeffler’s and itching
syndrome

Iron deficiency
anemia

DOC:
Mebendazole
Pyrantel pamoate

Diagnosis Direct microscopy in feces

Caproculture: Harada—Mori technique

Strongyloides stercoralis
●​ ‘Threadworm“
●​ Free - living existence: both male and female
●​ Parasitic existence: only female (parthenogenetic)
●​ Life cycles:
○​ Direct: filariform larva (skin penetration) > blood > heart > lungs > esophagus >>> small
intestine > adult > egg > rhabditiform larva (feces)

○​ Indirect: free-living rhabditiform larva > adult > copulation > egg > embryonation >
rhabditiform larva

○​ Autoinfection: rhabditiform larva (in intestines) > filariform larva > skin penetration in
perianal area
●​ Pathogenesis: Strongyloidiasis
○​ Ground itch, Coolie itch, Dew itch, Loeffler’s syndrome
○​ Cochin-China diarrhea / Vietnam diarrhea, Larva currens
●​ Diagnosis:
○​ Direct microscopy in feces
○​ Caproculture: Harada - Mori technique, Baermann technique, Enterotest, Sputum, Urine

Hookworm Strongyloides stercoralis

Rhabditiform larva Long buccal cavity Short buccal cavity

Small genital primordium Large genital primordium

(conspicuous)
 Filariform larva Short esophagus long esophagus

Pointed tail Notched / Forked tail

FILARIAL PARASITES

Filarial Parasites Other name Preferred Habitat Vector Disease

Wuchereria Bancroft’s filaria Lymphatics Mosquito Filariasis (lower

bancrofti *Anopheles extremities) -
*Culex Elephantiasis
*Aedes Chylocoele
Chyluria
Tropical
Pulmonary
Eosinophilia
(TPE)

Brugia malayi Brugian filaria Lymphatics Mosquito Filariasis (upper

Malayan filaria *Mansonia extremities) -
similar to
Bancroftian
filariasis without
chyluria

Loa loa African eye worm Subcutaneous Mango fly / Deer Calabar swelling
tissues fly /Tabanid fly Fugitive swelling
*Chrysops

Onchocerca Convoluted filaria Subcutaneous Black fly/ Buffalo Blinding filariasis

volvulus Blinding worm tissues gnat River blindness
*Simulium Onchocercomata
damnosum Hanging groin
Leopard skin

Mansonella - Mesenteries Biting midges Calabar - like

perstans *Culicoides swelling
Kampala
Ugandan eye
worm

Mansonella Old name: Dermis, Biting midges Pruritic dermatitis

streptocerca Streptocerca subcutaneous *Culicoides
streptocerca tissues

Mansonella - Subcutaneous Biting midges Asymptomatic

ozzardi tissues *Culicoides

DIAGNOSIS

Species Specimen Periodicity Appearance Method

Wuchereria Blood Nocturnal CS: short Blood smear

bancrofti (10pm to 2am)
(Diurnally T: sheathed,
subperiodic) free from
nuclei

”graceful”
appearance

Brugia malayi Blood Nocturnal CS: long Blood smear

(Nocturnally
 subperiodic) T: sheathed,
two discrete
nuclei at tip of
the tail

Loa loa Blood Diurnal CS: short Blood smear

T: sheathed,
nuclei
irregularly
spaced to tip

Oncocerca Skin snips N/A CS: long Mozzoti test

volvulus
T: unsheathed,
free from
nuclei

Mansonella Blood Aperiodic CS: short Blood smear

perstans
T: unsheathed,
nuclei extend
to tip

Mansonella Skin snips N/A CS: long Mazzoti test

streptocerca
T: unsheathed,
nuclei almost
to tip

Bent in
Shepherd’s
crook, Walking
stick

Mansonella Blood Aperiodic CS: short Blood smear

ozzardi
T: unsheathed,
free from
nuclei

Mazzoti test - use of diethylcarbamazine to provoke intense pruritus because of dying microfilariae
Circulating Filarial Antigens (CFAs)
Ultrasonography (Filarial Dance Sign FDS)

Dracunculus medinensis
●​ Other names:
○​ Guinea worm
○​ Serpent worm
○​ Dragon worm
○​ Medina worm
○​ Fiery Serpent of Israelites
●​ Longest nematodes parasite that infect man
●​ Larva
○​ coiled
○​ rounded anterior end
○​ tapering pointed tail
●​ Adult
○​ Male - “catgut thread”
○​ Female - viviparous
●​ Intermediate host: Copepods (Cyclop, “water fleas”)
●​ Pathogenesis: blister formation

Dirofilaria immitis
 ●​ “Dog Heartworm”
●​ Very common filarial parasite in dogs
●​ Pathogenesis: almost all human infections come to medical attention as solitary, peripheral,
nodules in the lung (coin lesions), or subcutaneous nodules

Anisakis
●​ “Herring’s worm”
●​ Definitive hosts: dolphins and whales
●​ 3 Intermediate hosts:
○​ 1st: Copepods
○​ 2nd: Small fishes
○​ 3rd: larger fishes
●​ MOT: Ingestion of raw fish with larvae (e.g. sshimi)
●​ Pathogenesis: Granulomatous abscess