NEMATODES

CHAPTER
15
 Learning
objectives:
At the end of this chapter, the student should
be able to:
1. describe the general characteristics of the
medically important nematodes; and
2. characterize the different nematodes as to
their:

a. general features,
b. source of infection,
c. mode of transmission,
d. clinical manifestations,
e. treatment, and
f. prevention and control of infection.
 Nematode
s
Nematodes or roundworms are
unsegmented, bilaterally
symmetrical worms with elongated,
cylindrical bodies. They have
separate sexes, with females being
larger. A cuticle covers the body,
and long muscles beneath help
them move side to side.
INTESTINAL NEMATODES IN THE PHILIPPINE

• In the Philippines, common • Mode of Transmission:

intestinal nematodes - Ingestion of embryonated ova
include: (Ascaris, Trichuris, Enterobius)
- Ascaris lumbricoides
- Skin penetration (Necator,
- Trichuris trichiura
Ancylostoma, Strongyloides)
- Necator americanus
- Enterobius vermicularis
- Ingestion of raw/undercooked
- Ancylostoma duodenale
fish (Capillaria)
- Strongyloides stercoralis
- Capillaria philippinensis
(endemic in Northern Luzon)
BLOOD AND TISSURE
NEMATODES
• Blood and tissue nematodes do not stay in the intestines. They
travel through blood or affect body tissues.

• Important examples in the Philippines:

1. Wuchereria bancrofti – causes lymphatic filariasis (elephantiasis);
mosquito-transmitted.
2. Brugia malayi – another cause of filariasis; also via mosquito bite.
3. Trichinella spiralis – causes trichinosis; from eating
raw/undercooked pork; affects muscles.

• These infections may lead to swelling, muscle pain, or severe

organ complications if untreated.
INTESTINAL
NEMATODES
 ASCARIS
LUMBRICOIDES
Ascaris is the largest
intestinal roundworm.
Infection occurs by
ingesting embryonated
eggs from contaminated
food or water. Mild
infections are often
asymptomatic, but heavy
infections can cause
allergic reactions (e.g.,
Löffler’s syndrome),
abdominal pain, vomiting,
or intestinal obstruction.
ENTEROBIUS VERMICULARIS

Also called pinworm, it

causes enterobiasis.
Infection spreads
through ingestion of
eggs. Females lay
eggs around the anus
at night, causing
itching.
PATHOGENESIS AND TREATMENT AND
DIAGNOSIS PREVENTIONS

• Pinworm is common in
children and crowded • Treatment: Albendazole,
places. mebendazole, or pyrantel
pamoate. Household
• Main symptom is anal members should be treated.
itching.
• Prevention involves hygiene,
• Diagnosis is confirmed cleaning of beddings, and
using the Scotch Tape using damp cloths to clean
surfaces.
method.
TRICHURIS TRICHIURA (HUMAN
WHIPWORM)
Also known as
whipworm, identified by
foot ball or barrel-
shaped eggs with polar
plugs.

Heavy infections may cause

dysentery, anemia, and
growth retardation in
children. Rectal prolapse
and inflammation may
occur. In adults, symptoms
resemble inflammatory
bowel disease.
 ANCYLOSTOMA DUODENALE (OLD WORLD
HOOKWORM) & NECATOR AMERICANUS (NEW
WORLD HOOKWORM)
Epidemiology and Pathogenesis
Infection occurs through
skin contact with
contaminated soil, often
by walking barefoot.
Symptoms include skin
irritation at the entry
site and lung
 HOOKWORM INFECTION

Skin penetration by filariform

larvae causes a pruritic lesion
called "ground itch." During
the lung phase, pneumonia
with eosinophilia may
develop. As the worms feed
on blood, they may cause
microcytic, hypochromic
anemia similar to iron
deficiency anemia.
 Strongyloides stercoralis
(Threadworm)
Characteristics and Life Cycle: Epideniology and
Pathogenesis
Strongyloides stercoralis eggs Threadworm infection is found
resemble hookworm eggs but are worldwide, especially in tropical,
smaller and contain well-developed subtropical, and warm
larvae. Its rhabditiform larva has a temperate regions. It is common
longer buccal cavity and a smaller in agricultural areas where
genital primordium than that of frequent soil contact occurs.
hookworms. The infective stage for
both is the filariform larva, but
Strongyloides' filariform has a longer
esophagus and a notched tail, while the
hookworm’s has a pointed tail.
 STRONGYLOIDIASIS
(COCHIN CHINA
DIARRHEA)
• In light infections of Strongyloides stercoralis, patients
are usually asymptomatic. However, skin irritation may
occur at the site where larvae penetrate the skin. As
larvae migrate through the lungs, they may cause
pneumonitis, similar to that seen in hookworm and
Ascaris infections.
• When a high number of adult worms are present in the
intestines, patients may experience: Diarrhea, This results in:
abdominal pain - Malabsorption syndrome, Steatorrhea
(fat in the stool), Nutrient deficiencies,
Epigastric pain and tendernes,
• Some individuals develop recurrent allergic reactions
Persistent or increasing diarrhea
due to the parasite, leading to: Urticaria (hives),
Eosinophilia In some cases, this condition may be
mistaken for peptic ulcer disease.
• In severe cases due to autoinfection, a hyperinfection
Laboratory Diagnosis
• Eggs are rarely seen in stool but may be present in cases of
heavy worm burden with severe diarrhea.
• The primary diagnostic method is the detection of rhabditiform
larvae in fresh stool samples
Treatment
• ivermectin with mebendazole and thiabendazole

Prevention and Control

• health education of the population at risk, proper sanitation and
sewage disposal, wearing of protective footwear, and prompt
treatment of infected individuals.
 CAPILLARIA PHILIPPINENSIS (PUDOC WORM)

Important Characteristics and Life Cycle

The parasite was first identified in the Philippines in 1963, with

outbreaks causing over 100 deaths by 1968. Unlike other
intestinal roundworms, its natural hosts are migratory fish-
eating birds. Eggs are passed in feces into freshwater, where
they become embryonated and are ingested by fish (commonly
bagsit in Ilocos). Humans get infected by eating raw or
undercooked freshwater fish. In the intestines, larvae mature,
burrow into the intestinal wall, and lay eggs. Some eggs may
develop within the host, leading to autoinfection.
 Epidemiology and
Pathogenesis

Capillaria philippinensis is endemic to the Philippines,

especially the Ilocos region, with cases also reported
in Thailand, Zambales, and Southern Leyte. The large
number of worms in the host causes intestinal
damage. Adult worms create micro-ulcers in the
intestinal lining, which can lead to malabsorption
syndrome if severe.
DISEASE: INTESTINAL
CAPILLARIASIS
Is characterized by abdominal
pain with a gurgling stomach
(borborygmus) and chronic
diarrhea. The chronic diarrhea
leads to weight loss which is
aggravated by the
accompanying loss of appetite
(anorexia), nausea, and
vomiting, Malabsorption of fat,
carbohydrates, and proteins as
well as electrolyte abnormalities
can be fatal.
 LABORATORY DIAGNOSIS TREATMENT AND
PREVENTIONS

Diagnosis is confirmed by Albendazole is the drug of

detecting characteristic eggs in choice; mebendazole is an
stool. In heavy infections, alternative. Treatment lasts
larvae and adult worms may at least 20 days. Severe
also be found. cases require electrolyte
replacement and a high-
PREVENTION AND CONTROL protein diet.

Prevent by thoroughly cooking freshwater fish, practicing proper

waste disposal, health education, and treating infected
individuals promptly.
BLOOD AND
TISSUE
NEMATODES
Wuchereria bancrofti (Bancroft's Filarial Worm)
and Brugia malayi (Malayan Filarial Worm)

Important Characteristics & Life Cycle:

• Both are mosquito-borne parasites with two

forms: adult worms and microfilariae
(larvae).
• Adult worms are threadlike, creamy
white, and males are similar in size to
females.
• Microfilariae have a sheath and show
periodicity—appearing in the bloodstream
during certain times (nocturnal, diurnal, or
sub-periodic) matching mosquito feeding
times.
• Humans are infected through mosquito
bites; larvae migrate to lymphatics and
 Epidemiology &
Pathogenesis
• W. bancrofti is the most common cause of filariasis worldwide; B.
malayi is more frequent in Asia.
• In the Philippines, W. bancrofti is more common.
• Vectors: W. bancrofti: Culex, Anopheles, Aedes, Mansonia. B.
malayi: Mansonia and Aedes
• In rural areas: Anopheles minimus flavirostris is the main
vector.
• In urban areas: Culex spp. breed in dirty water sources.
• 46 provinces in the Philippines were identified as endemic,
mostly in the south. As of now, 43 have been declared filariasis-
free.
• Pathogenesis: Disease is caused by adult worms obstructing
DISEASE: FILARIASIS

Filariasis is a parasitic
disease caused by
mosquito-borne filarial
worms, primarily
Wuchereria bancrofti and
Brugia malayi. It affects
the lymphatic system and
progresses through three
clinical stages:
Asymptomatic, Acute
stage, Chronic Stage
 THREE STAGES

1. ASYMPTOMATIC 2. ACUTE STAGE 3. CHRONIC STAGE

STAGE (ADENOLYMPHANGITIS)
• Develops over years of
• Fever and lymphadenitis (swollen repeated infections.
lymph nodes). • Chronic edema, lymphatic
• Presence of
• Male genitalia commonly affected obstruction, and fibrosis.
microfilariae in the
in W. bancrofti infections. • Leads to elephantiasis—
bloodstream.
• Extremities affected in Brugia thickened, hardened limbs.
• Adult worms
malayi infections. • Hydrocele: fluid accumulation
reside in
• Females may have breast in the scrotum (common in W.
lymphatics.
lymphatic involvement. bancrofti).
• No visible
• Other signs: Epididymitis, • Brugia malayi may cause:
symptoms despite
orchitis (testicular inflammation) • Milder deformities
active infection.
• Retrograde lymphangitis • Enlarged lymph nodes
• Localized inflammation of limbs (epitrochlear, inguinal, axillary)
• Transient subcutaneous swellings • Elephantiasis typically below
(Calabar swellings) the knee
• Scrotal involvement is rare
 LABORATORY PREVENTION &
TREATMENT
TREATMENT AND
CONTROL
DIAGNOSIS PREVENTIONS
• Diethylcarbamazine • Mass drug
• Peripheral blood (DEC) administration (MDA) in
smear (Giemsa- • Ivermectin endemic areas.
stained): gold Albendazole (often used • Example: Philippine
standard. in combination) DOH campaign (since
• Best collected at • DEC and ivermectin kill 2001) with DEC +
night (9:00 PM–4:00 microfilariae; higher Albendazole.
AM) for nocturnal doses target adults. • Vector control:
periodic species. • Surgery: may be • Use of mosquito nets,
• Formalin method needed to remove adult repellents, insecticides
can enhance worms. • Protective clothing
detection in light • Supportive care: Anti- • Health education to
infections. inflammatory meds, Limb raise awareness and
• Alternative tests: elevation and elastic ensure compliance with
• Antigen detection bandages to reduce prevention strategies.
INTESTINE
TISSUE
NEMATODE
TRICHINELLA SPIRALIS (MUSCLE WORM / TRICHINA
WORM)
Important Characteristics and Life Cycle:

• Exists in two forms: larvae (encysted in

muscles) and adult worms (in intestines).
• Larvae are coiled and encysted in striated
muscles, within "nurse cells".
• Humans are accidental hosts; infection
occurs by eating raw or undercooked pork or
wild meat with encysted larvae.
• In the stomach, gastric acid and pepsin
release larvae from cysts.
• Larvae invade intestinal mucosa, mature
into adults, and females release larvae (no
egg stage).
• New larvae enter the bloodstream and
migrate to striated muscles, where they
 TRICHINOSIS (TRICHINELLOSIS)

Trichinosis, also known as

Trichinellosis, is a parasitic
infection caused by the
roundworm Trichinella spiralis
and related species. It is
acquired by eating raw or
undercooked meat (especially
pork or wild game) that
contains the encysted larvae of
the parasite.
 PHASES OF INFECTION

1. Enteric Phase – Larvae invade intestines causing

diarrhea, abdominal pain, and vomiting.

2. Invasion Phase – Larvae migrate to striated muscles.

Symptoms include facial and periorbital edema, fever,
myalgia, conjunctivitis, rashes, splinter hemorrhages,
eosinophilia, and may lead to myocarditis.
3. Convalescent Phase – Larvae encyst in muscle;
symptoms gradually resolve. Disease is self-limiting, but
rarely causes heart failure or respiratory paralysis.
 LABORATORY PREVENTION &
TREATMENT
TREATMENT AND
CONTROL
DIAGNOSIS PREVENTIONS

•Muscle biopsy: • Usually self-limiting;

Confirms presence of • Properly cook
main treatment is
encysted larvae. supportive care (bed
and freeze meat.
rest, pain and fever • Avoid feeding
•Blood tests: Reveal relief). pigs raw pork
eosinophilia, leukocytosis, scraps.
and elevated muscle • Meat inspection
•Corticosteroids: For
enzymes (LDH, aldolase,
severe inflammation. and rodent control
CPK).
in farms.
•Serologic tests: May •Thiabendazole: • Health education
require repetition due to Effective only in early on safe meat
early false negatives. infection (kills adult handling practices.
worms, not larvae).
Thank You!
GROUP 8