CHAN NICOLE B.

BSMLS 2A
CLINICAL PARA LECTURE 2
MORPHOLOGY, PATHOPHYSIOLOGY, LIFE
CYCLE, SPECIMENS USED FOR
IDENTIFICATION, DIAGNOSTIC FEATURES,
PREVENTION & CONTROL OF PHASMID
NEMATODES (PHASMIDEA)
PHASMIDS – sensory organ is located at
POSTERIOR ENDS.
1. Ascaris lumbricoides
- Most common intestinal roundworm
- COMMON NAME – Giant Intestinal
roundworm
- INFECTIVE STAGE – embryonated ova
- DEFINITIVE HOST – man (no intermediate
host needed)
- MAIN HABITAT – Lumen of the SI
- LIFE SPAN – 12-17 months
DEVELOPMENTAL STAGES
1. Ova/Eggs Types of eggs
A. Unfertilized: longer and narrower
2 layers of the eggshell
- Albuminous layer
- Chorionic layer of true shell
 Filled with an amorphous mass.
 Lack of the crescentic clear area.

B. Fertilized: broadly avoidal and thick 3

layers:
- Chorionic/true shell – chitinous layer; the
secretory product of the egg
- Vitelline layer – fertilization membrane; a
highly impermeable membrane that
protects the inner embryo.
- Protein coat/albuminous layer:
outermost.
 Embryonated – same as fertilized but
contains the larva of the embryo
 Decorticated – lacks the albuminous
mamillated shell; usually seen in old
specimens; it may be fertilized or
unfertilized.
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
Adult: white, creamy, or pinkish yellow when rash (hives, vascular reaction of the upper
freshly expelled and resembles earthworm dermis. Eosinophilia in the circulatory
(lumbricus); the head is provided wt three blood)
conspicuous lips which are finely denticulated; B. DUE TO ADULT WORMS
each lip has minute twinned sensory papillae. - Diarrhea, vague abdominal pain, nausea,
and loss of appetite
- Due to its erratic behavior, vomiting,
suffocation, intestinal obstruction,
appendicitis, acute pancreatitis, and
peritonitis. (Perforation of the bowel)
DIAGNOSIS
STOOL EXAMINATION – may give negative
results due to the ff:
- During the early stage of infection
- During larval migration through the
bloodstream – when only male worms are
present in the intestines.
PREVENTION:
- Sanitary disposal of human excreta
- Personal hygiene
- Avoid the use of night soil fertilizer.
- Thorough cooking of food particularly
vegetables and washing of fruits
- Washing solution: aqueous iodine solution
A. MALE (200 parts/million)
- 10-31 cm - Kills infective egg and larva in 15 minutes.
- Usually shorter and slender
- Vertically curved posterior end with 2 CHARACTERISTICS OF HOOKWORM
spicules. DEFINITION
- Genitalia: composed of a single, long A. Necator americanus – semi-luna
tortuous tubule cutting plate
B. FEMALE B. Ancylostoma braziliense – 2 pairs of
- 35 cm long x 3-6 mm teeth
- Straight posterior end C. Ancylostoma canicun – 3 pairs of
- Paired reproductive organs located in the teeth
2/3 of the body. D. Ancylostoma duodenale – 2 pairs of
- Oviparous teeth
- Gravid uterus: 200,000 eggs
DISEASE: Ascariasis, dooryard or backyard
infection
PATHOLOGY
A. DUE TO LARVAL MIGRATION:
- ASCARIS PNEUMONITIS: Damage to the
pulmonary tissue (petechial hemorrhage)
when larvae break out of the lung
capillaries into the air sacs.
- Symptoms manifested: asthmatic type of
respiration, cough, bronchial rales
(abnormal respiratory sound), urticarial
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
2. HOOKWORMS FEMALE – 9-13 mm by 0.35-0.6 mm
Huma Hookworms MALES – 5-11mm by 0.3-0.45m
a. Necator americanus
HOOKWOR BUCCAL COPULATORY BURSA
b. Ancylostoma duodenale
M SPP CAVITY
c. Ancylostoma ceylanicum
Animal Hookworms: N. - 1 pair - fused spicules, deep
americanus semilunar cleft
(Cause skin lesions or larval migrants in man)
cutting plates, - bipartite dorsal rays
d. Ancylostoma braziliense
dorsal
e. Ancylostoma canicum
median
DEVELOPMENTAL STAGES: tooth, deep
1. OVA – avoidal, colorless/hyaline and thin pair of
shelled; 56-60µ : 4-8 cell stage when triangular sub
passed in the feces (surrounded by a clear ventral
zone) lancets.
2. RHABDITIFORM LARVA: A.duodenale 2 pairs of -Unfused spicules:
- Feeding stage, short and stout fused ventral shallow cleft
- Has a long narrow buccal cavity teeth -tripartite dorsal rays
- Flask shaped esophagus A.canicum 3 pairs of -bursa is supported by
- Very small genital primordium ventral teeth long, slender rays
3. FILARIFORM LARVA A.braziliense 1 pair of -Bursa is supported by
- Non-feeding larger outer short stubby rays.
- Infective stage teeth and 1
- Mouth is close with t=a protecting sheath pair of every
- Longer and slender with a pointed inconspicuous
posterior end. median tooth
DISEASE: Necatoriasis/Uncinariasis: Necator
americanus
Ancylostoma: Ancylostoma spp
PATHOLOGY
a. Due to larval stage:
1. Ground itch/Coolie itch/Dew itch
- Dermatitis at the site of entrance of
filariform HOOKWORM SPP
- Intense itching, edema and erythema, and
later papulovesicular eruption
2. Creeping eruption/Cutaneous larval
migrains/Plumber’s itch/ Duck Hunter’s
itch
- Due to the exposure of the skin to the
filariform larvae of A. braziliense and A.
canicum, occasionally of N. americanus
and A. duodenale.
- “Serpiginous tunnel” in the stratum
germinativum of the skin
4. ADULT HOOKWORMS
- Small, cylindrical, fusiform, grayish white
- Relatively stout with a cervical curvature
which appeared like a hook.
- With a well-developed buccal capsule
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
3. PULMONARY LESIONS: Wakana disease DEVELOPMENTAL STAGES
- petechial hemorrhages with eosinophilic 1. OVA
and leukocytic infiltration the=at induces - Avoidal thin-shelled, transparent,
cough and pyrexia resembles a Chinese lantern.
- Not found in feces except in diarrhea and
b. DUE TO ADULT WORM
hyperistalsis
1. Hookworm anemia
- Contains a fully developed embryo.
- Chronic blood loss due to continuous
2. Rhabditiform larvae – Flask-shaped &
mechanical suction of blood from the
stout esophagus
intestinal mucosa and the presence of
- Short buccal activity
bleeding areas left by the adult as they
- Conspicuous genital primordium
transfer to new areas.
3. Filariform larvae
- Blood loss: “Mycrocytic Hypochromic
- Non-feeding stage with a long and
Anemia”
delicate esophagus
2. Hypoalbuminemia
- Forked or notched tail.
- Loss of protein due to a combined loss of
blood and lymph and the protein loss is as 1. Parasitic
well in excess of the loss RBC. - Inhabits the intestine of host
- Female is a delicate filiform worm
DIAGNOSIS
- Esophagus: occupies 1/3 of the anterior
A. Ground its and creeping eruption – part (longer)
characteristics of the lesion and the - Parthenogenetic
history of skin contrast with soil. 2. Fee-living
B. Recovery of eggs – DFS, J=KTS, Brine - Exists in the environment.
flotation and FECT - Buccal cavity: slightly larger than parasitic
C. Harada Mori culture technique male worm
- Treatment – Mebendazole, Pyrantel - Adult female: shorter, smaller
pamoate, oxantel - Shorter esophagus
SEVERE ANEMIA – raise the hemoglobin level MOT – skin penetration, autoinfection
to about 70-80 g/l, iron therapy.
DISEASE – Cochin-china diarrhea,
(Ferrous sulfate, 200 mg 3x a day for 3 Strongyloidiasis, Strongyloidosis
months)
PATHOLOGY AND SYMPTOMS
PREVENTION 1. Skin: allergic, raised red blotches at
a. Sanitary disposal of feces the site of larva; penetration
b. Avoid sites where infected dogs and 2. Migration of larvae: bronchial
cats may defecate. verminous pneumonia
c. Eradicating the infection in dogs and 3. Intestine: abdominal pain, diarrhea,
cats by periodic antihelminthic and constipation, vomiting, weight
treatment loss, variable anemia, eosinophilia,
d. Personal hygiene such as use of shoes protein-losing enteropathy
or slippers 4. Death in immune-compromised px
e. Avoiding ingestion of raw vegetables due to heavy autoinfection or larval
migration throughout the body.
Strongyloides stercoralis
COMMON NAME – Theadworm
DEFINITIVE HOST – man
HABITAT – upper small intestine (duodenum)
- 2 spp: S. stercoralis, S. fuellerboni
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
ENTEROBIUS VERMICULARIS MODE OF TRANSMISSION
Synonym: Oxyuris vermicularis - By anus to the mouth via contaminated
Common name: pinworm, seat worm fingers and fomites
Main habitat: cecum and appendix - Through contaminated food and drinks
Definitive host: man especially if the food handler is the carrier
Reservoir host: dogs and cats - Via inhalation: viable ova can float in the
Infective stage: embryonated egg air.
- Retro infection: gravid female after laying
DEVELOPMENTAL STAGES their eggs in the perianal area goes back
1. OVA through the anus to the large intestine.
- Double lined chorionic shell, transparent The larvae upon hatching migrate back to
& colorless, elongated and ovoidal wt one the large intestine.
side flattened.
PATHOLOGY & SYMTOMATOLOGY
- With inner embryonated layer and outer
albuminous shell - Some are asymptomatic: rarely causes
- Embryonated when laid at the perianal serious lesion.
area. - Other symptoms
- Remain viable up to 13 days, rarely seen  Nocturnal perianal itching
in stool.  Vulva irritation: vulvovaginitis, salpingitis
 Cardinal feature: hypersensitivity
 Mild nausea or vomiting
 Loss of sleep, irritability
 Slight irritation to intestinal mucosa
CONTROL & PREVENTION: extremely difficult
once sets in the household.
- Home and community sanitation
- Better personal hygiene: fingernails
should be cut short.
- Use showers rather than bath tubs
- Infected persons should sleep alone
DIAGNOSIS
a. Graham scotch tape
2. Adult
technique/cellulose acetate technique
- Small, spindle-shaped, relatively stout
b. NIH Swab Technique
with dorsoventral bladder-like expansions
c. Schuffner and Swelling Rebel Method
of cuticle called the “cephalic alae” or
“lateral wings”. TOXOCARA SPP
- Have an oral end and three lips, Toxocara canis & Toxocara cati
hourglass-shaped esophagus. - Synonyms: Ascaruis mystax/Belascaris
a. Male: 2-5 mm long, strongly curved cati
pointed tail which is used for  Can infect humans and damage of the
copulation, spicule is conspicuous visceral organs.
b. Female: 8-13 mm in length by 0.4mm; MORPHOLOGY: adult female
posterior end is sharply pointed; vulva
- L: 10-12 cm
found in the middle third; paired
- Passes numerous eggs into their host’s
genital organs.
feces

DISEASE: Enterobiasis, Oxyuriasis

CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
DISEASE: there are two major forms of LARVA
toxocariasis: - Four rows of hooklets extruding from the
1. Ocular larva migrans (OLM) surface of the cephalic bulb
- Toxocara infections can cause OLM, an - Tiny, cuticular spines run along the length
eye disease that can cause blindness. of their bodies.
2. Visceral larva migrans (VLM) - Twi types of papillae extend from the
- Heavier, or repeated Toxocara infections, worm, a cervical papilla off the main body
while rare, can cause VLM, a disease that and two labial papillae on the cephalic
causes swelling of the body’s organs or bulb
central nervous system - Four sac-like openings in the cephalic bulb
- Liver lesions: gray, elevated,
EGGS/OVA
circumscribed.
- Diameter: 4mm - Ovular with a mucus plug at one end
- Granulomatous lesions: eosinophils, - Approximately 40 micrometers to 70
lymphocytes, epitheloid cell and giant micrometers
cells of foreign-body type  May cause a VLM like syndrome
- Larvae: liver, brain, eye, spinal cord, lungs, (southeast Asia) the larvae may migrate
cardiac muscle, kidney and lymph nodes. through subcutaneous tissues, causing
transient swelling, and deepen tissues,
SYMPTOMS: due to the inflammatory eventually invading the CNS.
reaction at the site of infection
Gnasthostomiasis (Gnasthostoma
- Benign: 20-80% eosinophilia and
spinigerum)
hepatomegaly
- Severe: intermittent pain., dermatitis and - Food-borne parasitic infection that results
neurologic disturbances, pneumonitis. from the human ingestion of the third-
Liver and spleen enlargement, skin rashes stage larvae.
on the lower extremities OTHER TERMS – Choko-fushu Tua chid or
- Larvae: liver, brain, eye (blindness-most chokofishi (Japan)
serious), spinal cord, lungs, cardiac - Consular disease (Nanjing)
muscle, kidney and lymph nodes. - Shanghai rheumatism
TREATMENT: Mebendazole to eliminate the - Tau-cheed (Thailand)
worm: prednisone for inflammatory - Woodbury bug (Australia)
symptoms. - Yangtze River edema
PREVENTION: avoidance of infected dogs and MODE OF TRANSMISSION
cats - Eating undercooked or raw freshwater,
DIAGNOSIS: eels, frogs, and reptiles
- Clinical s/s: a triad of marked eosinophilia, - Contaminated water
hepatomegaly & hyperglobulinemia - In rare instances, larvae can directly
- History of exposure to dogs, cats and dirt penetrate the skin of individuals who are
eating exposed to contaminated food sources or
- ELISA; EIA freshwater.
Gnasthostoma spp SIGNS & SYMPTOMS
1st IH – copepods - Migratory swelling under the skin
2nd IH – fish and amphibians - Increased levels of eosinophils in the
Diagnosis – migratory lesions, eating raw fish. blindness
LENGTH – 2-3 cm long and rust-colored - Rarely, the parasite can enter other
tissues such as the liver, and the eye,
vision loss or blindness.
- It can also affect the nerves, spinal cord,
or brain, resulting in nerve pain, paralysis,
coma, and death.
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
Trichostrongylus spp about 5 days by suitable weather (hot and
Zoonotic infection (herbivores) humid), significantly longer by cold
- Human infection: weather. These infective larvae can
 T. colubriformis survive in the environment and remain
 T. orientalis infective for up to 6 months.
 T. axei Angiostrongylus cantonensis
 T. brevi
Synonym – Pulmonema cantonensis
 T. tenuis
Common name – rat/rodent lungworm
- They infect poultry and other birds
Definitive host – rats
worlwide
- T. axei – the stomach hairworm, infects Main habitat – lungs
cattle, sheep, goats, pigs, and horses, and Disease – Human Angiostrongylosis
many wild mammals. Found worldwide MOT – ingestion of larvae in raw or
other less frequent app are T. probolurus undercooked snails or other verctors, or
and T. vitrinu contaminated water and vegetables
- HABITAT – small intestines: eggs – larvae- Infective stage – 3rd stage larva
ingestion by DF
DEVELOPMENTAL STAGES
- DISEASE: light & asymptomatic; heavy
1. OVA
infection may produce abdominal pain
- Elongated, ovoidal with a delicate hyaline
and diarrhea, usually with eosinophilia.
shell – 46-48 to 74 microns
Trichostrongylosis or Trichostrongyliasis 2. 1st stage larva
- Worms damage the lining of the small - Has a distinct dorsal minute notch near
intestine or the stomach – enteritis, the tip of the tail.
gastritis, and sometimes anemia. 3. 3rd stage larva
- Typical signs are diarrhea (mucous and/or - With 2 well developed chitinous rods with
hemorrhagic) or constipation – general expanded knob-like tips at the anterior
weakness and wasting end
- Loss of appetite 4. Adult worms
- Reduced weight gains or even weight loss, - Filiform worms wt a length of 17-25mm
etc. a. FEMALE – the milky white uterine
- Acute severe infections in young animals tubules are spirally wound around the
may be fata. blood-filled intestine and can be seen
through transparent cuticle as a
- Eggs resemble those of hookworms “barbers pole” pattern
(78-98μm by 40-50μm) slightly tapered at b. MALE – has a well developed caudal
one end. bursa which is kidney-shaped and
DIAGNOSIS single lobed
- Detection of characteristics eggs in the PATOLOGY & SYMPTOMATOLOGY
feces - Confusion, incoherence, disorientation
- Determination of the spp requires post and impairment of memory of profound
mortem examination of adult worms after coma
necrops. DIAGNOSIS
- Brain dyscrasia – moderate to high
LIFE CYCLE eosinophilic counts in the spinal fluid
 DIRECT LIFE CYCLE - History of the px as to ingestion of snails,
- Adult females lay eggs in the large crabs or leafy vegetables
intestine of the host that are shed with - Autopsy to make thorough gross and
the feces. Once in the environment the microscopic examination of the brain and
eggs release the L1-larvae that complete spinal cord
development to infective L3-larvae in
CHAN NICOLE B.
BSMLS 2A
CLINICAL PARA LECTURE 2
TRANSMISSION
- Ingestion of raw mollusks containing the
3rd stage larva
- Ingestion of raw leafy vegetables
contaminated with mucus secretions of
the mollusks containing the 3rd stage
larva.
- Drinking water contaminated with the
infected larva.
- Ingestion of paratenic hosts such as
freshwater pawns and crabs containing
the infective larva.

PREVENTION & CONTROL

- Thorough cooking of prawns and crabs
- Through washing of leafy vegetables
- Avoidance of ingestion of raw Achatina
fulica
- Elimination of the snail and eradication o
rodents