MEDICAL PARASITOLOGY

PHASMID 1
DR. DUEÑAS / ROXAS
OLFU • FUMC ½ COLLEGE OF MEDICINE
Ref: Medical Parasitology in the Philippines by: Belizario

NEMATODES: • Adult females – 20 to 35cm ® longer and larger

• Ascaris lumbricoides o Straight end tail
• Enterobius vermicularis o Vulval is mid-ventral at the junction of the anterior and
• Toxocara canis / cati middle 3rd of the body
• Anisakis o Prominent “genital girdle” ® circular groove at the
level of the vulva
INTRODUCTION o Single vaginal that branched to form a pair of genital
tubules, each of which consist of uterus seminal
2 types of Nematodes (roundworm) receptacle, oviduct and ovary
Intestinal Nematodes Blood and Tissue Nematodes o Theses coiled at the posterior 2/3 of the body
– Ascaris lumbriocoides – Wuchereria bancrofti
– Hookworm (Necator and – Brugia malayi
Ancyclostoma) – Angiostrongylus cantonensis
– Trichuris trichiura – Trichinella spiralis
– Enterobius vermicularis
– Capillaria philippinensis
– Toxocara canis/cati
– Anisakis

• 2 General Phases of Morphology: Adult female A. lumbricoides Close-up of the anterior

o Pre-Parasitic Phase ® Egg, L1, L2, L3 end of an adult A.
§ Occurs outside the environment (free-living) lumbricoides
in form of egg Note: The 3 'lips'
§ Then it modifies into L1, L2, L2 stages by
molting • Adult males – 15 to 30cm
§ Occurs within Intermediate Host o Curved tail at posterior
§ (L) mean Larval Stages end
§ L3 ® usually the Infective Stage o Single tubule (testis, vas
o Parasitic Phase ® L4, L5, Adult Stages deference, ejaculatory
§ L5 ® sexually immature adult duct) and tortuously
§ Occurs within the Final host (human) coiled at the posterior
• Habitat: half
o Soil (egg) ® soil transmitted helminth
o Duodenum and Proximal Jejunum (host) ® small Habitat Small intestine – but do not attach to mucosal walls
intestine Infective stage Embryonated egg
o Ascaris suum ® ascaris from pigs MOT Fecal-Oral route
• Cause: Host Human, swine (Ascaris suum), monkeys, apes
o Tissue reaction to the invading larva Infective stage Embryonated egg
o Intestinal irritation (adult) Diagnostic stage Unfertilized or fertilized egg and adult worm
o Complication due to extraintestinal migration
• Infertile or Unfertilized Egg ® non-infectious
ASCARIS LUMBRICOIDES o 88-94 x 39-44 um, longer and narrower
• Most common intestinal nematode o Mamillated coating ® outside
• Infection occurs worldwide and common in tropical and o Refractile Granules ® inside
subtropical areas o Elongated with 2 layers of eggshell ® middle is thin with
• Cylindrical body with gradually tapered anterior and posterior end little or no outer albuminous coat
• Flesh-colored body has a streak of whitish lateral line along the o Gold/Yellow in color
entire length o Contains disorganized yolk cell appearing as tiny
• Anterior part is provided with 3 lips bubbles
• Found in association with poor personal hygiene, poor sanitation o Very difficult to identify and seen only 2 of 5 infection -
and in places where human feces are used in fertilizer Belizario
• Rural > Urban o Note:
• Children > Adult § Unfertilized egg that lost mamillated layers
that may resemble as hookworm egg
Parasitic Biology
• Largest nematode ® giant round worm
• Adult worm lives in the lumen of the small intestine
• Adult worms can live 1 to 2 years
• 200,000 eggs/day passed out in feces
• Liver-Lung migration (hepato-tracheal) ® 14 days to complete
• Dogs does not indicate a true infected but spurious passage of
eggs following coprophagy

1 of 7
 MEDICAL PARASITOLOGY
PHASMIDS 1
• Decorticated Egg o The larvae mature further in the lungs (10 to 14 days),
o Similar to unfertilized but No mammillations penetrate the alveolar walls, ascend the bronchial tree
o 45-75 x 35-50 um to the throat, and are swallowed (7)
o Broadly ovoid in shape o Upon reaching the small intestine, they develop into
o Eggshell (2 layers) in transparent due to absent adult worms. Between 2 and 3 months are required
albuminous coat from ingestion of the infective eggs to oviposition by the
o Contains a mass of organized yolk cells adult female
o Adult worms can live 1 to 2 years

• Fertile or Fertilized Egg ® diagnostic stage

o 45-75 x 35-50um
o Broadly ovoid/Round oval in shape with thick and
transparent shell
o Innermost layer ® “Vitelline layer” and lipoid that is
impermeable
o Middle layer of shell is thick and transparent and the
outer layer called ® “albuminous coat” is mamillated
(diagnostic)
o The outer shell of the egg ® golden brown color
o Seen with an organized mass of course ® lecithin
granules
o Ovoid mass ® consist of protoplasm will develop into
Larval on the 14th day

Note: Life Cycle !!

• Intestinal wall ® Venule ® Liver via portal vein ® Heart ®
Pulmonary vessels ® Rupture the capillaries and enter the air
sacs ® Molting before further migration into the larynx and
oropharynx ® Swallowed into the digestive tract

Note: Eggs in the soil

• 4 to 6 weeks or 2 to 3 months for the eggs to become
• Infective or Embryonated Egg infectious outside the environment
o Shell is trilaminar and broadly ovoidal in shape • Affected by: Temperature, Moisture and Humidity
o Brownish-Yellow on color
o Contains coiled larva inside
o Hatch inside the Small Intestine Clinical Manifestation
o The larva penetrates in the intestinal wall and venules • NO symptoms ® most cases
o Larva ® moves to the lever, postal vein, heart and • If symptoms occur – light abdominal discomfort
pulmonary vessels • Heavy infections can cause intestinal blockage and impair growth
o Lungs ® these larvae undergo series of mottling then in children ® lead to obstruction (forms ball of worm)
migrates to the larynx and being swallowed • Stunted growth or malnutrition in children ® deworm them!
• “Loeffler’s Syndrome” ® migration of larva from intestine to the
lungs
o Last for 10 days
o Transient accumulation of eosinophils in the lungs
o PBS/Serum ® eosinophilia
o Respiratory symptoms
o Rare, but seen in previously exposed ascaris antigen
• 7 to 10 days ® migration phase and mottling stages
• Prepatent period ® 60 to 70 days (2-3 months)
• Life Cycle: CDC • 10 to 20 worms may present asymptomatic ® except in stool
o Adult worms (1) live in the lumen of the small intestine examination
o A female may produce approximately 200,000 eggs per • Lung migrans ® cause lung infiltration, asthmatic attacks and
day, which are passed with the feces (2) edema of the lips
o Unfertilized eggs may be ingested but are not infective. • Abdominal pains ® most common
o Larvae develop to infectivity within fertile eggs after 18 • Eosinophilia, Lactose intolerance, Bowel obstruction
days to several weeks (3), depending on the • Obstruction (compilation) of the respiratory system, bile duct, gall
environmental conditions (optimum: moist, warm, bladder, appendix, pancreas ® may lead to peritonitis and
shaded soil) secondary t infections
o After infective eggs are swallowed (4), the larvae
hatch (5), invade the intestinal mucosa, and are carried
via the portal, then systemic circulation to the lungs (6)

2 of 7
 MEDICAL PARASITOLOGY
PHASMIDS 1
Diagnostic
• Stool sample
o Identification of Ascaris using microscope
• Microscopic identification of eggs in the stool
• Kato-Katz or fecal flotation ® quantitative assessment
• Adult worms are occasionally passed in the stool or through the
mouth or nose
• Sputum or gastric aspirate during the pulmonary ® migration Parasitic Biology
phase • Eggs can survive for 2 to 3 weeks (indoor environment)
• Direct fecal smear ® less sensitive • Oral end ® lacks a true buccal capsule but with 3 lips
• Anterior end ® dorso-ventral bladder-like expansion of the
Note: cuticula, the cephalic area, also with prominent esophageal bulb
• Light infection ® 20 eggs/slide per 3mg of feces • Both sexes ® there are cephalic expansions
• Heavy infection ® 100 eggs/slide • Night Gravid females migrate down the intestines and exit through
the anus to deposit eggs – 4,672 to 16,888 eggs/day on the
Treatment perianal skin
• Albendazole ® drug of choice o Occurs in the evening
o 400mg one time dose o Female dies after depositing its eggs
• Mebendazole • Eggs containing 3rd stage larvae hatch in the duodenum and
o 500mg onetime dose develops into adult at the cecum
• Pyrantel pamoate ® 10mg/kg dose • Resistant to disinfectant
• Ivermectin ® 200um/kg dose • Dehydrate in the air within a day but remain viable in moist
• Nitazoxanide condition for more than 13 days

Note: Erratic migration ® wrong medication and decision Habitat Large intestine (lower ileum and Cecum)
• Give anthelminthic first ® albendazole (400mg) Infective stage Embryonated egg
• Antipyretic ® control fever Diagnostic Embryonated egg
• Anesthetics ® next if surgery will be done MOT Human to human (ingestion, inhalation)

Prevention and Control • Egg

• Avoid ingestion soil that may be contaminated with human feces, o 50-60 x 20-30um (one side is flattened, one side is
including where human fecal matter “night soil” or waste water is convex) ® planto-convex
used to fertilized crops o Transparent, elongated oval in shape, and slightly
• Proper hand washing flattered on one side
• Wash, peel, or cool all raw vegetables and fruits before eating, o Partially embryonated when shed
particularly those that have been grown in soil that has been o Diagnosed by applying cellulose tape to the anus,
fertilized with manure especially in the morning before the patient’s first
• Regular deworming bowel movement ® eggs will adhere to the tape and
can been microscopically
ENTEROBIUS VERMICULARIS o Mechanical protection ® translucent shell with triple
• Pinworm or “seat worm” or thread worm ® human pinworm albuminous covering
• Characterized by perineal itching or pruritus ani o Chemical protection ® Inner embryonic Lipoidal
• Not a significant cause of mortality and morbidity, without it may membrane
cause complications beyond perianal areas o Colorless
• Most common helminth in temperate regions where sanitations o Resistant to disinfectants
are on place o Viable outside ® 13 days (moist area)
• Most common in children, institutionalized person, and household o Can be matured (infective stage) within 4-6 hours
member of person with pinworm infection outside the host
• Human are the only species that can transfer this parasite

Note: CDC
What is pinworm?
• A pinworm (“threadworm”) is a small, thin, white roundworm
(nematode) called Enterobius vermicularis that sometimes lives
in the colon and rectum of humans
• Pinworms are about the length of a staple
• While an infected person sleeps, female pinworms leave the • Male adult worm
intestine through the anus and deposit their eggs on the o 2-5 x 0.5-0.2mm
surrounding skin o Spindle shaped, and posterior end is curved ventrally
Symptoms of a pinworm infection o Markedly reduced bursa, the caudal alae
• Pinworm infection (Enterobiasis/Oxyuriasis) ® causes itching o Blunt posterior end with single spicule
around anus can lead to difficulty sleeping and restlessness o Note:
• Caused by female pinworm laying her eggs § Die after copulation
• Mild and some infected person have no symptoms § Rarely seen
Who is at risk?
• Affects all ages and socioeconomic levels
• School-aged and preschool-aged children
• Institutional persons
• Household members and caretakers of persons with pinworm
infections

3 of 7
 MEDICAL PARASITOLOGY
PHASMIDS 1
• Female adult worm Clinical Manifestation
o 8-13 x 0.3-0.5mm • Itching in the anal region, Abdominal pain, Appendicitis
o Spindle shaped, with sharply pointed posterior end • Infection of the female GUT
o Vulva is mid-ventral Infront of the middle 3rd of the • Clinical features ® associated with inflammation and secondary
body infection
o Uterus distended ® full of eggs o Mild catarrhal inflammation of the intestinal mucosa
o Note § Mechanical irritation and secondary
§ Long, slender pointed tail bacterial infection
§ Dies after deposition of eggs o Perianal region irritation
§ Due to the migration and deposition of
gravid female eggs
o Secondary bacterial infection
§ Itching and scratching
o Insomnia
§ Sleep disturbances in children
o Appendicitis, vaginitis, endometritis, salpingitis,
peritonitis
§ Ault migration
• Life cycle:
Diagnostic
o Gravid adult female Enterobius vermicularis deposit
eggs on perianal folds (1) • Look for the worms in the perianal region 2 to 3 hours after the
o Infection occurs via self-inoculation (transferring eggs to infected person as asleep
the mouth with hands that have scratched the perianal • “Scotch tape method” or Graham’s Scotch Adhesive tape swab
area) or through exposure to eggs in the environment o Perianal cellulose tape swab ® more sensitive and
(e.g., contaminated surfaces, clothes, bed linens, specific and more eggs seen
etc.) (2) • Analyzing samples from fingernails under a microscope
o Following ingestion of infective eggs, the larvae hatch in • Direct fecal smear ® 5% less sensitive
the small intestine (3) and the adults establish
themselves in the colon, usually in the cecum (4)
o The time interval from ingestion of infective eggs to
oviposition by the adult females is about one month.
o At full maturity adult females measure 8 to 13 mm, and
adult males 2 to 5 mm; the adult life span is about two
months 200 Textbook of Medical Parasitology
o Gravid females migrate nocturnally outside the anus
and oviposit while crawling on the skin of the perianal
area (5)
o The larvae contained inside the eggs develop (the eggs
become infective) in 4 to 6 hours under optimal
conditions (1)

Flowchart 20.1: Laboratory diagnosis of Ascaris lumbricoides

Treatment
by demonstrating the larvae in sputum, or more often in Blood Examination
•
gastric washings. Mebendazole 500mg single dose Complete blood count may show eosinophilia in early
Presence of Charcot-Leyden crystals in sputum and an
• Albendazole 400mg single dose
attendant eosinophilia supports the diagnosis. At this
stage of invasion (Flowchart 20.1).
stage, no•eggs are
Pyrantel pamoate ® DOC
seen in feces.
Chest X-ray may show patchy pulmonary infiltrates.
o st Treatment
10mg/kg (1 dose and 2 dose 2-4 weeks after)
nd

Eggs Several safe and effective drugs are now available for
treatment of ascariasis. These include pyrantel pamoate
Note:
Definitive diagnosis of ascariasis is made by demonstration
(11 mg/kg once; maximum 1 g), albendazole (400 mg once),
of eggs in feces.
Ascarids are• prolific
Given egginlayers.
1 dose at first
A single and then
female another
mebendazole (100 single dose
g twice daily for 32days
weeks
or 500 mg once),
about 3 eggs per mg of feces. At or ivermectin (150–200 mg/kg once). These medications are
may account for later
this concentration, the eggs can be readily seen by contraindicated in pregnancy; however, pyrantel pamoate
microscopic • examination
Treatofthe whole
a saline family
emulsion member
of feces. is safe is recommended
in pregnancy.
Both fertilized and unfertilized eggs are usually present. Partial intestinal obstruction should be managed with
Occasionally, only one type is seen. The fertilized eggs nasogastric suction, intravenous fluid administration,
and instillation of piperazine through the nasogastric
Note: may sometimes appear decorticated. The unfertilized
eggs are not detectable by salt floatation. TOXOCARA tube.
• Rarely, eggs may become airborne and be inhaled and Rarely when the infestation is light, eggs are Complete obstruction requires immediate surgical
• only Canis – dog methods. intervention.
swallowed demonstrable by concentration
o maleAbility
Eggs may not be seen if only forpresent,
worms are transplacental
as migration
• Retro-infection, or the migration of newly hatched larvae from may occasionally be the case. Fecal films often contain
many artefacts resemblingo Ascaris Ability forcare
eggs and visceral Prophylaxis
must larva migration
the anal skin back into the rectum ® may occur but the them. Cervical alae ® longer
be taken to differentiateo than broad
Ascariasis can be (diagnostic)
eliminated by preventing fecal
frequent with which this happens in unknown Eggs may be demonstrative in the bile obtained by contamination of soil. The Ascaris egg is highly resistant.
duodenal • aspirates
Cati(Flowchart
– cat 20.1).
• Fomites / oral: contaminated cloth, hands, bed sheets Therefore, the use of night soil as manure will lead to
o Cervical alae ® broadspread of the infection, unless destruction of the eggs is
• 1 month Serological Tests ensured by proper composting. Treatment of vegetables
• canVitulorum ® cattle nematode and other garden crops with water containing iodine
o Ingestion of matured egg (embryonated) Ascaris antibody be detected by:

o Hatching of larva in the small intestine • hemagglutination

Indirect Tales 2 to (IHA)
4 weeks for Toxocara larvae200 ppm tofor develop
15 minutesand foreggs
kills the theandeggslarvae of
Immunofluorescence antibody (IFA) Ascaris and other helminths.
toimmuno-sorbent
become infectious
o Adults moves to the colon (cecum) ® 2 months life Enzyme-linked assay (ELISA) Avoid eating raw vegetables.

span • isEmbryonated
Serodiagnosis eggsascariasis
helpful in extra intestinal are resistant
like to freezing,
Improvement moisture
of personal hygiene.and
Loeffler’s syndrome (Flowchart 20.1). Treatment of infected persons especially the children.
extreme pH levels for at least a year

4 of 7
 MEDICAL PARASITOLOGY
PHASMIDS 1
Infective stage Eggs • Life cycle: CDC
Diagnostic stage Larva in tissue o Toxocara spp. can follow a direct (one host) or indirect
Definitive host Dogs and cats (multiple host) life cycle.
Accidental host Man o Embryonated eggs are shed in the feces of the definitive
Paratenic host Rabbit / ducks host (canids: T. canis; felids: T. cati) (1)
MOT -Human or other animals can be infected by o Eggs embryonate over a period of 1 to 4 weeks in the
accidentally ingesting toxocara eggs environment and become infective, containing third-
-Transplacental or transmamarry (dogs and cats) stage (L3) larvae (2)
Habitat Small intestine o Following ingestion by a definitive host (3), the infective
eggs hatch and larvae penetrate the gut wall.
• Hatch on the intestine gut wall ® L3 larva o In younger dogs (T. canis) and in cats (T. cati), the larvae
migrate through the lungs, bronchial tree, and
• Young cat/dog
esophagus, where they are coughed up swallowed into
o They can migrate to the lungs bronchial tree and
the gastrointestinal tract; adult worms develop and
esophagus and cough up and swallowed
oviposit in the small intestine (4)
• Adult dog/cat
o In older dogs, patent (egg-producing) infections can also
o Egg producing infection but other larva arrested in to
occur, but larvae more commonly become arrested in
the tissues
tissues
• Infected the young puppy/kitten
o Arrested larvae are reactivated in female dogs during
o Transplacental (major)
late gestation and may infect pups by the transplacental
o Transmmamary (minor)
(major) and transmammary (minor) routes (5) in whose
small intestine adult worms become established (6)
Parasitic Biology
o In cats, T. cati larvae can be transmitted via the
• Worm
transmammary route (5) to kittens if the dam is infected
o Canis
during gestation, but somatic larval arrest and
§ Cervical alae “longer than broad”
reactivation does not appear to be important as in T.
(diagnostic)
canis
§ 3 lips characteristics of ascarid
o Toxocara spp. can also be transmitted indirectly
through ingestion of paratenic hosts. Eggs ingested by
suitable paratenic hosts hatch and larvae penetrate the
gut wall and migrate into various tissues where they
encyst (7)
o The life cycle is completed when definitive hosts
consume larvae within paratenic host tissue (8), and
the larvae develop into adult worms in the small
o Cati intestine
§ Cervical alae is broad o Humans are accidental hosts who become infected by
ingesting infective eggs (9) or undercooked
Beginning to Hatch Larva Hatching Larva meat/viscera of infected paratenic hosts (10)
o After ingestion, the eggs hatch and larvae penetrate the
intestinal wall and are carried by the circulation to a
variety of tissues (liver, heart, lungs, brain, muscle,
eyes) (11)
o While the larvae do not undergo any further
development in these sites, they can cause local
reactions and mechanical damage that causes clinical
toxocariasis

• Eggs
o Eggs are not clinically diagnostic for human cases as
humans are incapable of harboring adult worms that
pass eggs
o Golden in color, spherical to slightly pear shaped, thick-
shelled and have pitted surface
o Eggs are extremely hardly and can persist in the
environment for years
o Canis ® slight larger (80-85um)
o Cati ® (65-75 um)
o Eggs (unembryonated) are shed by the definitive host
(cat/dog)
o Eggs mature into (embryonated) with L3 larva
§ Mature in the environment ® 4 weeks

5 of 7
 MEDICAL PARASITOLOGY
PHASMIDS 1
Note: Life Cycle • Treatment to OLM is more difficult and usually contains of
• Hatch in the intestine gut wall L3 larva measures to prevent progressive damage to the eye
• Young cat/dog
o They can migrate to the lung bronchial tree and Prevention and Control
esophagus and cough up and swallowed • Deworming pets regularly
• Habitat ® small intestine • Clean your pet’s living area at least once a week
• Adult dog/cat • Proper hand washing
o Egg producing infection but other larva arrested
into the tissue ANISAKIS
• Infects the young pups/kitten • “Herring Disease” or Ascarid of sea mammals, codworm,
o Transplacental (major route) sealworm
o Transmammary (minor route) • Human-Infecting anasakid species:
o Anisakis simplex
o Pseudoterranova decipiens
Clinical Manifestation o Contracecum osculatum
• Most cases ® asymptomatic • Caused by Anisakiasis / Anisakidosis
• Visceral Larvae Migrans (VLM) • Anisakis simplex or Pseudoterranova decipiens - reside in the
o Produced an intense inflammatory response stomach of marine mammals
manifested as eosinophilic granules due to subsequent • They can cause GIT infections and allergic reactions in humans
death of the larvae in the different tissue and organs with consumption or raw and undercooked squid and fist
(liver, lungs, skeletal muscle. Heart) containing 3rd stage larvae
o Nonspecific symptoms and hyper eosinophilia
o Confirmed with tissue biopsy
o Pre-school children

Habitat Fish nematode

Intermediate host Salt water fish
Salmon
• Ocular Larvae Migrans (OLM) Squid
o Expressed with signs and symptoms manifested in the Shrimp-like crustaceans
eyes occurs in children – 5 to 10 y/o Infective stage L3 larva from eating undercooked paratenic host
o Diffuse Unilateral Subacute Neuroretinitis (DUSN) MOT Human ingestion of undercooked
Diagnosis Gastroscopic examination with intact worm or
biopsy with worm (eosinophilic granuloma) ®
stomach
Treatment Removal per endoscopy
Diagnostic Larva

• Neural Larva Migrans (NLM)

o Death in meningoencephalitis
o Confirmed with brain biopsy

Parasitic Biology
• Morphology:
o They have elongated vermiform bodies without
segmentations
o Complete digestive tract
o Separated sexes
• Anisakis simplex (3rd stage) – milky white in color, 19 to 26mm in
length
• Covert Toxocariasis o Type 1 – long stomach and blunt tail with mucron
o Less specific, asymptomatic o Type 2 – shorter stomach, and blunt tails
• Pseudoterranova (3rd stage)
Diagnosis o Yellowish brown in color, 25 to 50mm length
• Biopsy ® definitive diagnosis o Ten units ® 1cm
• ELISA o Note: Large Butterfly-shaped lateral chords (black
• PCR arrow)
• CT scan and MRI ® for CNS lesion
• Direct fecal smear ® for primary host (dogs/Cats)

Treatment
• Albendazole
• Mebendazole

6 of 7
 MEDICAL PARASITOLOGY
PHASMIDS 1
• Life cycle: CDC Diagnostic
o Adult stages of anisakid nematodes reside in the • Gastroscopic examination
stomach of marine mammals, where they are • Gastric biopsy
embedded in the mucosa in clusters. Unembryonated
eggs produced by adult females are passed in the feces
of marine mammals (1)
o The eggs become embryonated in water, undergoing
two developmental molts (2a), and hatch from the eggs
as free-swimming unsheathed third-stage (L3)
larvae (2b)
o These free-swimming larvae are then ingested by
crustaceans (3)
o The ingested larvae grow within the crustacean
hemocoel, and become infective to fish and cephalopod
Treatment
paratenic hosts. After preying upon infected
• Surgical intervention for obstruction
crustaceans, the digested L3 larvae migrate from the
• Endoscopic forceps – main approach to mechanically remove the
paratenic host intestine into the abdominal cavity, and
larvae
eventually to the tissues of the mesenteries and skeletal
• DOC – albendazole
muscle. Through predation, tissue-stage L3 larvae can
be transmitted among paratenic hosts (4)
Prevention and Control
o Fish and squid maintain L3 larvae that are infective to
• Avoid eating raw and uncooked fish, squid and crustaceans
humans and marine mammals (5)
o When fish or squid containing third-stage larvae are
ingested by definitive host marine mammals, the larvae
molt twice and develop into adult worms (6)
o After ingestion by humans, the anisakid larvae
End
penetrate the gastric and intestinal mucosa, causing
the symptoms of anisakiasis (7)

...summary of the Diagnosis...

A lumbricoids T. canis/cati Anisakis spp. E. vermicularis
Direct fecal smear Tissue biopsy Gastroscopy “scotch tape” – to
Kato-katz ELISA X-ray examination demonstrate the
Concentrated technique Fluorescent Serology teat embryonated ova
Visualization of worm with Antibody test
barium meal examination Stoll examination
– may not be helpful in

Clinical Manifestation
• Pseudoterranova spp.
o Does not penetrate stomach
o Throat irritation
o Cough
• Anisakis simplex
§ Local tissue response (reaction surrounding larvae)

7 of 7