NEMATODES/ ROUNDWORMS

Characteristics: 1. ADULT- elongated, cylindrical 2. Supporting body consists of: a. OUTER hyaline noncellular cuticle b. Subcuticular epithelium c. Muscle cells 3. Alimentary tract is a simple tube (ext. from mouth to anus); NO circulatory system 4. Separate sexes a. Female- larger, pointed Types of Female: - Oviparous nematode- lays egg in unsegmented stage (unembryonated) - Ovoviviparous/ oviviparous- lays egg in segmented stage - Viviparous/ Larviparous- female gives birth to larva; no egg * Trichinella spiralis b. Male- smaller, curved tail 5. Provided with CHEMORECEPTOR a. CEPHALIC CHEMORECEPTOR (Amphids)- found in the head b. CAUDAL CHEMORECEPTOR (Phasmids)- found in the tail Classification of Nematodes According to Habitat I. Intestinal Nematode A. Small Intestines C. philippinensis A. lumbricoides S. stercoralis H ookworms T. spiralis adult B. Large Intestines E. vermicularis T. trichiura II. Extraintestinal Nematode A. Filarial Worms- Lymphatics and Subcutaneous tissue W. bancrofti B. malayi B. Muscle T. spiralis larva ASCARIS LUMBRICOIDES - Common name: GIANT INTESTINAL ROUNDWORM - Lumbricus terres- resemble the common earthworm - ADULT o Habitat: small intestine o Head is provided with 3 lips and a triangular buccal cavity - EGG o Consists of 3 layers:

*Larvae that undergo heart to lung migration: ASH (A. lumbricoides, S. stercoralis, Hookworm) - MOT: ingestion; IS: embryonated egg - Vector for A. lumbricoides: cockroach - Symptoms and Pathology o Chest pain, couch, fever (during larval migration) o High Eosinophil count o IgE elevated o Resembles Loefflers syndrome o Intestinal perforation possible; bolus formation - Stool Exam o DS: Egg (unembryonated) o Negative stool exam: 1. No infection; 2. Early infection; 3. All male worm infection Note: Ascarids- VLMs (Visceral Larval Migrants) Toxocara cati- ascarid of cat Toxocara canis- ascarid of dog ENTEROBIUS VERMICULARIS - Common name: PINWORM, seatworm, social/ society worm (has familial/ group tendency) High incidence worms: EAT (E. vermicularis, A. lumbricoides, T. trichiura) - Habitat: large intestines - Adult o Small, whitish, brownish o Anterior end with lateral wings/ cephalic alae

- Egg o Flattened on one side/ D- shaped

- MOT: ingestion; IS: embryonated egg - Migration: adult female migrates to perianal region (to lay eggs) o Colder temperature, aerobic condition - S/S: pruritus ani/ nocturnal ani - Pathology: Mothers complex 1. pruritus ani 2. lack of sleep 3. extraintestinal enterobiasis - Autoinfection (E. vermicularis- external, S. stercoralis) in the same host - Diagnosis: perianal/ scotch tape swab (D-shaped egg) TRICHURIS TRICHIURA - common name: WHIPWORM - Diseases: trichiuriasis, trichocephaliasis, whipworm infection - Adult: attenuated and slender, resembling a whip

o Female ascaris infection: UNFERTILIZED EGG - EGG: barrel shaped/ Japanese lantern shape/ football shaped with BIPOLAR MUCUS PLUGS - Life cycle o Adult: small intestine o Undeveloped egg in feces, embryonates in warm moist soil o Embryonated egg is INGESTED by man o Larva hatch in small intestine and begin larval migration (intestinal wall- blood vessels- liverblood vessels- lung- alveoli- bronchioles- pharynxsmall intestine); adults tend to be erratic

- Habitat: large intestine - MOT: ingestion; IS/DS: egg - Pathology: diarrhea, abdominal pain, rectal prolapse (in heavy infection) Note: UNHOLY THREE: HAT (Hookworm, A. lumbricoides, T. trichiura)- soil transmitted

CAPILLARIA PHILIPPINENSIS - common name: PUDOC WORM - disease: Pudoc disease/ mystery disease - Adult o Female: has eggs in utero o Male: with spicule, sheath - Egg (DS) o With bipolar mucus plugs o Guitar/ peanut shaped

Animal hookworm/ CLM (Cutaneous Larval Migrants)- creeping eruption A. braziliense- cat hookworm A. caninum- dog hookworm B. Larval Migration - pulmonary lesion, hemorrhages C. Adult - Iron deficiency anemia STRONGYLOIDES STERCORALIS - Common name: THREADWORM - Disease: strongyloidiasis, Cochin- china diarrhea - No parasitic male, only parasitic female - Facultative nematode o Parasitic- small intestine o Free-living- soil - Female is capable of parthenogenesis (fertilization without the benefit of male) - MOT: skin penetration - IS: filariform larva Differentiating Hookworm and threadworm larva Hookworm Threadworm Rhabditiform larva Buccal cavity Long Short Genital Small/ Prominent, primordium inconspicuous conspicuous Filariform larva Sheath Present Absent Tail Pointed notched - Internal autoinfection may occur - Pathology o Larval penetration- allergic reaction o Larval migration- heart to lung migration; S/S resembling bronchopneumonia o ADULT- honeycomb appearance of intestinal mucosa; Cochin-china/ Vietnam diarrhea - Lab diagnosis o Stool exam DS: rhabditiform larva Eggs in stool: heavy infection o Culture technique: Harada Mori/ Filter paper culture technique o Baerman Technique TRICHINELLA SPIRALIS - common name: MUSCLE WORM - parasite that causes highest elevation in eosinophils - Habitat o Larva: muscle o Adult: small intestine site of multiplication - Adult o Male- with conical papillae o Female- club shaped uterus; LARVIPAROUS *after copulation, the male dies - MOT: ingestion of meat - IS/DS: encysted larva - Pathology o GREAT IMMITATOR- mimic other diseases o Larva- muscle pains, edema, difficulty in breathing and swallowing o Adult- diarrhea, abdominal pain - Diagnosis o Muscle biopsy- DS: encysted larva o Immunologic Test Bentonite Flocculation Test (T. spiralis, E. granulosus) Intradermal Test- Bachmann o Xenodiagnostic Test (T. spiralis, T. cruzi) - Becks Test- albino rats mice

2.

Differentiate from T. Trichiura 1. smaller, striated 2. mucus plugs not as protruded - MOT: ingestion of fishes (IH) bearing the infective larva o IH: ipon - Pathology o Malabsorption (C. philippinensis, G. lamblia) o Borborygmi (peculiar gurgling sound) o LBM alternating with constipation HOOKWORMS - S/ C shaped - Agent of laziness in poor white population and Tropical Anemia in Puerto Rico - Habitat: Small intestine - (DS) Egg: ovoidal, thin-shelled and colorless, insibe is a germ cell in fragmentation; same for all species

*Parasites that cannot be differentiated by their eggs: HFT (Hookworm, Fasciola, Taenia) - Larva o Rhabditiform - 1st stage - short and stout - open mouth/ feeding stage o Filariform - long and slener - closed mouth/ non-feeding stage - INFECTIVE STAGE - Adult Necator americanus Ancylostoma duodenale Common New world/ Old world hookworm name American murderer hookworm Cervical S- shape C- shape curvature Buccal Semilunar cutting 2 pairs of teeth cavity plate

Male hookworm copulatory bursa

- bipartite/ 2 digits - barbed/ bristle like

- tripartite (3 digits) - simple, not barbed

- MOT: skin penetration - Diagnosis: stool examination o DS: eg o Culture Technique: Harada Mori/ Filter Paper Culture Technique - Pathology A. Larval Penetration 1. Human Hookworm- allergic reaction: ground itch, watersore, mazzamora

FILARIAL WORMS/ VECTOR- BORNE NEMATODES - DH: man - IS to DH: filiform larva. 3rd stage larva - IH: vector - IS to IH: microfilaria
Habitat Vector Wuchereria Brugia bancrofti malayi Lymphatics Aedes Mansonia Anopheles Blood Sheathed, tail with 2 separate nuclei Loa loa Onchocerca volvulus Subcutaneous tissue Chrysops Simulium Tabanid/ sp/ black fly mango fly Skin snips Sheathed, Unsheathed, nuclei up nuclei absent to tip of in tail tail

- Physical Characteristics: ALL FLUKES Flat, leaflike Hermaphroditic Operculated egg MOT: ingestion of METACERCARIA 2 IH

TREMATODES/ FLUKES
SCHISTOSOMES Elongated, cylindrical Separate sexes Non-operculated egg MOT: skin penetration of CERCARIA (fork-tailed) 1 IH (snail)

Specimen Microfilaria

Sheathed, nuclei absent in tail

- Adult o 2 suckers for attachment

Periodicity

Nocturnal

- Loa loa: eyeworm, calabar, fugitive swelling - Onchocerca volvulus- blinding worm, river blindness RARE PARASITES OF MAN Dipetalomena perstans - habitat: body cavity - vector: Culicoides sp. - Sx: blood - Microfilaria: unsheathed, nuclei up to the tip of tail - Non- periodic Mansonia ozzardi - Habitat: body cavity - Vector: Culicoides sp. - Sx: blood - Microfilaria: unsheathed, tail free of nuclei - Non-periodic - Diagnosis: Knotts technique- blood + formalin, stain with Giemsa Dirofilaria immitis - dog heartworm - man: coin lesion in lungs Dracunculus medinensis - Common name: MEDINA DRAGON/ SERPENT, GUINEA WORM - Largest nematode parasite of man - Length up to 1 m - Habitat: subcutaneous tissue - IH: copepods, Cyclops Angiostrongylus cantonensis - Common name: RAT LUNGWORM - Man: eosinophilic meningcoencephalitis - Adult female: barbers pole appearance (looping of whitish uterus to red deigestive tract) - DH: Rattus rattus, Rattus norvegicus - IH: mollusks - Lab Dx: high eosinophil in CSF Anisakis spp. - Common name: HERRINGS WORM - Pathology: Herrings disease - DH: whales, dolphins - 1st IH: copepods, Cyclops - 2nd IH: smaller fishes - 3rd IH: larger fishes- salmons, cods - man: granuloma and abscess

Subperiodic Nocturnal

Diurnal

Nonperiodic

exception: H. heterophyes

- EGGS o Mature when laid (embryonated) Schistosoma Heterophyes Opistorchis Clonorchis o Immature when laid Fasciola Fasciolopsis Paragonimus Echinostoma - Classification of Trematodes According to IH- all have 2 IH except schistosomes Schistosomes: snail 2nd IH: Fishes: C. sinenss, O. felineus, H. heterophyes Crabs: P. westermani Water vegetation: F. hepatica, F. gigantica, F. buski Snail: E. ilocanum - Classification According to habitat: Liver Flukes Fasciola hepatica - Sheep liver fluke causing ship liver rot - Egg: operculated, immature when laid, resemble F. gigantica, and F. buski Fasciola gigantica - Giant liver fluke - Infect cattles Clonorchis sinensis - Chinese liver fluke/ oriental liver fluke - MOT: ingestion; IS: metacercaria - Most important liver fluke of man - Egg: old fashioned electric light bulb; operculated, mature when laid Opistorchis felineus - Cat liver fluke resembling C. sinensis Small Intestines Fasciolopsis buski - Giant intestinal fluke - Eggs: hens egg shape

- Largest fluke parasitizing man - Eggs are indistinguishable from eggs of Fasciola Echinostoma ilocanum - Garrisons fluke -