Nemathelminthes review
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Transcript of Nemathelminthes review
![Page 1: Nemathelminthes review](https://reader038.fdocuments.in/reader038/viewer/2022102717/55c8b3f8bb61ebc85f8b46c1/html5/thumbnails/1.jpg)
NEMATHELMINTHES
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1. ASCARIS OVA
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1. ASCARIS LUMBRICOIDES
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1.ASCARIS LUMBRICOIDES• Common name: Giant Intestinal roundworm• Definitive host: Man (No intermediate host)• Habitat: Small intestine• Diagnostic stage: ova (fertilized or unfertilized)• Infective stage: Embryonated ova• SOI: soil-transmitted, eggs remain viable in the soil for month-10 years• MOT: Ingestion, hand to mouth; fingers contaminated by soil contact
• Adult worm : “erratic ascaris” brain, liver , lungs• Cause: Loeffler’s syndrome
• Treatment: Mebendazole or pyrantel pamoate• Control: education and chemotherapy
• Ectopic sites: appendicitis, biliary tract duct of pancreas• Children cause mental retardation
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Ascaris wormToxocara cati, T. canis
• Cause: visceral larva migrans or Toxocariasis• Eggs are threat to human• Children more prone to infect because of a contact• Migration produces hemorrhage, necrosis, granulomas• Eosinophillia, liver damage, pulmonary inflammation,
ocular problem will be observed.
• Take note: they do not develop further than larva stage
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2. Hookworm Ova
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ascaris lumbricoides ova
Trichuris trichiura ova
hook worm ova
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2. Hookworm RhabditiformDiagnostic stage
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2. Hookworm filariformInfective stage
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Hookworm in human
• Ancylostoma duodenale and Necator americanus
• Infection occurs when filariform (LARVAE) penetrates the skin of man
• Causing “ground itch” or “dewy itch” maculopapular lesion
• Iron deficiency anemia, hypoalbuminemia
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Hookworm in Human
• Common name: Old world hookworm( Ancylostoma duodenale), New world hookworm (Necator americanus)
• Definitive host: Human (no intermediate host)• Body curvature: “C” shaped and “S” shaped• Dental pattern: 2 pairs of teeth, semilunar-cutting plate• Habitat: Small intestine• Diagnostic stage: Ova• Infective stage: L3 (filariform)• Mode of transmission: skin penetration, transmammary and
purely percutaneous
• Disease: Hookworm infection, Ancylostomiasis
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Animal Hookworm • Ancylostoma caninum and Ancylostoma
braziliense• Causing Cutaneous Larva Migrans (CLM)
produces linear, pruritic, papulovesicular lesions• Condition referred to serpiginous dermatitis or
creeping eruption
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2. Hookworm
• Infective stage: filariform larva(L3)• Skin: site of entry of filariform• Lung: Larva migration- bronchitis, pneumonitis• Small intestine: habitat of adult worm-
steatorrhea, diarrhea w/ blood and mucus• Eosinophil 30-60%• Treatment: mebendazole (DOC) and pyrantel
pamoate
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Characteristic of hookworm dentition
• A: Necator americanus, semi-luna cutting plate• B: Ancylostoma braziliense: 2 pair of teeth• C: Ancylostoma caninum: 3 pairs of teeth• D: Ancylostoma duodenale: 2 pair of teeth
A B C D
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Hookworm
No acute symptomChronic secondary • Microcytic hypochromic anemia (iron deficiency/loss
blood)• Hypoalbuminemia (loss blood, lymp, protein)• Other symptom dyspnea, weakness, dizziness,
lassitude, signs include rapid pulse edema, albuminuria
• In children: heavy infection-stunting growth & mental retardation
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Hookworm
• Laboratory diagnosis: based on the identification of eggs1. DFS (only in heavy infection)2. Kato technique or Kato-katz method: detection rate,
quantitative diagnosis3. Concentration method like ZnSO4 contrifugal
floatation& formalin-ether concentration method, increase positive finding many folds
4. Harada-Mori culture allow hatching larva from eggs on strips of filter paper with one end immersed in water.
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3. ENTEROBIUS VERMICULARIS or PINWORM OVA
D-shape
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3. ENTEROBIUS VERMICULARIS or PINWORM FEMALE
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3. Enterobius vermicularis
• Common name: Pinworm, seatworm, society worm• Final host: man (without intermediate host and reservoir host)• Habitat: large intestine (caecum and colon)• Diagnostic stage: ova• Infective stage: Embryonated ova• Source of infection: contact borne• Mode of transmission: ingestion, inhalation
Take note: Larva develop and the eggs become infected within 4-6 hours
Newly hatched larva migrate back to anus- Retroinfection
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3. Enterobius vermicularis or Pinworm
• Causing enterobiasis, oxyuriasis or seatworm infection• Lab: scotch tape method early in the morning before taking
a bath• Familial disease
• Treatment: 1. pyrantel pamoate 10mg/kg w/ a second dose 2-4 wks later2. Albendazole(400mg) mebendazole (500mg) single dose
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4.TRICHINELLA SPIRALIS LARVA
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4. Trichinella spiralis
• Common name: Trichinia worm• Infective stage: Encysted larvae• Habitat: Striated muscle tissue• MOT: ingestion of raw/ uncooked
contaminated meat• Diagnostic specimen- skeletal muscle, biopsy/
blood (LDH adolase, CPK, eosinoplil etc.)
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4. TRICHINELLA SPIRALIS
• Infective stage: encysted larva (viable for 10 years)
• Impregnated female penetrates the duodenal wall start to produce lava after a week
• Favorite sites: heart & systematic circulation, striated muscle(heaviest infection), CNS, serous cavities
• Treatment: Thiabendazole(intestinal phase), corticosteroid (inflammation), salicylates(pain)
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5. TRICHURIS TRICHIURA or WHIPWORM
bipolar plug
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5. TRICHURIS TRICHIURA OVA
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5. Trichuris trichiura
• Common name: whip worm• Final host: human• Habitat: Large intestine-attached• Diagnostic stage: Ova• Infective stage: Embryonated ova• Source of infection: Soil-transmitted helminthes• Mode of transmission: Ingestion• Portal of entry: mouth
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5. Trichuris trichiura
• Egg Morphology; hatched in Large intestineTrichuris trichiura eggs are 'football' or 'barrel' shaped with clear, mucoid-appearing polar plugs at each end.
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5. Trichuris trichiuraWhipworm
• Infective stage: fully embryonated egg found in brackish
• Stool exam: reveals bile-stained eggs w/ polar plugs• Pathology: Rectal prolapsed in children,
appendicitis, Iron deficiency anemia, diarrhea and eosinophilia (seen in severe infection)
• Treatment : mebendazole(DOC)
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To declare free from Ascaris lumbricoides and Trichuris trichiura
• Three specimen- negative• Stool examination negative for eggs-
interpreted as1. All male parasites2. Female worms are immature(migration
stage)3. Unfertilized eggs (all females and males-
immature)
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6. Capillaria philippinensis or Pudoc worm
Peanut shaped Flattened bipolar plug
Striated shells
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• Common name: Pudoc worm• Final host: man/other vertebrate; fish-eating birds• Intermediate host(IH): glass fish, fresh brackish-water fish• Diagnostic stage: Ova in stool;peanut-shaped(unembryonated
egg)• Infective stage: encysted larva (larva in IH)• Habitat: small intestine• Source of infection: food borne• Mode of transmission: eat raw brackish water fish/
contaminated fish• Portal of entry: mouth
6. Capillaria philippinensis or Pudoc worm
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6. Capillaria philippinensis
Autoinfection and hyperinfection
Ova(diagnostic stage): Produced by typical female Moderately thick striated egg sheath with
flattened bipolar plug
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6. Capillaria philppinensis or Pudoc worm
Pathology Decrease secretion of xylose, low e’lyte(K+) Cause micro ulceration, depression of intestinal villi (cause
malabsorption of fluid, protein and electrolytes) Borborygmi (Gurgling stomach) Malabsorption syndrome(Fat&sugar)
Laboratory test DFS (direct fecal stool exam) Concentration technique(FECT) Examination of duodenal aspirate
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6. Capillaria philippinensis orPudoc worm
• Treatment: 1. Albendazole(DOC) 400 mg once daily for 10 days2. Mebendazole 200 mg 2 tab once daily for 20 days
Relapse may occur if the treatment regimen is not followed. If dis. Not treated soon after severe manifestation – die
Parasites can be found in small intestine by: “duodenal aspiration”
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7. Strongyloides stercularis
• Common name: Threadworm, smallest nematode of man• Final host: man• Diagnostic stage: Rhabditiform Larva• Infective stage: Filarliform Larva(L3)• Mode of transmission: Skin penetration of infective larva;
AUTOINFECTION• Causative agent of : Cochin China Diarrhea,
malabsorption syndrome
Take note: Hyperinfection are limited to Lungs and GIT
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Rhabditiform larva of S. stercoralris can be mistaken from of that the hookworm Rhabditiform
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8. Wuchereria bancrofti
• Common name: Bancroft’s firalial worm• Vectors: Anopheles, Culex, Aedes• Host-adult: Lower lymphatic• NO ANIMAL RESERVOIR
• Diagnostic stage: Microfilariae• Infective stage: L3 filariform larva• MOT: Skin penetration• Periodicity: Nocturnal (Blood smear 10pm-4am)• Habitat: Lymphatic and blood (disappear at day time)• Pathology: BANCROFTIAN FILARIASIS
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8. Wuchereria bancrofti Diagnosis:• Blood smear examination between 10 pm -4am.• Knott’s concentration technique • RDT-ICT antigen detection (CFA)• Both W. bancrofti & Burgia malayi demonstrates a sheath on
microfilariae
Treatment• Bancroftian filariasis 6 mg/kg/day DEC for 12 days• Burgian filariasis 3-5 mg/kg/day up to 36-72 mg/kg
Diethylcarbamazine(DEC) and Ivermectin
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9. Burgia malayi
• Common name: Malayan filarial worm• Final host: Mansonia bonneae, M. uniformis• Host-adult: upper limbs lymphatic• Diagnostic stage: Microfilarial• Infective stage: L3 filariform larva• MOT: skin penetration• Periodicity: nocturnal subperiodic• Pathology: MALAYAN FILARIASIS• Reservoir: Cats & monkeys
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9.Loa Loa• Common name: African eye worm• Vector: a biting fly- CHRYSOPS• Reservoir host: monkeys
• Blood smear between 10pm.-2am.
• Causing agent of subcutaneous nodules or ONCHOCERCOMATA contain adult worms-painless
• Ocular disease: RIVER BLINDNESS
• Migratory lesion: CALABAR SWELLING- result of allergic reaction or metabolic production, transients, painful & pruritus
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10. Onchocerca volvulus
• Habitat: Laymphatic & subcutaneous tissues• Causes: Onchocerciasis( River blindness)• Vector: Black fly (Genus Simulium damnosum)-majority• Human is a natural host• Diagnostic stage: unsheathed microfilariae• Infective stage: Microfilariae
Pathology• Onchocerciasis(river blindness), the least pathogenic-
causing ONCHOCERCOMATA(subcutaneous nodules)
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11. Dirofilaria immitis
• Common name: Dog heartworm• Intermediate host: mosquitoes• Host: dogs, cats, raccoons, bobcats in nature,
occasionally man• Cause: Man-subcutaneous nodules or so-called
“coin-lesion” in lungs• Dogs- dog heartworm, rare in human’s heart• Transmission- by mosquitoes controlled,
treating dogs with Ivermectin
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12. Dracunculus medinensis• “Little dragon of Medina”- ancient worm infection; “fiery serpant”
noted by moses with the Isralites at the Red Sea
• Reservoir host: dogs, fur-bearing animals drink contaminated water containing infective Cyclops
• Human infection- result of ingestion of water from so-called “stepwell” where people stand or bathe in the water , at which gravid female worm discharges lava from lesion on the arms, legs, feet, ankles to infect cyclops in the water.
• Take note: a filarial worm but a tissue invading nematodes. They are not appeared in the blood
• Immediate host: fresh water microcutaneous(copped) of genus Cyclops
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12. Dracunculus medinensis
• Laboratory diagnosis: observation of typical ulcer & flooding the ulcer with water to recover& discharge the larval form
• Occasionally, x-ray examination reveals worms in various part of the body
• Treatment: Surgical removal, wrapping the worm on a twig
• Tiridazole(DOC), alternative drug:metronidazole, thiabendazole
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Take Note
• Filariform larva:-infective stage of hookworm , ascaris and other nematodes, long, thread-like often “designed” for penetration
• Filarial worm: any of a group of parasitic worms of family Filariaidae (Phylum Nematodes) requires 2 hosts, an arthropod(Intermediate host) and a vertebrae (primary host) to complete the life cycle