NEMATODES

GENERAL CHARACTERISTICS OF NEMATODES

1. Elongated worms, cylindrical
2. Not segmented
3. Have a complete digestive system
4. Have separate sexes (though some maybe parthenogenic)
5. Presence of sensory organs (with exceptions)
6. Mostly are intestinal parasites

CLASSIFICATION OF NEMATODES
A. Presence or Absence of Chemoreceptors
1. Phasmid minute receptor organs
- with chemoreceptors
2. Aphasmid without chemoreceptors
Ex: Trichuris trichiura, Trichnella spiralis, Capillaria philippinensis

B. Habitat
1. Intestinal
a. small intestines: Ascaris, hookworms, Strongyloides, Capillaria
b. large intestines: Trichuris, Enterobius
2. Extraintestinal
a. Lymph nodes/vessels: Wuchereria and Brugia
b. Eyes and menginges: Angiostrongylus
c. Muscles: Trichinella

C. Infective stages and Modes of Transmission
1. Ingestion of embryonated eggs A,T,E
2. Ingestion of infective larva Capillaria, Trichinella, Angiostrongylus
3. Skin penetration of L3 hookworms and Strongyloides
4. Vector-borne Wuchereria and Brugia
5. Autoinfection Capillaria, Strongyloides and Enterobius
6. Transmission through inhalation Enterobius and Ascaris

DEVELOPMENTAL STAGES
1. Egg
2. Larva
a. L1 : rhabditiform larva
b. L2 :
c. L3 : filariform larva
3. Adult

Ascaris lumbricoides
Common name : Giant intestinal/round worm
Final Host : man
Habitat : small intestine
Diagnostic stage : fertilized and unfertilized egg
Infective stage : embryonated egg
Source of ex. to inf. : soil-transmitted helminth
MOT : Ingestion
Pathology : Ascariasis
Diagnosis : Stool Exam, Concentration technique
Drug of choice : Albendazole
(Mebendazole and Pyrantel Pamoate)
Ascaris suum Ascaris of Pigs

MORPHOLOGY

Trilobate lips with sensory papillae


PATHOLOGY
A. Due to larva
*Ascaris pneumonitis or Loefflers Syndrome
- occurs during lung migration resulting in allergic reactions
such as lung infiltration, asthmatic attacks and edema of the
lips, similar symptoms of pneumonia, vague abdominal pain
* Eosinophilia is present
B. Due to adult worm
- worm bolus causing obstruction
- diarrhea
- abdominal pain
Erraticity: if worm migrates to ectopic sites (gallbladder, hepatobilliary tree,

through the nostrils or inhaled to the trachea.
- Maybe due to medication, spicy-diet and fever

DIAGNOSIS
A. Stool Examination
1. Direct Fecal Smear
2. Kato-thick
3. Kato-katz
B. Concentration Technique
1. FECT
2. MIFCT
3. Brine floatation
4. Zinc sulfate floatation technique
C. X-ray (extra-
D. CBC (demonstrate eosinophilia)

PREVENTION AND CONTROL
1. Sanitary disposal of human feces
2. Health education
3. Mass chemotheraphy
4. Avoid using night soil
5. Proper food preparation

Integrated Helminth Control Program (DOH)
Targets and Doses
1. Children aged 1 year to 12 years old
For children 12 24 months old
Albendazole - 200 mg, single dose every 6 months. Since the preparation is
400mg, the tablet is halve and can be chewed by the
child or taken with a glass of water
Or
Mebendazole - 500 mg, single dose every 6 months
For children 24 months old and above
Albendazole - 400 mg, single dose every 6 months
Or
Mebendazole - 500 mg, single dose every 6 months
Note: If Vitamin A and deworming drug are given simultaneously during the
GP activity, either drug can be given first.
2. Adolescent females
It is recommended that all adolescent females who consult the health be
given anthelminthic drug
Albendazole 400 mg once a year
Or
Mebendazole 500 mg once a year
3. Pregnant women
It is recommended that all pregnant women who consult the health be given
anthelminthic drug once in the 2nd trimester of
pregnancy.
In areas where hookworm is endemic:
Where hookworm prevalence is 20 30%
Albendazole 400 mg once in the 2nd trimester
Or
Mebendazole 500 mg once in the 2nd trimester
Where hookworm prevalence is > 50%, repeat treatment in the 3rd trimester
4. Special groups, e.g., food handlers and operators, soldiers, farmers and
indigenous people
Selective deworming is the giving of anthelminthic drug to an individual
based on the diagnosis of current infection. However, certain
groups of people should be given deworming drugs regardless of their status
once they consult the health center.
Special groups like soldiers, farmers, food handlers and operators, and
indigenous people are at risk of morbidity because of their
exposure to different intestinal parasites in relation to their occupation or
cultural practices.
For the clients who will be dewormed selectively, treatment shall given be
anytime at the health centers

Trichuris trichiura
Common name : Whipworm
Final Host : man
Habitat : large intestine
Diagnostic stage : egg
Infective stage : embryonated egg
Source of ex. to inf. : soil-transmitted helminth
MOT : Ingestion
Pathology : Rectal prolapse, IDA, diarrhea
Diagnosis : Stool Exam, Concentration technique
Drug of choice : Mebendazole
(Albendazole as alternative drug)
* Usually observed occuring together with Ascaris lumbricoides


MORPHOLOGY
Lemon shaped/barrel-shaped/football shaped/ japanese
lantern with translucent polar prominences aka mucoid
bipolar plugs


PATHOLOGY
1. Rectal prolapse
- a condition in which the rectum
(the lower end of the colon,
located just above the anus)
becomes stretched out and
protrudes out of the anus.
Weakness of the anal sphincter
muscle is often associated with
rectal prolapse at this stage,
resulting in leakage of stool or
mucus.
2. Appendicitis and granulomas due to irritation and
inflammation brought by the worms
3. Blood streaked diarrheal stools, abdominal pain,
tenderness, anemia and weight loss

DIAGNOSIS
A. Stool Examination
1. Direct Fecal Smear
2. Kato-thick
3. Kato-katz
B. Concentration Technique
1. FECT
2. MIFCT
3. Brine floatation
4. Zinc sulfate floatation technique

PREVENTION AND CONTROL
1. Treatment of infected individuals

3. Washing of hands
4. Health education (sanitation and hygiene)
5. Proper food preparation practices

Enterobius vermicularis
Common name : Pinworm, Seatworm, Society worm*
Final Host : man
Habitat : (cecum) large intestine
Diagnostic stage : ova
Infective stage : embryonated egg
Source of ex. to inf. : contact-borne
MOT : Ingestion, inhalation
Pathology : Enterobiasis or oxyuriasis
Diagnosis : Scotch tape swab
Drug of choice : Pyrantel pamoate
(Mebendazole and Albendazole as
alternative)
* Familial disease
Morphology

D-shaped eggs of E. vermicularis
Asymmetrical, with one side flattened and the other side is convex
Translucent shell triple albuminous outer layer for mechanical protection
and inner embryonic lipoidal layer for chemical protection
Ovum develops into a tadpole-like embryo

PATHOLOGY
1. Inflammation of the intestinal mucosa
2. Nocturnal Pruritus ani perianal itching which may
lead to secondary bacterial infection and lack of sleep
3. Other complications: appendicitis, vaginitis, endometritis
and peritonitis.
4. Poor appetite, weight loss and abdominal pain
DIAGNOSIS
1. Grahams scotch adhesive tape
swab (Perianal cellulose tape swab)
- provides the highest percentage of
(+) results
PREVENTION AND CONTROL
1. Personal cleanliness and hygiene are essential
2. Hand washing
3. Boiling of linen and clothing