PHASMIDS 1- Intestinal Nematodes

ROUNDWORMS
Non-segmented, elongated and cylindrical in shape
Has COMPLETE DIGESTIVE TRACT
BODY: covered with TOUGH, IMPERMEABLE CHITINOUS LIKE CUTICLE

Ascaris lumbricoides

HABITAT
MORPHOLOGY

MOST COMMON intestinal

nematode of MAN(children)
GIANT INTESTINAL
ROUNDWORM
Soil transmitted helminth
SMALL INTESTINE

Toxocara canis/
Toxocara cati
Dog roundworm- T.canis
Cat roundworm-T.cati
(definitive host)
Accidental host: MAN

White or Pink worms are quite large

With SMOOTH striated muscles
On each side of the worm is a faint
LONGITUDINAL LINE

Anisakis spp.
Ascaris of SEA MAMMALS
Sushi
Definitive host: marine fishes/
birds/ mammals
Accidental host: MAN

Enterobius vermicularis

Oxyuris vermicularis
PINWORM/SEATWORM

CECUM/LOWER ILEUM

Oral end lacks TRUE BUCCAL

capsule
3 lips
Anterior end: dorsoventral
bladderlike expansion of cuticula
Cephalic alae: ESOPHAGEAL
BULB

ADULT

MALES
SMALLER
Centrally curved posterior/ventral
end with 2 SPICULES
SINGLE, LONG TORTUOUS TUBULE

FEMALES
LARGER
Paired reproductive organ in the
posterior 2/3 (GENITAL GIRDLE)
SINGLE vagina branched to form a
LJA

Toxocara canis
Transplacental and
transmammary
FEMALE larger
Cylindrical body with
tapering anterior and
posterior ends
MALE: coiled posterior
end
FEMALE: straight end
and vulva to 1/6 from
anterior end
CERVICAL ALAE: longer

MALES
SMALLER
curved tail
1 SPICULES
Spindle shaped with sharply
pointed posterior end
Reduced BURSA, caudal alae and
copulatory SPICULE
FEMALES
LARGER
Long pointed tail
CUTICULAR ALAR expansion at
cephalic alae
Esophageal bulb

pair of GENITAL TUBULES each

consists of uterus seminal
receptacle,oviduct and ovary
CONSTRICTION near MIDLINE
-MOUTH with 3LIPS and SENSORY
PAPILLAE ( no interlabia/alae)

Toxocara cati
FEMALE larger
Cylindrical, ivory or
flesh-colored tapered
both ends
MALE: coiled posterior
end
FEMALE: straight end
and vulva from
anterior end
CERVICAL ALAE: broad

LARVA

EGGS

FERTILIZED EGG
Golden brown
BROADLY OVOID
THICK and TRANSPARENT shell
Innermost of which is called
VITELLINE LAYER( highly
impermeable)
outer, coarsely MAMMILATED,
albuminous coat
UNFERTILIZED EGG
ELONGATED
2 layers of EGGSHELL
Thin middle layer with LITTLE or
NO ALBUMINOUS COAT
Disorganized yolk cells appearing as
TINY BUBBLES
With REFRACTILE granules
DECORTICATED EGG (diagnostic)
BROADLY OVOID
2 layers of EGGSHELL
TRANSPARENT shell due to absence
of ALBUMINOUS COAT

LJA

Toxocara canis
SUBGLOBOSE
Little bit spherical in
shape
MODERATELY THICK
COARSELY PITTED
eggshell (diagnostic)
Granular yolk cells
May contain coiled larva
inside
Toxocara cati
SUBGLOBOSE
Little bit ovoid in shape
THIN SHELL
FINELY PITTED
eggshell (diagnostic)
Mass of organized yolk
cells
May contain an embryo

Vulva: mid-ventral infront of

middle third of the body

RHABDITIFORM
- Has Esophageal bulb
- NO CUTICULAR EXPANSION
(ant.end)
Asymmetrical
One side flat; other side convex (D
SHAPED)
Translucent shell- lipoidal
membrane for chemical
protection
PLANOCONVEX
2 layers shell

4-6 HOURS maturation

Contains a mass of organized YOLK

cells

EMBRYONATED EGG
BROADLY OVOID
TRILAMINAR eggshell
Has coiled larva inside

PATHOGENESIS

-ADULT WORMS cause no SYMPTOMS

-cause APHAXIA in lungs
LUNGPHASE:
- cough
- dyspnea
- hemophysis
- eosinophilia
- pnemonitis

* LOEFFLERS
SYNDROME(larva)

DIAGNOSIS

LJA

Other clinical manifestations:

PNEUMONITIS
ASTHMA
SYMPTOMATIC LACTOSE
MALDIGESTION or INTOLERANCE
BOWEL OBSTRUCTION
Abdominal distention and
tenderness, vomiting, rebound
tenderness
EOSINOPHILIA
Increased IgG and IgE
Sphincter of Oddi obstruction;
ACUTE ABDOMINAL PAIN
gallstone, pancreatitis, cholangitis
Eggs in FECES
Direct fecal smear
Kato-katz method
Barium meal exam

VISCERAL LARVA MIGRANS

(VLM)

-PRESCHOOL CHILDREN common-

Migration of larva (liver,

heart, lungs, brain,
muscle)
Hypereosinophilia
Hepatosplenomegaly
Pneumonitis
Hyperglobulinemia an d
fever
Endopthalmitis
(children)
Anorexia
Weight loss
Cough, wheezing
Rashes

Nausea
VIOLENT abdominal pain
Vomiting 1-2 hours after
ingestion
Larvae occly cough up
Eosinophilic
granulomatous response
2weeks

*CROHNS DISEASE

Peritonitis
Anisakiasis

Immunodiagnosis
Histopathologic exam
Gastroscopic exam

No serious lesions
Mild catarrhal inflammation
Intense itching due to migration
of egg laying female to anus
INSOMIA due to puritus
COMPLICATION:
- Appendicitis
- Vaginits
- endometritis
- Salphingitis
- peritonitis
Poor appetite
Weight loss
Irritability
Grinding of teeth
Abdominal pain

OCULAR LARVA MIGRANS

(OLM)

-OLDER CHILDREN; YOUNG ADULTS-

Ophthalmologic lesions
Retinoblastoma
Rare eosinophilia or
visceral manifestation
Tissue biopsy
ELISA
Fluorescent Antibody
Test

Perianal itching relieved by

vigorous scratching
Scoth adhesive tape swab

TREATMENT

INFECTIVE
STAGE
DIAGNOSTIC
STAGE

LJA

ALBENDAZOLE
MEBENDAZOLE
PYRANTEL PAMOATE

FULLY EMBRYONATED EGG

Egg/adult

ALBENDAZOLE
MEBENDAZOLE
OLM- more difficult
VLM- antiparasitic drugs;
anti-inflammatory

EGG

SURGERY
Endoscopic removal
Commercial blood
freezing

L3 larvae

MEBENDAZOLE
PYRANTEL

FULLY EMBRYONATED EGG