Intestinal Parasites (:

Ascariasis
Ascaris lumbricoides

Types

Epid

Cosmopolitan
socioeconomic condition
poor hygiene
Poverty- food intake

Characteris
tic

Hookworm
Necator americanus ( NA,
Msia)
Ancylostoma duodenale
(AD, subtropics)
Ancylostoma caninum /
ceylanicum (animal)
Ancylostoma malayanum
(animal msia)
Rainfall favours spread, shade,
moisture, humus

Clinical
Larva:
manifestati o Lung manifestations: Each larva in lung tissue 7
on
days & continuous in endemic area
o Normally in light infection & sensitivity to repeated
infection
o Inflammation & haemorrhage in migration path
granuloma
o Asthma like pneumonitis ascariasis (Loeffler
syndrome)
Fever, cough, haemoptysis, dyspnea, eosinophils

Strongyloidiasis
S. stercoralis
S. fulleborni

o
o
o
o
o

NA: smaller, blood

consumption
AD: larger, blood
consumption
Have buccal cavity,
anticoagulant glands
Segmented egg when
passed
Larva:
Skin
Intense itch 7-10 days
Ground itch
larvae unrelieved
pruritus
Erythematous popular rash
vesicular 2o infection
Animal larva > severe
creeping eruption

immunocompromised
institutions

Parthenogenesis
Autoinfection

Asymptomatic no
mucosal lesions
Larva
L3
o Penetration rapid & no
ground itch
o Capable mature to adult in
lung granuloma
(bronchitis / asthmatic
symptoms)

Sputum may contain: Charcot Leyden crystal /

eosinophil
Adult:
Severity:
No of worms: <10 worms (normal) / single can be
severe- allergic response
Location: Jejunum > ileum > duodenum
Intestinal irritation
Intermittent colicky pain, cramps
LOA, fretfulness, protuberant abdomen
Villus atrophy
Due to its spiral movement nutritional
impairment malnutrition child kwashiorkor
Lactose intolerance
Affected absorption vitamin A, nitrogen, carbs
Loss of plasma albumin
Intestinal obstruction (child)
Acute: often complete,SI, usually mechanical, due
to hernia volvulus intussusception ascaris bolus &
gallstones
Chronic: incomplete, LI, inflammation / tumour
stricture
Ascaris bolus: common in acute & tropic in child,
>10 worms, mainly terminal ileum, presents w/
colicky pain, vomiting, constipation, dehydration
Ectopic migration
Adult & children
Worms emerge: mouth, nose (tracheal
obstruction), eye
Enter orifice + wound block passage
appendicitis, ductus biliary blockage lead to calculi
on death form & cholangitis, pancreatitis, rarely
enter hepatic vein brain, lung,

o
o
o

o
o
o

(cutaneous larva migransThiabendazole topical)

Lung:
Minute focal haemorrhage
loeffler- transient
Pharyngitis, laryngitis
Adult
Causing severity:
worms
Blood sucking for food & O2
Changes location 4-6 times /
day capillaries ruptured
bleeding from mucosa /
anticoagulant in worm &
tissue
Status host immunity
Acute:
Fatigue, N&V, burning +
cramping abdominal pain
( peptic ulcer), flatulence,
duodenitis
If last 2-6 weeks diarrhea
(red/ black feces), pallor
Chronic:
IDA, pallor, oedema (facial &
pedal), apathy, Hb,
cardiomegaly, mental +
physical dev
Hypoalbuminemia +
oedema: d/t
haematological index

Larva currens (running

larva)
o In sensitized persons
o L3 doesnt enter blood
o Migration in skin diffused
eruption
o Rushes 10 cm / hr
o 12-48 hr heals
Loeffler
Adult
Asymptomatic
Heavy infection
o Intestinal irritation
o Epigastric pain
o Vomiting, LOA
o Loss body weight
o Eosinophilia
Jejunum + submucosa
o Eosinophils
o Villi flattened
o Fibrosis of lamina propria
o Malabsorption
o Enteritis
Immunocompromised
(AIDS)
o CMI, steroid therapy
dissemination of worms
from jejunum to all organs
o Fatal, diarrhea, hepatitis,
myocarditis, pneumonitis,
coma
Epidemic:
o Hyperinfection acute

Life cycle

MOI
Dx

Rx

Cx

Granuloma
o Allergy (A. suum) Hypersensitive rxn
o Predisposition to infection in endemic area
Adult + larva
o Immune response, mechanical effect & nutritional
loss
Infective egg in vegetable, furniture, dust, RM
infected by contaminated food eggs hatch in
duodenum migrated in blood & reach lung
migrate to bronchus swallowed again to small
intestine & mature in 2 months eggs in feces
unfertilized/ decorticated/ larva 1 larva 2 larva
3 (infective)
Food, water contamination
Door knob, furniture, dust, chopping boards
Stool exam

abdominal pain /
pneumonitis fatal /
swollen belly syndrome

Infective larvae penetrate

skin / oral migrate & reach
lung shortsojourn in lung
swallowed again adult in SI
2 months worm attach to
intestinal wall egg in feces
L1-L3
Skin penetration

L3 penetrate skin blood

lung & trachea swallowed
adults in SI
parthenogenesis / autinfection
L1 in stool 2 moults L3

Egg in feces
Harada mori technique
Grow in polythene bags
detection
Single dose albendazole /
repeat 3 weeks
Heavy infection:
albendazole, Fe
supplement, protein diet

Feces disposal-night soil

Wearing shoes
Personal health

Supplement
Rest, oral fluid-potassium replacement
Antihelminth- albendaole (stat & repeat 3 weeks)
Antispasmodic drug- Mazxdon
Surgery

Rx- twice yearly- endemic area

Environmental sanitation
Health education

Skin penetration

Epigastric pain, diarrhea

L1 in feces
Harada mori technique
S. fulleborni eggs in feces
Creeping eruption
triabendazole topical
Intestinal triabendazole /
albendazole
Hyperinfection
unresponsive Rx
Similar to Hw, shoes

Type
Epid

Characteris
tic
Clinical
manifestati
on

o
o

Trichuriasis
Trichuris trichiura
Cosmopolitan: tropics, warm, humid climate
Common but difficult in Rx
Infection w/ ascaris
Adult attached to mucosal cell caecum +
upper colon
Unsegmented Golden yellow egg
Abdominal pain, distension, diarrhea /
dysentery, headache, tenesmus, anorexia
Light infection:
Petechial + subepithelial haemorrhage
Mucosal cell destruction

Enterobiasis
Enterobius vermicularis
Commonest worm infection
Cosmopolitan
Difficult to diagnose
Reinfection is important!

Attributed symptoms
Anxiety, irritability, emotional stability, nail biting, nose picking,
teeth grinding
Pruritus ani
worm migration

Mild diarrhea
Heavy infection:
Bowel irritation poor water resorption in
colon diarrhea
o Dysentery
o Haematochezia : blood + mucus in feces
(melena)
o Anaemia (hypochromic): blood sucked / thru
haemorrhage
o Malnutrition: groth retardation, shunting,
reversible
o Appendicitis: lumen blockage / irritation/
inflammation
o Rectal prolapse: heavy worm load to rectum,
muscle layer damaged, strain to defecate
prolapse
o Finger clubbing: koilonychia
Contaminated food, unhygienic habit egg
hatch in stomach/SI head penetrate & grow
no migration to lung immature worm
migrates to cecum ant. Penetrate & grow
adult in LI buried in mucosa egg deposited
in feces 2 weeks in soil mature egg
Contaminated food, unhygienic habit

o
o
o

Life cycle

MOI

Dx

Stool exam eggs

Deformed egg after Rx

Deposition of eggs (glue) cause intense itching scarification (2o

infection)
o Loss of sleep
o Abnormal sleep position
Adult:
In lumen cecum migrate
Entry to mucosa rare (only injury to mucosa)
Migrate to appendix appendicitis
: proximity of genital to worm migration area
Migrate to fallopian tube salpingitis
Cause pruritus vaginae
Mucoidal discharge
Migrate to urinary tract Urinary genital disturbance
Eggs: rarely migrate (ectopic) to liver, lung thru blood, lymphatics

Infective egg by inhalation / ingested autoinfection egg

swallowed grows into adults in 1 month adult in LI migrate
(nocturnal) & deposit eggs perianally

Person to person
Clothes sharing
Beds, dust
Autoinfection
Not found in feces
Modified scotch tape
Done on wacking up
Before defecation + washing
Dobbing- perianal area

Rx

Cx

Mebendazole course
Albendazole repeat 3 weeks
Repeated Rx needed to expel worm

Albendazole / mebendazole repeat after 1 month

Personal hygiene- finger, nails

Clean toilets
Avoid sharing clothes (pyjamas) / sharing beds
Regular medication