Nemathelminthes

Platyhelminthes

Class Nematoda

Class Cestoda dan Class Trematoda

Silindris, panjang

Pipih seperti pita atau daun

Tidak bersegmen

Bersegmen

Sex terpisah antara jantan dan betina

Pada umumnya hermaphrodyte

Saluran pencernaan lengkap

Saluran pencernaan tidak lengkap

Mempunyai rongga tubuh

Tidak memiliki rongga tubuh

The Nematodes (roundworms)

Morphologic features :
- Nonsegmented
- Generally cylindrical, mostly tapered at both
ends
- Covered by cuticle
- Generally a light cream-white colour
- Well formed digestive tracts, with anal and
oral openings
- Separated sexes (in which the males are
generally smaller than the females)
- Certain modifications of apparatus in the oral
opening and esophagus are important in the
identification of the species

Ascaris lumbricoides
Epidemiology :
- Affects more than other parasitic
diseases
- More prevalent in areas with poor
sanitation, areas where human feces
are used as fertilizer

Telur infektif tertelan

Telur fertil menjadi
infektif setelah 18 hari
sampai beberapa
minggu

Larva menetas di
sal.cerna, penetrasi ke
mukosa intestinal

Terbawa aliran darah

portal, terbawa aliran
darah sistemik ke
paru

Telur keluar bersama tinja

Larva menjadi cacing

dewasa di usus halus
deposisi 200.000 telur per
hari

Larva matur di paru

(10-14 hari),
menembus alveolus
naik ke bronchial tree,
tertelan kembali ke
sal.cerna

Morphologic features of adult worms :

- Resembles earth worm
- Length : females 20-35 cm,
males seldom excedeed 30 cm
long
- Creamy white in colour

Clinical manifestations :
- Asymptomatic in mild infection
- Heavy infection can cause bowel
obstruction fever, malaise, abdominal
distention, abdominal pain, vomitting
- Pneumonitis during larval migration
through the lungs

 Diagnosis :
- Examination of the stool fertile or infertile
eggs
Corticated
Fertile
Ascaris lumbricoides
eggs in fresh stool
examination

Decorticated
Infertile

 Fertile corticated eggs :

- Broadly oval, 45-75 m X 35-50 m
- Consists of 3 layers, outer covering
(albuminoid coat) stained golden brown by
the bile, coarse surface

 Fertile decorticated eggs :

- Broadly oval, 45-75 m X 35-50 m
- Consists of 2 layers, already lost its outer
covering (albuminoid coat) thick
yellowish inner shell is obvious

 Infertile eggs :
- Longer and narrower than the fertile
eggs, 90 m X 40 m
- The wall might consists of 2 or 3 layers,
coarse surface

Treatment of infections :
Albendazole single dose 400 mg
Mebendazole 2x100 mg selama 3 hari
Pyrantel pamoate single dose 11 mg/KgBB

Hookworm (Ancylostoma
duodenale and Necator
americanus)

Epidemiology :
- High prevalence in population which defecate
directly onto the soil and do not costumarily
wear shoes
- Climate : sufficient rainfall, sandy loam soil

the infective larvae

penetrate the skin
carried through the
blood vessels to the
heart and then to the
lungs

after 5 to 10 days
rhabditiform become
filariform (third-stage)
larvae that are infective

under favorable
conditions (moisture,
warmth) larvae hatch
in 1-2 days
rhabditiform larvae

penetrate into the

pulmonary alveoli,
ascend the bronchial
tree to the pharynx,
and are swallowed

larvae reach the small

intestine, where they
reside and mature
into adults

Eggs are passed in the

stool
Adult worms attach to
the lumen of small
intestine, with
resultant blood loss

 Morphologic features of adult worms :

N. americanus adult worms similar to
Ancylostoma duodenale but slighly smaller
clinically it is considered unimportant to
differ these two
Difference : the buccal capsule of N.
americanus armed with a pair of cutting
plates, while the buccal capsule of
Ancylostoma duodenale had 2 pair of teeth
Grayish white or pinkish
Male 1 x 0.5 cm, female somewhat larger

Clinical manifestations :
- In penetrating the skin may cause ground itch
(less common with Ancylostoma than with N.
americanus)
- Pneumonitis less severe than in Ascariasis
- Heavy infection : gastrointestinal discomfort,
diarrhea
- Acute intestinal hemorrhage is rare
- Chronic infection : iron deficiency anemia

Diagnosis :
- eggs in fresh stool examination
- larvae might be seen in the eggs of hours long
specimens

 Eggs in stool examination :

- Oval, 56-60 m X 36-40 m
- Thin and colourless shell

- Hatched larvae in the stools must be differentiated from

larvae of Strongyloides stercoralis
- Rhabditiform larvae of hookworms have a long & narrow
buccal capsule (between oral opening and esophagus)
- Strongyloides has a very short and somewhat stout buccal
capsule
Hookworms rhabditiform
larvae

Strongyloides stercoraliss
rhabditiform larvae

Treatment :
Albendazole single dose 400mg
Mebendazole 2x100mg selama 3 hari
Pyrantel pamoate single dose 11 mg/KgBB

Strongyloides stercoralis
Epidemiology :
- similar as hookworm

life cycle of
Strongyloides
stercoralis

Free living cycle

Parasitic cycle

 Morphologic features of adult worms :

- Very small, about 1 mm long

Clinical manifestations :
- Ground itch similar to hookworms infection
- Pneumonitis less severe than in Ascariasis
- Heavy infection : gastrointestinal
discomfort, diarrhea, duodenal ulcer,
melena
Diagnosis :
- Larvae in the stools
- In a case with severe diarrhea,
embryonated eggs may be present in stool

 Larvae in stool examination : similar to

hookworms larvae with a very short and stout
buccal cavity.
Eggs in stool examination : similar to
hookworms eggs, buat the Strongyloides eggs
always contained well-developed larvae

Hookworms eggs

Strongyloides
stercoraliss egg

Treatment :
- albendazole 400 mg/hari selama 3 hari
- Ivermectin 200 g/KgBB per hari selama 2 hari

Trichuris trichiura (whipworm)

Epidemiology :
- High prevalence in population which defecate
directly onto the soil and where human feces
are used for fertilizer

Morphologic features :
- The adult worms : 2-5 cm long, male
slightly smaller than female
- Whip-like tail

ingestion of
infective eggs (soilcontaminated
hands or food)
2-cell stage eggs
embryonate and become
infective in 15 to 30 days

Larvae hatch in
the small
intestine

Larvae matured
and established
themselves as
adults in the colon

the eggs develop

into a 2-cell
stage in the soil

adult worms are fixed in

caecum, the anterior
portions threaded into
mucosa

unembryonated
eggs are passed
with the stool
Female worms in the
cecum shed between
3,000 and 20,000
eggs per day

Clinical manifestations :
- Mild infection : asymptomatic
- Heavy infection : abdominal pain,
abdominal distention, bloody or
mucoid diarrhea, tenesmus, prolapse
of the rectum, weakness
- Chronic infection : anemia
Diagnosis : eggs in stool examination

Eggs in stool examination :

- barrel-shaped/footballshaped
- 50-54m in length with
polar plugs in either
ends

 Treatment :
- Albendazole single dose 400 mg

THE CESTODES

The Cestodes : review

Also called tapeworms
Adult tapeworms found in human all have a flat, ribbonlike body, white or yellowish in colour
The cestode body consists of an attachment organ
named scolex, followed by a chain of segments
(proglottids) named strobila
Strobila growth throughout the life of tapeworms by
continous proliferation of new proglottids in the region
immediately posterior to the scolex
The terminal portion of strobila contains gravid
segments
In some cestodes, these terminal proglottids may
become detached in the intestine and pass out with
stool

The Cestodes : review

The cestodes

Diphyllobothrium latum,
Taenia saginata, Taenia
solium, Echinococcus
granulosus, Dipylidium
caninum, etc

Taenia saginata (beef tapeworm) &

Taenia solium (pork tapeworm)

Epidemiology : worldwide distribution

Morphologic features of
adult worms ::
- flat, ribbon-like body,
may reach several meters
- Yellowish white in colour
- T. saginata : scolex bears 4 muscular suckers
and a small rostellum without hooks
- T. solium : scolex bears 4 muscular suckers and
a double crown with hooks

Differentiating the scolex

T. saginatas scolex

T. soliums scolex

 Clinical manifestations : Mostly

asymptomatic
Diagnosis : eggs and or gravid
proglottids in stool examination
Eggs (undifferentiated between the
T. saginata or T. solium) :
- Round shaped, dark brown in
color
- Distinguished characteristic : a
thick, radially striated covering,
called the embryophore

Differentiating the gravid

proglottids
- Mature segments :
width > length
- Gravid segments :
length > width
- Gravid segments
contain a branched
uterus filled with eggs :
T. solium : 7-13
branches on each side
T. saginata : 15-20
branches on each side

 Treatment :
- Praziquantel single dose 10 mg/KgBB

Cysticercosis
A condition where humans ingested T. solium eggs
oncosphere hatch in small intestine invade intestinal
wall enter systemic circulation lodge in any tissues
(most commonly in voluntary muscles) cysts
Treatment :
- surgical removal
- albendazole 15 mg/KgBB per hari selama 8 hari