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Tissue Nematoda

Adult in tissues

Larva in tissues

Filarial worms

Lymphatic

subcutaneous tissues

Wuchereria

Loa loa.

bancrofti.

Onchocercus

Wuchereria

volvulus

serous cavities

Mansonella
species

malayi.
Dr. Mona El Sobky

Trichinella spiralis
Toxocara canis &
cati (visceral larva
migrans).
Ancylostoma
caninum &
braziliense
(cutaneous larva
migrans)
Larvae of filariae
(microfilaria in
blood)
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Trichinella spiralis
Distribution:
World wide specially in pork eating countries.
Definitive host:
Pigs, rats & sometimes man.
Intermediate host:
Pigs, rats & sometimes man.
Habitat: Adults live in the small intestine.
Males in lumen & females in tissues (embedded in submucoa).
Larvae live mainly in active striated muscles.
Dr. Mona El Sobky

General characters
Small thread like nematode.
Thin

anterior

part

which

becomes

gradually thickened posteriorly.


Simple mouth.
Cellular

oesophagus

(1/3

the

body

length.
Dr. Mona El Sobky

Male:
Shorter than female .
Posterior end coiled.
One set of genitalia.
Two conical papillae at
post. end.

Dr. Mona El Sobky

Female:
Posterior end is blunt .
One set of genitalia.
Vulva opens anteriorly at
the ventral side.
Larviparous.

Dr. Mona El Sobky

Larva:
0.1 mm. long.
Rhabditiform oesophagus.
Passes in stool sometimes.
Passes to the blood to reach muscles
& becomes encysted.
Dr. Mona El Sobky

Encysted T. spiralis larva in muscles (I.S):


1 mm. long.
Coiled.
Live in active striated muscles as eye lid,
tongue,

ms

of

mastication,

deltoid,

diaphragm & intercostal ms.


Surrounded by a fibrous capsule (made by
the host).
The cyst lies in between & parallel to
muscle fibres.
The encysted larvae become calcified in 612 months.

Dr. Mona El Sobky

Dr. Mona El Sobky

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Mode of Infection
1. Rats are infected by eating infected pig muscles in
garbage containing encysted T. spiralis larva or
eating infected rats by cannibalism.
2. Pigs are infected by eating meat of dead pigs or dead
rats containing encysted T. spiralis larva.
3. Man is infected by eating undercooked pork meat,
containing encysted T. spiralis larva.
Dr. Mona El Sobky

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Pathologenesis & Symptomatology


Disease: Trichinellosis, trichiniasis

The symptoms vary depending on the


amount of encysted larvae ingested, age
and host immunity.
There are two main phases for infection:1- Enteral phase (affecting the intestine).
2- Parenteral phase: (outside the intestine).
Dr. Mona El Sobky

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1- Enteral phase
(Affecting the intestine)
Light infection usually asymptomatic.
Heavy infection produces symptoms such as
nausea, vomiting, dyspepsia, abdominal pain and
diarrhea (like food poisoning).
This phase occurs in the 1st week after infection.
Eosinophilia detected early and increased.
Larvae can be detected in the stool.

Dr. Mona El Sobky

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2- Parenteral phase
(Outside the intestine)
Larvae migrate in the blood invade different tissue initiate
inflammatory reaction and presented by:Fever and urticarial rash due to toxaemia.
Muscles: Pain and tenderness of the affected muscle: Eye lids periorbital oedema (a classic sign), subconjuctival
haemorrhage and difficulty in eye movement.
Tongue difficulty in speaking and dysphagia.
Diaphragm and intercostals muscles difficulty in breathing.
Muscles of mastication difficulty in mastication.
Splinter haemorrhage under the nails (a common symptom)
Larynx: Hoarseness of voice.
Heart: Myocarditis may lead to heart failure.
Lung: Pneumonia.
Brain: Encephalitis and meningitis.
In severe cases, death can occur 4-6 weeks after the infection and is
usually caused by myocarditis, encephalitis or pneumonia.
Eosinophilia: 20-50%.
Dr. Mona El Sobky
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Periorbital oedema
Dr. Mona El Sobky

Splinter
haemorrhage under
the nail

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Laboratory Diagnosis
Direct

Indirect

Stool examination: For larvae or adult.

Intradermal test (Bachman test).

Blood examination: For larvae.

Serological tests: CFT, IHA, IFAT,

Muscle biopsy: Taken from the swollen

ELISA.

tender part & compressed between two

Eosinophlia (20-50%).

slides after digestion in acid pepsin to


see larvae .
Trichinoscopy: To see larvae in muscle.
X ray for calcified cyst.
CT for brain lesions.
Dr. Mona El Sobky

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Treatment
Specific therapy

General treatment
Bed rest and fluid therapy

Thiabendazole.

Sedatives for headache

Mebendazole.

and muscle pain.


Corticosteroids to reduce
inflammatory reaction.
Cardiac and respiratory
monitoring.
Dr. Mona El Sobky

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Onchocercus volvolus
(River Blindness worm)

Geographical distribution: Sudan, Saudi Arabia, Yemen and Central


America.

Habitat:

Adult inhabits subcutaneous tissues over boney prominences.

Microfilariae does not reach the circulation, they are present in the
dermis, subcutaneous nodules, subcutaneous tissues, all chambers
of the eye and they are non periodic.

D.H: Man.

I.H (vector): Female Black flies (Simulium).

Dr. Mona El Sobky

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Morphological characters
I. Adults (D.S):
Male:

shorter than

female.
Female:

Layes

micrifilaria

in

subcutaneous
nodules.

Dr. Mona El Sobky

Section in skin nodule


shows female uteri full of
microfilaria
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Microfilaria (D.S):

II.

Smooth curves.

Non sheathed.

Anterior end & tail free of nuclei.

Not found in blood but found in


subcutaneous

nodule

&

eye

chambers.
III. Filariform larva (I.S): in the mouth
parts of black fly.

Dr. Mona El Sobky

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Dr. Mona El Sobky

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Pathogenesis and symptomatology


Disease: Onchocercosis or river blindness.
1- Cutaneous lesions
Onchocerca

nodule

(onchocerchoma ):
Fibrous

subcutaneous

nodules

over

prominences

as

bony
scalp,

elbow, knee, ribs, iliac crest


& scapula.
Firm rounded or oval.
Containing
microfilariae

adults

and

The skin over and near

The lymph nodes in

nodules shows sever

femoral

dermatitis, an intense itching

enlarged (in males and

and may lead to 2ry

females)

infection.

groin) with loss of skin

Skin may be depigmented

elasticity

(Leopard) or hyper

the skin).

triangle

are

(hanging

(sagging

of

pigmented (Sowda) with


oedema.
Dr. Mona El Sobky

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Onchocerca nodule

hanging groin

Onchocerca nodule

Dr. Mona El Sobky

Onchocerca nodule

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Sowda (hyperpigmentation)

Leopard (Hypopigmentation)
Dr. Mona El Sobky

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2- Eye lesions
River blindness or Sudanese blindness
Due to immunologic response to microfilaria that

invade the eye.


Microfilaria invades many parts of the eye

keratitis with corneal opacity iridocyclitis,


chorioretinitis with degenerative changes and
optic neuritis blindness.
Dr. Mona El Sobky

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River blindness or Sudanese blindness


Dr. Mona El Sobky

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Laboratory diagnosis
Indirect

Direct
Demonstration
microfilaria

in

of
aspirate

of

nodules or skin snips.


Demonstration of adult in
excised nodule.
Eye examination: presence
of microfilariae in cornea and
eye chambers.

Eosinophilia (20%).
Intradermal test (using Dirofilaria
antigen).
Serological tests and PCR.
Mazzotti test: 50 mg - 100 mg of
hetrazan is given orally appearance
of skin rash, itching within 24 hours
(due

to

death

of

microfilaria

in

subcutaneous tissue and liberation of


high amount of antigen and toxins).

Dr. Mona El Sobky

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Treatment
Surgical removal of the nodule.
Hetrazan.
Ivermectin (Drug of choice).

Dr. Mona El Sobky

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Dr. Mona El Sobky

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