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[PARASITOLOGY ENTEROBIUS- DR AYOCHOK] Oct.

10, 2014
Compensations or adaptations:
1. Increase tolerance to anoxia
2. Decrease systolic BP
3. Decreased peripheral blood flow
4. Increase collateral circulation
5. Vital capacity = increase
Attach to Small intestine mucosa: suck blood until area
is spent, then moves to another site (moving to
another site causes blood lost).
Diagnosis:
1. Cutaneous
History of exposure and creeping eruptions
inspect lesions
2. Hookworm dse
hookworm eggs in stool
Decreased hgb/hct

Threshold level: 20 eggs/mg (well-nourished)

5eggs/mg (iron or protein deficiency)

Stored feces >24hours: see rhabdditiform larvae


Treatment:
1. Creeping eruptions:
Thiabendazole
Manual removal or larvae
Supportive or symptomatic:
antihistamine
2. Intestinal:
Albendazole
Mebendazole
Pyrantel pamoate
3. Wakana dse (allergic reaction):
corticosteroids to decrease
inflammation
Prevention and control

Sanitary disposal of human feces

Construction and proper manintenance of


latrines

Treatment of eggs passers (asymptomatics)

Creeping eruptions:
o Covering sandboxes
o No dogs or cats in bathing
o Wearing shoes. Slippers and boots
o Health education on personal, family and
commmunity hygiene

Mass chemotherapy if prevalence is more than


50%

Male: caudal papillae (a lot to


compensate because of lack of gubernaculum),
single spicule

Females: eggs with embryo


inside, flat on one side (D-shaped)
Enterobius vermicularis

Human pinworm, Human seatworm

Dse: oxyuriasis/ enterobiasis

Adults: cecum, appendix, ascending colon

Oral end: no true buccal capsule, 3 lips,


cuticula with bladder-like expansions forming
the CEPHALIC ALAE

Esophagus: divided into muscular and bulbous


portions (continuous to intestines)

Males:

2-5mm x 0.1-0.2mm (shorter)


Posterior end is curved ventrally
Single copulatory spicule
No gubernaculum
Prominent caudal alae (functions:
chemoreceptor, mechanical receptor)

Enterobius vermicularis
Superfamily oxyuroidea
General Characateristics:
o Stout nematodes with distinct esophageal
bulbs
o Monoxenous (bisexual/ with separate sexes:
male and female)

Females: longer

Tail: sharply pointed like a pin, hence the term


pinworm

Vulva opens midventrally at the middle 3rd of


body

[PARASITOLOGY ENTEROBIUS- DR AYOCHOK] Oct. 10, 2014

Paired genital organs


Gravid female migrates to anus to deposit eggs
then die (happily)
Less Capacity (vs Hookworm): 4672 eggs to
16888 eggs/ female/day

*Immmature female: no cephalic cuticle, has loosening


of tail (molting), look like L1 of strongyloides
Eggs:

D-shaped (compressed on 1 side)

Elongated ovoidal, compressed laterally, flat on


one side

Shell is thick and colorless


o Outer triple albuminous covering: mechanical
protection
o Inner embryonic lipoidal membrane: chemical
protections

Eggs are usually deposited at the perianal region


(of the host)

No intermediate host required

Infective within a few hours after deposition

Resistant to drying (in moist environment = lives


up to 2 weeks)

Resistant to disinfectants

Retroinfection (type of autoinfection)


- Not taking a bath
- Eggs remain at perianal area> eggs hatch> larvae
migrate up again

Enterobius vermicularis eggs


Life cycle:

Eggs with infective larvae> swallowed> hatch


in small intestine> travel to cecum> mature>
mates, females become gravid> migrate to
anus: oviposit

Development to egg-laying stage (2 weeks to


2months)
Eggs embryonate in 4-6 hours

Epidemiology:
Group infection
Families, asylums, children (higher
incidences)
MoT:
1. Direct, anus to mouth by fingers (most
common)
2. Soiled bed linen, table tops door knobs
3. Infected persons sleeping in same bed or
room
4. Airborne (eggs could float on air)
5. Retroinfection
Will sanitary disposal of human feces help? NO

Eggs deposited in the perianal region (folds) (not in


the lumen)

Phil: 29% exclusive schools


56% public schools

[PARASITOLOGY ENTEROBIUS- DR AYOCHOK] Oct. 10, 2014


Pathology Symptomatology
Crawling sensation, pruritus (esp. upon
waking up)
Most cases: no clinical evidence
Eosinophilia: +/- (peritoneal invasion)
Children: nervousness, insomnia, nightmares
Females; urinary, genital, abdominal findings
(UTI, discharges, fallopian tubes and open
to peritoneal cavity)
Diagnosis:
History, manifestations recorded
Eggs: Feces, peri-anal scrapings, swabs
Colonoscopy: capture adult worms
Graham: scotch tape technique (best!)
- Greatest # of eggs yield
- Highest % of positive results
- Done in the morning: before a stool
is passed
Treatment
Pyrantel pamoate
Mebendazole
Albendazole
Repeat after 2 weeks to eliminate possible
reinfection (be cautious)
Prevention:
Sunlight = kills larva in eggs
UV lamp radiation
Dry oven heat
Personal and group hygiene
Treating entire family
Keep fingernails short and clean

Morphology:
Males: 15-31cm (1 ruler)

Posterior end is curved ventrad

Genitalia: testis, vas deferens, ejaculatory duct,


1 pair of copulatory spicules with pointed ends

No gubernaculum

Posterior end: with caudal papillae

Adult has a lateral white line running through


the whole body of worm

Ascaris Lumbricoides
Superfamily Ascaridoidea
Large members
Common Name: Giant or Large intestinal round worm
Another Soil transmitted helminth
Eggs are thick shelled (unembryonated when passed)
Adult:

3 well-developed lips

Cylindrical esophagus

Lateral line: whitish streak along length of fleshcolored body

2 ventrolateral and 1 dorsal lips ( has fine


denticulations)

Triangular buccal cavity extending to pharynx

X section, males: testis, intestines, lateral nerve cords


(no alae)

Females: 20-35cm

Genital girdle: in females with no sperm


(almost exhausted of storage of sperm supply)
indication of estrus (in-heat)

[PARASITOLOGY ENTEROBIUS- DR AYOCHOK] Oct. 10, 2014

Single paired reproductive organs: single


vagina paired tubules
Vulva is at midventral portion of the body
Capacity: 200,000/female/day (usually lucky to
have 1-2 females in body and dies out)

X section females:
uterus, ovary along with
intestines, lateral nerve
cords (no lateral alae)
Fertilized eggs:

Broadly ovoid
(50-75um) to
spherical (up to
60)

Thick transparent
shell

Inner lipoidal
vitellin membrane

Thick transparent middle layer


Outer mamillated albuminoid layer (if absent: it
is a decorticated egg)
Unsegemented when discharged
Content: coarse lecithin granules with larvae
Vitelline layer means fertilized (complete 3
layers)

Notetaker: Maria Kristina Ibarra


Mary Anne Lorraine Kua