NEMATODES

Trichinella spiralis

Male: measures 0.62 to 1.58 mm by 0.033 mm

Has single testis located near the posterior end of the body, and is joined in the
mid-body by the genital tube, in turn, extends to the cloaca.
Cloaca has a pair of caudal appendages and two pairs of papillae
Female: 1.26 to 3.35 mm by 0.028 to 0.038 mm
Has a single ovary, which is situated in the posterior part of the body.
Has an oviduct, a seminal receptacle, a coiled uterus, a vagina, and a vulva.
Larvae: 80 to 120 um by 5.6 um at birth, reaches the size of 0.65 to 1.45 mm in
length and 0.026 to 0.040 mm in width after it enters a muscle fiber,
A spear-like, burrowing anterior tip.
Digestive tract = encysted in a muscle fiber resembles that of adult worm
Reproductive organs = not fully developed
Mode of existence: Parasitic
Infective stage: Encysted larvae
Pathologic stage: Adult worm
Clinical signs and symptoms: diarrhea, abdominal cramps, muscle pain, and fever
Pathologic Pathway: Caused by the ingestion of undercooked meat containing encysted
larvae of Trichinella species. After exposure to gastric acid and pepsin, the larvae are
released from the cysts and invade the small bowel mucosa where they develop into adult
worms. Females are 2.2 mm in length; males 1.2 mm. The life span in the small bowel is
about four weeks. After 1 week, the females release larvae that migrate to striated muscles
where they encyst. Diagnosis is usually made based on clinical symptoms, and is confirmed
by serology or identification of encysted or non-encysted larvae in biopsy or autopsy
specimens.
Mode of Treatment: Mebendazole 5 mg/kg body weight daily
Albendazole 15 mg/kg body weight per day in two divided doses for 10-
15 days.

Trichuris trichiura

Adult worm: Adult Trichuris trichiura males are 30-45 mm long, with a coiled
posterior end. Adult females are 35-50 mm with a straight posterior end. Both
sexes have a long, whip-like anterior end. Adults reside in the large intestine,
cecum, and appendix of the host
Egg: 50-54 um x 23 um
lemon-shaped or barrel-shaped with plug-like translucent polar prominences
with yellowish outer and transparent inner shell
Mode of existence: Parasitic
Infective stage: Embryonated eggs
Pathologic stage: adult worms
Clinical signs and symptoms: Abdominal pain, tiredness and diarrhea.
The diarrhea sometimes contains blood.
Pathologic Pathway: anterior portions of the worms embedded in the mucosa, resembles
ulcerative colitis
Mode of Treatment: Mebendazole given 100 mg twice a day for 3 days
Alternative drug: Albendazole 400 mg given once a
day for 3 days
Capillaria

Adult: small, slender

anterior end : with esophagus made up of stichosomes
posterior end: intestine and reproductive organs
Male: 1.5- 3.9 mm; presence of spicules, enclosed in a sheath
Female : 2.5-4.3 mm
larviparous: producing embryonated thin-shelled
eggs
oviparous: producing unembryonated thick-shelled
eggs
Egg: peanut-shaped
bioperculated egg with flat polar plugs
pitted shell
Mode of existence: Parasitic
Infective stage: Larvae
Pathologic stage: adult worm
Clinical signs and symptoms: diarrhea, abdominal pain, borborygmi, marked weight loss,
protein and electrolyte loss, and cachexia

Pathologic Pathway: membrane and distention of mucous glands and plasma cell, flattened
villi, atrophied crypts of liberkuhn, edema in basement, infiltration in the lamina propia, severe
protein-losing enteropathy, malabsorption of fats and sugars, decreased excretion of xylose,
low electrolyte levels, high levels of Ig E
Mode of Treatment: Mebendazole, 200 mg twice a day for 20 days
Albendazole, 400 mg given once daily for 10 days

Strongyloides stercoralis

Adult: Adults of Strongyloides stercoralis may be found in the human host or soil. In the
human host there are no parasitic males, and parasitic females are long, slender and
measure 2.0-3.0 mm in length. In the environment, rhabditiform larvae may develop into
infective filariform (L3) larvae (direct cycle) or free-living adults that contain both males and
females (indirect cycle). Free-living adult males measure up to 750 µm long; free-living
females measure up to 1.0 mm long.
Larvae: up to 600 µm long. The tail is notched and the esophagus to intestine ratio is 1:1.
Rhabditiform: 180-380 µm long, with a short buccal canal, a rhabditoid esophagus and a
prominent genital primordium.
Mode of existence: Parasitic
Infective stage: Flariform larvae
Pathologic stage: Rhabditiform larvae
Clinical signs and symptoms: Strongyloidiasis was usually a chronic relapsing illness of
mild to moderate severity characterized by gastrointestinal complaints
(diarrhea, pain, tenderness, nausea, vomiting) and peripheral eosinophilia. Hypoalbuminemia
also occurred.
Pathologic Pathway: The rhabditiform larvae passed in the stool either become infective
filariform larvae (direct development), or free-living adult males and females that mate and
produce egg from which rhabditiform larvae hatch and eventually become infective filariform
larvae. The filariform larvae penetrate the human host skin to initiate the parasitic cycle (see
below). Parasitic cycle: Filariform larvae in contaminated soil penetrate the human skin, and
by various, often random routes, migrate to the small intestine. Historically it was believed
that the L3 larvae migrate via the bloodstream to the lungs, where they are eventually
coughed up and swallowed. However, there is also evidence that L3 larvae can migrate
directly to the intestine via connective tissues. In the small intestine they molt twice and
become adult female worms. The females live threaded in the epithelium of the small
intestine and by parthenogenesis produce eggs, which yield rhabditiform larvae. The
rhabditiform larvae can either be passed in the stool, or can cause autoinfection. In
autoinfection, the rhabditiform larvae become infective filariform larvae, which can penetrate
either the intestinal mucosa (internal autoinfection) or the skin of the perianal area (external
autoinfection); in either case, the filariform larvae may disseminate throughout the body.
Mode of Treatment: Albendazole
Thiabendazole
Ivermectin

Ancylostoma duodenale

Adult: Males measure approximately 8-12 mm long and are bursate, with two spicules that
do not fuse at their distal ends. Females measure approximately 10-15 mm long. Adults of
both sexes have a buccal capsule containing sharp teeth.
Egg: thin-shelled, colorless and measure 60-75 µm by 35-40 µm.
Rhabditiform (L1) larvae:hatch from eggs are 250-300 µm long and approximately 15-20
µm wide. They have a long buccal canal and an inconspicuous genital primordium.
Filariform larvae: are 500-600 µm long. They have a pointed tail and a striated sheath.
Mode of existence: Parasitic
Infective stage: Filariform larvae
Pathologic stage: Adult worms
Clinical signs and symptoms: abdominal pain, colic, or cramping and excessive crying in
infants, intestinal cramps, nausea, fever, blood in your stool, loss of appetite, and itchy rash.
Pathologic Pathway: Eggs are passed in the stool, and under favorable conditions
(moisture, warmth, shade), larvae hatch in 1 to 2 days. The released rhabditiform larvae grow
in the feces and/or the soil, and after 5 to 10 days (and two molts) they become filariform
(third-stage) larvae that are infective. These infective larvae can survive 3 to 4 weeks in
favorable environmental conditions. On contact with the human host, the larvae penetrate the
skin and are carried through the blood vessels to the heart and then to the lungs. They
penetrate into the pulmonary alveoli, ascend the bronchial tree to the pharynx, and are
swallowed. The larvae reach the small intestine, where they reside and mature into adults.
Adult worms live in the lumen of the small intestine, where they attach to the intestinal wall
with resultant blood loss by the host. Most adult worms are eliminated in 1 to 2 years, but the
longevity may reach several years.
Mode of Treatment: Albendazole 400 mg single dose for adults and children over
2 years old
Mebendazole for children and adults given as a 500 mg single dose
Enterobius vermicularis
female: 8-13mm x 0.4 mm
: cuticular alar expansion at the anterior end, a prominent esophageal bulb and a long
pointed tail
male: 2-5 mm x 0.2 mm
: curved tail and single spicule; rarely seen
: rhabditiform larva: no cuticular expansion
Larva: rhabditiform larva; 140-150 um
Egg: 50-60 um x 20 – 30 um
: asymmetrical, with one side flattened and the other side convex
(D-shaped)
: transluscent shell consists of an outer, triple albuminous covering for
mechanical protection and an inner lipoidal membrane for chemical protection
Mode of existence: Parasitic
Infective stage: Embryonated eggs
Pathologic stage: Adult worms
Clinical signs and symptoms: Itching of the anal or vaginal area, insomnia, irritability
and restlessness, and intermittent abdominal pain and nausea.
Pathologic Pathway: Eggs are deposited on perianal folds. Self-infection occurs by
transferring infective eggs to the mouth with hands that have scratched the perianal area.
Person-to-person transmission can also occur through handling of contaminated clothes or
bed linens. Enterobiasis may also be acquired through surfaces in the environment that are
contaminated with pinworm eggs (e.g., curtains, carpeting). Some small number of eggs may
become airborne and inhaled. These would be swallowed and follow the same development
as ingested eggs. Following ingestion of infective eggs, the larvae hatch in the small intestine
and the adults establish themselves in the colon. The time interval from ingestion of infective
eggs to oviposition by the adult females is about one month. The life span of the adults is
about two months. Gravid females migrate nocturnally outside the anus and oviposit while
crawling on the skin of the perianal area. The larvae contained inside the eggs develop (the
eggs become infective) in 4 to 6 hours under optimal conditions. Retroinfection, or the
migration of newly hatched larvae from the anal skin back into the rectum, may occur but the
frequency with which this happens is unknown.
Mode of Treatment: Mebendazole 100 mg PO single dose
Albendazole 400 mg PO single dose
Pyrantel pamoate 11 mg/kg base PO single dose

Ascaris lumbricoides

Adult: male 10-31 cm; female 22-35 cm

smooth finely striated cuticle
conical ant./post. extremeties
ventrally curved post. end of male with 2 spicules
paired reproductive organs in female; single in male
Egg: fertile eggs: 45-70 um x 35-50um
outer coarsely mammilated albuminous covering
thick transparent hyaline sheath/shell with thick outer layer
delicate vitelline lipoidal inner membrane (impermeable)
infertile eggs: 88-94 um x 39-44 um; with refractile granules
Mode of existence: Parasitic
Infective stage: Embryonated egg
Pathologic stage: Adult Worm
Clinical signs and symptoms: Abdominal discomfort, abdominal cramping,
abdominal swelling (especially in children), fever, coughing and/or wheezing, nausea, and
vomiting.
Pathologic Pathway: Adult worms live in the lumen of the small intestine. A female may
produce approximately 200,000 eggs per day, which are passed with the feces. Unfertilized
eggs may be ingested but are not infective. Fertile eggs embryonate and become infective
after 18 days to several weeks, depending on the environmental conditions (optimum: moist,
warm, shaded soil). After infective eggs are swallowed, the larvae hatch, invade the intestinal
mucosa, and are carried via the portal, then systemic circulation to the lungs. The larvae
mature further in the lungs (10 to 14 days), penetrate the alveolar walls, ascend the bronchial
tree to the throat, and are swallowed. Upon reaching the small intestine, they develop into
adult worms. Between 2 and 3 months are required from ingestion of the infective eggs to
oviposition by the adult female. Adult worms can live 1 to 2 years.
Mode of Treatment: 400 mg single dose of albendazole
500 mg single dose mebendazole
10 mg/kg single dose pyrantel pamoate