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Prepatency: 2 months
Pneumonitis: 4 – 16 days after infection, short duration (~3
Note 3 and 4 were corrected by Dr. Yolo, initially weeks)
#3 was the VD and #4 was the testis
LIFE CYCLE
1.Adult worms live in the lumen of the small intestine.
Ascaris lumbricoides – egg
2. A female may produce up to 240,000 eggs per day, which
A fertilized corticated (which means it are passed with the feces
has an outer mammillary coat made of
3. Fertile eggs embryonate and become infective after 18
albumin) Ascaris egg, still at the
unicellular stage, as they are passed in days to several weeks, depending on the environmental
stool. All membranes are present. The conditions (optimum: moist, warm, shaded soil).
outer mamillary coat, the middle
glycogen layer and the innermost 4. infective eggs are swallowed
lipoidal vitelline layer. The middle 5. the larvae hatch
golden staining portion is the glycogen 6. invade the intestinal mucosa, and are carried via the portal,
and the inner is the embryo which is
the vitelline layer. It is finely granular then systemic circulation to the lungs.
and organized.
*Lacking in decorticated ova.
7. The larvae mature further in the lungs (10-14 days), Source of STH
Infection
penetrate the alveolar walls, ascend the bronchial tree to Mode of Ingestion
the throat, and are swallowed Transmission
8. Upon reaching the small intestine, they develop into adult Portal of Entry Mouth (oral-fecal route)
Life span 1-3 years
worms. Between 2 and 3 months are required from
Morphology - Flesh colored or pinkish slender
ingestion of the infective eggs to oviposition by the adult worm
female. Adult worms can live 1 to 2 years - Anterior 2/3 of the worm is
attenuated and thin in contrast
DIAGNOSIS: to the remaining posterior 1/3
1. Direct Fecal Exam which is fleshy and robust
2. Kato (qualitative) and Kato-katz technique - “Whip like appearance”
Is a close relative of A. lumbricoides, since they often
(quantitative)
co-infect
3. Zinc Sulfate Conc. technique No extra-intestinal phase
4. Brine floatation 90% infections are asymptomatic
5. FECT Symptoms with heavy infections
o Intensity of infection peaks by age 10
CLINICAL
- Larval phase: eosinophilia, pneumonitis (Loeffler’s) MORPHOLOGY
LEFT: FEMALE (posterior is straight)
- Adult phase:
RIGHT: MALE (posterior is curved)
Malnutrition, Impaired Physical Growth So that during copulation, male can carry female because
Mild abdominal discomfort → → Small bowel female is on top. The curved part of the male is where the
copulatory spicule is so it can penetrate.
obstruction (in children, few as 60 worms)
Wandering ascaris: biliary tract obstruction,
cholangitis, pancreatitis, liver abscess
Treatment Approach: Selective and or Mass
Treatment
Drug of choice: Albendazole x 1 dose
LIFE CYCLE
1. The unembryonated eggs are passed with the stool.
2. In the soil, the eggs develop into a 2-cell stage, an
advanced cleavage stage,
3. and then they embryonate; eggs become infective
2. Trichuris trichiura in 15 to 30 days.
Common name Whipworm (cause anterior 2/3 is 4. After ingestion (soil-contaminated hands or food), the
whiplike) eggs hatch in the small intestine, and release larvae
5. that mature and establish themselves as adults in the
Final host Man
colon
Habitat Large intestine (CECUM)
6. The adult worms (approximately 4 cm in length) live in
Diagnostic Ova
the cecum and ascending colon. The adult worms are
Stage fixed in that location, with the anterior portions
Infective Stage Embyronated ova threaded into the mucosa. The females begin to
oviposit 60 to 70 days after infection. Female worms in
the cecum shed between 3,000 and 20,000 eggs per
day. The life span of the adults is about 1 -3 years.
HEAD:
- Consider the # of teeth
Necator americanus – bungi
Ancylostoma duodenale – 2 pairs
Ancylostoma braziliense – 1 pair
Ancylostoma caninum – 3 pairs
COPULATORY BURSA:
1. Spicule
2. Dorsal Ray
3. Cleft
Necator americanus
Clinical Features:
spicule is fused and barbed
o Asymptomatic
dorsal ray is bidigitate or bifid
o Physical Weakness, Anemia (prevents iron
absorption) cleft: deep
o Stunted Growth, Cognitive Deficits Ancylostoma duodenale
o Stool frequency (12+/day), nocturnal urgency spicule is not fused and not barbed
to defecate dorsal ray is tridigitate or tripartite
o Trichuris dysentery syndrome cleft: very shallow
o Trichuris colitis (inflammation of colon)
o Rectal prolapse
whipworms Rectal Prolapse from
Trichuris trichiura
o DUE TO ADULT
Abdominal discomfort
Progressive iron-deficiency anemia
(40 – 160 worms associated with
Hb < 11 g/dl)
Extreme fatigue, IQ loss
Treatment: Albendazole x 1 dose
HOOKWORM-BLOOD LOSS
Adult worms injure their host by causing intestinal blood loss: PATHOLOGY:
Anticoagulants, Hemolysins, and Hemoglobinases Diarrhea - causative agent of Cochin China (in Malaysia,
30 to 200 μL blood per day per hookworm a place with a lot of migrant Chinese) Diarrhea
Intestinal bloodloss and Iron Deficiency Anemia Honey Comb Ulcer
Hyper-Infection:
o Intestinal perforation hemorrhagic pneumonia,
shock, sepsis, eosinophilia may be limited
Larva currens
LIFE CYCLE:
1. Eggs are deposited at night by the gravid females.
2. Eggs are ingested via person-to-person transmission
through the handling of contaminated surfaces (such as
clothing, linen, curtains, and carpeting), or airbourne eggs
may be inhaled and swallowed. Self-infection may also
occur if eggs are transferred from to the mouth by fingers
that have scratched the perianal area.
3. After ingestion, larvae hatch from the eggs in the small
intestine. The adults then migrate to the colon. The life
span of the adults is about two months. Adults mate in the
colon, and the males die after mating.
4. Gravid females migrate nocturnally to the anus and
ovideposit eggs in the perianal area. The females die after
laying their eggs. The time period from ingestion of
infective eggs to the ovideposition of eggs by females is
approximately one month.
5. The larvae develop and the eggs become infection within
4-6 hours. Newly hatched larvae may also migrate back
into the anus, and this is known as retroinfection.
MORPHOLOGY:
Adult Male:
The adult male is about 2-5 mm in
length and has a curved, relatively
blunt posterior end (arrow).