NEMATODES  1683- Anatomy of A.

lumbricoides was first

described by Edward Tyson. It is known
 commonly known as intestinal roundworms as Lumbricus teres.
 unsegmented worms with long, thin bodies that  1758- Linnaeus named it as Ascaris
narrow at both ends lumbricoides.
 members of the class Nematoda may assume  1922- Shimesu Koino discovered the life cycle
three basic morphologic forms: eggs, larvae and of Ascaris lumbricoides.
adult worms
 are dioecious II. Morphology
 mild to warm temperatures are optimal
developing temperatures A. Unfertilized egg
 reproduce primarily through sexual - contains refractile granules
reproduction - unembryonated
 The adult male worm is smaller than the adult - longer and narrower
female worm. possess digestive, nervous,
excretory, and reproductive systems, but lack a Parameter Description
discrete circulatory or respiratory system. Size 85-95 um by 38-45 um
Shape Ovoid
Molting Embryo Unembryonated;
- A nematode can continue to grow only if it amorphous mass of
sheds its old outer cuticle, and grows a new, more protoplasm
flexible cuticle. Shell Thin
Other Features Usually corticated
It involves two steps:
1.) Synthesis: creating a new cuticle by the hypodermis. B. Fertilized Egg
This is when the larvae is enclosed by the new cuticle - Resistant to: desiccation, low
with the old cuticle. temperatures, and strong chemicals
- Moist shady habitat at 22 - 33°C
2.) Exsheathment: process where the old cuticle is -Moist temperature above 70°C
loosened and fractured, followed by the larvae wiggles is lethal
out of the old cuticle's casing. - 2-3 weeks embryonation
- Golden brown in color

The parasitic phase takes place Parameter Description

inside the definitive host while Size 40-75 um by 30-50 um
the pre-parasitic phase occurs Shape Rounder
either as a freeliving phase in the Embryo Undeveloped unicellular
external environment. embryo
Shell Thick chitin
Ascaris lumbricoides Other Features May be corticated or
 Most common intestinal nematode decorticated
 The giant roundworm
 A soil-transmitted helminth (STH) C. Adult Worms
 It is an obligate parasite - A. lumbricoides adult worms reproduce through
 Most prevalent in children (2-10 yrs old) mating
 Responsible for the disease Ascariasis - Large cylindrical worms with tapering ends
- Terminal mouth with 3 lips and sensory papillae
I. History - Pale pink or flesh color in stool
- Polymyarian type
 Aristotle was the first to discussed about A. - Fine striation in the cuticle
lumbricoides
 Adult worms live in the lumen of the small intestine. A
Characteristics Female Worm Male Worm female may produce approximately 200,000 eggs per
Size 22-35 cm Up to 30 cm day, which are passed with the feces. Unfertilized eggs
Color Creamy white pink Creamy white may be ingested but are not infective. Larvae develop to
tint pink tint infectivity within fertile eggs after 18 days to several
Other Pencil lead Prominent weeks, depending on the environmental conditions
Features thickness incurved tail (optimum: moist, warm, shaded soil). After infective
eggs are swallowed, the larvae hatch , invade the
Male intestinal mucosa, and are carried via the portal, then
- Ventrally curved posterior systemic circulation to the lungs. The larvae mature
end with 2 copulatory further in the lungs (10 to 14 days), penetrate the
spicules alveolar walls, ascend the bronchial tree to the throat,
- Its genitalia is a single long and are swallowed. Upon reaching the small intestine,
tubule composed of testis, they develop into adult worms. Between 2 and 3
vas deferens, and months are required from ingestion of the infective
ejaculatory duct. eggs to oviposition by the adult female. Adult worms
can live 1 to 2 years.
Female
- Straight and conical posterior end IV. Pathogenesis and Symptoms
- Its genitalia is called the vulva or genital
girdle composed of uterus, seminal A. Asymptomatic- infected with small number of worms
receptacle, oviduct,and ovary. (paired reproductive (5-10)
organs) B. Ascariasis (Roundworm Infection)
- Able to produce 200,000 eggs per day Symptoms include:
- Lives 1-2 years - Vague abdominal pain
- Vomiting
III. Life Cycle - Fever
- Distention
- Mode of Transmission: Ingestion of contaminated food May also experience pulmonary symptoms:
with embryonated eggs - Low-grade fever
- Definitive Host: Humans - Cough
- Infective stage: Embryonated eggs - Eosinophilia
- Diagnostic Stage: Eggs and Adult worms - Pneumonia

Migration of larva to lungs:

 Allergic manifestations (lung infiltration, asthma
attack, edema of the lips)
 Destroys capillaries in the lungs, causing
hemorrhage
 Pulmonary Edema: Heavy infections can lead to
pools of blood which block air sacs
 Ascaris pneumonitis also known as Loeffler's
syndrome
 Lung tissue destroyed and bacterial infections
occur may be fatal

Fatal effects are due to erratic migration of adult

worms:
 Mechanical effects
-may stimulate reflex peristalsis (severe
clockily abdominal pain)
- Intestinal obstruction (bolus formation/ worm
ball)
  Ectopic Ascariasis (Erratic) - 400 mg single dose (200 mg for children 10-23
- A. lumbricoides worms wander when the host months)
is ill with the temperature above 39°C.  Mebendazole
- acute biliary obstruction or pancreatitis - 500 mg single dose
- liver abscess  Pyrantel Pamoate
- obstructive appendicitis - 10 mg/kg single oral dose
` - may go to the brain  Ivermectin
- effective as albendazole
V. Laboratory Diagnosis - dose of 200 ug/kg single dose
 Nitazoxanide
Laboratory Test - 500 mg twice a day for 3 days
1. Macroscopic identification (100 mg twice a day for 3 days for children 1-3
- of adults passed in stool or through mouth or nose yrs old; 200 mg twice a day for 3 days for
2. DFS- less sensitive children 4-11 years old)
3. Kato-Katz techniques (98% sensitivity)
4. Kato thick smear VIII. Prevention and Control
5. SAF (93% sensitivity)  Avoidance of using human feces as fertilizer
6. Formalin-ether concentration technique  Exercising proper sanitation
 Personal hygiene practices
Special Test  Regular deworming
1. ELISA  WASHED framework (control of STH infections)
2. Sputum Smear  Preventive chemotherapy (Mass
3. Gastric washing Drug Administration)
4.Endoscopic
retrograde cholangiopancreatography (90% sensitivity) NICE TO KNOW!!!
- A. lumbricoides female worm can carry 23,000,000
Classification of Intensity of STH eggs
- Eggs of A. lumbricoides was found in the intestine of a
2,300 year old preserved body
- Was mentioned in Ebers Papyrus
- Seen in Egyptian hieroglyphics
- Lesser laid eggs as the worm burden increases
- Produces pepsin inhibitor 3 (PI-3) protects
VI. Epidemiology worm from digestion
 considered as the most common intestinal -Produces phosphorylcholine that suppresses
helminth infection in the world lymphocyte proliferation
 cosmopolitan distribution
 5-15 years old have the highest intensities of
infection
 population most at risk of contacting this
parasite is children who place their
contaminated hands into their mouths
 person of all ages may become infected where
vegetables are grown using contaminated
human feces as fertilizer
 highest number of cases is found in East Asia
and Pacific Island
 In Philippines, prevalence may reach 80% to
90% in certain high-risk groups

VII. Treatment
 Albendazole