PLATYHELMINTHES PHYLUM NEMATODA Nematodes are unsegmented true round worms. The body is elongated, cylindrical and covered with a tough cuticle. They have complete alimentary canal with an anteriorly terminal mouth and posteriorly sub terminal anus, no circulary system, @ simple excretory system. The eggs of the nematodes infecting man are never operculate an usually the egg ruptures to release the contained larva. The word “nematode” comes from a Greek word Cuticle — The cuticle is shared with arthropods and other di periodically shed during the life of a nematode as it grows, reaching the adult stage. The cuticle is the closest thing a round worm has toa skeleton and uses it as a support and leverage point for movement. Many nematodes are able to suspend their life processes. “nema” that means “thread”. lysozoans. The cuticle is usually 4 times beforeThe nematode which are commonly found in man are classified as follows: Dracunculoidea ‘Superfamily Genus Ascaridoidea Ascaris Oxyuroidea Enterobius Rhabditoidea Strongyloides Trichuroidea Trichuris Trichinella Strongyloidea Ancyclostoma Necator Filarioidea Wuchereria Brugia Loa Onchocerca Acanthocheilonema Mansonella DracunculusNEMATO! The nematodes which are commonly found in man are classified as follows; Intestinal, Blood and Tissue Helminths. Ascaris lumbricoides = Round worm Trichuris trichuira = whip worm Hookworms - Aneylostoma duodenale Necator americanus Strongyloides stercoralis Enterobius vermicularis Blood and tissue Nematodes Trichinella - spiralis Filariodea Filaria worms —- Wuchereria bancrofti Brugia malayi Onchocerca volvulus Loa loa Mansonella ozardi SUPERFAMILY ASCARIDOIDEA This superfamily includes a number of sout worms of large size in which the head possesses three lips. The oesophagus is muscular and club-shaped, without a posterior bulb. Mouth: This ascarids species have lips with minute teeth but no cervical alae. The caudal alae. male is smaller than the female and has a conical tail without There are two spicules, equal in size without lateral wings The Female: It has vulva situated in front of the middle of the body# are characteristic in that they have a thick, smooth shell, surrounded by a Eggs: comugated or mammilated protein coat which becomes brownish in colour and contains large unsegmented ovum when passed in faeces, ASCARIS LUMBRICOIDES ----Round worms Geographical distribution - Cosmopolitan Habitat: a, Adult:- b. Eggs in human faeces are not infective to man when passed, ¢. Infective larvae — are contained in eggs which are found in soil, water or on In the intestine of man and pigs green vegetables, Morphological character rm is the largest of the human intestinal nematodes. The wor The three lips lie one dorsal and two subventral finely toothed. The male is smaller than the female having its length and breadth as 22cm x 4mm, the female measures 35cm x 5mm. The posterior extremity though conical is not pointed nor ventrally curved as in the male. Eggs: They are round or oval in shape, brownish in colour measuring 60. x 45 in length and breadth. The egg shell is colourless and extremely resistant. Within the egg shell is a very delicate vitelline envelope which is even more resistant than the egg-shell; as a result, some eggs can remain viable for about a year. When passed, the egg contains a very large conspicuous, fertilized unsegmented ovum which is contracted away from the vitelline membrane at the pole.ed within an hour Its in the soil and Tetain the oocyst cuticle anda Where they remain for several days, grow and moult twice. They are carried through the trachea, epiglottis, esophagus and stomach to the intestine. The journey takes about 10 days from intestine back to intestine, . They moult for the fourth and last time in the intestine and grown ten times their original size. They become matured in 2 months and live for about a year. On occasions, infective larvae when they hatch bore through the intestinal wall into the peritoneal cavity and migrate to the lungs Pathogenicity a. Migration through the lungs gives rise to minute haemorhages and to oedema and exudation. b. In severe infection they can produce symptoms resembling lober pneumonia and may cause death in young children. 5¢. Allergic manifestation may result from the presence of the parasites. d, The worms frequently migrates and may be vomited or escape through the anus, urethra or nose. e. Ifnumerous, they may obstruct the lumen of the intestine. f. Single worms may enter bile or pancreatic duct, or the appendix and may penetrate the intestinal wall causing peritonitis. Diagnosis Macroscopically — Adult worm may be noticed in the faeces when passed. Microscopically — Wet preparation of the faeces. Fertilized and unfertilized eggs may be seen under microscope with x10 and x40 objective. In infant pneumonia, mother’s faeces should be examined for evidence of infection. Prevention 1. Several drugs of low toxicity given in a single dose are available for mass treatment and have satisfactorily reduced Ascaris prevalence. Mass treatment should be repeated every few weeks for a period. 2. Provision of sufficient latrines in the community. 3. Education of mothers and children on hygiene of high standards. 4. Discourage the use of human faeces as fertilizer for vegetables or could be fermented at 50°C or higher to kill the eggs.SUPERFAMILY OXYUROIDEA This family e C4 amily embraces all Hematodes whose oesophagus has a globular enlargement of the posterior end, The genus is Enterobius, Mouth: The cuticle near the Mouth of both male and female worms is expanded laterally into alae which run along cach side as a keel, Female: The tail is tong, ‘aPering and pointed, The vulva is situated at the junction of the anterior and middle thirds of the bod. Male: Is very much smaller than the female and has a truncated coiled tail? A Single brown spicule and small caudal alae, ENTEROBIUS VERMICULARIS Common Name: Thread-worms, Pin worm Geographical distribution - Cosmopolitan Habitat: The worm is a common parasite of man especially children a. The young and mature forms are found in ileum, The gravid female are found in the rectum, b. Eggs are deposited on the perianal skin, ¢. Infective larvae are found in eggs on the buttocks a few hours after being Passed, Morphological characters The male worm measures about 4mm in length and a maximum diameter of about 150. The posterior extremity is curved and sharply truncated with a single hook-like spicule measuring 701 in length. Female lcm in height with diameter of about 400u. Eggs Eggs are colourless, asymmetrical one side being a little flattened and they measure 5Su by 25.This worm is peculiar in that it does not lay eggs in the intestine, but on the perianal skin. When deposited, they contain a tadpole-like larva which becomes infective to man within 6 hours as a coiled-up young worm in the egg. Life cycle When the infective eges are swallowed by man the larvae escape in the upper intestine. After moulting twice they become adult in the lower ileum. Life cycle of egg to adult takes 2 ~ 4 weeks. The worms becomes mature in the small intestine, the male fertilizes the female. The male is rarely seen. The female when gravid migrates to the rectum, during night, passes out of the anus, deposits its eggs on the perianal skin and dies. As a result of the itching caused by moving over the skin, the female worm may be crushed by the patient scratching the affected part thereby releasing masses of eggs on the buttock. During scratching with fingers, eggs may subsequently be carried to the mouth. Eggs on clothing or bedding may be transferred to the mouth on the fingers or may be inhaled in dust. The infective eggs sometimes hatch on the skin of the buttocks and the larvae migrate through the anus up the bowel to become adult. Pathogenicity 1. Main symptom is pruritus 2. Fatigue and loss of sleep 3. There could be heamorhage or inflammation at the site of attachment to the mucosa. 4. Appendicitis may occur if they invade that organ. Diagnosis Gravid females may be found in faeces after a purge or salt enema, or may be seen if the buttocks are examined at night during sleep, NIHswabsadhesivecellulose tape may be used to collect thi © eggs on the skin of the buttocks at sleep Prevention All persons in the community that are infected must be treated with effective drug. Fig. 11.12. NIH swab, dose 11 mg per kilogram of body weight (maximum, 1 gram); mebendazole in a single dose of 100 mg; albendazole in a single dose of 400 mg; and piperazine citrate in a7-day course of 65 mg per kilogram of body weight,oe w Fic. 77. Enterobius vermicularis. (@) Male. 1. ocsophagus. 3. intestine. 5, SPpicule. | 2. bulb behing ocsophagus. 4. testis. 6. seminal vesicle. () Gravid female. 1. cervical alae. 3. bulb bchind oesophagus. = oesophagus. 4. intestine, 7. uterus. 8. anus.‘chistosomu haematobium. _f- Ascaris lambricoides. 4. Diphylloborbriun latwn A, Ancylostoma duodeSUPERFAMILY RHABDITOIDEA. This Superfamily includes minute worms which are either free-living or are adapting themselves to a Parasitic existence and have alternate free-living and S$ muscular, It contains only one genus of medical importance namely strongyloides, GENUS STRONGYLOIDES Species: Strongyloides stercoralis Geographical distribution: Most commonly found in humid tropical countries, a. Habitat: Adults — Females alone occur and they are found buried in the mocusal glands of the duodenum and jejunum, They are believed to reproduce parthenogenetically ie., without sexual union, The normal host is 1 may act occasionally as man, but certain domestic and wild anima temporary hosts, b. Larvae, not eggs are passed in human faeces, ¢- Infective larvae. They are found in contaminated soil and water. They occur in the intestine or on the perineum in cases of auto-infection. Morphology The parasitic female measures about 2mm in length by 50u in breadth. Can only be found in post mortem by scraping the mucosa and examine under low magnification. The oesophagus is about '/; the length of the body and it is cylindrical. The female worm is colourless, semi-transparent with short bucal cavity and long oesophagus. The gravid female has about 20 gs transparent in the uterus, Eggs - are oval, colourless, 50 x 30um similar but slightly smaller than hookworm eggs. The eggs hatch almost immediately after they are laid and therefore the female worm is said to be Ovoviviparous, oatThe Rhabditiform larva measures about 25pm x 16m. They have a and posterior bulb. short club-shaped anterior bulb oesophagus. A constriction Filariform larvae: This is long and slender(600 x 15,m) with a along cylindrical cosophagus, The filariform larva can survive several weeks awaiting an opportunity to infect man by penetrating the skin, Life cyele Strongyloides stercoralis has a complex life eycle, {tis capable of a free-living existence by continuing its non ‘Warm soil, it can also exist in a parasitic form in humans and other animals and can infective life cycle in a Cause auto-infection in the same host. The infection is acquired through skin penetration by infective filariform |: they are carried by the blood stream to the larvae from the soil. Following penetration, lungs passing through the heart. Being larger than the capillaries, break out into the alveoli, migrate through the trachea in the same way as Ascaris and hookworm larvae to be swallowed to reach the intestine. The female borrow into the upper part of the small intestine where they lay eggs. The contained rhabditiform larvae hatch and mi: igrate into the lumen of the intestine from where they are discharged with the faeces, The thabditiform larvae resemble hook-worm larvae but different in that they are smaller, and not found in freshly Passed unconstipated faeces, These larvae can develop in three different ways 1. Free living (indirect) cycle: The rhabditiform larvae evacuated with the faeces may now enter the soil and start a free-living existence. Under favourable conditions, they develop directly into adult male or female worms which mate,the female lay eggs and continue the cycle in the soil. Some of the rhabditiform larvae may develop under unfavourable conditionsAuto-infection: The rhabditiform larvae may become filariform while still in the intestine, it Penetrates the intestinal mucorsa or perianal skin and migrating in the usual manner through the body back to the intestine. Pathogenicity The larvae penetrating the skin may cause dermatitis with pruritis and urticaria and their migration commonly cause itchy-wheals on the buttocks, Symptoms include cough as the larvae passes through the lungs, breathlessness, fever, pneumonia, in heavy infection, intestinal mucosa may be damaged showing symptoms similar to peptic ulcer. Repeated autoinfection can be fatal especially in immune-suppressed patient. Diagnosis The presence of larvae in freshly-passed faeces is absolutely diagnostic of this species in man. Technique Microscopic examination of faeces or duodenal aspirate or other body fluid by 1. Wet preparation for motile larvae, 2. Iodine wet mount — larvae are immobilized and can be studied to identify (thabditiform or filariform) or differentiate hookworm larvae. 3. Concentration technique — formal ether or baerman technique. 3BSUPERFAMILY TRICHUROIDEA In worms of this 8roup, two distinct and a posterior stout portion, Qesophagus: The anterior hair-like has non-muscular oesophagus which consists of a narrow channel running through a column of large cells arranged in single file. The posterior Portion is usually much stouter than anterior. In all species the females possess only one ovary, This family contains only two genera of medical importance each with a single species. Trichuris trichiura and Trichinella spiralis, TRICHURIS TRICHIURA ~ Whip worm Trichuris trichiura, Worms almost morphologically identical with the humans species can be obtained from almost any mammal. Pigs, sheep, and cattle where the eggs can be found, Geographical distribution - Cosmopolitan but prevalent in worm moist region. Habitat: % Adult found in the caecum, appendix and colon of man Eggs are passed in faeces but not infective when passed. b. Eggs green vegetables, ¢. Infective larvae ~ Found in eggs, in soil, water and on Morphology Im shape and general appearance, the worms resemble a whip composed of a hair- like anterior part, the lash comprising roughly 3/5" the length of the worm, a much shorter part */s!" representing the stock. The parasite by means of a minute spear-like projection anterioly bore into the wall of the intestine, 14TRICHURIS TRICHIURA. Adult worms in caecum of man. (Ss. Engs passed in faccos, not Infec- Whilst on ground Jarva develops Rom ovinks aad the oma is then ‘inte eng containing larvae are ty" many cach larva pwatiowed Becomes lan’ adele in lascum of mas Female- measures up to Scm in length by 2mm in breadth. The vulva is situated near the junction of the two parts of the body. 208 — The eggs measure about 50 in length by 25u in breadth. They are brown E barrel-shaped with a plug at each pole. They contain a fertilized unsegmented ovum. Lifecycle The development of the eggs is completed in damp earth. They are infective only when they contain a larvae some three or more weeks after been passed. Infection in man occurs when the eggs are swallowed through contamination of hands by infected water, food and soil or pollution of uncooked vegetables. When swallowed, the larva escapes from the egg, move down to the caecum and grow directly into the adult worm which embeds its anterior part in the mucosa 15of the caecum. It develops into adult, lay eggs that are pushed out through the faeces. Pathogenicity Apparently it is of little importance in the usual moderate infection. Diarrhoea and mild gastric disturbances sometimes occur. It can cause appendicitis if it enters into the appendix. Diagno: Wet preparation — by finding the characteristic eggs in the faeces Prevention a. Provision of widespread use of lactrines. b. Raising of standards of personal hygiene will reduce transmission. 16SUPERFAMILY STRONGYLOIDEA This superfamily embraces all nematodes in which the ‘SS nurse copulatrix posterior end, tubular in shape and supported Males ~ pos: by “rays” or ribs of stouter tissue. Qesophagus — is muscular and club — shaped. Eggs ~The eggs are oval, colourless, thin-walled and contain a morular when Passed in faeces. The superfamily contains two species parasitic to man. Aneylastoma dueodenale and Necato americanus both possess a large mouth cavity (buccal capsule) which is lined with chitin, which are developed into cutting organs as one aspect of the oral aperture. In Ancylasitoma duodenale, the oral cutting organs consist of teeth, while in Necator americanus they are plate-like. The anterior extremity of the worms is bent hence the name “hook worm”, 17Fic. 83. Ancylostoma duodenale. Head showing tccth, cervical papillae, nerve ring and oesophagus. Diagram showing the dorsally bent anterior extremities 18oo Necator americans on # Fic. 85, Diagram showing incylostoma duodenale. P. P plates (shaded) pili . . Posterior ‘ extremi buccal cavity of Ne ty of mle worm, showing co ' bursa with “rays”. fa : 2 Fe. § Aneyl Mattes ‘Vlostoma duodenale, Showing development of the ogg, 19HOOKWorms Ancylostoma duodenale and Necator americanus These are the two Species parasitic to man, Geo} The para idespread j Parasites are widespread in much of the tropics especially among the rural hical eas: i Peasants but may also occur in temperate zones where the temperature and humidity are favourable in which standards of hygiene are low. Adult Lives in the jejunum of man Eggs Eggs passed in human faeces are not infective to man. Infection larvae Found free in soil and water Morphology Both Ancylastoma deuodenale and Necator americanus possess a large mouth cavity (buccal capsule), which is lined with chitin. Portions of which are developed into cutting organs, Ina duodenale, the oral cutting organ consist of teeth while in N. americanusi they are plate-like. The anterior extremity of the worms is bent, hence the name “hookworm”. The females measure 8-13mm in length while the male measure 6-10mm. The male has a broad translucent membranous bursa, with rib like rays at the posterior end which is used for the attachment to the female during copulation. The chief morphological differences between the two hookworms are:- 1. Size and shape — N. americanus adult worm is slightly smaller than that of A. duodenale and is characteristically bent anteriorly in direction opposite to the body curve. 202. Buccal cavity — 4, duodenale has two pairs of teeth on the ventral surface and a smaller, single pair of teeth on the dorsal surface (four teeth). N. americanus has no teeth but cutting plates, one pair each on its dorsal and ventral surfaces, is a broad, Copulatory bursa ~ The posterior end of the male hookworm ha: I ray of A. a translucent membranous bursa with rib-like rays. The dorsal NN. americanus duodenale divides into two i.e. separate spicules, while the dorsal ray has deep cleft, blind tips with fused spicules. Egg — The eggs of both hookworms look similar. They are oval and colourless with broadly rounded extremities, measuring 60 x 40um. The egg shell is thin, transparent and contains an ovum, The ovum may be unsegmented or segmented into two or eight blastomeres, between the egg-shell and the segmented ovum. there being a clear space Lifecycle Hookworm infection is acquired through penetration of the skin by filariform larva from the soil usually between the toes or the dorsum of the foot. ‘The larva hatches out of the egg in twenty four to forty eight hours in the damp soil, warmth and sufficient oxygen. ‘The newly hatched larva (250, in length) has a thabditiform oesophagus about half the length of its intestinal tract and possesses a rounded anterior end and a sharp tail. It moult twice in the soil, the eosophagus becomes filariform and the larva is now infective. At this stage it is rapidly killed by freezing, dessication, direct sunlight or certain chemicals. It may live for several months in the surface of damp soil when infecting. It penetrates the unbroken skin and migrate to the blood or lymph stream and are carried to the heart and lungs. They leave the circulation, enter the alveoli, pass to 21the trachea, o1 i ‘ h ver the epiglottis down to oesophagus and through the stomach to the duodenum, t ti hu » Moult four times and develop to adult worm with tecth. The worm is sexually matured and may live as long as five years or more. Eggs are produced 5-6 Weeks after infection and are passed out in the faeces, Occasionally, infection may occur by ingesting infective larvae through contaminated food. In this case the larvae mature into adult worms without passing through the lung. Pathogenicity (clinical disease) The penetration of the infective larvae causes a popular urticarial eruption of the skin known as Ground-itch. The level at which symptoms become evident is related to the number of worms present and the resistance acquired by the individual to the pathological effects of the worms. Loss of over 6ml of blood daily, indicated by 4,000 ova per gram of faecal, Produces slight anaemia, and over 10,000 ova per gram is associated with severe anaemia, resulting in lassitude, dyspnoea, palpitation of the heart, oedema of the feet and ankles. Diagnosis Based on finding the eggs in the faeces, through a. Saline wet preparation b. Concentration method. It is advisable to indicate the degree of severity of infection by mentioning the egg load (scanty, few, moderate, many) in the specimen. If the stool specimen is not fresh, the eggs may hatch to produce larvae. If larvae are seen in the specimen, they should be identified and differentiated from those of strongiloides, 22Larva migrans oF Creeping Bey This condi Auto infection with the rhabditiform larvae of strongiloides stercoralis may give tise to tortuous uticarial wheals of the thigh and trunks. Visceral Larva Migrans It is an invasion of man’s internal organs by helminthes, normally infecting animals,e.g, larvae of the nematode Toxocara canis. Granulomata of the retina have been found to contain Toxocara larvae. The diagnosis of visceral larva migrans is suggested by the presence of non- Specific symptoms associated with persistent eosinophilia and by positive serological tests. In hepatic lesions, larvae may be demonstrated in serial sections of biopsy specimens of the liver. 23‘Ancyloston duodenale we) Baccalcavity showing | Buccal cavity two pars of feth cutting pat non Spicules Sues” | ela reo aeitgeten | Sea Fig. Differentiating features of the two hhookworms: 24Fig. 102. Helminth eggs drawn to show relative sizes and the more important anatomical details 4, Schistosoma haematobium. —f- Ascaris lumbricoides. j. Trichuris trichiura, k. Hymenolepis nana. 4. S, mansoni, 4. Diphyllobathrium latum. ©. Fasciola hepatica, h. Aneylastoma duadenate |. Taeniaspp. d. S. japonicum, and Necator americamus. im. Clonorchis sinensis. € Paragonimus westermant, 4. Enterobius vermicularis.BLOOD AND TISSUE NEMATODES Trichinella spiralis Geographical distribution — cosmolitan among most pork — eating races. Habitat — a) Adult:- This worm is essentially a parasite of rats. It gives rise to a disease which is both enxootic and epizootic, It has extended to pig and man and lives in the duodenum and jejunum. b) Larvae:- No eggs are passed in faeces but larvae, liberated by the female into the lymph and blood stream, encyst in muscles. c) Infective larvae:- Found encysted in the flesh of the rate, pig and man. 25orphological Characte eee ee The male which is rarely found measures 1.5 mm in length and 40 in breadth. It will therefore be clear that the Parasite is difficult to see with the naked eye. female:- The fer vhich te uot ‘en he female which is viviparous measures about 3mm in length and 60 in breadth. The vulva is situated close to the anterior extremity. Life History:- These worms differ from all other nematodes of medical importance in that although two hosts are necessary for the completion of the life cycle of the Parasite, each host is infected with the adult and all the larval forms. When a rat eats a portion of another rat containing encysted larvae, they rapidly become adult male and female worms in its intestine. Following fertilization the females burrow into the villi and lymphatic ducts and about five days begin to liberate larvae into the blood and lymph vessels. After about ten days, they are carried to all parts of the body. Only those which reach striated muscle survive to become infective. The muscles most commonly found parasitized are those which are most active, including that of diaphragm, including that of diaphragm, tongue, throat, eye and thorax. The larvae now grow rapidly to adult size of 100 by 6p within three weeks. The encysted larvae may remain infective for as long as thirty years; but frequently the cyst and sometimes the larva becomes classified in the course of a few months. Pig becomes infected by eating infected flesh from other pigs fed to it in uncooked garbage. Man acquires the parasite by eating the insufficient cooked meat of an infected pig. In the intestine of man, the gastric juice digest the cysts, liberating the larvae which are resistant to digestion. The larvae then pass through the developmental cycle already described ending with the encystment of larvae in man’s voluntary muscles and are unable to develop further. 25pathogenicity 1m the great majority of infected persons, the infective dose is small and consequently no symptoms are produced and infection is not suspected. During the burrowing of the adult female in the intestinal mucosa, there are gastro-intestinal symptoms, such as nausea, vomiting, colic and diarrhea sometimes with haemorrhage, During the second week of infection there is oedema of the orbit, headache, insomnia and increasing eosinophilia, severe pain, dyspnoea, pyrexia and sometimes rash. Depending on the severity of the infection, the individual may die or recovery may begin with chronic pain in the muscles affected. gnosis This can be established only towards the end of the second week when examination under the low-power of the microscope should reveal larvae in tissue, obtained by biopsy from the deltoid or thigh muscles and strongly compressed between sheets of glass. Prevention Since pig is the reservoir of human infection, control measures are aimed at preventing infection of the pig and preventing human consumption of infective pork. All garbage fed to pigs should be cooked to sterilize scraps of infected meat possibly contained in it. Personal prophylaxis consist in the thorough cooking of pork and pork dishes. 26infective forms. It is only intermediate host that he becomes infected Man cannot acqui . = person en a ety a an infected Person, the only harm @ reservoir from which the intermediate host becomes Parasitized by larvae, In all species the host of the larva is an insect. The family contains the following genera and species. Genus Wuchereria species IV. bancrofti Genus Brugia species B, malayi Genus Loa Species Loa loa Genus Onchocerca Species O. Volvulus GenusMansonella Species M. ozzardi Genus Acanthocheilonema Species A. pertans A. steptocerca Adult worms are rarely obtained except at autopsy or during surgical operations and so diagnosis of the species causing infection is based on examination of the larval forms, the microfilariae, found in the peripheral blood or skin, muscles, connective tissues or serous cavity which vary in size from 100 to 300p. These slender filarial worms are arthropod — transmitted parasites. The four major human pathogens are Wuchereria bancrofti, Brugia malayi, Onchocerca volvulus and Loa 27Mansonella ox ‘ardi are le: 7 ‘SS Commonly ji ny ; iieeyele, y involved. Each parasite has a complex Wuchereria bancrofi Brugia mai I ‘hocerca volvulus ig Hayi, Loa loa, Onchoce ne te Periodicity “ere Nocturnal periodic yarn rin highest number of microfilariae occur in blood at © type, the number of microfilariae during the day are about the same as that during the night, Lifecycle 2. Numerous species of the genera culex, Aedes and Anopheles can act as hosts of the larvae for IV. bancrofti and for Brugia malayi b. Chrysops (mango fly) as host for Loa loa larvae. ¢. Simulium (black fly) as host for Onchocerca volvulus from the superficial layer of the skin which it lacerates in the process of biting to reach the blood. The life cycles of all the filarial worms are similar with minor differences which help in their identification. The life cycle involves: 1. Penetration of the skin by the infective larva through the bite wound made by the insect vector. The larvae reach their site of maturation, such as lymphatics (Wuchereria id bancrofti, Brugia malayi) connective tissue or conjunctivae (Loa loa) or subcutaneous tissue (Onchocerca volvulusi) and grow into adult worms. . The female worm discharges microfilariae in blood (W. banerofti, B. malayi, » Loa loa) or in skin, body fluids or urine (O. volvulus). 4. The microfilariae are taken up by the respective vector where they undergo development to form infective larvae to infect humans,sosphology adult worms Adult worms tuclei extends nearly the . al 'Y the whole length an most the entire Width of the bod Caces The abs: il , ence or presence of nuclei at the tip of the tail varies with species and diagnostics, The microfilariae of jy. Bancroft, B. malayi and Loa loa are sheathed, Pathogenicity Lymphatic filariasis is caused by Wuchereria bancrofti and less frequently by Brugia malayi. irregular fever, enlargement of lymphatic glands, Elephantiasis of the legs, scrotum and vulva, Chyluria is caused by W. bancrofti, when the lymphatics which transport chyle from the intestine are blocked, the chyle appears in the urine giving it a milky appearance. Calabar swellings are caused by Loa Joa infection as an allergic response to the adult worm migrating in the subcutaneous tissue. The swellings last for few days and do not contain any worms. Loa loa adult worms can sometimes be seen in the conjuctiva but do not cause blindness. The infections are generally symptomless. Onchocerca volvolus can cause dermatitis, onchocerciasis in man subcutaneous nodules in various part of the body. O. volvolus causes ocular lesions that lead to blindness. The ocular lesions is a result of host’s immune response to microfilaria. 29In, | hydrocoele and urine depending fi nosis “ qemonstration of microfilari } filaria in blood, ski I, skit on the infecting species, Blood Collection time of b] lo or nocturnel seta - depends on the periodicity of the infectin, i oes periodicity, the blood is collected between 10; fs ~ ‘in snips — the blo in snip is os ‘od or skin snip is collected during mid-day. The skin snips hi should be taken from scapula, gluteal or calf areas. Techniques 1. Examination of blood for microfilariae by: (a) Wet preparation — for motile free moving microfilariae (b) Thin blood film stained by Giemsa or fields technique (c) Concentration methods ‘on of urine or hydrocoele fluid. Make a wet preparation from the 2. Examinati microscopically for motile centrifuged microfilariae. mmerse the skin snip in saline on a glass slide, ce it in a moist chamber to avoid drying, Examine under one hour and deposit of the specimen and examine cover it with a 3. Skin snip: coverslip and pla low power objectivs e after 30 minutes, overnight incubation for from the skin. percentage of the microfilariae emerging |. Serological diagnosis is of limited value because a high ‘on will show positive reaction. populatiwy indy, blood Migr bloo a sent) © are { Spec infer, pres N met 12¢ lyc are ler is itt th me)Acanthocheiiong " er GeoerPMiCAl distripygig, MS Ang as Athoch ei . ilon Habitat: "2.60 South tic rm Senacerg a) Adult Worms ofa Of man espeoi * TOUS caviti _ a reopen IS CaVities ang Connective tissue “anthocheitoneman Stre aay ang — —Ptocerca Occur in the IMB Non-periodic, The microfita by day and night but are not Peripheral blood of man by Mae Of 4. streptocerca occur found in the blood. They are : non: IM the skin of ‘man °) Infective I ; ‘arvae: 4. Perstances — The developmental forms occur in the gut and mus. coi i cles of the Senus culicoides, The infective larvae reach their mouth, Adult male — measures 4cm by 70 in breadth Female —7em by 1304 in breadth Microscopically, the cuticle in both sexes are smooth. The head of this species is peculiar in having short cuticular shields (“epaulettes”) bearing symmetrical papilla — The tip of the tail in both sexes is curved and split to form cuticular flaps. A. streptocerca — The adult of this species have been recovered only from animal host and the worm in man is known only in the microfilarial stage, Pathogenicity Itching and allergic swellings of the skin in both species. Diagnosis The method used are as for W. bancrofti. The microfilariae has no sheath. le Prevention This has not been attempted. 32* Geoeraphical distribution women Ozzara — West ic Habitat: Indies and Norther parts of South Amer erica, a) Adults Worms are found in the mes, wall of man, entery, Tetro-peritoneal tissue, abdominal b) The Uunsheathe microfilariae . Occur in the peri night — non-perodie, Peripheral blood of man day or ©) Infectiy © larvae — The developmental forms are found in the gut and muscles of certain Colicoides and simuliu Present in the mouth parts, Morphological Character Adult male unknown except for one fragment 3.8em by 200p in breadth. Adult female — 7em by 230p in breadth. im species, The infective larvae are Microfilariae in the blood of man Life History M. ozzardi follows in its vectors much the same development as does W. bancrofii in mosquitoes. Pathogenicity — Skin rashes Diagnosis — methods used are as for W. bancrofti The microfilaria has no sheath. Prevention: Not attempted as yet. Prevention: 33