Ascaris lumbricoides

Common name: Giant Human Intestinal Roundworm / Roundworm of Man

Description:
• Largest intestinal roundworm affecting humans
• Member of the STH (Soil Transmitted Helminthes)
• One of the most common intestinal worm infections together with Trichuris trichiura, hookworms,
and Enterobius vermicularis.
Host: Humans, Small intestine
Biology/Structure:
Fertilized ova
PARAMETER DESCRIPTION

SIZE 45 to70 um x 35 to 50 um

SHAPE Oval to spherical

EMBRYO Undeveloped unicellular embryo, ovoid mass of protoplasm

SHELL Thick chitin

Other Features Corticated or decorticated, bile stained

Unfertilized Ova
PARAMETER DESCRIPTION

SIZE 88 to 94 um by 39 to 44 um

SHAPE Longer and narrower

EMBRYO Unembryonated, amorphous mass of protoplasm

SHELL Thin shell and irregular mammilated coating

Other Features Usually corticated

Adult Worms
• Have terminal mouth with 3 lips and sensory papillae: 1 dorsal and 2 ventrolateral
• Polymyarian type- somatic muscle arrangement in which cells are numerous and project well
into the cavity.
• whitish or pinkish worms are large with smooth striated cuticles
PARAMETER FEMALE MALE
LENGTH 10 to 31 cm 22 to 35 cm
WIDTH 3-6 mm 2-4 mm
 POSTERIOR straight and conical curved ventrally forming a hook,
with 2 copulatory spicules
Other Features paired reproductive a single, long, tortuous tubule
organs in the posterior two-third

Infective Stage: Fully Embryonated Eggs

Mode of Transmission: Ingestion of embryonated egg by the host
Portal of Entry: Mouth
Portal of Exit: Anus
Life Cycle:

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. Larvae
develop to infectivity within fertile eggs 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.

Methods done to diagnose: DFS (Direct Fecal Smear), Kato-Katz technique

Pathology: (a) tissue reaction to the invading larvae, (b) intestinal irritation to the adult, and (c)
other complications due to heavy infection and extraintestinal migration
• Ascariasis
• Ascaris pneumonia
• Loeffler’s syndrome
• Charcot –Leyden crystals
 Trichuris trichiura
Common name: Human Whipworm
Description:
• Early names: Trichocephalus trichiurus and trichocephalus dispar
• Member of the Holy Trinity of Intestinal worm infection
• Harder to eradicate than Ascaris infection because its anterior part penetrates deeply into the
intestinal mucosa
• Member of the STH
• Classified as a Holomyarian
Host: Humans, Large intestines and Cecum
Biology/Structure:
• Member of the superfamily Trichuroidea, closely related to Trichinella spiralis
• Adults have thin elongated anterior portion and a thickened posterior- giving a whiplike
appearance
ADULT WORMS
PARAMETER FEMALES MALES
LENGTH 35-50 mm long 30-45 mm long
POSTERIOR blunt posterior end coiled posterior end with a single spicule and retractile sheath

Other • attenuated anterior portion (Contains the esophagus)- embedded in the

Features intestinal mucosa
• posterior part contains intestines and reproductive organs
• Average life span: 2 years but could reach up to 4 years

OVA
PARAMETER DESCRIPTION
SIZE 50 to 54 um by 23 um
SHAPE Lemon or football shaped, barrel shaped

EMBRYO Unsegmented at oviposition

SHELL Yellowish outer and a transparent inner shell

Other Features Prominent bipolar plugs

Infective Stage: Fully Embryonated Eggs

Mode of Transmission: Ingestion of embryonated egg by the host
Portal of Entry: Mouth
Portal of Exit: Anus
Life Cycle:
The unembryonated eggs are passed with the stool . In the soil, the eggs develop into a 2-cell stage , an
advanced cleavage stage , and then they embryonate ; eggs become infective in 15 to 30 days. After
ingestion (soil-contaminated hands or food), the eggs hatch in the small intestine, and release larvae that
mature and establish themselves as adults in the colon . The adult worms (approximately 4 cm in length)
live in the cecum and ascending colon. The adult worms are fixed in that location, with the anterior portions
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 year.
Methods done to diagnose: DFS, Kato- Katz technique, eggs may be difficult to be detected in light
infections, therefore concentration techniques are recommended
Pathology:
• Most infections are asymptomatic
• Severe infections can lead to rectal prolapsed
• Deep penetration to intestinal mucosa can lead to entorrhagia or intestinal bleeding (Trichuris
dysentery syndrome), GI problems (Abdominal pain, diarrhea, anorexia, etc..). headache,
fatigue and eosinophilia
• Severe infections are also correlated to anemia of patients.
 Hookworm spp.
Common name: New World Hookworm and Old Worm Hookworm
Description:
• Blood-sucking nematodes
• Member of STH
• Commonly found in tropical and subtropical countries which occurs in single or mixed infections
• Member of the Holy Trinity of Intestinal worm infections
Host: Humans, small intestine
Biology/Structure:
• Classified as Meromyarian- somatic muscle with 2-5 cells arranged per dorsal or ventral half

Necator americanus Ancylostoma duodenale

New World Hookworm Old World Hookworm
Small, cylindrical, fusiform and grayish-white Larger than N.americanus
nematodes; Adults are smaller compared to
A.duodenale
• Females: 9-11 mm x 0.35 mm Adults has single paired male or female
• Males: 5-9 mm x 0.30 mm reproductive organs
Posterior end of the male has a broad,
membranous caudal bursa with rib like rays
(for copulation)
Head is curved, opposite to the curvature of Head: Continues in the same direction as the
the body (Looks like a hook at the anterior curvature of the body
end)
Buccal capsule has a ventral pair of semilunar Buccal capsule has two pairs of curved ventral teeth
cutting plates

HOOKWORM OVA
PARAMETER DESCRIPTION
SIZE 50 to 70 um
SHAPE Oval with rounded slightly flattened poles
EMBRYO 4 to 8 cells blastomeres, granular to embryonated
SHELL Thin shelled
Other Features Pale gray

HOOKWORM LARVAE
RHABDITIFORM LARVA FILARIFORM LARVA
• Indistinguishable for both Compared to S. stercoralis that has a longer
• longer buccal cavity and smaller esophagus and notched tail, it has a shorter
genital primordium compared to the esophagus and pointed tail (SSLN)
commonly mistaken, S. stercoralis (LSSL)
• Feeding stage
Infective Stage: Filariform larvae
Mode of Transmission: Skin penetration of parasitic filariform larvae
Portal of Entry: Skin
Portal of Exit: Anus
Life Cycle:

Eggs are passed in the stool , and under favorable conditions (moisture, warmth, shade), larvae
hatch in 1 to 2 days and become free-living in contaminated soil. These 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, typically bare feet, 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 jejunum of the small intestine, where they reside and mature
into adults. Adult worms live in the lumen of the small intestine, typically the distal jejunum, 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.
Methods done to diagnose: DFS, Kato-Katz technique, Concentration methods, Harada-Mori culture
technique
Pathology:
• Itchiness in the site of entry which is termed as Dew/Toe/Ground itch
• Site of skin entry causes itching, edema, erythema and later papulovesicular eruptions which
can last for 2 weeks.
• Abundant larvae migration to the lungs causes bronchitis or pneumonitis.
• Chronic or heavy hookworm infection can lead to progressive, secondary, microcytic and
hypochromic anemia (Iron Deficiency Anemia)
 Strongyloides stercoralis
Common name: Thread Worm
Description:
• Characterized by a free-living rhabditiform larvae (in soil) and a parasitic filariform larva.
• Only species of its genus to be pathogenic to man
• Capable of autoinfection
Host: Humans, small intestine
Biology/Structure:
S. stercoralis ova
• Resembles hookworm eggs but are smaller

Filariform and Free-living Stages

PARASITIC FILARIFORM FREE-LIVING FEMALE FREE-LIVING MALE
FEMALE (Parasitic males are of rare
occurrence)
LENGTH 2.2 mm 1 mm, (generally, smaller 0.7 mm
than the parasitic female)
WIDTH 0.04 mm 0.06 mm 0.04 mm
ESOPHAGUS Long slender esophagus Has a distinct muscular Parasitic males are of rare
that extends to the double bulbed esophagus occurrence
anterior 4th of the body
VULVA 1/3 of body length from 2/5 of body length from
posterior end posterior end
UTERI contain a single file of 8-12 single column of thin-
thin-shelled, transparent, shelled, transparent,
segmented ova segmented ova
ANTERIOR Slender tapering; 4
END/TAIL indistinct lips
POSTERIOR Short conical Ventrally curved
END/TAIL Two copulatory spicules

Comparison of S.stercoralis and Hookworm rhabditiform larvae and Filariform larvae

RHABDITIFORM FILARIFORM
HOOKWORM Long buccal cavity short esophagus
Small genital primordium Pointed tail
THREADWORM Short buccal cavity Long esophagus
Prominent genital primordium notched tail

Infective Stage: Filariform larvae

Mode of Transmission: Skin penetration of parasitic filariform larvae
Portal of Entry: Skin
Portal of Exit: Anus
Life Cycle:
- When conditions in the soil become unfavorable, rhabditiform larvae develops into filariform
larvae
- Only nematode capable of producing embryonated egg without the presence of a male:
PARTHENOGENESIS
The Strongyloides stercoralis life cycle is complex, alternating between free-living and parasitic cycles and
involving autoinfection. In the free-living cycle: Rhabditiform larvae are passed in the stool of an
infected definitive host , develop into either infective filariform larvae (direct development) or
free-living adult males and females that mate and produce eggs , from which rhabditiform
larvae hatch and eventually become infective filariform (L3) slarvae . The filariform larvae
penetrate the human host skin to initiate the parasitic cycle (see below) . This second generation
of filariform larvae cannot mature into free-living adults and must find a new host to continue the life
cycle.
Parasitic cycle: Filariform larvae in contaminated soil penetrate human skin when skin contacts
soil , and migrate to the small intestine . It has been thought that the L3 larvae migrate via the
bloodstream and lymphatics to the lungs, where they are eventually coughed up and swallowed.
However, L3 larvae appear capable of migrating to the intestine via alternate routes (e.g. through
abdominal viscera or connective tissue). In the small intestine, the larvae molt twice and become
adult female worms . The females live embedded in the submucosa of the small intestine and
produce eggs via parthenogenesis (parasitic males do not exist) , which yield rhabditiform larvae.
The rhabditiform larvae can either be passed in the stool (see “Free-living cycle” above), or can
cause autoinfection .

Methods done to diagnose: Harada-Mori Culture technique – most successful in parasite detection,
Concentration techniques- Bearmann funnel gauze method, Bael’s String test, Duodenal
Aspiration, Small bowel biopsy
Pathology:
• Causes Cochin-China diarrhea/Vietnam diarrhea
• Capable of autoinfection
• Site of skin penetration leads to erythema, pruritic elevated hemorrhagic papules
• Larval migration to the lungs causes pneumonia-like symptoms with hemorrhag.
• Cough and tracheal irritation mimicking bronchitis.
 Enterobius vermicularis
Common name: Human pinworm/ human seatworm / societal worm
Description:
• Familial or a Group disease
• Classified as meromyarian
• Most common parasite identified in temperate regions, where sanitation is poor
• Prioritized less in tropical areas
Host: Humans
Biology/Structure:
• Adults have cuticular expansions at the anterior end and a prominent posterior esophageal bulb

ADULT FEMALE ADULT MALE RHABDITIFORM LARVAE

8 to 13 mm by 0.4 mm and 2 to 5 mm by 0.1 to 0.2 mm Has a esophageal bulb but does

has a long pointed tail has a curved tail and a single not have cuticular expansions on
(resembling a pin head) spicule the anterior end
Uteri of gravid females are Males are rarely seen because
distended with eggs they die after copulation

OVA
PARAMETER DESCRIPTION

SIZE 50 to 60 um by 20 to 30 um
SHAPE One side flattened and the other side convex, “D” shaped ova
EMBRYO Tadpole like embryo, “C” shaped larvae

SHELL Translucent shell of an outer triple albuminous covering

Other Features Pale gray

Infective Stage: Embryonated egg

Mode of Transmission: Infection through ingestion or Inhalation of embryonated egg (E.vermicularis
ova can be blown by the air)
Portal of Entry: Mouth or nose
Portal of Exit: Anus
Life Cycle:
Gravid adult female Enterobius vermicularis deposit eggs on perianal folds . Infection occurs via
self-inoculation (transferring eggs to the mouth with hands that have scratched the perianal area) or
through exposure to eggs in the environment (e.g. contaminated surfaces, clothes, bed linens,
etc.) . Following ingestion of infective eggs, the larvae hatch in the small intestine and the
adults establish themselves in the colon, usually in the cecum . The time interval from ingestion of
infective eggs to oviposition by the adult females is about one month. At full maturity adult females
measure 8 to 13 mm, and adult males 2 to 5 mm; the adult life span 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 .
Methods done to diagnose: Graham’s scotch adhesive tape swab (perianal cellulose tape swab) - offers
highest detection rate, DFS
Pathology:
• Infection of this parasite is termed as Enterobiasis or Oxyuriasis
• Mild catarrhal inflammation of the intestinal mucosa
• Migration of egg-laying females to the anus causes irritation of the perineal region
• Children infected with this parasite may suffer from insomnia due to the pruritus.
• Other signs of infection are poor appetite, weight loss, irritability, grinding of teeth, and
abdominal pain
 Capillaria philippinensis
Common name: Pudoc worm
Description:
• Intestinal capillariasis, a zoonotic disease
• Member of superfamily Trichinelloidea
• Thin filamentous anterior end and a slightly thicker and shorter posterior end.
• Esophagus has rows of secretory cells
• Capable of autoinfection
Host: Humans, small intestine; Freshwater fish – intermediate host; Birds
Biology/Structure:
ADULT
ADULT FEMALE ADULT MALE

Length: 2.3 to 5.3 mm Length: 1.5 to 3.9 mm

Vulva is located at the junction of anterior and Contains male spicule and an unspined sheath
middle thirds

OVA
PARAMETER DESCRIPTION

SIZE 36 to 45 um by 20 um

SHAPE Peanut shaped

EMBRYO Granular, unsegmented

SHELL Striated shells

Other Features Flattened bipolar plugs, pale yellow brown

Infective Stage: Embryonated egg

Mode of Transmission:
• Ingestion of raw or undercooked infected fish
• Studies showed that most parasitic stages are harbored in raw Bagsit (Hypseleotris bipartita)
Portal of Entry: Mouth
Portal of Exit: Anus
Life Cycle:
Typically, unembryonated, thick-shelled eggs are passed in the human stool and become
embryonated in the external environment in 5—10 days ; after ingestion by freshwater fish,
larvae hatch, penetrate the intestine, and migrate to the tissues . Ingestion of raw or
undercooked fish results in infection of the human host. The adults of Capillaria philippinensis are
very small (males: 2.3 to 3.2mm; females: 2.5 to 4.3 mm) and reside in the human small intestine,
where they burrow in the mucosa . In addition to the unembryonated, shelled eggs which pass
into the environment, the females can also produce eggs lacking shells (possessing only a vitelline
membrane) , which become embryonated within the female’s uterus or in the intestine. The
released larvae can re-invade the intestinal mucosa and cause internal autoinfection . This
process may lead to hyperinfection (a massive number of adult worms).
Methods done to diagnose: DFS, Concenctration techniques
Pathology:
• Causative agent of “Mystery Disease”
• Usual symptoms are abdominal pain and borborygmi
• Intermittent diarrhea
• Weight loss, malaise, anorexia, vomiting, and edema
• Laboratory findings show severe protein-losing enteropathy and hypoalbuminemia
• The ulcerative and degenerative lesions in the intestinal mucosa may account for malabsorption
of fluid, protein, and electrolytes
• Histologically, the intestines also show flattened and denuded villi, and dilated mucosal glands.
 Trichinella spiralisis
Common name: Muscle worm/Smallest round worm/Dead-end alley/ Blind infection agent
Description:
• Most adapted to domestic and wild pigs making it the causative agent of most Trichinellosis
Host: humans, rats, dogs, cats, pigs, bears, foxes, walruses, or any other carnivore or omnivore)
• Habitat: Encysted larvae in the striated muscles, adults in the small intestine
• An infected organism serves as the final and intermediate host by harboring both adult and larval
stages of the parasite

Biology/Structure:

ADULT

ADULT FEMALE ADULT MALE

Measures about 1.26 to 3.35 mm by 0.029 to Measuring 0.62 to 1.58 mm by 0.025 to 0.033
0.038 mm mm
Single ovary which is situated in the posterior Has a single testis located near the posterior end
part of the body of the body, and is joined in the mid-body by the
genital tube which, in turn, extends back to the
cloaca
Has an oviduct, a seminal receptacle, a coiled The posteriorly-located cloaca has a pair of caudal
uterus, a vagina, and a vulva appendages and two pairs of papillae.
• Vulva is situated in the anterior 5th on
the ventral side of the body,
Viviparous female lives for 30 days and is
capable of producing more than 1,500 larvae in
its lifetime.

Encysted larvae
• Spear like, burrowing anterior tip
• Average lifespan is about 5 to 10 years can survive up to 40 years
• Highest eosinophilia among all other parasitic disease
• Diagnosed by muscle biopsy or serologic test.

Infective Stage: Encysted larvae

Mode of Transmission: Ingestion of raw or undercooked meat containing encysted larvae
Portal of Entry: Mouth
Portal of Exit: Anus
Life Cycle:
Trichinellosis is caused by the ingestion of undercooked meat containing encysted larvae (except
for T. pseudospiralis and T. papuae, which do not encyst) 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.
Methods done to diagnose: Muscle Biopsy-Method of choice
Pathology:
• Light infections are usually asymptomatic
• Moderate infections with 50-500 larvae results to gastroenteritis, diarrhea, and abdominal pain
approximately two days post infection
• Heavy infections with 100-300 larvae results to Parasitic infection (divided in 3 phases):
1. Enteric Phase
• Resembles of acute food poisoning (Diarrhea/constipation, vomiting, abdominal
cramps, malaise and nausea.
2. Invasion Phase
• Migrating larvae and resulting metabolites lead to immunological, pathological, and
metabolic reactions.
• Inflammatory reaction to the infection results in eosinophilia, which results in the
release of histamines.

Cardinal Signs of Trichinellosis: severe myalgia, periorbital edema, and eosinophilia

Summary of Modes of Transmission
Ingestion of embryonated egg (ATE)
1. Ascaris lumbricoides
2. Trichuris trichiura
3. Enterobius vermicularis

Skin Penetration (StAN)

1. Ancylostoma duodenale
2. Necator americanus
3. Strongyloides stercoralis

Ingestion of larvae
1. Capillaria philippinensis (fish)
2. Trichinella spiralis (meat)

Heart-Lung Migration
1. Ascaris lumbricoides
2. Hookworm spp.
3. Strongyloides stercoralis