Medical parasitology

Medical Helminthology
 Class Nematoda*
The parasitic nematodes are divided into:
• Intestinal nematodes
• Tissue nematodes

* Note: the new classification names the Nematoda as a Phylum.

 Intestinal Nematodes

• Live in the small intestine

– Ascaris lumbricoides (large roundworm)**
– Hookworms (Ancylostoma duodenale and Necator americanus)**,
– Strongyloides stercoralis (dwarf threadworm)

• Live in the large intestine.

– Trichuris trichiura (whipworm)**
– Enterobius vermicularis (pinworm)

** Soil-transmitted helminthes
 Ascaris lumbricoides (Large
Roundworm)
Causative agent of Ascariasis (ascariosis)

• Occurrence

– Worldwide distribution.

– It is one of the most widespread of all human parasites.

– Infecting about 1221 million people worldwide with 60 thousand

deaths per year.

– The main endemic regions, with prevalence rates of approx. 10–

90%, include countries in Southeast Asia, Africa, and Latin America.

– It is endemic in Yemen.
 Ascaris lumbricoides
• Parasite
– The adult worms live in the small intestine
– They are 15–40 cm in length, about as thick as a pencil and of a
yellowish pink colour.
– The sexually mature females produce as many as 200 000 eggs per
day, which are shed with faeces in the unembryonated state.

Kayser, Medical Microbiology © 2005 Thieme

 Ascaris lumbricoides
• Egg (the diagnostic stage)

– The round-to-oval eggs are about

60 X 45 μm in size, yellow-
brown and have a thick shell
covered by an uneven
albuminous coat. Contains a
central granular mass which is Monica Cheesbrough; Medical laboratory manual for
tropical countries
the unsegmented fertilized ovum. Left: fertilized (usually in the faeces
Right: unfertilized (occasionally).

– Occasionally unfertilized are

passed when the worms in the
intestine are mostly female.
 Ascaris lumbricoides

• Egg (the infective stage)

– At optimum temperatures of
20–25 ᵒC with sufficient
moisture and oxygen, an
infective larva in the egg
develops within about three to
six weeks. Foundations in microbiology / Kathleen Park
Talaro, Barry Chess. — 8th ed.

An infective larva in the egg.

 Ascaris lumbricoides
• Epidemiology

– Reservoir hosts of the parasite are humans.

– It is found most frequently, in moist, warm areas with low hygienic standards, poor
standards of sanitation.

– The excreted eggs remain viable for years in a moist environment (soil), but are unable to
withstand desiccation and direct sunlight.

– It is spread by faecal pollution (contamination) of the soil.

– A person becomes infected by ingesting infective eggs (the egg containing larva: infective
stage) in contaminated foods and soil.

– In endemic areas, the prevalence and intensity of A. lumbricoides infections are highest in
children.
 Ascaris lumbricoides
• Life Cycle

– Ingested eggs hatch in the small intestine.

– The larvae penetrate the blood vessels in the intestinal wall.
– and circulate in the blood. From the heart they migrate to the
lungs during which they develop.
– After migrating up to the trachea, the larvae are swallowed.
– They remain in the small intestine and grow into mature worms.
– After mating, the females lay the eggs which are passed in the
faeces.
– The prepatent period is about 2 months.
– The lifespan of these parasites is 12–18 months.
Prepatent period is the period between infection of an individual by a parasite and the first
ability to detect from that host a diagnostic stage of the parasite.
 Ascaris lumbricoides

Kayser, Medical Microbiology © 2005 Thieme

 Ascaris lumbricoides
Clinical Features and Pathology

• During their heart-lung larval migration, they can cause

– Inflammatory and hypersensitive reaction including
pneumonia-like symptoms (Ascaris pneumonitis or
Loeffler’s pneumonia)
– Attacks of coughing
– Bronchial asthma
– Eosinophilia is common and often urticaria

These features are less marked after the larvae return to the
 Ascaris lumbricoides
Clinical Features and Pathology

• During the intestinal phase of the infection,

they can cause
– Abdominal pain, nausea, diarrhoea and
vomiting.
– Heavy infection can cause
• Malnutrition especially in children.
• Fatal complications : Obstruction and
perforation of the intestine, sometimes
also migrate into the pancreatic duct or
the bile ducts and cause obstruction.
• Others complications: Liver abscesses
and appendicitis (caused by immigrating
 Ascaris lumbricoides
Clinical Features and Pathology

• Intestinal phase of the infection:

Worms can pass out through the anus
and be vomited or they may simply exit
through the nose or mouth, causing a
predictable consternation.

• Frequent contact with volatile Ascaris

antigens (laboratory staff!) can cause
allergies.
 Ascaris lumbricoides
Diagnosis

Laboratory confirmation of ascariasis is by:

• Ascariasis can be diagnosed by finding eggs in the stool (the
diagnostic stage).

• Identifying worms expelled through the anus and mouth.

 Ascaris lumbricoides
Treatment

• Mebendazole is the drug of choice. Pyrantel, albendazole, and

nitazoxanide are also effective against the intestinal stages of
Ascaris.

• Migratory stages are not affected by normal dosage levels.

• Due to the possibility of reinvasion of the intestine by larvae

migrating in the body, the treatment should be repeated after
two to three weeks.
 Ascaris lumbricoides
Prevention and control
• Providing and using adequate latrines, improvement
of sanitation.
• Good hygiene practices (washing hands before &
after eating , washing fruits and vegetables, cooking
foods, etc.)
• Regular antihelminthic treatment of infected persons
in endemic areas, especially children.
 Trichuris trichiura (Whipworm)
Causative agent of trichuriasis (trichuriosis)

Occurrence
• Worldwide distribution.

• With prevalence around 2–90% in the main endemic regions.

• Infecting about 1000 million people worldwide with 10 thousand deaths

per year.

• It is endemic in Yemen.
 Trichuris trichiura
Parasite
• The name whipworm characterizes the
form of this 3–5 cm nematode with a very
thin anterior part and a thicker posterior
part.

• Lives in the large intestine, mainly in the

caecum. The whipworm

• The females lay 2000– 14000, thick-

shelled, yellow-brown eggs per day.
 Trichuris trichiura
Egg
• The eggs (the diagnostic stage) are about
50–55 μm long, yellow-brown, thick-
shelled and has a characteristic barrel shape
with colourless protruding mucoid plug at
each end.
The diagnostic stage

• An infective larva develops in the egg after

2-3 weeks (the infective stage).
• In moist surroundings, Trichuris eggs
remain viable for months or even years.
 Trichuris trichiura
• Epidemiology: Like ascariasis
• Life Cycle
• like Ascaris but restricted to the intestine throughout development.

– The infective larvae hatch in the small intestine and penetrate villi.
– After 7-10 days, the larvae leave the small intestine and migrate to the
large intestine (caecum) where they develop into adult worms.
– The thin anterior part of the worms becomes embedded in the
intestinal mucosa.
– After mating, the females lay eggs which are passed in the faeces.
– The prepatent period is two and a half to three months.
– The parasite can live for several years.
 Trichuris trichiura
Clinical Features and Pathology

• Light infections produce few symptoms..

• Heavy infections can cause:
– Abdominal pain and diarrhoea often with
blood being passed.
– There is usually eosinophilia.

• In young children, severe infections can cause: Prolapse of the rectum caused by T. trichiura

– Chronic diarrhoea - Intestinal ulceration

Courtesy of Herman Zaiman; also, courtesy of University of Miami
– Anaemia - Failure to develop at the normal rateSchool of Medicine. From J. W. Beck and J. E. Davies, Medical
parasitology, 3d. ed.St. Louis, The C. V. Mosby Co., 1981.
– Weight loss - Prolapse of the rectum

• Massive infections can be fatal.

 Trichuris trichiura
Diagnosis

Laboratory confirmation of trichuriasis is by:

• Finding eggs in the stool (the diagnostic stage).

• The lab. report should include a semiquantitative estimation

of the number of eggs because heavy infections are associated
with serious complications, especially in children.

Note: heavy infections can be diagnosed clinically by examining

the rectum for worms using a proctoscope.
 Trichuris trichiura
Treatment

• Albendazole, mebendazole, and oxantel.

Prevention and control

• See ascariasis for appropriate prevention and control

measures.
 Capillaria philippinensis
• Is a very small whipworm
• Normally parasitic in fish-eating birds.
• Can infect humans causing capillariasis.
• Occurs in Philippine, Thailand, Japan.
 References
• Kayser, F.H. , et al. (2005). Medical Microbiology. Stuttgart , Germany & New York , U.S.A.:
Thieme.
• Cheesbrough, M. (1987). Medical Laboratory Manual for Tropical Countries. U.K.: ELBS
with Tropical Health Technology/Butterworth-Heinemann.
• Schmidt, G. D. & Roberts, L. S. (2009). Foundations of Parasitology (8th ed.). New York,
U.S.A.: McGraw-Hill.

September 30, 2023 25

 Thank you
Assis. Professor Dr. Abdulelah H. Al-Adhroey

September 30, 2023 26