SOIL TRANSMITTED

HELIMENTHS
 INTESTINAL NEMATODES

LARGE INTESTINE
NEMATODES SMALL INTESTINE
1. Trichuris trichiura NEMATODES
2. Enterobius 1. Ascaris lumbricoides
vermicularis 2. Hook worm
 Trichuris trichiura
• Whipworm

• Habitat - Large intestinal nematodes (mainly cecum

and appendix).

• Trichuriasis is distributed worldwide, mainly in warm

and moist climates similar to ascariasis.

• Children are commonly affected.

MORPHOLOGY
Adult worm
EGG

• Barrel-shaped; surrounded by a
shell, bear mucus plug at both poles.

• 50–54 µm long and 22–23 µm wide

• Bile stained

• Float in saturated salt solution.

 Life cycle

• Mode of transmission – feco

oral route contamination
• Infective form –
embryonated egg
• Diagnostic form –
unembryonated eggs
PATHOGENICITY AND CLINICAL FEATURES
• The incubation period varies from 70 to 90
days.

• Most infected individuals are asymptomatic,

with or without having eosinophilia.

• In people with heavy infections:

Mechanical distortion: leads to inflamed,

edematous, and friable mucosa

• Allergic response by the host

COMMON MANIFESTATIONS
INCLUDE:
• Abdominal pain, anorexia, etc.

• Trichuris dysentery syndrome

• Iron deficiency anemia

• Recurrent rectal prolapse

• Growth retardation and impaired cognitive function

 LABORATORY DIAGNOSIS

• Stool Examination –

Because the level of egg output is high (approximately

200 eggs/g of feces per worm pair), a microscopic
examination of a single fecal smear is sufficient for the
diagnosis of symptomatic cases.

1. Wet mount - Barrel-shaped; 50–54 µm long and 22–

23 µm wide, Bile stained Trichuris trichiura (A) Egg in
saline mount;
2. Concentration techniques – Float in a saturated salt (B) Adult female
solution.
LABORATORY DIAGNOSIS

Other Findings:

• Peripheral blood eosinophilia (<15%)

• Increased serum IgE level.

TREATMENT

• Mebendazole (500 mg once) or albendazole (400 mg daily for three doses) is safe
and moderately effective for treatment, with cure rates of 70%

• Ivermectin (200 mg/kg daily for three doses) is also safe but is less effective.
 Enterobius vermicularis
• Pin worm or Thread worm.

• Habitat – large intestine (cecum, appendix, adjacent portion of

colon).

• Prevalence – maximum in children (5 & 14 years).

• People carry the infection for years together due to autoinfection

cycles.

• “You had the infection as a child, you have it now and you will again
get it when you have children”.
Factors promoting infection
1. Overcrowding

2. Impaired hygiene

3. Poor personal care (nail biting

or inadequate hand washing)
 MORPHOLOGY

ADULT WORMS

• It is small, white & thread-like

(thread worm).

• Male worm – 2-5mm x 0.1-0.2mm.

• Males die soon after fertilization.

• Female worm – 8-13mm x 0.3-

0.5mm.
EGGS –

• Oval or planoconvex

• 50-60µm x 20-30µm

• Surrounded by double-layered eggshell.

• Not bile stained

• Embryonated when passed fresh –

contains a tadpole larva inside.

• Floats in saturated salt solution.

 LIFE CYCLE
• Host – humans

• Infective form – embryonated eggs

• Mode of transmission –

 ingestion of eggs contaminated with fingers due

to inadequate hand washing or nail biting habit.

 Autoinfection –
 Endogenous – retrograde migration of the
hatched larva from the eggs in the perianal
skin.
 Exogenous – eggs cause intense irritation of the
perianal skin & scrapping of the area leads to
contaminated fingers.
 Pathogenicity & clinical features
• Asymptomatic.

• Symptomatic patients –

Females, children & young adults are often infected.

Cardinal symptoms – perianal pruritis (nocturnal migration of female worm)

Excoriation of perianal skin & bacterial super-infection may occur.

Abdominal pain & weight loss (heavy infection).

 Pathogenicity & clinical features

• Migration of the worm –

Rarely invades the female genital tract, causing vulvovaginitis & pelvic or
peritoneal granulomas.

Other sites involved are urinary tract, peritoneal cavity, lungs & liver

Eosinophilia is uncommon.
 LABORATORY DIAGNOSIS

• Female worms lay eggs in the

perianal area, not in the rectum.

• The deposited eggs are collected

by – applying cellophane tape or
NIH swab.

CELLOPHANE TAPE METHOD

TREATMENT

• Mebendazole (100mg once)

• Albendazole (400mg once) or

• Pyrantel pamoate (11mg/kg once; max 1g)

• The same treatment should be repeated after 2 weeks.

• Treatment of household members is advocated to eliminate asymptomatic

reservoirs of potential reinfection.
 Ascaris lumbricoides
• Largest nematode

• Round worm

• Cosmopolitan in distribution – mainly affecting tropical countries

including India.

• Transmission typically occurs through fecally contaminated soil.

• Clay soils are most favorable for the development of Ascaris eggs.

• Risk factors – children and malnutrition

 MORPHOLOGY
Adult worm –
• pinkish creamy in color and gradually fades color
and looks whitish
• Size – female worm: 20-35cm
male worm: 15-31cm
• Life span – 1-2 years
• Shape – Cylindrical, with tapering ends
• Mouth part – mouth opens anteriorly and bears 3
characteristic toothed lips.
• Body cavity – filled with a fluid called Ascaron /
Ascarase in which the intestine and genital organs
float.
Larva – 4 stages (L1-L4).
Eggs – 2 types
1. Fertilized eggs (corticated and decorticated eggs)
2. Unfertilized eggs
LIFE CYCLE
• Host – man

• Infective stage – embryonated

eggs containing the L2 larvae

• Mode of transmission – ingestion

of embryonated eggs from the
contaminated soil, food, and water.

• 3 stages –

i. Migratory phase

ii. Intestinal phase

iii. Development in soil

 Pathogenesis & Clinical features
• AFFECT DUE TO MIGRATING LARVA –

1. Pulmonary symptoms –

2nd week of ingestion.

Lungs provoke an immune-mediated hypersensitivity response

Symptoms – nonproductive cough, chest discomfort, fever.

Eosinophilic pneumonia (Loeffler’s syndrome) : In severe

cases, patients develop dyspnea & transient patchy infiltrates
seen on chest X-ray along with peripheral eosinophilia.
 Pathogenesis & Clinical features
• AFFECT DUE TO ADULT WORM –

1. Asymptomatic

2. Malnutrition & growth retardation

3. Intestinal complications – a large bolus of entangled

worms can cause abdomen pain – due to small bowel
obstruction, rarely perforation.
 Pathogenesis & Clinical features
4. Extraintestinal complications –

• Larger worms can enter & occlude the biliary tree – causing biliary colic,
cholecystitis, pancreatitis or rarely intrahepatic abscesses.

• Wandering worms – migrate to the pharynx & cause respiratory obstruction or

may block the eustachian tube.

5. Allergic manifestations – fever, urticaria, angioneurotic edema & conjunctivitis

may occur due to toxic fluid released by adult worms.
 LABORATORY DIAGNOSIS
1. Egg detection –
• Fertilized and Unfertilized egg – detected by stool examination by saline and
iodine mount
• Bile stained
• Concentration technique – Sedimentation method
2. Larva detection –

Early pulmonary migratory phase, larvae can be found in sputum or gastric aspirates
before the eggs appear in the stool.

3. Adult worm detection –

• Detected in stool or sputum by the naked eye.

• Barium meal X-ray of the GIT

• Ultrasound or cholangiopancreatography – extraintestinal sites.

 LABORATORY DIAGNOSIS

Serology :

• ELISA

• IFA (Indirect fluorescent antibody test)

• IHA (Indirect Hemagglutination test)

• Micro precipitation test using larva

Serology is useful in the pulmonary phase and for seroepidemiological purposes.

Other methods – eosinophilia is prominent (early lung stage), presence of charcot leden
crystals in sputum & stool.
TREATMENT

• Albendazole (400mg once), Mebendazole (100g twice daily for 3 days or 500mg
once) is effective.

• Alternate – Ivermectin (150-200mg/kg once) & Nitazoxanide are also effective.

• Pregnancy – Pyrantel pamoate.

• Symptomatic treatment –

partial intestinal obstruction – should be managed with nasogastric suction, IV

fluid administration.
PREVENTION

• Improved personal hygiene

• Proper disposal of feces

• Improved nutrition

• Treatment of infected persons

• Deworming
MCQs
1. A child aged 6 years vomited a white worm with a cylindrical body
measuring 20cm. Parents gave a history of passing similar worms in
feces a few months ago. A stool examination showed many brown
ova. The probable organism is – (RGUHS June 2024)

a. Necator americanus

b. Trichuris trichiura

c. Taenia saginata

d. Ascaris lumbricoides
2. Autoinfection is caused by –(RGUHS June 2024)

a. Taenia saginata

b. Taenia solium

c. Toxocara canis

d. Trichuris trichiura
3. Common name of Trichuris trichiura (RGUHS Feb 2024)

a. Pin worm

b. Round worm

c. Whip worm

d. Hook worm
4. Flotation technique is useful for the detection of (RGUHS Feb 2024)

a. Larva od Strongyloides

b. Fertilized eggs of Ascaris

c. Taenia eggs

d. Operculated eggs of trematodes

5. Most common presenting symptom of thread worm infection amongst
the following is -

a. Abdominal pain

b. Rectal prolapse

c. Urticaria

d. Vaginitis
6. Which helminth infection can be diagnosed using cello tape?

a. Pin worm

b. Hook worm

c. Whip worm

d. Round worm
7. Humans get roundworm infection by –

a. Penetration of skin by rhabditiform larva

b. Penetration of skin by filariform larva

c. Ingestion of egg containing rhabditiform larva

d. Ingestion of egg containing filariform larva

8. Loeffler’s syndrome is characterized by -

a. Irritating, non-productive cough

b. Burning substernal discomfort that is aggravated by coughing or

deep inspiration

c. Mild fever

d. All of the above

1. Define and list the types of Autoinfection.

2. List the parasites that cause Autoinfection.

3. Loeffler’s syndrome

4. Describe the life cycle of Ascaris lumbricoides. (RGUHS Feb 2024)

5. Describe the morphology of the egg of trichuris. (RGUHS Feb 2024)

6. NIH swab (RGUHS Feb 2024)

7. Name three soil-transmitted helminths (RGUHS Feb 2024)

8. Draw and label the egg of Ascaris lumbricoides (RGUHS Feb 2023)
 APPLIED
EXERCISE
MI 3.1.9
A 7-year-old girl presented with h/o abdominal pain, severe itching during the night around
the perianal region, and bed wetting. Inflammation and excoriation of skin in the
perianal region were observed.

Investigations:

Haemoglobin -10%, Total WBC count – 12,000 cells/dl with Differential count of
Neutrophils-60%, Eosinophils-14% Basophils-1%, lymphocytes-25%, Platelets-120000/dl.

The stool examination for ova and cyst was negative.

A wet mount of NIH swab early morning sample of the perianal region showed a non-bile-
stained Plano concave ova with the larva inside.
• Comment on:

1. What is your diagnosis?

2. What are the methods of sample collection?

3. What are the complications?

4. Name the parasites that cause autoinfection.

5. How do you treat this condition?

6. How do you prevent the transmission of infection?

1. What is your diagnosis?

• The probable diagnosis is Enterobius vermicularis infestation

(Enterobiasis).
 2. What are the methods of sample collection?
• Microscopy of perianal skin samples is the test of choice
which detects characteristic eggs.
• Two methods to collect specimens-
1. Cellophane tape method: eggs are detected by the
application of clear cellulose acetate tape to the perianal
region in the morning before the child goes for a bath. The
tape is then applied on a clear glass slide and observed
under the microscope for pinworm eggs.
2. NIH swab: the cellophane part of the glass rod is rolled
over the perineal & perianal skin to collect the sample. It
is then transferred onto a slide for microscopic detection
of pinworm eggs.
3. What are the complications?

• Excoriation of perineal & perianal skin with bacterial superinfection

• Abdominal pain with weight loss

• Malabsorption

• Vulvovaginitis in females

• Pelvic, peritoneal, urinary tract granulomas

4. Name the parasites that cause autoinfection.

• Enterobius vermicularis

• Strongyloides stercoralis

• Taenia solium

• Hymenolepis nana

• Cryptosporidium spp
5. How do you treat this condition?

One of the following drugs can be given:

• Mebendazole (100 mg once) or

• Albendazole (400 mg once) or

• Pyrantel pamoate (11 mg/kg once; maximum, 1 g)

• The same treatment should be repeated after 2 weeks

• Treatment of household members is advocated to eliminate asymptomatic reservoirs

of potential reinfection
6. How do you prevent the transmission of infection?

Improving personal hygiene –

• proper washing of bedclothes,

• keeping nails short and clean,

• frequent hand washing

These are the key measures to contain the transmission.