Professional Documents
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Intestinal and Tissue Nematodes
Intestinal and Tissue Nematodes
Intestinal Nematodes
A – Ascaris lumbricoides
C – Capillaria philippinensis
H – Hookworms
E – Enterobius vermicularis
S – Strongyloides stercoralis
T – Trichuris trichiura
Ascaris lumbricoides
Common names: Giant round worms, Pink worm, Giant intestinal roundworm, and
roundworm
Most common (MC) Soil-Transmitted Helminth (STH) as well as the MC intestinal
nematode infection.
PARASITE BIOLOGY
● Cream colored roundworm that’s parasitic in the human intestines.
● Have a terminal mouth with three lips and sensory papillae
● Adults reside but do not attach to the mucosa wall of the small intestines.
● Shown to produce:
o pepsin inhibitor 3 (PI-3) protects worms from digestion
o phosphorylcholine suppresses lymphocyte proliferation
MORPHOLOGY (ADULT)
Male Female
● 10-31 cm in length ● 22-35 cm in length
● Ventrally curved posterior end ● Paired reproductive organs in the
with two spicules posterior two-thirds
● Produces 200,000 eggs per day,
decrease when worm load increases.
MORPHOLOGY (OVA)
Unfertilized Egg Fertilized egg Embryonated Egg
● 88-94 by 39-44 µm ● 45-70 by 35-50 µm ● Infective stage
● Longer and ● Thick, transparent, ● When ingested, larvae
narrower than hyaline shell hatches in the small
fertilized eggs. ● Thick outer layer as intestine’s lumen to
● Thin shell and a supporting release the larvae.
irregular structure ● It’s very distinct due to its
mammilated ● Delicate vitelline, very circular shape and
coating filled with lipoidal, inner having a thick shell.
refractile granules. membrane (highly
impermeable)
● Larvae develops in
14 days in the
protoplasm.
EPIDEMIOLOGY
MODES OF TRANSMISSION
● Fecal-oral route, MC mode of transmission
• Inhalation of contaminated dust
• Transplacenta may occur
Individual
● Practice proper hand washing with antiseptic soap
● Wash fruits and vegetables before consumption
Capillaria Philippinensis
Common name: Pudoc Worm
One of the four species of capillaries known to infect humans. It is a zoonotic disease,
characterized by abdominal pain, chronic diarrhea, and gurgling stomach. May also be
associated with protein-losing enteropathy, electrolyte imbalance, and intestinal
absorption.
(The illness typically results in severe enteropathy, diarrhea, and malabsorption
syndrome when nutrient absorption in the small intestine is limited (intestinal disease).
Reason behind the common name of C. philippinensis? The name “Pudoc worm” was
based on the name of the place where the illness and related worm were initially found,
which was Pudoc West, Tagudin, Ilocos Sur.
PARASITE BIOLOGY
● Both have an esophagus with secretory cells called STICHOCYTES
● The esophageal structure is called STICHOSOME
● Characteristic, thin and filamentous anterior end and a slightly thicker and
shorter posterior end.
(Anterior)
• Esophagus
• Esophageal glands
(Posterior)
• Intestine
• Reproductive system w/ slightly
prominent vulva
MORPHOLOGY (OVA)
● 36-45 µm by 20 µm
● eggs are peanut-shaped or barrel-shaped; Oval in shape
● Thick and striated shells
● flattened ends, and flattened to slightly prominent bipolar
Morphology mucoid plugs.
(Ova)
LIFE CYCLE
PATHOGENESIS & CLINICAL MANIFESTATIONS
Patients initially experience intermittent diarrhea (progresses to 8-10 volumes/day).
After a few weeks, noticeable weight loss, anorexia, vomiting, edema, and malaise.
Laboratory findings will show severe protein-losing enteropathy and hypoalbuminemia;
malabsorption of fats and sugars; low serum potassium, sodium, and calcium.
(malabsorption syndrome when nutrient absorption in the small intestine is limited)
The large number of worms is responsible for the severe pathology
If the disease is not treated soon after symptoms occurs, severe manifestations of the
disease will develop with a potentially fatal outcome.
DIAGNOSIS
● Finding eggs in the excreted feces
● Laboratory methods:
a) DFS
b) Stool concentration methods
c) Enzyme-linked immunosorbent assay (ELISA)
TREATMENT
For severe cases, patient is treated with electrolyte replacement and a high protein diet.
While also be given anthelminthic drugs.
Drug of choice Adult dose Pediatric dose
EPIDEMIOLOGY
• Sporadic cases have been reported from other East and Southeast Asian
countries.
Individual
• Do not eat raw or undercooked fish
• Practice proper hand washing
Ref:
https://www.dovemed.com/article-synonyms/capillaria-philippinensis-infection/
https://www.chegg.com/flashcards/parasitology-nematodes-b2a799ba-d500-4450-
a93c-8125adb75e59/deck
https://www.cdc.gov/dpdx/ascariasis/index.html
Nematode Infections: Intestinal Nematodes
HOOKWORMS: Necator americanus and Ancylostoma duodenale
GENERAL CHARACTERISITCS:
• soil-transmitted helminths (STH)
• blood-sucking nematodes attach to the mucosa of the small intestine
• commonly found in tropical & subtropical
• where they occur as single and mixed infections
• all hookworms have the meromyrarian type of somatic cell w/ 2 to 5 cells
arranged per dorsal or ventral half.
MORPHOLOGY:
Necator americanus Ancylostoma duodanale
Adults are: Adults are:
• small cylindrical • slightly larger than N.
• Fusiform Americanus
• grayish-white nematodes
Head: curved opposite to the curvature Head: same direction as the curvature of
of the body the body.
• like a hook at the anterior
end.
Buccal capsule: ventral pair of semilunar Buccal capsule: has 2 pairs of curved ventral
cutting plates teeth.
SHAPE SHAPE
Posterior end: Mature cells Adults has single pair Adults has single
broad, membranous produces = 5000 of reproductive organ pair of reproductive
caudal burse with to 10,000 eggs organ
rib-like rays – used
for copulation
BUCCAL SPEARS:
FILARIFORM
RHABIDITFORM LARVAE
N. americanus and A. duodenale
● are distinguishable
● they resemble those Strongyloides stercoralis there are larger, more attenuated
posteriorly and have longer buccal cavity
● Genital primordium: smaller in hookworms compared to S. stercoralis
A, Hookworm rhabditiform
larva
C.Hookworm rhabditiform,
B, Hookworm rhabditiform larva. larval form buccal capsule
Note: long buccal capsule and lack of prominent
genital primordium.
EGGS
MOLECULAR:
1. PCR-based
a. Detection of hookworm DNA in feces
2. Enzyme-linked immunosorbent assay (ELISA)
a. Detection of secretory/excretory coproantigens
EPIDEMIOLOGY
INFECTED PERSONS
In the world:
A. duodanale or N. Americanus
In the Philippines;
LOCAL STUDIES
Out of 1,958 Samples positive for hookworms in cultures
97% N. Americanus
1% A. duodenae
2% Mixed infections
LOCAL DISTRIBUTIONS
(agricultural areas)- Famers (affected)
50% - more than (late 1990’s) Compestela Valley province
HIGH-RISK GROUPS
(prevalence of hookworm infection- high)
5.5% and 2.8% Pregnant women and adolescent females
GENERAL CHARACTERISITCS:
MORPHOLOGY
Adult Worms:
● cuticular alar expansions at the anterior end
● a prominent posterior esophageal bulb
● Found: in the cecum and adjacent portions of the small & large intestines
Male Female
-2 to 5 mm by 0.2 mm -8 to 13 mm by 0.4 mm
-curved tail and single spicule - long pointed tail
- rarely seen because they die after -Uteri of gravid females: distended with
copulation. eggs
- Single female produces = more than
10,000 eggs
SHAPE SHAPE
RHABIDITIFORM LARVA:
• 140 μm to 150 μm by 10 μm
• Charateristics: esophageal bulb no cuticular expansion on the anterior end
EGGS:
• D-shaped eggs
• From 50 to 60 μm by 20 to 30μm
• Size averaging: 55 by 36 μm
Translucent shells
• outer: triple albuminous covering for
mechanical
• Inner: embryonic lipoidal membrane for
chemical protection
LIFE CYCLE:
Gravid adult female E.
Vermicularis deposit eggs on perianal
folds
Infection occurs via self
innocilation
Following ingestion of infective eggs, the
larvae hatch in the small intestines
Adults establish themselces: in colon
(cecum)
The time interval from ingestion of
infective eggs to oviposition by the adult
females is about one month.
Full maturity adult Adult life
span is 2 months
Female: 8 to
33mm
Male: 2 to 5
mm
Gravid females migrate
nocturnally outside the anus and
oviposit while crawling on the skin of
the perianal area.
Larvae contained inside the eggs develop
(the egg become infective) – 4 to 6 hours
under optimal conditions
Enterobius vermic: innocuous parasire & rarely produces any serious lessons
Mild catarrhal inflammation of the Result: from the attachment of the worms
intestinal:
Other signs of infection:poor appetite, weight loss, irritability, grinding of teeth, and
abdominal pain.
Aberrant adult worm migration Complications: appendicitis, vaginitis,
endometritis, salpingitis, and peritonitis.
DIAGNOSIS: Enterobiasis should be suspected in: children and adults who shows
perianial itching
EPIDEMIOLOGY:
Enterobiasis
● Occurs in both temperature and tropical regions of the world
● High prevalence in both developed and developing countries
o Only intestinal nematode infection that cannot be controlled through
sanitary disposal of human feces.
● Eggs: usually contaminated underwear and beddings.
● Route of Infection: Mouth, Respiratory System, Anus
● Risk Factors for infection: Overcrowding, Thumb-sucking, nail biting, & lack of
parental knowledge on pinworms
INFECTED PERSONS
208.8 million In the world
18 million Canada and the United States
of America
12 to 41% Washington, D.C
In the world:
INFECTED PERSONS
Prevalence level
29% Schoolchildren
● Exclusive Private schools
Local:
16% Female
9% Male
In the Philippines:
TREATMENT AND PREVENTION & CONTROL
PARASITE BIOLOGY
A. Morphology
a) Eggs
- Less resistant to desiccation than A. lumbricoides
Basis Eggs
Size 50 – 54 um by 23 um
Shape Lemon/football-shaped;
barrel-shaped, thick-shelled and possess
a pair of polar “plugs” at each end.
Shell Yellowish outer;
transparent inner shell
b) Larva
- the larvae escape and penetrate the intestinal vili where they remain for 3 to
10 days
c) Adult
DIAGNOSIS
TREATMENT
Medications Dosage Contraindications Adverse Effects
Mebendazole 100 mg Hypersensitivity Mild and transient
2x/day for 3 Early pregnancy may present as
days headache, nausea,
vomiting,
Single Dose: gastrointestinal
discomfort,
500 mg used itchiness
for mass
treatment
Albendazole 400 mg once Hypersensitivity Mild and transient
for 3 days Early pregnancy may present as
headache, nausea,
vomiting,
gastrointestinal
discomfort,
itchiness
Benzimidazole
Ivermectin
Combination of
albendazole exhibit
better cure rate &
err
→ Deworming (children)
● shown to contribute to improved motor and language development, reduced
malnutrition
● nutritional status and intellectual development have shown to improve after
deworming
EPIDEMIOLOGY
→ Trichuriasis
● occurs temperate and tropical climate; widely distributed in warm, moist areas
of the world
● 604 – 795 million are infected globally
● Most prevalent in East Asia, Pacific Island Regions
→ Age Groups
● Children 5 – 15 years of age are most frequently infected, have highest
intensities of infection
→ In Philippines
● Prevalence ranged from 4.5 – 55.1% in preschool children
● 8.1 – 57.9% in school-age children
→ Distribution is similar to A. lumbricoides
→ Prevalence of coinfections with 2 helminths is 19.1%
PARASITE BIOLOGY
❖ Morphology
▪ Strongyloides stercolaris exist in both parasitic and free living form.
▪ In the parasite phase, the females are readily discovered but not the males.
a) Eggs
b) Larva
Larva Basis Rhabditiform larva Infective Filariform larva
Size 225 um by 16 um 550 um
Color
Appearance Smaller than Smaller than female;
parasitic female:
No caudal alae
Tail Ventrally curved
Buccal Cavity
Esophagus Muscular double-
bulbed esophagus
Intestine Straight cylindrical
tube
Reproductive Organs 2 copulatory spicules:
Gubernaculum:
A. Parasitic
Female
B. Free-Living
Male
C. Free-Living
Female
B. Life Cycle
a) Free-Living Cycle
1. Female worm lays embryonated eggs;
2. developed into rhabditiform larvae;
3. transforms into free-living adults ;
4. reproduced;
5. rhabditiform larvae hatch;
6. conditions became unfavorable develops into filariform larvae.
b) Parasitic Cycle
1. Filariform larvae penetrate human skin;
2. enter circulation;
3. pass thru lungs;
4. migrated to larynx;
5. swallowed;
6. larval maturation in duodenum;
7. reproduction by parthenogenesis;
8. deposits eggs in intestinal mucosa;
9. rhabditiform larvae maturation;
10. fecal excretion.
→ Autoinfection
● Occurs when rhabditiform larvae pass down the large intestine and
develop into filariform larvae
A. First Phase
Larval invasion of skin produces erythema and pruritic elevated hemorrhagic
papules
B. Larval Migration Phase
Lungs are destroyed causing lobar pneumonia with hemorrhage, cough,
tracheal irritation, mimicking bronchitis
C. Third Phase
Intestinal mucosa migration from pylorus, rectum, greatest numbers found in
duodenal regions, upper jejunal regions
A. Complications
→ Light Infection
● Asymptomatic
→ Moderate Infection
● Causes diarrhea alternating with constipation
→ Heavy Infection > Cochin China diarrhea
● Intractable, painless, intermittent diarrhea , episodes of watery and
bloody stools
→ Hyperinfection
● Syndrome of accelerated autoinfection, manifests with exacerbation of
gastrointestinal and pulmonary symptoms and increased numbers of
larvae in stool/sputum
● Immunocompromised
→ Other complications:
a) Edema
b) Emaciation
c) Loss of appetite
d) Anemia
e) Lobar pneumonia
f) Ileus
g) Intestinal obstruction
h) Gastrointestinal bleeding
i) Malabsorption leading to cachexia
DIAGNOSIS
Laboratory Techniques Description
Baermann funnel gauze method Operates on the principle that the
nematode larvae wiggle out of the
biological material, cannot swim
against gravity and will fall through
the water to the area of clamped off
tubing.
Harada-Mori culture Positive stool is applied to filter
paper and placed into a test tube w/
about 7ml of boiled/distilled water
Beale’s string test or Doudenal aspiration “Entero Test” or String Test, where
capsulated yarn is swallowed by the
patient to reach the duodenum
Small bowel biopsy Diagnostic procedure in which a
portion of the small bowel lining is
removed for examination
Serologic testing A laboratory test that checks for the
presence of antibodies or other
substances in a blood sample.
Nutrient Agar Plates Nutrient medium used for the
cultivation of microbes supporting
growth of a wide range of non-
fastidious organisms.
TREATMENT
→ In Philippines
● Strongyloides is relatively rare
● Prevalence fluctuates between 0 – 2.3%
● Infection is more frequent in 7 – 14 years old male children
→ Risk Factors
● Poor sanitation
● Indiscriminate disposal of human feces
LYMPHEDEMA
LYMPHANGITIS
chronic case;
3. ELEPHANTIASIS
Scientific classification:
● KINGDOM- Animalia
● SUBKINGDOM- Metazoan
● PHYLUM- Nematoda
● FAMILY- Filaridae
● GENUS- Wuchereria
● SPECIES- W. bancrofti
Types of Hosts:
Definitive host:
5. Humans are the definitive host for the worms that cause lymphatic filariasis
Intermediate hosts:
LYMPHATIC FILARIASIS
D. Adult worms in the lymph nodes cause inflammation that eventually obstructs the
lymphatic vessels, causing edema. Massive edema of the legs is called elephantiasis.
i. Later, fever, lymphangitis, and cellulitis develop. Gradually, the obstruction leads to
edema and fibrosis of the legs and genitalia, especially the scrotum
ii. Elephantiasis occurs mainly in patients who have been repeatedly infected over a long
period
iv. These symptoms are caused by microfilariae in the lung that elicit an immediate
hypersensitivity reaction characterized by a high immunoglobulin E (IgE)
concentration and eosinophilia
Diagnosis:
• Due to nocturnal periodicity of most W.Bancroti stains, wet smears or thick blood
smears are taken between 8 p.m – 4 a.m
a. Thick blood smear: 2-3 drops of free flowing blood by finger prick method, stained
with JSB-II
b. Membrane filtration method: 1-2 ml intravenous blood filtered through 3µm pore
size membrane filter
c. DEC provocative test (2mg/Kg): After consuming DEC, mf enters into the
peripheral blood
Treatment:
→ The World Health Organization (WHO) in the 50th World Health Assembly has
targeted LF for elimination by the year 2020. The Global Programme to Eliminate
Lymphatic Filariasis has two major goals:
- and to provide care for those who suffer from the clinical manifestations of
LF through hygiene education programs.
D. The goal for endemic communities is to eliminate the presence of microfilariae in the
blood in order to prevent transmission of the disease by vectors.
E. According to the WHO, single doses of DEC in combination with another drug such
as albendazole or ivermectin is 99% effective in removing microfilariae from the
blood for up to one year from treatment.
Epidemiology:
Affects more than 100 million people in the tropical Affects 12.5 million people in SOUTHEAST ASIA
areas of INDIA, SOUTHEAST ASIA, PACIFIC
ISLANDS, AFRICA, and SOUTH and CENTRAL
AMERICA
Philippines:
REGION IV
REGION VIII
REGION IX
REGION X
REGION XI
REGION XII
CARAGA
Parastrongylus contonensis
Pathogenesis and Clinical manifestation:
● Paresthesia
● Vomiting,
● Fever, nausea
● Fatigue.
● Confusion,
● Incoherence,
● Disorientation,
● Memory lapses
Diagnosis:
• CSF eosinophilia of greater than 10% in proportion to WBC will exclude other
common causes of meningitis.
• The CSF protein level in most patients is mildly elevated, while the CSF glucose is
normal. However, other infections (e.g., cysticercosis, trichinosis, visceral larva
migrans, schistosomiasis, paragonimiasis, and gnathostomiasis) involving the
central nervous system must first be ruled out.
Treatment:
• Anthelminthic therapy has been shown to relieve symptoms and reduce the duration
of the disease.
• Ocular parastrongyliasis may require surgical removal of worms from the eyes.
Symptomatic treatment with the use of analgesics and lumbar puncture can relieve
the headaches experienced by the patient with eosinophilic meningitis.
● The public should be discouraged from eating raw or poorly cooked mollusks or
unwashed vegetables.
● Copper barriers against snails and slugs are also utilized by farmers to prevent
contamination of vegetable and fruit crops.
Epidemiology:
● Human infection with P. cantonensis was first reported in 1945 by Nomura and Lin in
Taiwan.
● Further studies showed that its prevalence in rats is less than 7%. The presence of P.
cantonensis as a parasite of rats and/or snails has been reported in the following
provinces of Luzon: Batangas, Bulacan, Cavite, Ilocos Norte, Laguna, Mountain
Province, Nueva Ecija, Pampanga, Pangasinan, Quezon, Rizal, Sorsogon, Tarlac, and
Metro Manila.
● Two cases of ocular parastrongyliasis have been reported from the East Avenue
Medical Center.
● The patients were blood relatives coming from Isabela who have eating history of
improperly cooked snails.
● The worms were identified at the College of Public Health, University of the
Philippines Manila.
Trichinella Spiralis
Trichinella spiralis is a nematode parasite, occurring in rats, pigs, bears and humans,
and is responsible for the disease trichinosis. It is sometimes referred to as the "pork
worm" due to it being found commonly in undercooked pork products.
Brief History
- First described by Tiedemenn in 1822
- First observed in 1835 in the muscles of a patient at autopsy by James Paget
who was a first year medical students at St Bartholomew’s Hospital London.
- Owen in 1835 describe the encysted larva form in the muscle and named it
Trichina spiralis.
- Leuckart, Virchow and Zenker independently proved the infectivity of the
encysted larvae when fed to experimental animals.
- They traced the life cycle of the worms from the encysted larvae in muscles,
to adult in the duodenum and then again encystement in muscles.
- Trichinella derived from minute size of adult (Gr.trichos-hair ella spiralis refers
to spirally coiled appearance of larva in muscles.
- They traced the life cycle of the worms from the encysted larvae in muscles,
to adult in the duodenum and then again encystement in muscles.
- Trichinella derived from minute size of adult (Gr.trichos-hair ella spiralis refers
to spirally coiled appearance of larva in muscles.’
- Host: humans, rats, pigs, bears, foxes, walrus or any other carnivore or
omnivore serves as both the final and intermediate host.
Scientific Classification:
● Kingdom: Animalia
● Phylum: Nematoda
● Class: Adenophorea
● Order: Trichurida
● Family: Trichinellidae
● Genus: Trichinella
● Species: spiralis
● There are eight know species and genotypes under the genus: Trichinella.
o Trichinella spiralis
o Trichinella britovi
o Trichinella native
o Trichinella murrelli
o Trichinella nelson
o Trichinella papuae
o Trichinella pseudospiralis
Morphology:
● The adult male has a body size ranges from 0.62 to 1.58mm, has one testis
located on the posterior end of its body and adult females are 1.26 to 3.35mm
by 0.029- 0.038mm one ovary located on the posterior end.
Life Cycle:
After humans ingest the cysts from infected undercooked meat, pepsin and
hydrochloric acid help free the larvae in the cysts in the stomach.
B. Thirty to 34 hours after the cysts were originally ingested, the adults mate,
and within five days produce larvae.
C. The larvae then use their piercing mouthpart, called the "stylet", to pass
through the intestinal mucosa and enter the lymphatic vessels, and then enter
the bloodstream.
D. Then burrow into the sub-epithelium of the vili.
E. The infective stage is the encysted larva found in the muscle of pigs and other
animals.
F. The larvae then migrate to the small intestine, where they molt four times
before becoming adults.
G. The larvae travel by capillaries to various organs, such as the retina,
myocardium, or lymph nodes; however, only larvae that migrate to skeletal
muscle cells survive and encyst.
The larval host cell becomes a nurse cell in which the larvae will be encapsulated.
The development of a capillary network around the nurse cell completes encystation
of the larvae
o Diarrhea
o Constipation
o Vomiting
o Abdominal cramps
o Malaise
o Nausea
● Stage of intestinal: the larvae encyst, invade the intestinal epithelium in the
duodenum and jejunum and develop into adult.
Immonological
Pathological
Metabolic
Symptoms
• A large burden of adult worms in the intestines promote symptoms such as
nausea, heartburn, dyspepsia, and diarrhea from two to seven days after
infection.
• As the larvae migrate through tissue and vessels, the body's inflammatory
response results in edema, muscle pain, fever, and weakness.
• A classic sign of trichinosis is periorbital edema, swelling around the eyes,
which may be caused by vasculitis.
• Splinter hemorrhage in the nails is also a common symptom.
• Most dangerous case is worms entering the central nervous system. Cannot
survive there, but they may cause enough damage to produce serious
neurological deficits (such as ataxia or respiratory paralysis), and even death.
• Trichinosis can be fatal depending on the severity of the infection; death can
occur 4– 6 weeks after the infection, and is usually caused by myocarditis,
encephalitis, or pneumonia.
Diagnosis
● Digestion of muscle samples with pepsin and hydrochloric acid can also be
done to determine the number of larvae per gram of muscle, or to isolate
larvae for molecular characterization.
● The digestion technique, however, is limited to muscle larvae that are about
10 to 12 days old (about 2-3 weeks post infection) since younger larvae may
be destroyed by the digestion fluid.
● Latex agglutination technique may be utilized for rapid (<1 hour) confirmation
of trichinellosis.
Treatment:
• The treatment of choice for trichinellosis is mebendazole 5 mg/kg body
weight daily, or albendazole 15 mg/kg body weight per day in two divided
doses, for 10 to 15 days.
• For children 2 years and older, albendazole should be given at 10 mg/kg body
weight.
Epidemiology:
Anisakis spp.
D. Anisakids are nematode parasites of whales, dolphins, porpoises, walruses,
seals, sea lions, and other deep marine mammals.
E. Like any nematode, anisakids have elongated vermiform bodies without
segmentation.
F. They have a complete digestive tract, and the sexes are separate. Although
they are parasites of marine mammals, they can cause gastrointestinal
infections and allergic reactions in humans with the consumption of raw and
undercooked squid and fish containing the 3rd stage larvae of the parasite.
G. Commonly involved infective species are Anisakis simplex and
Pseudoterranova decipiens.
Parasite Biology:
C. The 1st stage larvae that develop inside the eggs molt into the 2nd stage
larvae that hatch out of the egg.
D. The free swimming 2nd stage larvae are ingested by micro-crustaceans,
where the 3rd stage larvae develop.
E. Going up the predatory food chain, the third stage larvae are transported to
various paratenic hosts, like squid and several species of fish.
F. 3rd stage larvae are more concentrated in fish viscera but may occasionally
be found in the fish muscles.
G. Anisakis simplex are milky white in color, measuring 19 to 36 mm in length,
with a long stomach, and a blunt tail with mucron, and are referred to as Type
I larvae.
H. Following ingestion by marine mammals, the 3rd stage larvae molt twice and
develop into adult worms.
Life Cycle:
● Humans may ingest the 3rd stage larvae from raw or improperly cooked
infected fish.
● The 3rd stage larvae, however, do not develop into the adults in the human gut.
● Most infections are self-limiting as larvae are unable to survive for long
periods in the human host, but the associated tissue damage can cause
longer lasting symptoms.
● Antigens that remain in the fish muscle after the larvae are killed (e.g. after
freezing) can cause allergic reactions in some individuals.
Diagnosis:
• Anisakidosis should be highly suspected if there is a recent history of eating
raw or improperly cooked fish or squid prior to the acute onset of symptoms.
• Through gastroscopic/endoscopic examination, the larvae can be visualized
and removed for identification.
• Intestinal anisakidosis is more difficult to establish, and may be diagnosed
only after surgery.
• Serological procedures to detect specific antibodies have been employed with
good results, such as enzyme-linked immunosorbent assay (ELISA), and
radioallergosorbent test (RAST).
Treatment:
The treatment for anisakiasis may require removal of the worm from the body by
endoscopic removal. By using endoscopic forceps.
A. Corticosteroids
b. Albendezole
● Human infection with Toxocara spp. was first described by Wilder in 1950.
Scientific Classification
❖ Kingdom: Animalia
❖ Phylum: Nematoda
❖ Class: Chromadoria
❖ Order: Ascaridida
❖ Family: Toxocaridae
❖ Genus: Toxocara
Morphology
T.canis
Males: 10cm
Female: 18cm
and easily visible to the naked eye. Males and females have two long
andnarrow lateral cervical alae and three “lips” at the anterior end.
T.cati
Males: 6cm
Female: 10cm
Toxocara
canis larva
hatching.
Toxocara spp.
develop to third
stage (L3)
larvae in ovo.
When hatched,
L3 larvae are
about 350—400
µm long and
about 15—20 µm in maximum width, with a straight esophagus extending about a third of the
body length.
Adult Toxocara spp.measure approximately 4—6 cm long (males) and 6—10 cm long (females).
Like all ascarids, Toxocara have three “lips” on the anterior end of the worm. They also possess
large, spear-shaped cervical alae, which are broader in T. cati than T. canis.
-Toxocara sp. in tissue sections stained with hematoxylin and eosin.
In tissue, Toxocara spp. larvae are 15—20 µm wide in lateral sections and are often found
surrounded by a granulomatous reaction. Two large excretory columns are present and single-
pointed lateral alae are conspicuous along most of the body length.
HOSTS
LIFE CYCLE
• Eggs embryonate over a period of 1 to 4 weeks in the environment and become infective,
containing third-stage (L3) larvae
• Ingestion by dog
• Younger dogs larvae migrate through lungs, bronchial tree, esophagus, and move back
into the small intestine about 60 to 90 days after hatching
Older Dogs
Accidental Host
• Larvae dont undergo further development but can cause reactions in tissue (toxocariasis)
Transmission
▪ Ingestion of infective larval eggs
● Toxocara canis infections are more common than toxocara Cati infections because of
the defecation habit of dogs
SYMPTOMS
In Puppies
Noisey breathing
Vomiting
Diarrhea
Pot belly
● Abdominal pain
● Decreased appetite
● Fever
● Hives
● Restlessness
• Covert Toxocariasis
Is the result of migration and subsequent death of the larvae in the different
tissues and organs producing an intense inflammatory response manifested as
eosinophilic granulomas.
Caused from larvae wondering throughout various organs of the body ( Brain,
Lungs, Liver ( most common),Heart, Muscle)
Migration of the larvae causes inflammation of internal organs and something the
CNS
● Patients can present with a variety of signs and symptoms: Wheezing is a common
sign of VLM
→ Weight loss
→ Fatigue
→ Asthma
→ Vomiting
→ Headache
→ Irritability
→ Rash
→ Fever
• Least severe
b) Wheezing
c) Fever
d) Abdominal pain
e) Headache
f) Behavioral changes
✔ Other symptoms: red eye, white pupil, strabismus, fix pupil an retinal detachment
✔ Ocular granulomas conform around the larva and are commonly misdiagnosed
retinoblastoma
✔ Toxocara damage in the eye is permanent and can cause blindness if not threaten
- Neurological Toxocariasis
- larva migrate to the: brain, meninges and may be found in the cerebrospinal fluid
( CSF)
Diagnosis
- Fecalysis
- Biopsy
- Blood test
- CT ( computed tomography)
Treatment
- Antiparasitic drugs:
Loose ends
● However the genome for both varieties of toxocara have been sequence
Epidemiology
Human toxocariasis is primarily a Soil transmitted zoonosis with the infection more
commonly found in Children than adults.
- Cases are more frequently seen in Children living in homes and neighborhoods where dogs
and puppies are not dewormed and poor personal hygiene.
Number of surveys around the world demonstrated high rates of contamination of soil with
the parasite eggs in parks ,play grounds and other public places ( 10-30 %).
- In Western countries, the prevalence of infection in dogs was reported to be about 25% but
may be as high as 30 to 60 %.
- Studies have also demonstrated contamination of soil samples taken from gardens of
homes where clinical case of toxocariasis has been found.
• Make sure to treat your dogs, more important regularly for worms
• Teach your kids not to look with their eyes not their mouths
• Contamination of soil
• Dogs and cats source of infection, treatment program starting at 2 to 3 weeks of age should
implemented