طفيليات 6

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1 Medical Parasitology /lecture 6+7/ 2nd class Asisst.L.

Marwa Mohammed

Nematodes:
General Features

Nematodes are said to be the most worm-like of all helminths. This is because
they generally resemble the common earth worm in appearance, which is
considered to be the prototype of worms . However, taxonomically earthworms are
not nematodes as they are segmented worms of the Phylum Annelida.

Nematodes are elongated, cylindrical, unsegmented worms with tapering ends.


The name nematode ‘means thread-like‘, from nema ‘meaning thread‘.

Unlike trematodes and cestodes, all of which are parasitic, most nematodes are
free-living forms found in soil and water.

Several species are parasites of plants and are of great economic importance.
Many nematodes parasitize invertebrate and vertebrate animals.

The largest number of helminthic parasites of humans belong to the class of


nematodes. There are an estimated500,000 species of nematodes.

General Characteristics:

They are cylindrical, or filariform in shape, bilaterally symmetrical with a


secondary triradiate symmetry at the anterior end.

➢ The adults vary greatly in size, from about a millimeter (Strongyloides


stercoralis) to a meter (Dracunculis medinensis) in length. Male is
generally smaller than female and its posterior end is curved or coiled
ventrally.
➢ Their body is covered with a tough outer cuticle, which may be smooth,
striated, bossed, or spiny. The middle layer is hypodermis and the inner
layer is the somatic muscular layer. They move by sinuous flexion of the
body.
➢ The body cavity is a pseudocele, in which all the viscera are suspended.
➢ The digestive system is complete, consisting of an anteriorly placed mouth
leading to the esophagus, which characteristically varies in shape and
2 Medical Parasitology /lecture 6+7/ 2nd class Asisst.L. Marwa Mohammed

structure in different groups. The intestine is lined with a single layer of


columnar cells and leads to the rectum, opening through the anus. In the
male, the rectum and the ejaculatory duct open into the cloaca.
➢ Nematodes have simple excretory and nervous systems.
➢ The nematodes are diecious i.e. the sexes are separate.
➢ The male reproductive system consists of a single delicate tubule
differentiated into testis, vas deferens, seminal vesicle, and ejaculatory duct,
which opens into the cloaca. It also includes copulatory structures such as
spicules or bursa or both.
➢ The female reproductive system consists of the ovary, oviduct, seminal
receptacle, uterus, and vagina.
➢ Female nematodes may produce eggs (oviparous) or larvae (viviparous).
Some lay eggs containing larvae, which immediately hatch out
(ovoviviparous).

Modes of Infection:

➢ By ingestion of:
• Eggs: Ascaris, Enterobius. Trichuris
• Larvae within intermediate host: Dracunculus
• Encysted larvae in muscle: Trichinella
➢ By penetration of skin: Ancylostoma, Necator, Strongyloides
➢ By blood-sucking insects: Filariae
➢ By inhalation of dust containing eggs: Ascaris, Enterobius.
3 Medical Parasitology /lecture 6+7/ 2nd class Asisst.L. Marwa Mohammed

Enterobius Vermicularis

Common name: Pinworm, Seatworm, Threadworm

* E. vermicularis is considered to be world’s most common parasite, which


specially affects the children.

Habitat

Adult worms are found in the caecum, appendix,


and adjacent portion of ascending colon.

Morphology

Adult Worm: The adults are short, white,


fusiform worms with pointed ends, looking like
bits of white thread.

* The mouth is surrounded by 3 wing-like


cuticular expansions (cervical alae), which are
transversely striated.

* The esophagus has a double-bulb structure, a


feature unique to this worm.
4 Medical Parasitology /lecture 6+7/ 2nd class Asisst.L. Marwa Mohammed

Female Worm: The female is 8–13 mm long and 0.3–0.5 mm thick.

* The worm is oviparous.

* Females survive for 5–12 weeks.

Male Worm: The male worm is 2–5 mm long and 0.1–0.2 mm thick.

*Males live for about 7–8 weeks.

Egg: The egg is colorless and not bile-stained.

* It floats in saturated salt solution.

* It has a characteristic shape, being elongated


ovoid, attended on one side, and convex on the
other.(plano-convex egg).

Life Cycle:

E. vermicularis is monoxenous, passing its entire life cycle in the human host. It
has no intermediate host and does not undergo any systemic migration.

Natural host: Man

Infective form: Embryonated eggs.

Mode of infection: Man acquires infection by ingesting embryonated eggs


containing larva by means of:

1- Contaminated fingers

2-Autoinfection

* Eggs laid on perianal skin containing infective larvae are swallowed and hatch
out in the intestine.

*They molt in the ileum and enter the caecum, where they mature into adults.

* It takes from 2 weeks to 2 months from the time the eggs are ingested, to the
development of the gravid female, ready to lay eggs.
5 Medical Parasitology /lecture 6+7/ 2nd class Asisst.L. Marwa Mohammed

* The gravid female migrates down the colon to the rectum. At night, when the
host is in bed, the worm comes out through the anus and crawls about on the
perianal and perineal skin to lay its sticky eggs. The worm may retreat into the anal
canal and come out again to lay more eggs.

*The female worm may wander into the vulva, vagina and even into the uterus and
fallopian tubes, sometimes reaching the peritoneum.

* The male is seldom seen as it does not migrate. It usually dies after mating and
is passed in the feces.
6 Medical Parasitology /lecture 6+7/ 2nd class Asisst.L. Marwa Mohammed

*Autoinfection: Ingestion of eggs due to scratching of perianal area with fingers


leading to deposition of eggs under the nails. This type of infection is mostly
common in children. This mode of infection occurs from anus to mouth.

* Retro infection: In this process, the eggs laid on the perianal skin immediately
hatch into the infective stage larva and migrate through the anus to develop into
worms in the colon. This mode of infection occurs from anus to colon.

Pathogenicity and Clinical Features:

Enterobiasis occurs mostly in children. It is more common in females than in


males. About one-third of infections are asymptomatic.

➢ The worm produces intense irritation and pruritus of the perianal and
perineal area (pruritis ani), when it crawls out of the anus to lay eggs. This
leads to scratching and excoriation of the skin around the anus.
• As the worm migrates out at night, it disturbs sleep. Nocturnal enuresis is
sometimes seen.
• The worm crawling into the vulva and vagina causes irritation and a mucoid
discharge. It may migrate upto the uterus, fallopian tubes and into the
peritoneum. This may cause symptoms of chronic salpingitis, cervicitis,
peritiontis, and recurrent urinary tract infections.
• The worm is sometimes found in surgically removed appendix and has been
claimed to be responsible for appendicitis.
7 Medical Parasitology /lecture 6+7/ 2nd class Asisst.L. Marwa Mohammed

Laboratory Diagnosis:

Pinworm infestation can be suspected from the history of perianal pruritus.


Diagnosis depends on the demonstration of the eggs or adult worms.
Demonstration of Eggs

* Eggs are present in the feces only in a small proportion patients and so feces
examination is not useful in diagnosis.

* They are deposited in large numbers on the perianal and perineal skin at night
and can be demonstrated in swabs collected from the site’s early morning, before
going to the toilet or bathing. Swabs from perianal folds are most often positive.

* The eggs may sometimes be demonstrated in the dirt collected from beneath the
finger nails in infected children.

NIH Swab Method

The NIH swab (named after National Institutes of Health, USA) has been
widely used for collection of specimens. This
consists of a glass rod at one end of which a
piece of transparent cellophane is attached with
a rubber band. The glass rod is fixed on a rubber
stopper and kept in a wide test tube.

The cellophane part is used for swabbing by


rolling over the perianal area (Fig. 19.4). It is
returned to the test tube and sent to the
laboratory, where the cellophane piece is
detached, spread over a glass side and examined
microscopically.
8 Medical Parasitology /lecture 6+7/ 2nd class Asisst.L. Marwa Mohammed

Scotch Tape Method:

Another method for collection of specimens is with scotch tape (adhesive


transparent cellophane tape) held sticky side out, on a wooden tongue depressor.
The mounted tape is firmly pressed against the anal margin, covering all sides. The
tape is transferred to a glass slide, sticky side down, with a drop of toluene for
clearing and examined under the microscope.

Demonstration of Adult Worm

The adult worms may sometimes be noticed on the surface of stools.

* They may occasionally be found crawling out of the anus while the children are
asleep.

*They may be detected in stools collected after an enema and may be in the
appendix during appendicetomy.

Treatment:

Pyrantel pamoate (11 mg/kg once, maximum 1 g), Albendazole (400 mg once)
or mebendazole (100 mg once) can be used for single dose therapy, while
piperazine has to be given daily for one week.

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