طفيليات 6
طفيليات 6
طفيليات 6
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.
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.
General Characteristics:
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
Habitat
Morphology
Male Worm: The male worm is 2–5 mm long and 0.1–0.2 mm thick.
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.
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
* 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.
➢ 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:
* 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.
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.
* 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.