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2H. Parasitology > NEMATODES > Flashcards

NEMATODES Flashcards

1
Q

General characteristics: • Roundworms, elongated, cylindrical in shape with bilateral symmetry and unsegmented

Have complete digestive system, no circulatory system

  • Sensory organs known as chemoreceptors (phasmids)
  • Provided with separate sexes although some are parthogenetic or parthogenic (S. stercoralis)
  • Female maybe oviparous or viviparous
A

CLASS
NEMATODA

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2
Q

Developmental stages (5) of Nematode

A

o Egg

o Larva (1-­‐3)

o Adult

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3
Q

Intestinal Nematodes: • Classification according to source of infection: SOIL TRANSMITTED HELMINTHES (STH)

A

o Ascaris lumbricoides

o Trichuris trichuria

o Hookworms

o Strongyloides stercoralis

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4
Q

CAUSATIVE AGENT: _____________________-

  • Largest and most common nematode (roundworm) parasitizing the human intestine
  • Common name: giant intestinal roundworm
  • Habitat: small intestine •

Diagnostic stage: ova, adult

• MOT: ingestion

A

Ascaris lumbricoides

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5
Q

Infective stage of ASCARIASIS?

A

Infective stage: fully embryonated egg

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6
Q

Adult

o Freely moving; restless

o Female: 20 to 35 cm;

paired reproductive organ in posterior 2/3

o Male: 15 to 30 cm;

ventrally curved posterior end with two spicules o White, cream or pinkish yellow when fresh

o Head is provided with 3 lips and a triangular buccal cavity (trilobite)

A

ADULT ASCARIS

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7
Q
A

Adult

A. lumbricoides:
tri-­‐radiate
lips

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8
Q
A

Cross-­‐section of adult male and female: male-­‐ gut, seminal vesicle, testes, vas deferens; female-­‐gut, ovaries, uteri

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9
Q

Ascaris Eggs:

o Passed in the feces of infected persons

o Either fertile or infertile

o Viability on soils: ____________

A

2 years

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10
Q
A

A. Embryonated egg: INFECTIVE STAGE; contains larva inside

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11
Q
A

B. Fertilized decorticated egg: DIAGNOSTIC STAGE; has a single mass of germ cells but no outer albuminous mammillated layer

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12
Q
A

Fertilized corticated egg: DIAGNOSTIC STAGE;

3 layers:

o outer albuminous mammillated coat

o middle glycogen membrane

o inner lipoidal vitelline layer

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13
Q
A

Unfertilized egg: DIAGNOSTIC STAGE;

  • elongated in shape,
  • contains refractile lecithin granules,
  • lacks lipoidal membrane and
  • has glycogen layer
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14
Q

An ascaris female may produce approximately ________________which are passed with the feces 2 Unfertilized eggs may be ingested but are not infective.

A

200,000 eggs per day,

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15
Q

Fertile ascaris eggs embryonate and become infective after_____________, depending on the environmental conditions (optimum: moist, warm, shaded soil).

A

18 days to several weeks 3

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16
Q

Between___________ are required from ingestion of the infective eggs of ascaris to oviposition by the adult female.

A

2 and 3 months

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17
Q

May cause stunted growth

  • Usually no acute symptoms
  • High worm burdens may cause abdominal pain and intestinal obstruction
  • Migrating adult worms may cause symptomatic occlusion of the biliary tract or oral expulsion •
A

ASCARIS

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18
Q

During the lung phase of larval migration, pulmonary symptoms can occur (cough, dyspnea, hemoptysis, eosinophilic pneumonitis -­‐ ____________) • Pneumonia, cough, fever, eosinophilia during larval migration

  • Vomiting and abdominal pain (most frequent complaint)
  • Biting & pricking of intestinal mucosa may irritate nerve endings and result in intestinal spasm leading to intestinal obstruction and possibly, perforation
  • Adult worms usually cause no acute symptoms (10-­‐20 worms) -­‐Unnoticed unless stool examinatio
A

Loeffler’s syndrome

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19
Q

If symptoms occur: -­‐

They can be light only -­‐______________

Moderate infection: -­‐________________

Heavy infections: -­‐ Intestinal blockage -­‐Impair growth and cognition in children Other symptoms: -­‐ Cough

A

Abdominal discomfort

Lactose intolerance

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20
Q

Migrating adult worms may cause:

o BilliaryAscariasis §

 thru Ampulla Vater §

(+) severe colicky abdominal pain o Acute appendicitis

o Pancreatitis o Peritonitis

o Pulmonary symptoms -­‐ Loeffler’s syndrome

A

ASCARIs

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21
Q

What are the symptoms during larval migration

A

Pneumonia, cough, fever, eosinophilia during larval migration

  • Vomiting and abdominal pain (most frequent complaint)
  • Biting & pricking of intestinal mucosa may irritate nerve endings and result in intestinal spasm leading to intestinal obstruction and possibly, perforation
  • Adult worms usually cause no acute symptoms (10-­‐20 worms) -­‐Unnoticed unless stool examination
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22
Q

Vomiting and abdominal pain (most frequent complaint) in ascariasis

  • Biting & pricking of intestinal mucosa may irritate nerve endings and result in intestinal spasm leading to intestinal obstruction and possibly, perforation
  • Adult worms usually cause no acute symptoms (10-­‐20 worms) -­‐Unnoticed unless stool examination
A

Vomiting and abdominal pain

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23
Q

If symptoms occur: -­‐ They can be light only -­‐ ______________

A

Abdominal discomfort

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24
Q

The moderate infection in ascariasis is determined by ___________

A

Moderate
infection:
-­‐Lactose
intolerance

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25
Q

In asacaris Heavy infections: -­‐ Intestinal blockage -­‐_____________________

A

Impair growth and cognition in children

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26
Q

Migrating adult worms may cause: _________________

A

o BilliaryAscariasis § thru Ampulla Vater § (+) severe colicky abdominal pain

o Acute appendicitis

o Pancreatitis

o Peritonitis

o Pulmonary symptoms -­‐ Loeffler’s syndrome • Serious and fatal effects due to erratic migration of adult worms

o May be regurgitated and vomited, escape through nostrils, inhaled into trachea (rare)

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27
Q

ASCARIS

o less sensitive o 2mg of feces in a drop of NSS on a glass slide with cover slip on top; LPO under microscope

A

DFS

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28
Q

ASCARIS

____________ smear method

o 20-­‐60mg of feces

o Purely qualitative

o Mass examination of feces for diagnosis of Ascaris infection

A

Kato technique or cellophane thick

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29
Q

_____________

o Modified Kato technique

o Amount of feces to be examined is measured

o Used to quantify number of eggs, therefore a quantitative technique

o Used to determine egg reduction rate (ERR) § Egg count/ gram of feces §

To determine intensity of infection

A

Kato-­‐katz technique

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30
Q

_____________- are useful for individual and mass screening in schools and community; low cost; easy to maintain.

A

Kato technique & Kato Katz

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31
Q

ASCARIS

TREATMENT __________o DRUG OF CHOICE

o 400mg single dose (200mg for children <2yo)

• Mebendazole

o 500mg single dose

• Pyrantelpamoate

o 10mg/kg single oral dose

• Ivermectin

Has recently been shown to be as effective as albendazole if given at dose of 200ug/kg single dose *known to be teratogenic, not be given to pregnant women

A

• Albendazole

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32
Q

Geographic Distribution

o Areas with warm, moist climates and are widely overlapping

o Most common in tropical and subtropical areas where sanitation and hygiene are poor

  • Mostly young children (Phil – 80-­‐90% risk of public elementary school children)
  • Associated with poor personal hygiene, poor sanitation, and in places where human feces are used as fertilizer
  • Endemic in Southeast Asia, Aftrica, Cetral and South America
A

Ascaris

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33
Q

HOW TO DO PREVENTION & CONTROL IN ASCARIS

A
  • Avoid ingesting soil that may be contaminated with human feces
  • Wash hands with soap and warm water before handling food
  • Teach children the importance of washing hands
  • Wash, peel, or cook all raw vegetables and fruits before eating, particularly those that have been grown in soil that has been fertilized with manure • Mass chemotherapy done periodically, 1-­‐3x a year.
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34
Q

Common name: “human whipworm”

A

Trichuris trichuria

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35
Q

What is the shape of Trichuris eggs?

A

barrel shape

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36
Q

Where is the natural habitat of Trichuris trichuria?

A

• Natural habitat: cecum

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37
Q

Does Trichuris trichuria have a pulmonary phase? T or F

A

• No pulmonary phase

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38
Q

What causes anemia in Trichuris trichuria?

A

• Blood-­‐sucker-­‐ may cause anemia

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39
Q

What type of stool do patients with Trichuris have ?

A
  • Watery diarrhea
  • Dysentery – bloody stool
40
Q

What happens when there is hyperinfection in Trichuris patients?

A

• Hyperinfection: rectal prolapse

41
Q

What is the diagnostic stage of Trichuris?

A

• Diagnostic stage: unembryonated egg

42
Q

What is the infective stage of Trichuris?

A

• Infective stage: fully embryonated egg •

43
Q

What is the MOT of Trichuris?

A

MOT: ingestion

44
Q

What is the ___________-­‐ arrangement of somatic cell in cross section where the cells are small, numerous, and closely packed in a narrow zone

A

• Holomyarian

45
Q
A

A. Adult male T. trichuria

46
Q
A

B. Adult male T. trichuria

47
Q
A

T. trichuria egg:

50-­‐55 x 20-­‐25mm;

48
Q

football-­‐shaped,

thick-­‐shelled and

with a pair of polar “plugs” at each end (bipolar plugs), (lemon-­‐shaped with plug like translucent polar prominence)

A

Trichuris eggs

49
Q

Coiled end with a single spicule and retractile sheath

A

Male adult worm of Trichuris

50
Q

Bluntly
rounded
posterior
end

A

adult Trichuri female egg

Note: bigger than male

51
Q

What is the life cycle of T. trichuria

A

The unembryonated eggs are passed with the stool

  1. In the soil, the eggs develop into a 2-­‐cell stage

2, an advanced cleavage stage

3, and then they embryonate

4; eggs become infective in 15 to 30 days.

After ingestion (soil-­‐contaminated hands or food), the eggs hatch in the small intestine, and release larvae

5 that mature and establish themselves as adults in the colon . The adult worms (approximately 4 cm in length) live in the cecum and ascending colon

  1. The adult worms are fixed in that location, with the anterior portions threaded into the mucosa.

The females begin to oviposit 60 to 70 days after infection. Female worms in the cecum shed between 3,000 and 20,000 eggs per day.

The life span of the adults is about 1 year.

52
Q

What is the life span of Adult T.trichuris?

A

The life span of the adults is about 1 year.

53
Q

PATHOGENESIS AND CLINICAL MANIFESTATIONS of T. Trichuris

A
  • Most frequently asymptomatic
  • Heavy infections (especially in small children) can cause gastrointestinal problems:

o Abdominal
pain
o Diarrhea
(watery)
o RECTAL
PROLAPSE
o Possibly
growth
retardation

54
Q

• Anterior portion of the worms can cause____________

A

petechial hemorrhages which may predispose to amebic dysentery *Enterorrhagia-­‐ bleeding of the intestines*

55
Q

The lumen of the appendix may be filled with worms, and consequently irritation and inflammation may lead to appendicitis or granulomas

  • The mucosa is hyperemic and edematous
  • Symptomatic-­‐ infections with _______________
A

over 5 000 T. trichuria eggs per gram of feces

56
Q

What is the diagnostic modality of T.trichuris

A

DIAGNOSIS]

Microscopy

• Because eggs may be difficult to find in light infections, a concentration procedure is recommended • Because the severity of symptoms depend on the worm burden, quantification (e.g. with the Kato-­‐Katz technique) can prove useful

57
Q

TREATMENT______ what is the Drug of choice of Trichuris infection?

o Contraindications: hypersensitivity and early pregnancy

A

• Mebendazole

Note

• Albendazole

o Alternative drug

58
Q

EPIDEMIOLOGY

  • The third most common round worm of humans
  • More frequent in areas with tropical weather and poor sanitation practices, and among children 5 to 15 years old
  • It is estimated that 800 million people are infected worldwide
  • This also occurs in the southern United States
A

Trichuris Trichuria

Note: Third for Trichuris

T for T

59
Q

What are the factors in Trichuris transmission?

A

. • Factors affecting transmission are:

o Indiscriminate defecation of children around yards

o Frequent contact between fingers and soil among children at play

o Poor health education

o Poor hygiene

60
Q

What are the two hookworms that infect the humans?

A

CAUSATIVE
AGENTS:
Ancylostoma
duodenale
and
Necator
americanus

61
Q

Do hookworms have pulmonary phase?

A

With
pulmonary
phase

62
Q

These worms are also **soil-transmitted helmiths. **They are blood-­‐sucker (macrocytic hypochromic anemia) attach to the mucosa of the small intestine

A

hookworms

63
Q

What is the most common hookworm in the philippines?

A

• Most common hookworm in the Philippines: Necator americanus

64
Q

Which hookworm causes deeper injury?

A

• Deeper injury: Ancylostoma (3-­‐4 times blood loss) • Ancylostoma braziliense (cats)

• Ancylostoma caninum (dogs)

65
Q

Where is the habitat of hookworms?

A

• Habitat: lumen of small intestine

66
Q

What is the diagnostic stage of hookworms: egg • Infective stage: filariform larva • MOT: skin penetration

A

egg

67
Q

What is the infective stage of hookworms?

A

• Infective stage: filariform larva

68
Q

What is the MOT of hookworms?

A

• MOT: skin penetration

69
Q

o Small, cylindrical, fusidorm, grayish white

o Female: 9-­‐11mm x 0.35mm;

Male 5-­‐9mm x 0.30mm and posterior end has broad, membranous caudal bursa with rib-­‐like rays used for copulation

o Head is curved opposite to the curvature of the body o Buccal capsule – ventral pair of semilunar cutting plates

o More serious concern than A. Duodenale

A

Necator americanus

70
Q

o Slightly larger than N. Americanus

o Single paired male and female repro organ

o Head continues in the same direction as the curvature of the body

o Buccal capsule – 2 pairs of curved ventral teeth

A

Ancylostoma duodenale

71
Q
A

A. Necator americanus buccal cavity: semilunar cutting plates

Nmemonics: Necator to semiluNar

72
Q
A

B. Ancylostoma duodenale buccal cavity: 2 pairs of ventral teeth

73
Q
A

C. Ancylostoma caninum buccal cavity: 3 pairs of ventral teeth

Caninum : letter C is the 3rd alphabet : 3 pairs

74
Q
A

D. Ancylostoma baziliensis buccal cavity: 2 pairs of ventral teeth (median teeth smaller)

nmemonic : B : 2nd letter in alphabet: Bentral!!

75
Q
A

Hookworm egg: blunty rounded ends,

single thin transparent hyaline shell with blastomeres;

NOTE :DIAGNOSTIC STAGE *N. Americanus and A. duodenale are indistinguishable in this stage*

76
Q
A

Hookworm rhabditiform larva (L2):

short and stout,

open-­‐mouthed, feeding stage

*Should be differentiated from Strongyloides L1 IF found in stool via Harada Mori*

77
Q
A

C. Hookworm filariform larva (L3): pointed tail, closed mouth, sheathed, non-­‐feeding stage;

INFECTIVE STAGE *Can differentiate N. Americanus and A. duodenale*

78
Q

What is the life cycle of hookworms?

A

1 Eggs are passed in the stool , and under favorable conditions (moisture, warmth, shade), larvae hatch in 1 to 2 days. The released rhabditiform larvae grow in the feces and/or the soil.

2 After 5 to 10 days (and two molts) they become filariform (third-­‐stage) larvae that are infective 3. These infective larvae can survive 3 to 4 weeks in favorable environmental conditions. On contact with the human host, the larvae penetrate the skin and are carried through the blood vessels to the heart and then to the lungs.

They penetrate into the pulmonary alveoli, ascend the bronchial tree to the pharynx, and are swallowed

  1. The larvae reach the small intestine, where they reside and mature into adults. Adult worms live in the lumen of the small intestine, where they attach to the intestinal wall with resultant blood loss by the host
  2. Most adult worms are eliminated in 1 to 2 years, but the longevity may reach several years.

Some A. duodenale larvae, following penetration of the host skin, can become dormant (in the intestine or muscle). In addition, infection by A. duodenale may probably also occur by the oral and transmammary route. N. americanus, however, requires a transpulmonary migration phase.

79
Q

The Life Cycle of A. braziliense and A. caninum:

A

CUTANEOUS LARVAL MIGRANS Cutaneous larval migrans (also known as creeping eruption) is a zoonotic infection with hookworm species that do not use humans as a definitive host, the most common being A. braziliense and A. caninum.

80
Q

The normal definitive hosts for these Cutaneous
larval
migrans species are __________.

A

dogs and cats

81
Q

The life cycle of cutaneous larval migrans?

A

The cycle in the definitive host is very similar to the cycle for the human species.

Eggs are passed in the stool

  1. Under favorable conditions (moisture, warmth, shade), larvae hatch in 1 to 2 days.

The released rhabditiform larvae grow in the feces and/or the soil

  1. After 5 to 10 days (and two molts) they become filariform (third-­‐stage) larvae that are infective
  2. These infective larvae can survive 3 to 4 weeks in favorable environmental conditions. On contact with the animal host
  3. The larvae penetrate the skin and are carried through the blood vessels to the heart and then to the lungs.

They penetrate into the pulmonary alveoli, ascend the bronchial tree to the pharynx, and are swallowed.

The larvae reach the small intestine, where they reside and mature into adults. Adult worms live in the lumen of the small intestine, where they attach to the intestinal wall.

Some larvae become arrested in the tissues, and serve as source of infection for pups via transmammary (and possibly transplacental) routes 5. Humans may also become infected when filariform larvae penetrate the skin

  1. With most species, the larvae cannot mature further in the human host, and migrate aimlessly within the epidermis, sometimes as much as several centimeters a day. Some larvae may persist in deeper tissue after finishing their skin migration.
82
Q

What is the pathogenesis of HOOKWORM?

A

PATHOGENESIS AND CLINICAL MANIFESTATION

  • Iron deficiency anemia (caused by blood loss at the site of intestinal attachment of the adult worms) is the most common symptom
  • Can be accompanied by cardiac complications
  • Gastrointestinal and nutritional/metabolic • symptoms can also occur
  • Local skin manifestations (‘ground itch’) can occur during penetration by the filariform (L3) larvae
  • Respiratory symptoms during pulmonary migration of the larvae
  • Cutaneous larva migrans

o Also known as ground itch

o A migrating larva causes an intensely pruritic serpiginous track in the upper dermis

o Most common manifestation of zoootic infection with animal hookworm

  • Less commonly, larvae may migrate to the bowel lumen and cause an eosinophilic enteritis
  • In some cases of diffuse unilateral subacute retinitis, single larvae compatible in size to A. caninum have been visualized in the affected
83
Q

What is the common symptom in hookworm infection?

A

Iron deficiency anemia (caused by blood loss at the site of intestinal attachment of the adult worms) is the most common symptom

84
Q

Local skin manifestations (‘ground itch’) can occur during penetration by the filariform (L3) larvae

A

HOOKWORMS

85
Q

Skin

o Maculopapular lesions and localized erythema due to penetration of filariform larvae

o Ground itch or dew itch especially on dewy morning

• Lungs

o Bronchitis and pneumonitis during larval migration

• Small intestine (maturation site of worm)

o Abdominal pain o Steatorrhea o Diarrhea with blood and much

o Progressive, secondary, microcytic, hypochromic anemia of the IDA type (due to continuous blood loss) o Hypoalbuminemia § due to combined loss of blood, lymph, and protein

A

HOOKWORM

86
Q

__________

  • Other symptoms: exertional dyspnea, weakness, dizziness, lassitude
  • Signs: rapid pulse, edema, albuminuria
  • Usually chronic moderate or heavy infection; often no acute symptoms
  • In general, prognosis of hookworm is good
A

Cutaneous larval migrans

87
Q

HOOKWORM

o ________________-­‐ether concentration

o Increase positive findings

o Recommended for determining whether stool is egg positive/negative

A

Concentration methods

88
Q

Culture

o ______________-

o Allow hatching of larva from eggs on strips of filter paper, one end immersed in water

o Identification of filariform larvae

A

Harada-­‐Mori

89
Q

TREATMENT HOOKWORM

• ______________-

o DRUG OF CHOICE

o Larvicidal and ovicidal

o 400mg single dose for adults and >2y/o

o Not recommended for pregnant women

•

A

Albendazole

Mebendazole

o 500mg single dose o Not recommended for <2y/o *both blocks the uptake of glucose by most intestinal and tissue nematodes

  • Pyrantel Pamoate
  • Iron supplementation – correction of anemia
  • ** In countries where hookworm is common and reinfection is likely, light infections are often not treated**
90
Q

EPIDEMIOLOGY

  • ___________is the second most common human helminthic infection (after ascariasis)
  • are worldwide in distribution, mostly in areas with moist, warm climate
  • Both N. americanus and A. duodenale are found in Africa, Asia and the Americas
  • Necator americanus predominates in the Americas and Australia
  • Only A. duodenale is found in the Middle East, North Africa and southern Europe

*A. duodenale – prevalent Europe and Southeast Asia *N. Americanus– prevalent Tropical Africa and America

• Greater in agricultural areas (farmers)

A

Hookworm

91
Q

• Factors contribute to transmission:

A

o Eggs and larvae – damp, sandy or friable soil with decaying vegetation; 24-­‐32oC

o Fecal population of the soil o Contact between infected soil and skin/mouth

92
Q

Diagnosis of Intestinal Helminth Infections:
_________________
o worst diagnostic tool for helminthes

o amount: 1-­‐2mg of stool

o lack of sensitivity for detection of common worm eggs

o most useful in detection of intestinal protozoan trophozoites

A

• Stool examination/Fecalysis

93
Q

o microscopic examination of a fixed

quantity of fecal material (40-­‐50mg)

o enables semi-­‐quantitative diagnosis

o based on the number of eggs in feces

o greater egg count=greater number of female worms

o most useful tool for surveillance of schistosome

A

Kato Katz Technique

94
Q

________________

o examines 1g of feces

o best stool examination for screening foodhandlers

o most useful for detection of protozoan cysts

A

Formalin Ether Concentration Technique

95
Q

What is the treatment hookworms?

A

Treatment:

  • Albendazole (400mg; 200 mg if <2 years old)
  • Mebendazole
  • Results:

o Improved iron stores and hemoglobin levels o Improved growth

o Improved food intak

e o Improved cognitive performance

o Reduced incidence of complications

96
Q
A

2H. Parasitology (3 decks)

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