Parasitic Helminths - Hunter Flashcards
What type of parasitic nematode causes Enterobiasis?
Enterobius vermicularis.
Describe the epidemiology of Enterobiasis.
- greater than 500 million human cases world wide.
2. most common helminth in the US.
What is the geographic distribution of Enterobiasis?
Worldwide - most common nematode infection in temperate zone.
Describe the pathology of Enterobiasis.
- presence alone of adult pinworm in colon causes no symptoms.
- heavy infections cause pruritus ani - scratching can lead to cellulitis.
- occasional aberrant infection of vagina - probability of reinfection is extremely high
- autoinfection - can result form egg hatching and larval migration back into colon.
What type of immunity is associated with Enterobiasis?
- IgE
2. mast cells involved in worm expulsion
How is Enterobiasis diagnosed?
- collect worm from perianal region - adhesive tape works
2. identification of characteristic pinworm eggs or adults.
How is Enterobiasis treated and prevented?
- Pyrantel pamoate - retreat after two weeks to kill new worms
- prevention - drug treatment, difficult to eliminate through hygiene alone
- no vaccine
Describe the life cycle of Enterobius vermicularis.
- humans ingest embryonated eggs that hatch in the small intestine.
- larvae migrate to colon and mature into adults - male and female
- after copulation, male worms die and female worms migrate to perianal region where they lay up to 10,000 fertilized eggs.
- after laying eggs the female dies.
- eggs embryonate on perianum and are spread or can hatch and auto-infect.
- eggs very resistant to desiccation.
What is the infective form of Enterobius vermicularis?
embryonated eggs
What is another name for Enterobius vermicualris?
Pinworm disease.
What nematode parasite causes Trichuriasis?
Trichuris trichiura.
Describe the epidemiology of Trichuriasis.
Greater than one billion cases world wide.
What is the distribution of Trichuriasis?
Worldwide.
Describe the pathology of Trichuriasis.
- light infections - asymptomatic
- heavy infections - usually in children, may present as acute dysentery of chronic colitis that resembles inflammatory bowel disease or Crohn’s disease.
- children can develop chronic malnutrition and anemia - causing short stature.
- In some cases, extensive swelling of rectal mucosa causes tenesmus, protracted tenesmus can cause rectal prolapse.
What type of immunity is associated with Trichuriasis?
- IgA
2. mast cells and IgE
How is Trichuriasis diagnosed?
- identification of characteristic bipolar eggs in stool sample
- eosinophilia - all roundworm diseases present with this
How is Trichuriasis treated and prevented?
- Mebendazole or Albendazole
- surgical intervention in cases of rectal prolapse
- prevention - sanitary disposal of feces
- no vaccine
Describe the life cycle of Trichuris trichuria.
- humans ingest embryonated eggs that hatch in small intestine
- larvae migrate to colon and form adult female and male worms.
- worms copulate in colon
- adults embed in columnar epithelium where females lay about 3-5,000 eggs per day.
- unembryonated eggs pass in feces.
What is the infective form of Trichuris trichuria?
embryonated eggs
What is another name for Trichuriasis?
Whipworm disease.
What nematode parasite causes Ascariasis?
Ascaris lumbricoides.
Describe the epidemiology of Ascariasis.
Greater than one billion cases worldwide.
What is the distribution of Ascariasis?
World wide.
What type of immunity is associated with Ascariasis?
- allergic responses are common
2. humoral immunity may play a role
Describe the disease and pathology of Ascariasis.
- larval migration phase may cause intense pneumonitis, hepatomegaly and generalized toxicity
- intestinal phase often asymptomatic, large numbers of long worms may cause obstruction, children may develop malabsorption.
- Hepatobiliary and pancreatic ascariasis result from migration of adult worms into common bile or pancreatic ducts, adult worms can be found in vomitus and stool.
How is Ascariasis diagnosed?
- identification of characteristic egg in stool sample
- radiography for extraintestinal infection
- lab results - eosinophilia and hyperimmunoglobulinemia G
How is Ascariasis treated and prevented?
- Albendazole
- surgery
- prevention - sanitary disposal of feces
- no vaccine
Describe the life cycle of Ascaris lumbricoides.
- human ingests embryonated egg
- egg travels to and hatches in small intestine
- 2nd stage larvae penetrate mucosa and migrate to liver
- larvae migrate to lungs and molt twice then 4th stage larvae break out into alveoalr spaces.
- larvae migrate up bronchial tree to trachea and are swallowed
- larvae return to small intestine, become adults and mate.
- females lay eggs and greater than 200,000 unembryonated eggs are passed in feces - approx. 25,000 tons of ascaris eggs are passed each year
What is the infective form of Ascaris lumbricoides?
embryonated eggs
Name some aberrant infections caused by dog and cat ascarids.
Visceral larva migrans -(worm dies in skin because human not natural host but sometimes can get to eye) caused by Toxocara canis and T. felis. There are greater than 10,000 cases per year with 40% prevalence in regions of Southern US.
What parasites cause Hook worm disease?
- Ancylostoma duodenale
2. Necator americanus
Which of the 2 parasites that causes Hookworm disease is more virulent?
Ancylostoma duodenale is more virulent because it is a better blood sucker.
Describe the epidemiology of Hookworm disease.
Greater than one billion human cases worldwide.
Describe the distribution of Hookworm disease.
- A. duodenale is found in Mediterranean region, N. Asia and parts of S. America
- N. americanus is found in Western hemisphere, Africa, S. Asia and the Pacific region
What disease and pathology is caused by Hookworm disease?
- skin penetration by filariform larvae may cause pruritic, papular, vesicular dermatitis.
- lung migration of larvae can cause pneumonitis.
- intestinal phase often asymptomatic
- heavy infections can cause epigastric pain, nausea, vomiting
- adult worms attach to mucosa of small intestine and cause severe mucosal damage with significant blood loss - about 7 million liters of blood lost per day.
- causes eosinophilia and anemia
- causes iron deficiency anemia - leading to congestive heart failure and death
- can cause edema and ascites via protein malnutrition - common in childen
How is Hookworm disease diagnosed?
- eggs in stool, must find adults or larvae to speciate hookworms
How is Hookworm disease treated and prevented?
- Albendazole
- oral iron sulfate supplementation for anemia
- prevention - sanitary disposal of human feces
Describe the life cycle of Hookworm disease parasites.
- humans are infected by stage 3 filariform larvae that penetrate skin
- larvae migrate to lung, enter trachea and are swallowed
- larvae mature into adults and copulate in the small intestine and unembryonated eggs (A. duodenal produces many more eggs than N. americanus) are passed in the feces
- in the soil, Rhabditiform larvae become infectious filariform larvae
What is he infective form of A. duodenale and N. americanus?
3rd stage filariform larvae.
What is cutaneous larva migrans?
Aberrant infection caused by dog hookworm - Ancylostoma caninum and others.
What nematode parasite causes Strongyloidiasis?
Strongyloides stercoralis.
Describe the epidemiology of Strongyloidiasis.
Greater than 200 million human cases worldwide.
Describe the distribution of Strongyloidiasis.
- tropical, subtropical
- temperate - S.Eastern US
- prevalent in Australia
- many animal reservoirs
What is the lifecycle of Strongyloides stercoralis?
- Stage 3 filariform larvae penetrate human skin, enter blood stream and migrate to lungs.
- larvae enter alveolar space, migrate up respiratory tree and are swallowed
- larvae mature in small intestine to egg-laying adult parthenogenetic females that reside in columnar epithelium.
- eggs hatch in small intestine, molt twice and 2nd stage Rhabditiform larvae are passed in feces and mature in soil to stage 3 filariform larvae.
- can have a free living cycle
What is the infective form of Strongyloides stercoralis?
3rd stage filariform larvae
What is the disease and pathology of Strongyloidiasis?
- larval migration may cause serpiginous, creeping urticarial eruptions in skin
- larval migration through lungs may cause pnemonitis
- intestinal disease characterized by water, mucous laden diarrhea
- autoinfection or hyperinfection - infective filariform larvae develop in colon, often seen in immuocompromised and can lead to disseminatd disease such as secondary bacterial infection and death
What type of immunity is associated with Strongyloidiasis?
T cell function critical but exact mechanism unknown.
How is Strongyloidiasis diagnosed?
- stool examination for 2nd stage rhabditiform larvae
2. eosinophilia
How is Strongyloidiasis treated and prevented?
- Ivermectin or Albendozole
- especially important to treat immunocompromised pt’s
- prevention - sanitary disposal of human/animal feces
- no vaccine
What nematode parasite causes Trichinellosis?
Trichinella spiralis.
Describe the epidemiology of Trichinellosis.
1.5 million harbor parasite in US.
What is the distribution of Trichinellosis?
Worldwide - infects any mammal.
What is the lifecycle of Trichinella spirals?
- human consumes poorly cooked meat bearing encysted larvae
- the larvae are liberated by digestive enzymes and then penetrate columnar epithelieal cells
- They molt four times and become adults within columnar epithelium of small intestine
- after copulation, the females deposit living larvae that spread via blood or lymph and must penetrate striated muscle to survive.
- infected muscle cells become ‘nurse cells’
What is the disease and pathology of Trichinellosis?
- humans acquire by eating improperly cooked pork - humans are dead end host since nurse cells calcify.
- intestinal stages - severe gastroenteritis with vomiting, diarrhea and abdominal pain
- larvae penetrate andkill many cell types before dying and may cause myocarditis and encephalitis.
- larvae in striated muscle cells survive but cause myositis with fever, myalgia and periborbital edema
- in extremely heavy infection muscles can become dysfunctional leading to paralysis - if of the diaphragm then can be fatal
- lab findings include - eosinophilia, and elevated muscle enzymes - CPK, LDH
What type of immunity is associated with Trichinellosis?
ADCC against free larvae, mast cell mediated expulsion of adult worms.
How is Trichinellosis diagnosed?
- enzyme immunoassay to determine anti-Trichinella antibodies
- definitive diagnosis via muscle biopsy and histopath
How is Trichinellosis treated and prevented?
- Prednisone for muscle inflammation
- Abendazole to kill adult worms
- prevention - cook or freeze pork, prevent pigs from eating meat scraps
- no vaccine
What is the infective form of Trichinella spirals?
Encysted larvae.