HELMINTH

Ascaris
lumbricoides

TRANSMISSION
1) Ingests
eggs

MORPHOLOGY

1)

Adult attains a
length of 20-30 cm.

1)
2)
3)
4)

Necator
americanus
(Hookworm)

1)

Larvae
penetrate
through
skin

1)

Adult about 1 cm
long.

1)
2)
3)
4)

Strongyloides
stercoralis

1)
2)

Larvae
penetrate
thru skin
Autoinfecti
on

1)

Adult females 2
mm long.

CLINICAL FINDINGS
Asymptomatic in many
individuals.
Abdominal cramping.
Dry cough & fever while larvae
are in the lungs.
Children may develop
malnutrition as worms compete
for food.

Diarrhea, abdominal pain, &

weight loss.
Iron deficiency anemia
Itching @ site of skin
penetration + rash
Occasional cough with bloody
sputum.

1)

V/D, anemia & weight loss.

2)

Occasional fatal case caused

by massive autoinfection (in IC
host).

1)
2)
3)

1)

2)
3)
1)
2)

4)
5)

1)

Ingestion of
encysted
larvae, often
found in raw
pork.

1)

Cysts in skeletal
muscle.

1)
2)
3)

Fever, abdominal pain &

diarrhea
Muscle aches, as larvae migrate
to skeletal muscle.
Severe cases: larvae migrate to
& brain.

1)

2)
3)
4)
1)
2)
3)

Trichuris
trichiura
(Whipworm)

1)

Ingest eggs

1)

Eggs look like a

football with polar
bumps on each
end. Adults
whipshaped (3-5
cm long).

1)
2)

Diarrhea
Abdominal pain

1)
2)
3)

TREATMENT
Mebendazole:
paralyzes worm &
prevents it from
migrating out of the
small intestine to other
organs.
Albendazole (single
dose)
Ivermectin
Nitazoxanide
Pyrantel pamoate
(safe in pregnancy)
Mebendazole
Pyrantel pamoate
Albendazole

1)
2)
3)

Ivermectin
Albendazole
Thiabendazole

1)
2)
3)
4)

Albendazole
Mebendazole
Thiabendazole
Cook or freeze pork
prior to consumption

1)
2)

Mebendazole
Albendazole

1)

2)
3)
4)
5)

3)

Trichinella
spiralis

DIAGNOSIS
Fecal exam for
eggs
Sputum exam
may reveal
larvae
Eosinophilia

Fecal exam for

eggs (examine
quickly, as eggs
hatch rapidly).
Sputum exam
may reveal
larvae
Eosinophilia
Fecal exam for
larvae (no
eggs!).
Enterotest:
swallow long nylon
string later pull out
may show larvae.
Sputum exam
may reveal larvae.
Eosinophilia
Ab & ag serum
assay
Look for
microfilariae in
blood drawn @
nighttime
Biopsy
Serology
Tropical
pulmonary
eosinophilia:
Hypereosinophilia
ed levels of IgE
Granulomas within
lymph nodes,
spleen & lung

IMAGES

Enterobius
vermicularis

1)

Ingest eggs

1)

Adult worms 1 cm
long.

HELMINTH
TRANSMISSION
MORPHOLOGY
BLOOD AND TISSUE NEMATODES (ROUNDWORMS)
Onchocera
1) Vector =
1) Filariae:
volvulus
black fly,
1) Threadlike adult
which breeds
roundworms.
in rivers &
2)
Give birth to live
streams.
offspring called
Since cases
microfilariae,
cluster
which are
nearby, the
transmitted via
disease is
black fly.
called river
blindness.
2) Found in
Africa and
Central & S.
America.
3) Reservoir =
humans
Wucheria
1) Filariae:
1)
Vector =
bancrofti
1) Threadlike adult
mosquito
Pacific Islands
roundworms.
(transmits
& Africa
2)
Give birth to live
microfilariae)
Brugia malayi
offspring called
SE Asia
microfilariae.

1)

1)

2)

Larvae
within
African,
Middle
Eastern, &
Indian
freshwater
copepods
(tiny
crustaceans)
are ingested
when
drinking
freshwater.
Larvae
pentrate

1)
1)

2)

3)

Filariae;
Threadlike adult
roundworms: the
female can grow to
100 cm in size.
Adult female
pokes a loop of her
body thru the skin,
exposing her uterus.
When her uterus is
exposed to water,
1000s of
microfilariae are
released.

1)
2)
3)

CLINICAL FINDINGS
1)

DIAGNOSIS

TREATMENT

1)

1)

Filarial fever: febrile episodes

associated with headache &
swollen lymph nodes.
Elephantiasis: following repeat
infections, fibrous tissue forms
around the dead filariae that
accumulate within the lymph
nodes. This fibrous tissue plugs up
the lymphatic system, resulting in
swelling of the legs and genitals.
Thick, scaly skin covers the
edematous lower extremities,
giving the appearance of elephant
legs.
Tropical pulmonary
eosinophilia: hypersensitivity rxn
that causes bouts of wheezing &
coughing, associated with
hypereosinophilia.

1)
2)

Serology
Eosinophilia

1)

Diethylcarbamazine

2)

Doxycycine (kills
endosymbiont
Wolbachia).

Allergic symptoms occur during

the release of microfilariae: N/V,
hives & breathlessness.

1)

Demonstration
of eggs in stool
or urine samples
Eosinophilia
Ultrasound of
the liver will dx
liver disease

1)

Drive a small stick

under the part of the
worms body that is
looped out of the skin.
The stick is slowly
twisted each day to pull
out the 100 cm
Dracunculus.

2)

1)

Biopsy of
advancing edge
of rash

Mebendazole
Pyrantel pamoate
Albendazole

Skin nodules: contain adult

worms.
2) Allergic rxn to microfilarae
migrating thru the dermis
leads to:

Pruritic rash with darkened

pigmentation.

Lizard skin: intraepithelial

granulomas, resulting in thick, dry,
scaly skin.
3) River blindness: microfilaria
emirate thru the eye. A marked
inflammatory response can occur
upon their death, which can lead
to blindness.

3)

Dracunculus
medinensis
Guinea worm

Severe perianal itching

1)

2)
3)

4)

2)
3)

Ivermectin: kills
microfilarial stage only,
and prevents them from
leaving the uteri of
adult worms.
Doxycycline (kills
endosymbiont
Wolbachia).
Alternative:
diethylcarbamazine
(but er toxicity than
ivermectin).
Excise adult worms in
nodules.

IMAGES

Cutaneous
larva migrans
(commonly
Ancyclostoma
braziliense
dog hookworm)

1)

the
intestine &
mature
beneath
the skin.
Occurs in
SE US

1)

Larvae of dog &

cat tapeworms.

1)

Creeping eruption: larvae of dog

& cat hookworms penetrate the
skin & migrate beneath the
epidermis (a few cm per day). A
raised, red, itchy rash moves with
the advancing larvae.

1)
2)

3)
Visceral larva
migrans (MCly
Toxocara canis
dog
roundworm)

1)

Ingestion of
eggs

HELMINTH
TRANSMISSION
PLATYHELMINTHS (FLATWORMS)
Schitosomes
1) Penetrate
Schistosoma
thru
japonicum
exposed
Schistosoma
skin.
mansoni
2) Since the
Schistosoma
eggs must
haematobium
reach
freshwater
to hatch,
schistosom
es cannot
multiply in
humans.
3) Intermediat
e host =
fresh water
snail.

Taenia solium
(Pork
Tapeworm)

1)

2)

Ingest
undercooke
d pork
containing
larvae stage.
Ingestion of
eggs: results
in
cysticercosi
s.

1)

Larva of dog
roundworms,
which CAN NOT
mature in human.

Toxocariasis;

1)

MORPHOLOGY
Trematodes:
1) Eggs
2) Mature larvae
(called cercariae)
3) Male & female
adults

Cestodes:
1) Scolex: head with
hooks.
2) Gravid
ploglottids:
contain eggs &
uterus has < 15
pairs of lateral
branches.
3) Cysticercus: round,
fluid-filled bladder
with the larval form
within.

1)

Migration of larvae thru the

body results in fever, diarrhea,
wheezing, hepatitis, & visua
loss (from chorioretinitis).

CLINICAL FINDINGS
Schistosomiasis:
1) Pruritic skin rash @ site of
penetration.
2) Acute schistosomiasis
(Katayama fever):

Intense transient itching

Weeks later: fever, hives,

headache, weight loss, cough (lasts
about 3 wks).
3) Complications caused by
immune rxn against eggs released
by adults hanging out in the veins
surrounding the intestine or
bladder:
1) Liver: fibrosis of portal venous
system leads to portal HTN.
2) Lung: fibrosis of pulmonary
arterioles can lead to pulmonary
HTN.
3) Intestine: deposits of eggs lead to
inflammatory polyps.
1) Intestinal infection is usually
asymptomatic.
2) Cysticercosis: eggs hatch within
the small intestine, and larvae
travel to muscle, CNS &/or the eye,
where they eventually form
calcified cysts that are
inflammatory.
1) Blindness

2)

Neurologic manifestations:
seizures, focal neurologic deficits,
hydrocephalus blockage of CSF
drainage.

Fecal exam for

eggs or gravid
proglottids.
CT scan or
biopsy of brain
or muscle may
reveal calcified
cysticeri
Eosinophilia
occurs with
cysticercosis
Fecal exam for
eggs or gravid
proglottids

1)
2)

Ivermectin
Albendazole

1)
2)

Albendazole
Mebendazole

DIAGNOSIS
1)

2)

CT scan or
ultrasound
reveals cysts in the
liver or lung.
Serology

TREATMENT
1)

2)

Praziquantel: results
in immediate
exacerbation of
symptoms, followed
later by improvement.
Control: disposal of
human fecal waste &
destruction of
intermediate host
(snail).

1)

Praziquantel &
albendazole

2)

2nd choice for all

tapeworms:
niclosamide

IMAGES

4)
Taenia
saginatum
(Beef
tapeworm)

1)

Ingest
undercooke
d beef
containing
larvae
stage.

1)
2)

3)
Diphyllobothr
ium latum
(Fish
Tapeworm)

1)

2)

3)
Hymenolepsi
s nana
(Dwarf
Tapeworm)

1)

Echinococcus
(Hydatid
Disease)

1)

2)

Ingest
larvae in
raw
freshwater
fish.
Copepods
(crustacean
) ingests
larvae which
is then
ingested by
fish.
Grow into
adult
tapeworms
Ingest
fertilized
eggs
Autoinfection
Ingestion of
fertilized
eggs

1)

1)
2)

Adult can grow to

2-8 m.
Scolex: head with
suckers (but NO
hooks).
Gravid
ploglottids:
contain eggs &
uterus has more
than 15 pairs of
lateral branches.
Can grow to 10 m
in length
Can grow to 45 m
in length.

Adults: 15-50 mm.

Eggs are
infectious.

1)
2)

Usually asymptomatic
Occasionally develop
abdominal discomfort, weight
loss & diarrhea.

1)

Praziquantel

1)

Nonspecific abdominal
symptoms

1)

Praziquantel

2)

Vitamin B12 deficiency leading

to anemia.

1)
2)

Usually asymptomatic
Occasional abdominal
discomfort, N/V.

1)

Praziquantel

1)

Hydatid cysts: form most often in

the liver & lung. The cysts enlarge
over 1-20 yrs, producing
symptoms by mass effect. These
cysts can calcify.

1)

Liver: abdominal pain

2)

Surgical removal of
cysts: extreme caution
leakage of cystic fluid
can induce a severe
anaphylactic rxn.
PAIR- Percuatneous,
Aspiration, Infusion of
scolicidal agent, and
Reaspiration.
Albendazole or
Mebendazole are used
adjunctively.

3)