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Aschelminthes
1.
Nematoda (round worm)
Platyhelminthes (Flatworms)
2. Cestoda (tape worm)
3. Trematoda (flat worm = fluke)
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A. Nematoda (roundworm)
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Nematoda (roundworm)
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Intestinal nematodes
Larvae pass
through lungs
Larvae penetrate
through intact skin
strongyloides
hookworm
Eggs ingested
trichuris
enterobius
Larvae enter
bloodstreamascaris
Adult worms in the
the intestine
Eggs
Larvae hatch
from eggs
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Morphology
Adults -males are 15 to 30 cm long,with strongly curved tails; females are
20 to 35 cm long, with straight tails.
Eggs -one female produces 200,000per day. The egg has an outer shell
membrane which is heavily mamillated.
This layer is sometimes rubbed off in
passage down the fecal stream.
Infertile eggs often appear longer, andthinner shelled.
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Pathogenesis
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Signs and Symptoms
Major pathology and symptoms:
Pneumonia associated with
migration of larvae in the lungs.
Obstruction of the intestines,appendix, or common bile duct.
Vomiting and abdominal pain.
May cause malnutrition inchildren with heavy infections or
poor diet.
Some infections areasymptomatic.
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Diagnosis
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Prevention and Treatment
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molt molt 3 timesAdults Newly laid Infective Larvae Adults
eggs 6h eggs
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Necator americanus- The New World hookwormAncylostoma duodenale- The Old World hookworm
Hookworms are named for the dorsal curve in their anterior end.
Hookworms are quite small, Necatoramericanusis only 11mm long.
However, because they feed on blood a heavy infection can producesevere anemia.
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Morphology
Rhabditiform larvae - long buccal cavity,indistinct genital primordium. Filariform
larvae lose oral structures & have sharp
pointed tails.
Adults - males: 7 to 11 mm long with acopulatory bursa; females: 8 to 15 mm
long.
Eggs -55 to 70 x 35 to 40 microns; verythin shell; usually seen in the 8 - 32 stage
of cleavage.
Hookworm rhabditiform larva
Hookworm filariform larva
Hookworm egg
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Life cycle
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Pathology
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Major pathology and symptoms
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Diagnosis
Recovery and identification of eggs(rarely larvae) in the feces.
Cannot differentiate Hookwormspecies by egg appearance.
To determine if a significantinfection: count the number of eggson a direct smear of theunconcentrated specimen. 5 eggs per smear indicates a light
infection
20 or more eggs is clinically significant;
100 or more is indicative of a very heavyinfection.
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4 Strongyloides stercoralis (Threadworm)
Morphology:
Rhabditiform larvae - short buccal cavity; large, prominent
genital primordium.
Filariform larvae - tail has a notch in it, in contrast with the
filariform larva of hookworms.
Must be able to differentiate these from hookworm larvae.
Eggs hatch in the intestine (not usually passed in stool
specimens). Eggs resemble hookworm eggs, but are
embryonated.
Buccal cavity of rhabditiform larva Notch in tail of filariform larva
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Life cycle
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Strongyloides stercoralis rhabditiform larva
Strongyloides stercoralis filariform larva
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Diagnosis
Diagnosis:
Recovery and
identification of larvae inthe feces.
Recovery and
identification of eggs in
duodenal drainage.
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Major pathology and symptoms
Skin allergic reactions; raised, itchy, red blotches at the site oflarval penetration.
Lungs pneumonia.
Intestinal - abdominal pain, diarrhea, vomiting, weight loss,anemia, eosinophilia. Light infections usually asymptomatic;
Heavy infection - bowel becomes edematous and congested. Death occurs in immunosuppressed patients due to heavy
autoinfection.
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Direct stool smears (larvae)
Cultivation of stool. (Damp charcoal or Harada-Mori mediums).
Histological examination of duodenal or jejunal biopsyspecimens obtained by endoscopy can demonstrateadultworms embedded in the mucosa.
Eosinophilia, is present in uncomplicated strongyloidiasis, butis lost in hyper infection
For population screening in endemic areas, an ELISA for IgGanti-Strongyloides antibodies is effective.
iagnosis
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While hookworm infection dies out over aperiod of years after the patient has movedfrom an endemic area, strongyloidiasis maypersist for years, due to autoinfection(internal infection).
In cases with severe diarrhea, Strongyloideseggs may be present in stool specimens.Strongyloides eggs contain well-developed
larvae. Hookworm eggs do not have welldeveloped larvae until passed from the bodyand mature for one to two weeks in the soil.
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Microfilaria--177~296!m in length, encased in a
sheath with free endings. Bluntly rounded
anteriorly and tapers to a point posteriorly. A
large number of nuclei seen in the body are
arranged in a column from head to the posterior
Wuchereria bancrofti Brugia malayi
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W. bancrofti Brugia malayi
Size Larger, 244~296 by5.3~7 !m
Smaller, 177~230 by5~6 !m
Shape Curves of body arenatural, smooth
Curves of body arerigid, the small inlarger curve
Cephalic space Shorter (length is equalto or less than width)
Longer (length is twotimes as long as
width)Body nuclei Equal sized, clearly
defined, countableUnequal sized,coalescing, uncountable
Terminal nuclei No Two
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The Platyhelminthes (Flatworms):
Cestoda dan Trematoda
General Characteristics:
Multicellular animals characterized by a flat,
bilaterally symmetric body, dorsoventrallyflattened and solid (no body cavity).
Most are hermaphroditic.
Overall size varies greatly, some members are as
small as 1mm, and others may be 20 meters orlonger.
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B. Cestodes (tapeworms)
Adult worms -Flat & ribbon-like;
Scolex (head) -Characterized by thepresence of sucking disks or lateral grooves.Some have hooks (armed) to attach to a hostorganism.
Rostellum -A small button-like structure onthe scolex of armedtapeworms from whichthe hooks protrude. It may be retractable.
Strobila - Chain of segments (proglottids =
square body segments used for reproduction)
Immature proglottids: developing
reproductive
Mature proglottids: mature reproductive
organs.
Gravid proglottids: contain eggs in the
uterus, terminal segments.
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Cestodes (tapeworms)
Dioecious - each proglottid has both male & femalereproductive organs; can fertilize itself.
Reproductive organs Male: testes are spread throughout the segment; sperm is
collected in the seminal vesical; delivered to female organ viacopulatory spicules.
Female: ovaries produce eggs, which are stored in the uterus.
Development of proglottids -
New proglottids bud from behind the scolex.
As they are pushed back, they mature & eggs are produced.
When filled with eggs, they are gravid
proglottids. Eggsare sometime released in feces, but often are retained withinthe segment. Hexacanth embryos (onchospheres) developwithin the eggs.
Proglottids - a few are usually shed every 2-3 days.
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Cestodes (tapeworms)
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Taenia sppGeneral :
Scolex - attaches to human intestine.
Larva - cysticercus, a fluid filled bladder with an
invaginated scolex.
Eggs of both species are identical.
Adult Tapeworm have no intestinal tract.
Excretory system: flame cell (the function is
similar with kidney and anus in mamalia).
Length: T. saginata > T. solium
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Taenia solium The Pork Tapeworm
General:
Man is the only definitive host.
Infection - ingestion of cysticercus in flesh ofswine.
Size - up to 7 meters in length.
Life expectancy - 25 years or more.
Autoinfection called cysticercosis, due toingestion of eggs from feces if infected with adult
worm.
Racemose form of infection may develop in thebrain. A Racemose is a larva which is branching,spreading throughout tissue.
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Taenia saginata The Beef Tapeworm
General:
Man is the only definitive host.
Infection - ingestion of cysticercus in flesh ofcow.
Size - up to 10 meters in length (although 70'
worms have been reported).
life expectancy - 25 years or more.
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Taenia saginata The Beef Tapeworm
Morphology:
Scolex - unarmed (no hooks); 4
sucking disks.
Gravid proglottids - one inch orslightly longer; uterus contains
15 to 20 primary branches. The
uterine pore is located in a
lateral position.
Eggs are identical to T. solium,
measuring about 40 microns in
diameter.
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indistinguishable;
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Infeksi oleh kista yang mengandung larva
(cysticerci) Taenia solium.
Results when humans become the
intermediate host (incidental/accidental host)
More serious than infections with the adult
stage alone. This condition only occurs with
the pork tapeworm, Taenia solium. Neurocycticercosis: infeksi parasit pada CNS.
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1. Schistosomiasis
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Distribution Map
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Life Cycle (Basic)
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Cercariae penetrate skin"rash- called schistosome or swimmers itch.
Eggs laid in target organs release antigens
"cause Katayama fever- fever- urticaria
- malaise- diarrhea
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InS. mansoni infections
Wall of colon is damaged as eggs pass through
Inflamm. response"ulcers, inflammatory
polyps
Can lead to fibrosis
Clinically: diarrhea, abdominal pain
Eggs can also accumulate in the appendix
Can lead to appendicitis (inflammation of the appendix)
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Hepatosplenic schistosomiasis
Eggs carried by portal circulation"liver
Granulomatous response
Granulomas are walled off with fibroustissue"fibrosis obstructs portal veins"portal hypertension
Esophageal varices (dilated esophageal veins, which
drain the liver"bursting can cause bleeding todeath. Caused directly by portal hypertension.)
Splenomegaly (enlarged spleen, due to fibrosis)
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fv
A patient of
schistosomiasis
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In those with severe hepatosplenic schistosomiasis
Blood gets shunted directly back to the heart (doesnt passthrough liver).
Eggs accumulate in heart, sometimes lodged in pulmonary
arterioles.
Form granulomas"block pulmonary circulation"pulmonary hypertension.
Can lead to right ventricular strain, and eventually
cardiovascular collapse.
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Genitourinary complications Eggs lodge themselves in wall of bladder & can develop into polyps Polyps can erode, ulcerate & cause hematuria (blood cells in urine) Eggs lodge in ureters and urethra, cause lumps and lesions"
kidney failure
Eggs lodge into ovaries, the uterus, cervix, fallopian tubes"lumps"complications incl. infertility(For the men: eggs can also lodge into the testes and the prostate )
CNS complications S. haematobium and S. mansoni can migrate to the spine
S. japonicum found in the brain and causes encephalopathy(general brain dysfunction)
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Diagnosis
Microscopic Detection
Take stool or urinesample to detect eggs
S. haematobiumeggs areoval and have a spike atthe tip
S. japonicum eggs smalland almost spherical with
tiny spine S. mansonieggs have a
spike on the side (spine)
S. mansoni S. japonicum
S. haematobium
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Diagnosis
Antibody tests
An earlier and more sensitive form of detection
Some complications
Cross-reactivity with other helminthic infections (otherflatworm parasites)
Cant tell the difference between current and old
infections as antibodies stay long after infection is over.
Cant tell you anything about overall worm burden so wecant tell how serious the infection is
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Prevention
For travelers its easy- dont swim in fresh, stagnant water(running water is better, still not safe).
Harder in endemic areas"people are dependent onnearby freshwater.
Focused on education, eliminating snail nesting grounds Molluscicides can be used to eliminate snails. Proper irrigation systems and engineering are key There are ways to build irrigation and canalization systems
that dont allow snails to inhabit the surrounding area
However, many irrigation/canalization projects since the 50s haveignored UN instructions, may have contributed to spread of theparasite
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Treatment
Swimmers itch and Katayama Fever are usually treated
symptomatically.
Chemotherapy is treatment of choice - Praziquantel is mostwidely used drug.
Praziquantel
Extremely well tolerated, few side effects
Broad-spectrum antihelminthic drug (antihelminthic= drugs thatexpel parasitic worms)
Cures schistosomiasis in 8090% of patients, 90% reduction in
egg excretion in those not cured
Causes worm muscles contract cannot hold onto human tissues
Resistance has been reported in Egypt and Senegal
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Treatment
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