Introduction to helminth

1

• Introduction to helminth
• Helminth means worm. Their motile activity
  is accoplished by wriggling movement. The
  helminth of medical importance belong to 3
  classes Nematoda, Trematoda and Cestoda.
• Geohelminths refer to the helminths which
  complete their life cycles not requiring the
  processes of the development in intermediate
  hosts. They have only one host and a simple life
  cycle, such as ascarid, hookworm, pinworm and
  etc.
• Biohelminths refer to those that have to
  undergo the development in intermediate hosts to
  complete their life cycle , such as filaria,
  liver fluke, pork tapeworm and so on.

2

• Characteristics of Class Nematoda
• 1. Body is non-segmented and cylindrical in
  shape.
• 2. Two sexes are separated. ?is larger with a
  straight tail and a double set of
  reproductive organs. ?is smaller with a curled
  tail and a single set of reproductive organs.
• 3. With a complete digestive tract.
• 4. The body cavity is a protocoele.
• 5. Life cycle infective stage is embryonated
  egg or larva3.
• Egg larva (several stages)
  adolescent adult
• molt1 molt2
  molt3 molt4
• Larva1 L2 L3
  L4 Adult

3
Ascaris Lumbricoides

• Ascaris lumbricoides , common saying
  round worm of man, is the largest of the
  intestinal nematodes parasitizing humans. It is
  the most common worm found in human. It is
  worldwide in distribution and most prevalent
  through out the tropics, sub-tropics and more
  prevalent in the countryside than in the city

4
I. Morphology

• Adult The adults are cylindrical in shape,
  creamy-white or pinkish in color. The female
  averages 20-35cm in length, the largest 49cm. The
  male is smaller, averaging 15-31cm in length and
  distinctly more slender than the female. The
  typical curled tail with a pair sickle like
  copulatory spines. On the tip of the head there
  are three lips, arranged as a Chinese word ? .
  They have a complete digestive tract.
  Reproductive organs are tubular. male has a
  single reproductive tubule. The female has two
  reproductive tubules and the vulva is ventrally
  located at the posterior part of the anterior 1/3
  of the body.

5
Adult worm of A. lumbricoides
6
The lips of Ascaris lumbricoides
The three lips are seen at the anterior end.
The margin of each lip is lined with minute teeth
which are not visible at this magnification.
7
Ascaris lumbricoides Lips
8
Copulatory spines of male
9

• Egg There are three kinds of the eggs. They
  are fertilized eggs, unfertilized eggs and
  decorticated eggs. We usually describe an egg in
  5 aspects size, color, shape, shell and content.
• 1. Fertilized eggs broad oval in shape,
  brown in color, an average size 60 45µm. The
  shell is thicker and consists of ascaroside,
  chitinous layer, fertilizing membrane and
  mammillated albuminous coat stained brown by
  bile. The content is a fertilized ovum. There is
  a new-moon(crescent) shaped clear space at the
  each end inside the shell.
• 2. Unfertilized egg Longer and slender
  than a fertilized egg. The chitinous layer and
  albuminous coat are thinner than those of the
  fertilized eggs without ascaroside and
  fertilizing membrane. The content is made of many
  refractable granules various in size.
• 3. Decorticated eggs Both fertilized and
  unfertilized eggs sometimes may lack their outer
  albuminous coats and are colorless.

10
(No Transcript)
11
Fertilized egg of A. lumbricoides
12
Fertilized Ascaris Egg

• A fertilized Ascaris egg, still at the
  unicellular stage, as they are when passed in
  stool.  Eggs are this stage when passed in
  thewhen passed in stool. Eggs are normally at
  this stage when passed in the stool  

13
Fertilized Ascaris Egg
The ova begin fission
14
Embryonated Eggs of Ascaris
15
Freshly Passed Ascaris Eggs From faeces

• The eggs may appear from light to dark brown in
  color.

16

• Egg containing a larva, which will be infective
  if ingested. 

17
Unfertilized egg

• The chitinous layer and albuminous coat are
  thinner than those of the fertilized eggs without
  ascaroside and fertilizing membrane. The content
  is made of many refractable granules various in
  size.

18
Unfertilized egg
19
Unfertilized and Fertilized Eggs
20
II Life Cycle

• 1. Site of inhabitation small intestine
  
• 2. Infetive stage embryonated eggs
• 3. Route of infection by mouth
• 4. No intermediate and reservoir
  hosts
• 5. Life span of the adult about 1
  year
• This worm lives in the lumen of small
  intestine, feeding on the intestinal contents,
  where the fertilized female lays eggs. An adult
  female can produce approximately 240,000 eggs per
  day, which are passed in feces. When passed, the
  eggs are unsegmented and require outside
  development of about three weeks until a motile
  embryo is formed within the egg.

21

• After the ingestion of embryonated eggs
  in contaminated food or drink or from
  contaminated fingers, host digestive juices acts
  on the egg shell and liberate the larva into the
  small intestine. These larvae penetrate the
  intestinal mucosa and enter lymphatics and
  mesenteric vessels. They are carried by
  circulation to the liver, right heart and finally
  to the lungs where they penetrate the capillaries
  into the alveoli in which they molt twice and
  stay for 10-14days and then they are carried, or
  migrate, up the bronchioles, bronchi, and trachea
  to the epiglottis. When swallowed, the larvae
  pass down into the small intestine where they
  develop into adults. The time from the ingestion
  of embryonated eggs to oviposition by the females
  is about 60-75 days. The adult worms live for
  about one year. The ascarid life cycle is as the
  following diagram.

22
(No Transcript)
23

• swallowed
  digestive
• Infective eggs small intestine
  Larvae hatch out
• 
  juice act
• penetrate
  
• Lymphatic or venules
  Liver
• intestine mucosa
• 
  penetrate the molt2,3
• Right heart lungs
  Alveoli
• 
  alveolar wall
• Bronchiles Bronchi
  Trachea
• discharged with sputum
  die
• return to
  molt 4
• Pharynx Small intestine
  Adults

24
III. Pathogenesis

• There are two phase in ascariasis
• 1. The blood-lung migration phase of the
  larvae During the migration through the lungs,
  the larvae may cause a pneumonia. The symptoms of
  the pneumonia are low fever, cough, blood-tinged
  sputum, asthma. Large numbers of worms may give
  rise to allergic symptoms. Eosionophilia is
  generally present. These clinical manifestation
  is also called Loefflers syndrome.

25

• 2. The intestinal phase of the adults. The
  presence of a few adult worms in the lumen of the
  small intestine usually produces no symptoms, but
  may give rise to vague abdominal pains or
  intermittent colic, especially in children. A
  heavy worm burden can result in malnutrition.
  More serious manifestations have been observed.
  Wandering adults may block the appendical lumen
  or the common bile duct and even perforate the
  intestinal wall. Thus complications of
  ascariasis, such as intestinal obstruction,
  appendicitis, biliary ascariasis, perforation of
  the intestine, cholecystitis, pancreatitis and
  peritonitis, etc., may occur, in which biliary
  ascariasis is the most common complication.

26
(No Transcript)
27
A large mass of Ascaris
28
biliary ascariasis
29
Intestinal obstruction
30
III. Diagnosis

• The symptoms and signs are for reference
  only. The confirmative diagnosis depends on the
  recovery and identification of the worm or its
  egg.
• 1. Ascaris pneumonitis Examination of
  sputum for Ascaris larvae is sometimes
  successful.
• 2. Intestinal ascariasis Feces are examined
  for the ascaris eggs.
• (1) Direct fecal film It is simple and
  effective. The eggs are easily found using this
  way due to a large number of the female
  oviposition, approximately 240,000 eggs per worm
  per day. So this method is the first choice.
• (2) Brine-floatation method
• (3) Recovery of adult worms When adults
  or adolescents are found in feces or vomit and
  tissues and organs from the human infected with
  ascarids , the diagnosis may be defined.

31
V. Epidemiology

• World wide distribution, very common in
  China, especially in the countryside.
• Factors favoring the spread of the transmission
• 1.  Simple life cycle.
• 2. Enormous egg production ( 240,000 eggs/ day/
  female ).
• 3. These eggs are highly resistant to ordinary
  disinfectants( due to the ascroside). The eggs
  may remain viable for several years.
• 4. Social customs and living habits.
• 5. Disposal of feces is unsuitable.

32
VI. Prevention and Treatment

• 1.Treatment to ascariasis Mebendazole(????),
  Albendazole(????????? )and Levamizole are
  effective.
• 2. Sanitary disposal of feces.
• 3. Hygienic habits such as cleaning of hands
  before meals.
• 4. Health education.

33
Trichuris trichiura ( Whipworm)

• I.       Morphology
• Adult The worm looks like a buggy whip, the
  anterior 3/5 is slender and the posterior 2/5 is
  thick. It is pinkish gray in color. The female
  worm is 3-5 cm in length and has a long slender
  esophageal region. The male is smaller than the
  female and has a curved tail. The reproductive
  organs of male and female are all double tubule.
• Egg It is barrel or spindle in shape and 50 x
  20µm in size. It is brownish and has a
  translucent polar plug at either ends. The
  content of the egg is an undeveloped cell

34
(No Transcript)
35
Adults of T. trichiura
36
Eggs of T. trichiura under the high power
37
II.     Life Cycle

• 1.   Site of inhabitation cecum
• 2.   Infective stage embryonic egg
• 3. Infectve mode and route passively
  swallowed by the mouth
• 4. Without intermediate host and reservoir
  host
• 5. The life span of the adult is about
  3-5years.
• deposit 3weeks
  ingested by man
• Adults Eggs Infective
  eggs larvae hatch out
• 
  in small intestine
• invade the intestinal wall
• return to the
  intestinal lumen Adults
• develop 3-10 days

38
(No Transcript)
39

• III. Pathogenesis
• 1.  Light infection Asymptomatic
• 2. Middle infection Clinical manifestations
  are usually abdominal pain, anorexia, diarrhea,
  constipation .
• 3. Heavy infection Bloody diarrhea,
  emaciation, prolapse of the anus may occur.
• IV. Diagnosis
• Discover the eggs in feces by saturated brine
  flotation method or direct fecal smear.
• V. Treatment and prevention Same as those of
  ascariasis
• Take Mebendazole 3 days for a
  treatment course and repeat next week