Nematodes 1.

Enterobius vermicularis
▪ Enterobiasis: Pinworm
▪ Roundworms
▪ Common name: Pinworm, Seatworm,
▪ Multicellular with internal organs
Society worm
▪ 3 morphologic forms: Egg, larvae and adult
▪ Eggs:
worm
o Oval egg flattened on one side
o Eggs and larvae = can be seen
(loop-sided D)
microscopically
o Unfertilized egg (unembryonated)
o Adult worm = seen in stool sample
▪ No larvae inside
o All 3 are diagnostic stage
o Fertilized egg (embryonated)
▪ Separate sexes (Dioecious)
▪ Adult:
Life cycle: o Female
▪ Yellowish-white, organ
▪ Pinworms – ingestion/ inhalation of systems
infected eggs ▪ Clear pointed tail “pinhead”
▪ Hookworm (larvae) – burrow through skin o Male
of the foot ▪ Yellowish-white
o MOT: Skin penetration (Skin expose ▪ Smaller than females
to the soil) ▪ Laboratory diagnosis
▪ Adult female worm – lay eggs in the o Cellophane tape preparation
intestine (15,000-100,000 eggs) ▪ Scotch tape swab
▪ Larvae – inside the eggs ▪ Perianal region
▪ Trichinella spiralis, Dracunculus medinensis o Collect samples before defecation/
(reside in tissues) washing
▪ Facultative parasites (Free-living) o Recovered in stool samples (rare)
o Can cause disease or ▪ Human are the only known host.
nonpathogenic ▪ Adult worms (reside in the colon)
o S. stercoralis ▪ Copulation (mating), pregnant (gravid)
▪ Male S. stercoralis– Free female worm
living ▪ Retroinfection – migration of newly hatched
Recovery of eggs larvae and adult worms larvae from anal skin back into the rectum
▪ Autoreinfection – reinfect themselves
▪ Cellophane tape preparation – E.
vermicularis Epidemiology and transmission
▪ Stool samples, Tissue biopsies (T. spiralis) ▪ Hand to mouth contamination
and skin ulcers (D. medinensis) ▪ Responsible from transmission of
▪ Concentration technique Dientamoeba fragilis
1. FECT (Formalin Ether)
2. AECT (Acid Ether) Clinical Symptoms

▪ Intense itching and inflammation of

anal/vaginal areas
▪ Intestinal irritation
▪ Mild nausea
▪ Vomiting ▪ Larvae – small intestine
▪ Irritability ▪ Complete maturation (cecum)
▪ Difficulty in sleeping
Epidemiology
▪ Mild intestinal inflammation
▪ Abdominal pain ▪ 3rd most common helminth
▪ Defecating into the soil/using human feces
Treatment: Albendazole, Mebendazole and
as fertilizers
Pyrantel pamoate
Clinical symptoms
Prevention and control:
▪ 500 to 5000 worms (heavy infection),
▪ Practicing proper personal hygiene
▪ chronic dysentery
▪ Application of ointment in the infected area
▪ severe anemia
▪ Cleaning of potentially infected
▪ growth retardation
environmental surfaces (linens)
▪ Rectal prolapse, Tenesmus (to defecate
▪ Avoid scratching the infected area
frequently)
▪ Peristalsis
2. Trichuris trichiura
▪ Trichuriasis: Whipworm infection
3. Ascaris lumbricoides
▪ Common name: Whipworm
▪ Ascariasis: Roundworm infection
▪ Eggs:
▪ Common name: Large intestinal
o Barrel/football-shaped
roundworm
o Japanese lantern
▪ Unfertilized eggs (Vitelline layer is absent)
o Yellow-brown
– oval shaped
o Prominent hyaline polar plug
o Corticated – outer mamillated,
▪ Confused with Capillaria
albuminous coating
philippinensis
o Decorticated – outer layer is absent
▪ Adult:
o Anterior end
▪ Colorless with slender
esophagus
o Posterior end
▪ Pinkish-gray color
o Male is smaller than female

Laboratory Diagnosis:
▪ Fertilized eggs: (vitelline late is present)
▪ Stool sample
o More rounded than unfertilized egg
▪ Zinc flotation method
o Chitin
▪ Adult worms (intestinal mucosa)
▪ Thick Nitrogen-containing
▪ Rectum (heavy infections)
polysaccharide coating
o Biopsy
▪ Between the embryo and
Life cycle: mammillary albuminous
material
▪ Infective stage: embryonated ova ▪ Less evident in corticated
▪ Diagnostic stage: unembryonated ova eggs
 ▪ Lungs – low-grade fever, cough,
eosinophilia and Pneumonia
▪ Asthmatic reaction (presence of worms

4. Hookworms
a. Necator americanus
b. Ancylostoma duodenale
▪ Adult c. Ancylostoma caninum (dogs)
o Creamy-white color d. Ancylostoma braziliense (cats)
o Cuticle – surface covering
o Largest intestinal nematode *A. caninum and A. braziliense are causative
agents of CLM (Cutaneous Larval Migrant)
o Female: larger and pointed tail
▪ Tropical anemia (causes Laziness in white
o Male: curve
American population)
Laboratory diagnosis ▪ Necator americanus
o Common name: New World
▪ Stool sample Hookworm
▪ Others: Small intestine, gallbladder, liver o Necatoriasis
and appendix ▪ Ancylostoma duodenale
▪ Adult worms – present in stool, vomited up o Common name: Old World
or remove from the external nares Hookworm
▪ ELISA o Ancylostomiasis
▪ DFS ▪ Most common hookworm acquired by
▪ Kato-katz/Kato-thick humans
▪ Concentration techniques ▪ Skin penetration through soil
Life cycle: ▪ Eggs:
o Unsegmeneted
▪ Liver-lung migration o Embryonic cleavage
▪ Infective stage: Embryonated eggs o 2,4,8 cell stage
▪ Diagnostic stage: Fertilized, unfertilized o Thin, smooth, colorless shell
▪ Maturation of larvae- small intestine ▪ Larvae
▪ 250, 000 eggs per day are passed in the ▪ Rhabditiform larvae
feces o Non-infective (feeding) stage
Clinical symptoms o Buccal cavity/capsule (oral cavity)
o Genital primordium
▪ Vague abdominal paint ▪ Filariform larvae
▪ Vomiting o Infective stage
▪ Fever o Shorter esophagus than S.
▪ Distention stercoralis
▪ Obstruction of the intestine, appendix, liver o Distinct pointed tail
or bile duct
▪ Malnutrition
▪ Discomfort from adult worms exits in the
body through the anus, mouth or nose
 Laboratory diagnosis

▪ Stool samples
▪ Recovery and examination of buccal capsule
▪ Harada-Mori technique
▪ Eggs disintegrate immediately

Life cycle

▪ Infective stage: Filariform larvae

▪ Diagnostic stage: egg/ ova

Clinical symptoms:

▪ Ground itch – intense itching at the site of

infection
▪ Sore throat
▪ Bloody sputum
▪ Wheezing
▪ Headache
▪ Mild pneumonia with cough (larvae
migration to lungs)
▪ Adult:
▪ Mild gastrointestinal symptoms, mild
▪ Buccal capsule
anemia, Weight loss, Weakness, Diarrhea,
1. Necator americanus
Anorexia, Edema, Pain, Enteritis
a. Pair of cutting platers “S-
▪ Microcytic hypochromic Iron deficiency,
shaped”
weakness and hypoproteinemia
2. Ancylostoma duodenale
▪ Mortality – enormous loss of blood
a. Consist of actual/sharp teeth
▪ Wakana disease (Pneumoitis)
b. C-shaped
▪ Miner’s anemia (Microcytic hypochromic)
▪ Animal hookworm: Creeping eruption, CLM
▪ Visceral Larvae Migrans
o Causative agent:
▪ Toxocara canis
▪ Toxocara cati
5. Strongyloides stercoralis
▪ Strongyloidiasis – Threadworm infection
▪ Common name: Threadworm
▪ Smallest nematode
▪ Eggs:
o Smaller than hookworms
o Well developed larvae is contained
o “Chinese Lantern”
o Thin hyaline shell
▪ Larvae:
▪ Rhabditiform larvae:
o Short buccal cavity
 o Prominent genital primordium ▪ Immunocompromised (suffer from severe
▪ Filariform larvae: autoinfections)
o Long, slender ▪ Cochin China Diarrhea/Vietnam Diarrhea
o Long esophagus
Treatment:
o Notched tail
▪ Adult ▪ Ivermectin and Albendazole
o Short buccal cavity
o Long and slender esophagus Prevention and control
o Colorless body (transparent) ▪ Proper handling and disposal of fecal
o Parthenogenic material
▪ Male is not required for ▪ Adequate protection of skin from
fertilization contaminated soil
o Strong-independent women si ▪ Thorough treatment of infected person
Strongyloides (prevent autoinfection)
Laboratory diagnosis:
6. Trichenella spiralis
▪ Stool samples (severe diarrhea) ▪ Trichinosis, Trichinellosis
▪ Duodenal aspirates and stool (rhabditiform ▪ Common name: Trichina worm
larvae) ▪ Encysted larvae
▪ Enterotest o Coiling up in the muscle fiber
▪ Sputum (disseminated infection) o Striated muscle cell (nurse cell)
▪ Threadworm larvae (higher recovery in ▪ Surrounds the coiled larva
conce. samples) ▪ NO OVA
▪ ELISA
Laboratory diagnosis
Life cycle
▪ Examination of infected skeletal muscle
▪ Direct – similar to hookworms ▪ Laboratory findings: Eosinophilia and
▪ Indirect – Rhabditiform larvae are passed
leukocytosis, elevated LDH, Aldolase, and
into the outside environment (soil) and Creatinine phosphokinase (serum muscle
mature into free-living adults
enzyme)
▪ Autoinfection – Rhabditiform develop into ▪ Bentonite Flocculation test
filariform larvae inside the intestine and ▪ Beckman Intradermal test
may enter the lymphatic
system/bloodstream Life cycle:

Clinical symptoms: ▪ Zoonosis – accidental infection, normal host

is an animal
▪ Diarrhea, abdominal pain, Urticaria and ▪ Consuming undercooked, contaminated
eosinophilia
meat (striated muscle of pigs)
▪ Vomiting, constipation, weight loss, anemia ▪ T. spiralis larvae in the intestine – matures
and Malabsorption syndrome
into adult rapidly
▪ Site of larvae penetration (itchy red) ▪ Gravid adult female -> intestinal mucosa
▪ Recurring allergic reactions, pulmonary
(lay eggs)
symptoms (larvae to lung) ▪ Infant -> bloodstream -> striated muscle
(encyst)
Clinical symptoms:

▪ Light infection: Diarrhea, headache and

fever
▪ Heavy infection: Vomiting, nausea,
abdominal pain, diarrhea, headache and
fever (intestinal phase)
▪ Eosinophilia, pain in pleural area, fever,
blurred vision, edema, cough and death
(larval migration through the body)
8. Capillaria philippinenesis
▪ Muscular discomfort, edema, local
▪ Pudoc’s Mystery disease; Capillariasis
inflammation, overall fatigue and weakness
▪ Common name: Pudoc worm
(larvae settled into the striated muscle)
▪ Eggs: Flattened bipolar mucus plugs
7. Dracunculus medinensis
▪ Guitar/peanut-shaped
▪ One of the largest adult nematode
▪ Striated
▪ Dracunculosis, Dracunculiasis: Guinea worm
infection
▪ Common name: Guinea worm; Peri serpent
of the Israelites
▪ Larvae
o 1st/Rhabditiform larvae (diagnostic
stage)
o 3rd stage larvae

Life cycle:

▪ Ingestion of contaminated drinking water

with infected COPEPODS (freshwater fleas –
intermediate host)
▪ Copepods contain the 3rd stage larvae ->
intestine -> larvae mature into adult worm -
> penetrate the intestinal wall -> connective
tissue/body cavities
Life cycle:
o Biopsy or skin ulcer
o Submerge in cold water ▪ Intermediate host : Fresh water fish (Birot,
▪ Copulation -> subcutaneous tissue (lay 1st Bagsang Bagsit)
stage larvae) -> infected ulcer at the site of ▪ Diagnostic stage: Ova
larvae deposit ▪ Infective stage: Larvae
▪ One of the largest adult nematode ▪ Autoinfection
▪ MOT: Ingestion of raw/undercooked
infected fish
Clinical Symptoms: 1. Adult worms
▪ Creamy white
▪ Abdominal pain
▪ Thread-like appearance
▪ Diarrhea
▪ Borborygmi (abdominal gurgling sound)
2. Microfilariae (Larvae)
Unholy Three/Triad of Infection ▪ Distribution of nuclei within the tip of the
tail
▪ Hookworm ▪ Presence of sheath (transparent covering)
▪ Ascaris lumbricoides
▪ T. trichiura Life cycle:

Habitat ▪ Larvae – tissues (complete development)

▪ Adult worms – lymphatics, subcutaneous
▪ Small intestine (TCASH) tissues, body cavities
o T. trichiura ▪ Adult female worms – lay live microfilariae
o C. philippinensis in blood or dermis
o A. lumbricoides ▪ Microfilariae – exit the body through blood
o S. stercoralis meal (vector)
o Hookworms ▪ Intermediate host: Mosquitoes/flies
▪ Large Intestine
o E. vermicularis Laboratory Diagnosis
o T. trichiuris
▪ Periodicity
▪ Muscle
o Presence of parasites in
o T. spiralis
bloodstream during a specific time
▪ Zoonotic
(nocturnal, diurnal or subperiodic)
▪ Lymph nodes
o Helpful for specimen collection
o W. bancrofti
▪ Giemsa-stained blood smear/ tissue of
o B. malayi
infected nodule
▪ Microfilariae
▪ Knott technique
▪ CA of Elephantiasis
▪ Heart and Lung Migration (ASH) Pathogenesis & Clinical Symptoms
o A. lumbricoides
▪ Lesions, eosinophilia, fever and chills
o S. stercoralis
▪ Elephantiasis
o Hookworms
o Enlargement of the skin and
Filarial Worms subcutaneous
▪ Calabar swellings
▪ Adult worm (tissue/lymphatic system)
o Transient swelling of subcutaneous
▪ Larvae (microfilariae-blood)
tissue
▪ Periodicity (nocturnal, diurnal and
▪ Blindness
subperiodic)
▪ Viviparous/larviparous
▪ Vector: Mosquitoes and flies

Morphology

▪ Two morphologic forms:

1. Wuchereria bancrofti o Presence of two nucleic (tip of the
▪ Elephantiasis tail)
▪ Common name: Bancrofts’ filaria
▪ Microfilariae:
o Thin and delicate sheath
o Numerous nuclei
▪ Anterior end - blunt and round
▪ Posterior end – point, free from nuclei
o Walang nuclei at the tip of tail

Laboratory Diagnosis:

▪ Giemsa-stained blood smear

▪ Knott technique
2 Bilog sa nuclei
▪ Sample collected during night
(NOCTURNAL) Laboratory diagnosis:
▪ Peak hours: 9:00 pm to 4:00 am
▪ Antigen and antibody detection ▪ Giemsa-stained blood smears
▪ PCR ▪ Specimen collection during nighttime
▪ Knott technique
Life cycle:
Life cycle:
▪ Vector: Aedes, Anopheles and Culex spp.
▪ Vectors: Mosquito (Aedes, Anopheles or
Clinical symptoms Mansonia spp.)
▪ Co-infection with W. bancrofti can be
▪ Asymptomatic – self-limiting
possible
▪ Symptomatic – fever, chills and
eosinophilia, granulomatous lesions, Epidemiology:
lymphangitis, lymphadenopathy,
elephantiasis/ swelling of lower extremities ▪ Humans – Definitive host
(breasts/genitals), abscesses may occur ▪ Infect felines (cats) and monkeys

Treatment Clinical Symptoms:

▪ Diethylcarbamazine (DEC) and Ivermectin ▪ Fever, lesions, chills, lymphadenopathy,

with Albendazole lymphangitis and eosinophilia, elephantiasis
▪ Surgical removal of abscess of the legs and genitals (rare)
▪ Use of special boots “Unna’s phase boots” Treatment:
▪ Elastic bandages (reducing size of enlarged
limb) ▪ DEC (Diethylcarbamazine)

New Trend:
2. Brugia malayi
▪ Malayan Filariasis/Elephantiasis ▪ Brugia timori – can also cause Malayan
▪ Common name: Malayan filaria filariasis
▪ Microfilariae: ▪ Tropical Eosinophilia (Occult Filariasis) –
o Sheathed, round anterior end Pulmonary and asthmatic symptoms.
o Numerous nuclei Microfilariae resides in the lungs.
3. Loa loa
▪ Loiasis
Life cycle:
▪ Common name: African eye worm
▪ Microfilariae: ▪ Vector: Black fly (Simulium spp.)
o Sheathed ▪ Adult worms encapsulate in the
o Nuclei fill the organism subcutaneous fibrous tumors
o Nuclei at the tip of the tail ▪ Adult worms coiled and microfilariae
emerge
Laboratory diagnosis:
▪ Microfilariae -> infected nodules ->
▪ Giemsa-stained blood subcutaneous tissues -> skin -> eyes
▪ Corneal scrapings (adult worm)
Clinical symptoms:
▪ Knott technique
▪ Sample collection: 10:15am to 2:15 pm ▪ Severe allergic reactions, scratching (leading
(DIURNAL) to secondary bacterial infection)
▪ Lesions -> blindness (eyes)
Life cycle:
▪ Change in skin appearance (loss of elasticity
▪ Bite of Chrysops fly (vector) and location of nodules)

Clinical symptoms

▪ Pruritus/itchiness or localized pain,

Calabar swelling (anywhere in the
body).
▪ Circulating adult worms in the tissue
(no discomfort).
▪ Noticeable adult worms in the
conjunctiva of the eye/crossing under
the skin of the bridge of the nose

4. Onchocerca volvulus
▪ River Blindness, Onchocerciasis
▪ Common name: Blinding filaria
▪ Microfilariae:
5. Mansonella ozzardi
o Unsheathed
▪ Common name: New World Filaria
o Numerous nuclei
▪ Microfilariae:
o Found in subcutaneous
o Unsheathed
o No nuclei in tail (0)
o Numerous nuclei that do no extend
Laboratory Diagnosis: at the tip of long, narrowed,
tapered tail
▪ Giemsa-stained tissue biopsies
o Do not exhibit periodicity
▪ Skin snips
o No blood contamination
▪ Ophthalmologic examination using a slit
lamp
▪ PCR (low infection)
6. Mansonella perstans b. Masonella ozzardi
▪ Common name: Perstans Filaria
CESTODES
▪ Microfilariae:
o Unsheathed ▪ White to yellow
o Nuclei extend at the tip of the tail ▪ Multicellular worms
▪ Adult: ▪ Flat/Ribbon-like appearance
o Female is longer than male ▪ Flatworms or Tapeworms
o Resides in pleural and peritoneal ▪ Habitat: Small intestine
cavities ▪ No digestive tract

7. Dirofilaria immitis Morphology and Life cycle

▪ Common name: Dog heartworm 1. Egg (Hexacanth embryo/ Oncosphere)
▪ Common filarial parasite in dogs 2. Larval (1st larval stage – hooklets)
▪ Causes pulmonary diseases in humans 3. Adult worm (Scolex, neck, proglottids,
o Deadworms lodge in the pulmonary strobila)
vessels these infarcts are referred a. Scolex – site of attachment to
as “coin lesions” in chest intestine
radiography b. Proglottids - Segments
c. Strobila - Chain of segments
▪ Intermediate host – required for larval
development
▪ Hermaphroditic (self-fertilizing);
reproductive of both male and female
▪ Autoinfection (Hymenolepis nana)

1. Scolex (head) – attachment organ

a. Rostellum – Armed (with
hooks), Unarmed (without
hooks)
b. Suckers
2. Neck – region of growth
3. Proglottid – chain of segments (strobila)
a. Immature – no well-developed
reproductive structures
b. Mature (medial) and Gravid –
1. Lymphatic filariasis distal with ova
a. Wuchereria bancrofti
b. Brugia malayi Laboratory diagnosis:
c. Brugia timori ▪ Specimen:
2. Subcutaneous filariasis o Stool – eggs, gravid proglottids and
a. Loa loa scolex
b. Onchocerca volvulus o Biopsy of tissue – Echinoccocus
3. Serous/Body cavity Filiarisis granulosus
a. Mansonella perstans ▪ Serologic test
Pathogenesis and Clinical Symptoms: ▪ Finger-like

▪ Gastrointestinal discomfort, diarrhea and Life cycle:

abdominal pain
▪ Infective stage: Cysticercus larva
▪ Nausea, dizziness, headache and weight
▪ Diagnostic stage: Eggs and proglottids
loss
▪ Ingestion of raw/ undercooked beef/pork
▪ Intestinal obstruction and Vitamin B12 –
▪ Intermediate hosts:
Macrocytic anemia
o Cow/cattle (T. saginata) and pig (T.
o Diphyllobothrium latum
solium, T. asiatica)
▪ Liver and lung involvement, persistent
cough, localized pain, eosinophilia and Clinical symptoms
anaphylactic shock
o Echinococcus granulosus ▪ Diarrhea, abdominal pain, change in
appetite, slight weight loss, dizziness,
a) Taenia saginata nausea and vomiting
▪ Common name: Beef tapeworm ▪ Laboratory test: Eosinophilia
▪ Taeniasis – Beef tapeworm infection ▪ Cysticercosis (T. solium)
▪ Neurocysticercosis – headache, seizures,
b) Taenia solium confusion, ataxia and death
▪ Common name: Pork tapeworm Taenia asiatica
▪ Taeniasis – Pork tapeworm infection
▪ Has rostellum and hooks ▪ Common name: Asian tapeworm/Asian
taenia
▪ Acquired by eating raw pig liver
▪ Eggs: ▪ Clinical symptoms: abdominal pain, nausea,
o Roundish egg weakness, weight loss and headaches
o Hexacanth embryo with radial ▪ Treatment: Praziquantel
striations
o 3 pair of hooklets
o Yellow-brain shell (Embryophore)
o Nonembryonated/embryonated
▪ Scolex (distinguish)
o Equipped with four suckers
o T. solium
▪ Has rostellum and hooks
o T. saginata
▪ Lacks rostellum and hooks
▪ Proglottids 2. Hymenolopis diminuta
o Segments
▪ T. saginata – 1048 ▪ Common name: Rat tapeworm
▪ T. solium – 898 ▪ Hymenolepiasis
o Uterine branchers ▪ EGGS
▪ T. saginata – 15 to 30 o 3 pairs of hook
• Tree-like o Shell has distinct polar thickening
▪ T. solium – 7 to 15 and no polar filaments
 o Colorless embryophores ▪ Dipylidiasis
▪ Scolex ▪ Egg packets:
o 4 suckers, rostellum (no hooks) o 6-hooked oncospheres
▪ Proglottids: o Membrane-close packets
o Rectangular ▪ 5 to 3 eggs
o Mature segments contains both ▪ Scolex
female and male reproductive o 4 suckers
organs o Club-shaped armed rostellum
o Gravid proglottid: Sac-like uterus ▪ Proglottids
o “Pumpkin seeds/ melon
3. Hymenolepis nana
shaped”
▪ Common name: Dwarf tapeworm o Has both female and male
▪ Hymenolepiasis reproductive organs
▪ Eggs: o Eggs enclose in an embryonic
o Roundish to oval membrane
o 3 pairs of hooklets 5. Diphyllobothrium latum
o Polar thickening and polar filaments ▪ Common name: Broad fish Tapeworm
o Colorless embryophore ▪ Diphyllobothriasis
▪ Scolex ▪ Eggs:
o 4 suckers o Coracidium – ciliated larval
o Short rostellum stage
o One row of hooks o Smooth yellow to brown shell
▪ Proglottids o Operculum
o Resembles H. diminuta o Abopercular knob (terminal
▪ Life cycle: knob)
o IS/DS: Embryonated egg
o Cysticercoid larvae -> intestine <-
adult worm
o No intermediate host is required
o Autoinfection
o Transport hosts: Fleas, beetles, rats
and house mice

▪ Scolex
o 4 cup-like suckers
o Almond/ spatulate spoon-
shaped
4. Dipylidium caninum o 2 prominent sucking grooves
▪ Common names: Dog/Cat Tapeworm, ▪ Proglottids
Pumpkin seed Tapeworm
 o Centrally located uterine SPARGANOSIS
structure
▪ Transmission
▪ Rosette formation
1. Water contamination with copepods
2. Medicines contaminated with infected
animal by-products
▪ Sparganum – infected subcutaneous tissue;
white, wrinkled, ribbon-shaped
▪ Treatment: Removal of sparganum and
Praziquantel
o Also used for treating
Schistosomiasis
6. Echinococcus granulosus
▪ Common name: Dog
Tapeworm/Hydatid Tapeworm
▪ Echinococcosis, Hydatid cyst, Hydatid
disease, Hydatidosis
▪ Eggs: (Resemble Taenia spp.)
▪ Hydatid Cysts:
o Larval stage (human tissues)
o Daughter cysts
o Brood capsules, hydatid sand
Life cycle:

▪ Diagnostic stage: Unembryonated eggs

▪ Infective stage:
o Coracidium – Cyclops (1st IH)
o Procercoid – Fresh water fish (2nd
IH)
o Pleurocercoid – Man (final host)
▪ Paratenic host – large fish

Clinical symptoms:
▪ Adult
▪ Overall weakness, weight loss and o Scolex – 4 suckers with 36
abdominal pain hooks
▪ Vitamin B12 deficiency o Small neck
Treatment o 3 proglottids:
▪ Immature, mature and
▪ Praziquantel and Niclosamide gravid
Prevention and Control:

▪ Proper human fecal disposal, avoidance of

eating raw/ undercooked fish and thorough
cooking of all fish
 ▪ Lung involvement – chest pain, coughing,
shortness of breath
▪ Liver involvement – obstructive jaundice

Treatment

▪ Surgical removal of cysts

▪ Mebendazole, Albendazole and
Praziquantel

Prevention and Control

▪ Personal hygiene practices, discontinue

feeding canines with infected viscera,
prompt treatment of canines and
educational programs

7. Echinococcus multiocularis
▪ Accidental cause of hydatid cyst (Subartic,
Europe and India)
▪ Primary definitive host: Foxes
Laboratory Diagnosis
▪ Intermediate host: Rodents (mice and
▪ Biopsy samples – hydatid cysts fluid voles)
▪ Care in choosing method -> Anaphylaxis
Trematodes
▪ ELISHA, IHA and Western blot
▪ Bentonite Flocculation Test, Casoni test ▪ Commonly known as flukes, blood flukes
▪ Radiography, Computed Tomography (CT), (Schistosomes)
Ultrasound scan ▪ Hermaphroditic (self-fertilizing) – organ
o Liver and Lungs dwelling (internal organ- bile duct)
▪ Dioecious (separate sexes) - Schisotosoma
Life cycle:
▪ Intermediate host – Mollusks (snails)
▪ Infective stage: Embryonated eggs
Morphology
▪ Diagnostic stage: Hydatid cysts
▪ Accidental hosts/dead-end hosts – humans ▪ Morphologic stages: Eggs, multiple larval
▪ Intermediate hosts – sheep ▪ Lid-like structure – Operculum (Fasciolosis
▪ Definitive hosts – wild canines/ dogs and Fasciola)
▪ Eggs -> larvae -> intestine -> bloodstream -> ▪ Spines (Schistosoma spp.)
lung and liver o Terminal and Lateral
o Causes laceration (Hematuria)
Clinical symptoms
▪ Habitat: Intestine, bile duct, lungs and
▪ Enlargement of cysts -> necrosis of infected blood vessels
tissue
Life cycle:
▪ Rupture of cysts -> process of biopsy
procedure ▪ Mode of transmission: Ingestion of
▪ Anaphylactic shock, eosinophilia, allergic metacercaria (water plants – water
reactions and death chestnuts, fish, crab and crayfish)
▪ Metacercaria -> intestine, bile duct, lung
(adult stage)
▪ Eggs:
▪ Eggs -> feces/sputum -> fresh water
o Oblong undeveloped miracidium
(miracidium hatches) -> penetrates to the
o Operculum
snails (1st IH) -> Sporocysts -> Rediae ->
▪ Adult:
Cercariae
o F. buski – no shoulder
▪ Cercariae: Encyst on water plants, fish, crab
o F. hepatica – with shoulder
and crayfish (2nd IH)
Laboratory diagnosis:
Life cycle:
▪ Stool – recovery of eggs
▪ Penetration of cercariae in the skin
▪ Fasciola
▪ Schistosomule -> blood vessels (liver,
o Enterotest, ELISA and Gel diffusion
intestine and bladder
▪ Dioecious -> copulation -> eggs -> Life cycle:
urine/feces -> miracidium -> sporocysts ->
cercariae (Snail – IH) ▪ F. buski adult – resides in the small intestine
▪ F. hepatica adult – resides in the bile ducts
Laboratory Diagnosis:
Epidemiology
▪ Specimen
o Feces ▪ Mode of transmission: Ingestion of raw
o Duodenal aspirate water plants
o Recta biopsy ▪ Reservoir host: Rabbits, pigs and dogs
o Sputum ▪ Food sources: Water chestnuts, lotus and
o Urine water caltrop
▪ Eggs and adults worms (can be recovered). ▪ Fasciola hepatica (sheep and cattle)
▪ ELISA – blood flukes (Schistosoma spp.) 1. Natural host – sheep
2. Accidental host – humans
Pathogenesis and Clinical Symptoms
Clinical symptoms
▪ Eosinophilia
▪ Allergic and toxic reactions ▪ Fasciolopsiasis
▪ Tissue damage o Abdominal discomfort,
▪ Jaundice inflammation and bleeding in the
▪ Diarrhea infected area, jaundice, diarrhea,
gastric discomfort and edema
1. Fasciolopsis and Fasciola spp. o Malabsorption syndrome, intestinal
obstruction and death
Fasciolopsis buski ▪ Fascioliasis
o Headache, fever, chills, pain in liver
▪ Common name: Large intestinal fluke
area, eosinophilia, jaundice, liver
▪ Fasciolopsiasis
tenderness, anemia, diarrhea and
Fasciola hepatica digestive discomfort
o Biliary obstruction
▪ Common name: Sheep liver fluke
▪ Fascioliasis, sheep liver rot
▪ Halzoun
o Pharyngeal fascioliasis
o Laryngopharyngitis due to eating of
raw infected liver of sheep and goat
-> young adult attach to pharynx ->
asphyxia

Fasciola gigantica

▪ Common name: Giant liver fluke, Tropical

liver luke
▪ 1st and 2nd IH – same with Fasciola hepatica
▪ 1st – SNAIL
▪ 2nd – Water plants (kangkong)

2. Clonorchis sinensis

▪ Common name: Chinese liver fluke

▪ Clonorchiasis

▪ Eggs:
o Miracidium
o Operculum Laboratory diagnosis
o Thick rim (shoulders) ▪ Eggs or duodenal aspirates
o Small knob ▪ Adult worms (removed during surgery or
autopsy procedure)

Life cycle:

▪ Ingestion of undercooked fish with encysted

metacercariae
▪ Maturation – liver
▪ Adult worm – bile ducts
3. H. heterophyes / M. yokogawai

Heterophyes heterophyes

▪ Common name: Heterophid fluke

▪ Heterophyiasis
▪ Adults:
o Flattened Metagonimus yokogawai
o Lancet shaped ▪ Common name: Heterophid fluke
o Hermaphroditic ▪ Metagonimiasis
o Oral and ventral suckers are small
Laboratory diagnosis

▪ Stool samples

Life cycle
 1. Ingestion of contaminated undercooked Laboratory Diagnosis
fish
▪ Sputum samples – recovery of egg
2. Adult worms – reside in the small
intestine Life cycle:

4. Paragonimus westermani ▪ Ingestion of undercooked crayfish/crabs

▪ Common name: Oriental Lung fluke ▪ Immature flukes -> intestinal wall ->
▪ Paragonimiasis/Pulmonary distomiasis peritoneal cavity -> diaphragm -> Lung
▪ Eggs: tissue (encystation)
o Miracidium (thin shell) ▪ Reservoir hosts: Pigs and monkeys
o Operculum ▪ 1st IH – Brotia aspirate (snail)
o Terminal shell thickening ▪ 2nd IH – Sundathelpusa philippina,
o Opercular rim (shoulders) Parathelphysa mistio, Sundathelphysa
grapsoides (crabs)

Clinical symptoms:

▪ Mimics pulmonary tuberculosis

▪ Pulmonary discomfort – cough, fever, chest
pain, increased production of “blood-
tinged” sputum and Hemoptysis
▪ Chronic bronchitis, eosinophilia and fibrous
tissue
▪ Cerebral paragonimiasis
o Seizures, visual difficulties and
decreased precision of motor skills

5. Schistosoma spp.
▪ Adult: ▪ Schistosoma mansoni
o Oval o Common name: Mansoni’s fluke
o Red to brown colored ▪ Schistosoma japonicum
o Cuticle (spines) o Common name: Blood fluke
o Leyte, Samar, Sorsogon
▪ Schistosoma haematobium
o Common name: Bladder fluke
▪ Blood flukes – targets the veins

A. Schistosoma mansoni
▪ Eggs:
o Oblong
o Large Lateral spine (MAlaki)
o Anterior end is tapered and slightly
curved
▪ Mesenteric veins
B. Schistosoma japonicum Life cycle:
▪ Small
▪ Penetration of cercariae in the skin ->
▪ Roundish
schistosomula (bloodstream – maturation)
▪ SMALL LATERAL spine
o Swimmer’s itch
▪ Veins (intestinal tract – S. mansoni and S.
japonicum)
▪ Veins (bladder – S. haematobium)

Epidemiology:

▪ RH – monkeys, cattle, other livestock,

rodents, dogs and cats
▪ Schistosoma japonicum – Philippines
▪ Transport of organism – slave trade

Clinical Symptoms:

▪ Inflammation at the cercaria penetration

site
▪ Acute infection – abdominal pain, fever,
C. Schistosoma haematobium chills, weight loss, cough, bloody diarrhea
▪ Eggs: and eosinophilia
o Oblong ▪ Painful urination and hematuria (S.
o Large, prominent haematobium)
o TERMINAL spine ▪ Development of necrosis, lesions and
granulomas
▪ Obstruction of the bowel ureters,
secondary bacterial infections and CNS
involvement
▪ KATAYAMA FEVER
o Systemic hypersensitivity reaction
the schistosomulae
o Rapid onset of fever, nausea,
myalgia, malaise, fatigue, cough,
diarrhea and eosinophilia
▪ Adults:
▪ NEPHROTIC SYNDROME
o Separate sexes
o S. japonicum/ haematobium
o Male surrounds the female
▪ BLADDER CANCER
o Thin female resides in the
o S. haematobium
gynecophoral canal of the thicker
▪ SALMONELLA INFX.
male
o S. mansoni /japonicum
Laboratory Diagnosis ▪ SWIMMER’S ITCH
o Accidental infection with cercariae
▪ Stool and rectal biopsy (S. mansoni and S. o Penetration of fork-tailed cercariae
japonicum) in the skin
▪ Urine (S. haematobium)
 o Severe allergic reactions and
secondary bacterial infections
o Topical medications

Treatment:

▪ Praziquantel
▪ Oxamniquine (S. mansoni only)

Prevention and Control

▪ Proper human waste disposal, control of

snail populations, avoidance of human
contact in contaminated water and
educational programs
▪ Mass treatment

6. Opistorchis felineus
▪ Common name: Cat liver fluke
▪ 1st IH - Bulimus pentacolata (snail)
▪ 2nd IH – Barbus barbus, Tinca tinca (fish)

7. Echinostoma ilocanum
▪ Common name: Garrison’s fluke
▪ 1st IH and 2nd IH – Pila luzonica – snail
▪ Eggs: Straw-colored