dr. maramion intestinal_nematodes 2
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Intestinal NematodesTRANSCRIPT
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INTESTINAL NEMATODES
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ASCARIS LUMBRICOIDES
• Giant intestinal round worm• Ascariasis – intestinal• Loefer’s syndrome – pulmonary
• osmopolitan! endemic in t"e tropicsand su#tropics
• $%&' in(ected! )&* in Asia e+posed• ,re-alent. / – 0 yrs old m1( • Areas o( poor sanitation! crowded! (eces
used as (ertili2er
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A. lumbricoides
• Adult.
– Male $34&$cm! (emale 554&/cm
– Smoot" 6nely striated cuticle
– onical anterior7posterior e+tremeties
– 8entrally cur-ed posterior end o( malewit" 5 spicules
– ,aired reproducti-e or9ans in (emale!sin9le in male
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A. lumbricoides
• E99.
a% :ertile e99s. ;/4)3um + &/4/3um
–
Outer coarsely mammilated al#uminousco-erin9
– T"ic< transparent "yaline s"eat"7s"ell wit"t"ic< outer layer
–
Delicate -itelline lipoidal inner mem#erane=impermea#le>
'% In(ertile e99s. ??40;um + &04;;um! wit"re(ractile 9ranules
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Morphology
ylindrical wit" tapered ends
@"itis" strea<B
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$/4&3 cm
534;3 cm
:emale
Male
:
M
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:ertili2ed E99
)/ Ccm
'roadly o-oidal wit" t"ic< s"ell
Al#uminous coat
8itelline mem#rane
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n(ertili2ed e99 wit" no outer mamillated layer =decortic
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Unfertilized egg.Prominent mamillationsof outer layer.
Fertilized egg.
The embryo can be distinguisheinside the egg
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E99 containin9 a lar-a w"ic" will #e in(ecti-e i( in9est
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• A (emale may li-e in t"e intestine (or $5 to
$? mont"s and "as a capacity o( producin95/ million e99s at an a-era9e daily outputo( 533333%
• E99s are resistant to c"emical disin(ectantand sur-i-e (or mont"s in sewa9e #ut are<illed #y "eat =;3F (or $/ "ours>%
• omplete de-elopment o( lar-a reuires $?days
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• ,at"olo9y.• Immune reaction o( "ost
• Mec"anical eHects o( adult worms• EHects o( adult worms on t"e "ost
nutrition
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• linical presentation.• $% mi9ratin9 lar-ae. lun9s. Loefer’s pneumonitis!
Loefer’s syndrome – transient pulmonary
symptoms accompanied #y eosinop"ilia• 5% adult worm in t"e small intestine – Mild – Intermittent GI pro#lems
– "ronic in(ection. -illi atrop"y! elon9ation o(crypts! round cell in6ltrates in t"e lamina propria
• Nutritional impairment• Growt" impairment
•
&% aller9ic response• ;% complications. O#struction• Intussusceptions• Ectopic mi9ration
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•
La#oratory Dia9nosis.• Stool e+amination
– Direct (ecal smear
–
ato tec"niue 7 cellop"ane t"ic< met"od – ato at2 tec"niue or Modi6ed ato
tec"niue
•
Ancillary met"ods – '
– "est J4ray
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Treatment.• Supporti-e
•
Speci6c – Al#enda2ole. ;33m9 sin9le dose
– Me#enda2ole. /33m9 sin9le dose
– ,yrantel palmoate. $3m97<9 =ma+% $9m
4 ,ipera2ine citrate. $/3m97<9 initially(ollowed #y K/m97<9 at $5"rsinter-als (or erratic worm mi9ration
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Enterobius vermicularis
• A%<%a pinworm seatworm or societyworm
• osmopolitan distri#ution
• An ur#an disease o( c"ildren in
crowded en-ironment%
• Adults may 9et it (rom t"eir c"ildren%
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MO,OLOG
2-5 mm8-! mm
"ur#ed posterior en
"ephalic alae
Pointed posterior end
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$op-sided% Plano-con#e&%'-shaped
"olorless shell
5(-)( *m
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$+F, ""$,
,mbryonated are ingeste
atched in the duodenu
Matures in the ileum
/dults reach cecum and co
0ra#id female migrateto the perianal region
to deposit eggs
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• Em#ryonated e99s 4 in(ecti-e sta9e
• A 9ra-id (emales contains more t"an $3333e99s
•
E99s mature in an o+y9enated moisten-ironment and are in(ectious & to ; "ourslater%
• Man4to4man and auto in(ection are common%
• Man is t"e only "ost%
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Entero#ius -ermicularis adults in section o( appendi+
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1ymptoms•
Entero#iasis is relati-ely innocuous andrarely produces serious lesions%
• T"e most common symptom is perianal
perineal and -a9inal irritation caused #y t"e(emale mi9ration%
• T"e itc"in9 results in insomnia and
restlessness%
• In some cases 9astrointestinal symptoms=pain nausea -omitin9 etc%> may de-elop%
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'iagnosis
• Dia9nosis is made #y 6ndin9 t"eadult worm or e99s in t"e perianalarea particularly at ni9"t%
• Scotc" tape or a pinworm paddle isused to o#tain e99s%
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Treatment and "ontrol
• Two doses =$3 m97<9! ma+imum o( $9 eac"> o( ,yrantel,amoate two wee<s apart 9i-es a -ery "i9" cure rate%
• Me#enda2ole is an alternati-e%
• T"e w"ole (amily s"ould #e treated to a-oidrein(ection%
• 'eddin9 and underclot"in9 must #e saniti2ed #etweent"e two treatment doses%
• ,ersonal cleanliness pro-ides t"e most eHecti-e inpre-ention%
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TRICHURIS TRICHIURA
+P34M
,pidemiology
•
A tropical disease o( c"ildren =/ to $/yrs> in rural Asia =K/* o( t"e /334)33million cases>%
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Morphology
• T"e (emale or9anism is /3 mm lon9 wit" aslender anterior =$33 micrometer diameter>and a t"ic<er =/33 micrometers diameter>posterior end%
• T"e male is smaller and "as a coiledposterior end%
• T"e Tric"uris e99s are lemon or (oot#alls"aped and "a-e terminal plu9s at #ot"ends%
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Tric"uris tric"iura adult male and (emale
@"ip4li<eB
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'arrel s"aped Two polar plu9s ellow #rown e+ternal layer
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• Met"od o( transmission. in9estion o( in(ecti-e e99 wit" L$•
Li(e cycle. a-era9e o( &333 – 53333 e99s7day• Li(e span. $ year
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linical ,resentation
• Asymptomatic• lassical tric"uriasis wit" dysentery
syndrome• "ronic tric"uriasis = P$ year>• Growt" stuntin9! malnutrition• ectal prolapse• Tenesmus• Geop"a9ia• :in9er clu##in9 =anemia! su#stance
secreted #y parasite>• "ronic #loody mucoid stools•
A#dominal pain
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,at"olo9y.• Anterior portions o( t"e worms
em#edded in t"e mucosa• esem#les ulcerati-e colitis
• Aller9y
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La#oratory Dia9nosis.• Stool e+amination.
• Direct (ecal smear
•
ato cellop"ane t"ic< smear• ato4<at2 tec"niue. e99
countin9 to determine cure rate
e99 reduction rate and intensityo( in(ection
• Stool concentration = acid et"er!
(ormalin et"er>
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Treatment.
• Al#enda2ole. ;33 m9 sin9le dose
•
Me#enda2ole. /33 m9 sin9le doseQ $33 m9 #id (or & days
• ,yrantel palmoate
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OOOMS•
Ancylostoma duodenale OLD world• !ecator americanus NE world
• A. duodenale: Europe! Sout"western Asia
• N. americanus: A(rica America
• oo<worm in(ection7 disease
• osmopolitan tropical and su#tropicalareas
• 033 million in(ected
•
/3333 deat"s annually due to anemia
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:actors aHectin9 pre-alence.• ontinuous presence o( in(ection
• De(ecation "a#its
• Appropriate en-ironmental conditions• 4 temperature! rain(all! s"aded!
sandy soil
• Opportunity (or in(ecti-e sta9e tocome in contact wit" t"e s<in o( man
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Morp"olo9y.Adult.
• N. americanus . 04$$mm + 3%&/mm
. small cylindrical (usi(orm 9rayis"
. #uccal capsule "as a -entral pair o(
uttin9 plate
• A.duodenale
. #uccal capsule "as two pairs o(
cur-ed -entral teet". #i99er t"an N. americanus
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Ancylostoma duodenale adult
Males are 9enerally smallit" a dilated posterior p – @#ursa copulatri+B
:emale Male
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Necator americanus adult (emale anterior end
Semilunar cuttin9 plates
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Scannin9 electron micro9rap" o( t"e oral openin9 o( Ancylostomaduodenale anot"er species o( "uman "oo<worm% Note t"e presence o(
(our cuttin9 Rteet"R two on eac" side%
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Necator americanus adult male posterior end
'ursa is wide and lon9
,air o( "air li<e copulatory spicules@'ar#ed tipB'ipartite dorsal rays
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• Lar-a. resem#les lar-a o( S% stecoralis
4usually lar9er wit" attenuate posteriorend
4r"a#diti(orm – L$
4r"a#diti(orm – L5
46lari(orm – L& -ia#le (or 5 wee<s
• E99s. #luntly rounded e99s and sin9le t"in
transparent "yaline s"ell• 4e+creted in t"e (eces in early clea-a9e
sta9e "atc" in $45 days
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oo<worm 6lari(orm lar-ae=In(ecti-e sta9e>
losed mout":ili(orm esop"a9us
@s"eat"edB,ointed ends
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O-al or ellipsoidal s"ape T"in transparent s"ellontains an em#ryo
Li(e ycle
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Li(e ycle
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linical ,resentation.
•
utaneous. @9round itc"B @dew itc"B –reepin9 eruption =LM>
–S<in entry o( 6lari(orm lar-ae
• ,ulmonary. Loefer’s syndrome
–Lar-al lun9 in(ection
• Intestinal in(ection.
–Acute "ea-y
–"ronic "oo<worm
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oo<worm Disease• Microcytic "ypoc"romic anemia (rom
"oo<worm in(ection =>stoole+amination – A% duodenale. 3%5ml #lood7worm7day
– N%americanus. 3%3& ml7#lood7worm7day
• ,ro9ressi-e secondary microcytic"yoc"romic anemia o( iron4de6ciency
type due to continous #lood loss• ypoal#uminemia due to loss o(
#lood lymp" and protein
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La#oratory Dia9nosis.
A% Stool e+amination• Direct (ecal smear. low yield
• oncentration tec"niue!
–
inc Sul(ate entri(u9al :loatation – :ormalin4Et"er Met"od
'% Stool ulture.
•
arada Mori. culture met"od allowin9"atc"in9 o( lar-a (rom e99s on stripso( 6lter paper wit" one end immersedin water
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Treatment.• Me#enda2le. $33m9 #id + &days or
/334K33m9 sin9le dose• Al#enda2ole. ;33 m9 sin9le dose
• ,yrantel palmoate
• T"ia#enda2ole
STRO!"#LOIDES
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STRO!"#LOIDESSTERCORALIS
• A%<%a @T"readwormB
•
@oc"in4"ina diarr"eaB
• ,re-alent in tropical and su#tropical
areas wit" poor sanitation%
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Morphology
• as a (ree4li-in9 =r"a#diti(orm> andparasitic =6lari(orm> (orm%
• T"e r"a#diti(orm is t"e (eedin9 lar-alsta9e
• T"e 6lari(orm lar-a is t"e non (eedin9and in(ecti-e sta9e
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"a#diti(orm lar-a
U'roadly (usi(ormU,ointed and cur-ed tail wit" 5 spicules
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UDelicate loo<in9 V slender
ULon9 and capillary esop"a9usUlosed mout"UNotc" or #i6d tail
$if l
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$ife cycle
•
"aracteri2ed #y t"ree =&> diHerentp"ases o( de-elopment$% Direct de-elopment cycle
5% Indirect de-elopment cycle
&% Auto in(ection cycle cycle
a% E+ternal#% Internal
i l l
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Direct De-elopment ycle WAdults worm =upper small intestines>
lay partially em#ryonated e99s
"a#diti(orm lar-ae are e+creted in t"e (eces
:ilari(orm lar-a =soil>
,enetrates "ost’s s<in
eac" capillaries – "eart – lun9sMi9rate in epi9lottis – swallowed
UMatures in t"e small intestines
di l l
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Indirect De-elopment cycleW E+creted "a#diti(orm lar-a
mature in soil
:ree4li-in9 adults copulates
and lays e99s
:ree4li-in9 r"a#diti(orm lar-a
Matures into adults :ilari(orm lar-a
A i ( i l
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Autoin(ection cycle W
"a#diti(orm lar-ain t"e small intestine
:ilari(orm lar-a
,enetrates s<inin perianal area
=E+ternal>
,enetrates t"esmall intestine
=Internal>
apillaries 444 eart 4444Lun9s
Matures in t"e small intestine
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,at"olo9y
A% utaneous sta9e.• Eryt"ematous serpin9inous pruritic
s<in =creepin9 eruptions>
•@Lar-a currensB – i( multiple
'% Lar-al (orm
• ,neumonitis
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% Adult.
• @oney4com#B lesions o( t"eintestine
• Diarr"ea and a#dominal pain
La#oratory Dia9nosis
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La#oratory Dia9nosis
• Stool e+amination –
D:S "as low yield =/3 e99s7day> – ulture. sand7c"arcoal tec"niue!
'aerman’s tec"niue! arada4Mori culture
• 'ody Xuids
– Duodenal aspirate. Enterotest – Sputum! urine! ascitic Xuid! S:
• Small #owel #iopsy
•
Serolo9y – I:A -s% =(> lar-a =?/403*>
– ELISA
• '. "ypereosinop"ilia
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Treatment.• A#enda2ole. as dru9 o( c"oice ;33m9
(or & days• T"ia#enda2ole. 5/ m97<9 in & di-ided
doses daily (or & days
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apillaria p"ilippinensis
Distri#ution. ,"ilippines V T"ailand
ost. Marine mammals4 de6niti-e "ost
6s". in9est e99s P
in(ecti-e lar-a in muscles =in &4; w<s>
Transmission. In9estion o( raw orundercoo<ed 6s"
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apillaria p"ilippinensis
apillaria p"ilippinensis
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apillaria p"ilippinensis
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apillaria p"ilippinensis
,at"o9enesis V linical Diease
4 adult. #urrow in t"e YeYunum wall
4 inXammation V -illi atrop"y
P pain diarr"ea mala#sorption
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apillaria p"ilippinensis
• Dia9nosis
4 e99s in (eces
• Traetment
4 Me#enda2ole. dru9 o( c"oice