Intestinal Nematodes
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- Words: 1,796
- Pages: 7
Date:
Dec 13, 2007 Subject: Microbiology
Page 1 of 7
Lecturer: Dra. Reyes Transgroup: eis*, mel, mr Topic: Intestinal Nematodes Mary Jam Dice Joyce Elaine Joanna Adi Ysa Peng Tinay Aaron Anne MRose Joshua Rain Mika Frenche Ams Karla Divs Rache Esther Joel Glenn
Hehe, uunahin ko na yung filler. =p Guys, based ‘to dun sa handout na binigay ni doc. Parang simpler version nung prior trans na binigay last week. Hayun. Ay, btw, nagloload na ko ulit. :D just text me. Ay chaka invite ko na din kayo may free concert ang RockSteddy front act Malayang Pilipino sa church po namin. Please tell me if you wanna come para I can give you tickets (punta na kyo!). Sa Feb 15 po siya, Friday, 7pm. It’s gonna be at Faith in Jesus Christian Fellowship Church, Las Pinas. I can give directions. Yun lang ulit. Thanks! Nematode
Ascariasis
• • • •
Ascaris lumbricoides Largest nematode (roundworm) Female 20-35cm Male: 15-30cm Highest prevalence in tropical and subtropical regions, areas with inadequate sanitation
Clinical Features
• • • •
•
stunted growth (-) acute infections High warm burden: abdominal pain and intestinal obstruction Migrating adult worms: symptomatic occlusion of biliary tract or oral expulsion Lung phase of larval migration pulmonary symptoms: cough, dyspnea, hemoptysis, eosinophilic pnuemonitis (Loeffler’s syndrome)
Diagnosis
Microscopy: Diagnostic characteristics
•
Treatment
• • •
Albendazol e Mebendaz ole Pyrantel pamoate
Prevention
• • •
•
Educatio n Good personal hygiene Adequat e sanitatio n Avoid use of human feces as fertilizer
MICROBIOLOGY By: eis, mel, mr
INTESTINAL NEMATODES Dra. De Castro
Page 2 of 7 Dec 13, 2007
Size/sh ape
Unfertili zed
Fertilize d
Elongat ed, 90μm in length
Spheric al 60μm in diamete r Ovoid: 75μm
• • • • • •
Shell
Thinner
Thick
Mammil ated layer
Variable, large protuber ance or none
Externa l often, stained brown by bile, some: absent (decorti cate)
Eggs
Contain mainly a mass of refractil e granules
fertilized egg unicellular stage normally passed in the stool complete dev’t of larva in 18 days under favorable condition Unfertilized egg prominent mammilation of outer layer Fertilized egg embryo can be distinguished inside the egg Unfertilized egg with no out mammilated layer (decorticate) Fertilized eggs, embryo begins to develop
MICROBIOLOGY By: eis, mel, mr
INTESTINAL NEMATODES Dra. De Castro
Page 3 of 7 Dec 13, 2007
• • • • • • • •
Enterobiasis
Enterobius vermicularis • • • • •
Human pinworm Female: 8-13mm Male: 2-5mm Humans only host Frequent in school or preschool, crowded condition More common in temperate than tropical countries
• •
•
frequently asymptomatic nocturnal pruritus ani – lead to excoriations and bacterial superinfection occasionally: invasion of female genital tract vulvovaginitis pelvic/peritoneal granuloma anorexia, irritability abdominal pain
• • • •
• •
• • • Cappilariasis
• •
Cappilaria philippinensis Female 2.3-3.2mm Male 2.5-4.3mm
•
Currently considered a parasite of fish eating birds (natural definitive host) Endemic in the Philippines and Thailand Rare cases: other Asian countries, Middle East, Colombia
•
•
•
Abdominal pain, diarrhea
•
Protein losing enteropathy cachexia and diarrhea
• • • •
• •
Embryos in early stage of division (4-6 cells) Egg containing a larva Infective if ingested Adult ascaris: large and pink Length: 15-35cm Firm creamy cuticle Pointed extremities Female (+) genital girdle Perianal area: AM before defecation and washing Scotch test cellulose tape slide test on perianal skin Anal swabs or Swube tube eggs Less frequent in stools, occasionally urine/vaginal Adult worms: perianal area anorectal or vaginal exam Enterobius eggs
•
Pyrantel pamoate
•
Mebendaz ole Albendazol e
50-60μm x 20-32μm Tin walled ovoid and flattened on one side “D” shaped
stool exam intestinal biopsy eggs: larva and or adult worm Eggs are peanut shaped Measure 36-45μm in length x 21 μm in width (+) inconspicuous polar “plugs” and a striated shell
•
•
personal hygienelaunderi ng of bedding
MICROBIOLOGY By: eis, mel, mr
Strongyloidias is
INTESTINAL NEMATODES Dra. De Castro
• • •
• • Female
Male
Stongyloides stercoralis Smallest of intestinal nematodes Rural areas, institutional settings, lower socioeconomic group Acquired thru direct contact\ct of skin with soil dwelling larvae or ingestion of filariform contaminated food Facultative parasite Parasitic Free living Delicate filariform 2.2mm esophagus: 1/3 or 2/5 of the anterior part of the body parthenogenetic
Smaller 1mm short and stout double bulbed muscular esophageal pharynx
None
Broadly fusiform tail pointed and curved
Page 4 of 7 Dec 13, 2007
• •
• •
•
•
ventrad • • • • • •
frequently asymptomatic 3 phases of infection o Invasion of skin filariform o Migration of larvae thru the body o Penetration of intestinal mucosa by adult female worms Light infection: no intestinal symptom Moderate Infection: diarrhea alternating with constipation Heavy infection: intractable painless intermittent diarrhea numerous thin watery bloody Complication: edema, emaciation, loss of appetite, anemia, labor pneumonia, malabsorption Frequently asymptomatic GIT symptoms: epigastric pain, diarrhea Pulmonary symptoms: Loefller’s syndrome Pulmonary migration of filariform larvae Dermatology: urticarial rash in buttocks or waist area Massive huyperinfection/dissemin ted strongloides o Immunosuppres sed patient o Severe enterocoltis and widespread
•
• • • • • •
• •
• •
• • • •
Peptic ulcer like pain associated with peripheral eosinophilia strongly suggest diagnosis of stongyloidiassis Microscopy: larvae (rhabditifrom, filariform) Stool or duodenal fluid Wet mounts: Baermann funnel technique Harada Mori filter paper technique Culture: agar plate Enterotest string: duodenal aspiration Larva: sputum patient with disseminated strongyloidiasis Morphology of parasitic Filariform larvae o Long esophagus o No constriction of the esophagus o Long intestine o Esophagus equal in length to the intestine o Longer and more slender than rhabditoid o Nonsheathed Rhabditiform larva in wet mount after fixation in 10% Formalin Diagnostic characteristic Length 200-250μm Shot buccal cavity Prominent genital primordium Rhabditiform
• •
Ivermectin Albendazol e
•
•
Medical personn el caring for patients with hyperinfe ction syndrom es would wear gowns and gloves as stool, saliva, vomitus and body fluids may contain infectiou s filariform larvae Patients who have resided in an endemic area should be examine d for presence of this parasite before and during steroid treatmen t or immunos
MICROBIOLOGY By: eis, mel, mr
INTESTINAL NEMATODES Dra. De Castro
Page 5 of 7 Dec 13, 2007
o
o
dissemination to heart, lungs and CNS Abdominal pain distention, shock, pulmonary and neurologic complications septicemia Blood eosinophila: acute/chronic stage; (-) in dissemination
•
•
•
• • •
• •
Trichchuriasis
• • • • • • •
Tirchuris trichura Human whipworm Adult whipworm: 0-50mm in length Anterior 2/3 is thin and threadlike Posterior end is bulbous Tail; male-coiled: female – straight Tropical weather and poor sanitation practices
• • •
Most are asymptomatic Heavy infection GIT problem: o Abdominal pain, diarrhea, rectal prolapse, growth retardation
• • •
• • •
•
esophagus clearly visible in the larva Consists of a club shaped anterior portion, a post median constriction and a posterior bulb Antibody detection
uppressi ve therapy
Immunodiagnostic test: indicated when infection is suspected and organism cannot be demonstrated by duodenal aspiration \, string test or stool exam Derived from S. stercolais filariform larva EIIA 90% sensitivity (+) in immunocmopromised with disseminated stronglyoidiassis Cross reaction with filariasis and some nematode infection Ab levels decrease within 6 months post treatment Stool concentration methods to recover the eggs Moderate eosinophlia Rectal mucosa: protoscopy Trichuris eggs (wet preparation) has typical barrel shape 2 polar plugs that are unstained Size 50-54μm The external layer of the shell of the eggs is yellow brown in contrast to the clear polar plug
• •
Mebendaz ole Albendazol e
MICROBIOLOGY By: eis, mel, mr
Hookworm Infection
INTESTINAL NEMATODES Dra. De Castro
• •
•
Ancylostoma duodenale: old world hookworm Necator americanus: new world hookworm
Female
• • • •
Page 6 of 7 Dec 13, 2007
A. duodenale
N. americanus
10-13mm
9-11mm
Male
8-11mm
7-9mm
Transmissio n
Oral; percutaneou s
Percutaneo us
Temperatur e
Eggs and development al stages more tolerant of low T
Sensitive to low T
Infect: 900M Moist warm climate Local distribution: agricultural areas, rice field, vegetable garden Prevalence: 40-45% nationwide Factors that contribute to transmission o Suitable environment: damp, sandy or friable soil with decaying vegetation T 24-32 C o Mode and extent of fecal pollution of the soil unsanitary disposal of human feces use of night soil for fertilizer o Mode and extent of contact between infected soil and skin or mouth
•
• •
•
• •
Iron deficiency anemia: microcytic, hypochromic moderate of heavy chronic infection blood loss at the site of intestinal attachment of adult worm with cardiac complication Blood eosinophlia : 3060% GIT, nutritional, metabolic symptom, abdominal pain, steatorrhea, bloody/mucoid stools, edema, albuminuria Skin manifestation/ground itch/dew itch: penetration of filariform (L3) larvae (+) itching edema, erythema papulovesciular eruption x 2 weeks Respiratory symptom: pulmonary migration of larvae Bronchitis or pneumonitis, (+) minute hemorrhage with esonisohpilic and leukocytic infiltration
•
Eggs: unembryonated as eggs are passed in the stool
• •
adults: pinkish white head often curved in a direction opposite that of the body Males: unique fan shaped copulatory bursa Oral cavity: o A. duodenale: 4 sharp toothlike structure o N. americanus: dorsal and ventral cutting plates DFS (direct fecal smear) o Only when infection is heavy o May not detect parasite in light infection (400 eggs/gm feces) concentration methods: detect presence of egg o zinc sulfate centrifugal flotation o formalin ether method culture (harada mori): determine species Eggs are 57-76μm x 3547μm Oral or ellipsoidal shape Thin shells (Picture) The embryo began cellular division and is t an early
• •
•
•
• • • • •
•
• • • •
prioritize: pregnant women, children and patients with malnuitritio n, pulmonary TB and anemia Albendazol e Mebendaz ole Pyrantel pamoate Correct anemia: iron therapy
•
•
•
•
•
•
•
sanitary disposal of human feces wear shoes, slippers, boots health educatio n: personal, family and communi ty hygiene treatmen t of affected individua l mass chemoth erapy when incidenc e >50% protectio n of suscepti ble individua l natural food preserva tive substanc es: salt, sugar, acetic
MICROBIOLOGY By: eis, mel, mr
INTESTINAL NEMATODES Dra. De Castro
Page 7 of 7 Dec 13, 2007
•
• •
•
•
• • •
(gastrula) developmental stage Hookworm rhabdtiform larva on wet preparation has long buccal cavity, small genital primordium, constriction of esophagus It is larger than stornglyoides rhtabditoid More attenuated posteriorly than strongyloides rhabditiform Non-sheathed Hookworm filariform larva on wet prep has short esophagus, no constriction of the esophagus, long intestine Ration: esophagus intestine, 1:4 Longer and more slender than rhabtidoid stage (+) striations on the surface sheath
acid, onion garlic, mustard pepper spices: lethal to eggs and larvae
Dec 13, 2007 Subject: Microbiology
Page 1 of 7
Lecturer: Dra. Reyes Transgroup: eis*, mel, mr Topic: Intestinal Nematodes Mary Jam Dice Joyce Elaine Joanna Adi Ysa Peng Tinay Aaron Anne MRose Joshua Rain Mika Frenche Ams Karla Divs Rache Esther Joel Glenn
Hehe, uunahin ko na yung filler. =p Guys, based ‘to dun sa handout na binigay ni doc. Parang simpler version nung prior trans na binigay last week. Hayun. Ay, btw, nagloload na ko ulit. :D just text me. Ay chaka invite ko na din kayo may free concert ang RockSteddy front act Malayang Pilipino sa church po namin. Please tell me if you wanna come para I can give you tickets (punta na kyo!). Sa Feb 15 po siya, Friday, 7pm. It’s gonna be at Faith in Jesus Christian Fellowship Church, Las Pinas. I can give directions. Yun lang ulit. Thanks! Nematode
Ascariasis
• • • •
Ascaris lumbricoides Largest nematode (roundworm) Female 20-35cm Male: 15-30cm Highest prevalence in tropical and subtropical regions, areas with inadequate sanitation
Clinical Features
• • • •
•
stunted growth (-) acute infections High warm burden: abdominal pain and intestinal obstruction Migrating adult worms: symptomatic occlusion of biliary tract or oral expulsion Lung phase of larval migration pulmonary symptoms: cough, dyspnea, hemoptysis, eosinophilic pnuemonitis (Loeffler’s syndrome)
Diagnosis
Microscopy: Diagnostic characteristics
•
Treatment
• • •
Albendazol e Mebendaz ole Pyrantel pamoate
Prevention
• • •
•
Educatio n Good personal hygiene Adequat e sanitatio n Avoid use of human feces as fertilizer
MICROBIOLOGY By: eis, mel, mr
INTESTINAL NEMATODES Dra. De Castro
Page 2 of 7 Dec 13, 2007
Size/sh ape
Unfertili zed
Fertilize d
Elongat ed, 90μm in length
Spheric al 60μm in diamete r Ovoid: 75μm
• • • • • •
Shell
Thinner
Thick
Mammil ated layer
Variable, large protuber ance or none
Externa l often, stained brown by bile, some: absent (decorti cate)
Eggs
Contain mainly a mass of refractil e granules
fertilized egg unicellular stage normally passed in the stool complete dev’t of larva in 18 days under favorable condition Unfertilized egg prominent mammilation of outer layer Fertilized egg embryo can be distinguished inside the egg Unfertilized egg with no out mammilated layer (decorticate) Fertilized eggs, embryo begins to develop
MICROBIOLOGY By: eis, mel, mr
INTESTINAL NEMATODES Dra. De Castro
Page 3 of 7 Dec 13, 2007
• • • • • • • •
Enterobiasis
Enterobius vermicularis • • • • •
Human pinworm Female: 8-13mm Male: 2-5mm Humans only host Frequent in school or preschool, crowded condition More common in temperate than tropical countries
• •
•
frequently asymptomatic nocturnal pruritus ani – lead to excoriations and bacterial superinfection occasionally: invasion of female genital tract vulvovaginitis pelvic/peritoneal granuloma anorexia, irritability abdominal pain
• • • •
• •
• • • Cappilariasis
• •
Cappilaria philippinensis Female 2.3-3.2mm Male 2.5-4.3mm
•
Currently considered a parasite of fish eating birds (natural definitive host) Endemic in the Philippines and Thailand Rare cases: other Asian countries, Middle East, Colombia
•
•
•
Abdominal pain, diarrhea
•
Protein losing enteropathy cachexia and diarrhea
• • • •
• •
Embryos in early stage of division (4-6 cells) Egg containing a larva Infective if ingested Adult ascaris: large and pink Length: 15-35cm Firm creamy cuticle Pointed extremities Female (+) genital girdle Perianal area: AM before defecation and washing Scotch test cellulose tape slide test on perianal skin Anal swabs or Swube tube eggs Less frequent in stools, occasionally urine/vaginal Adult worms: perianal area anorectal or vaginal exam Enterobius eggs
•
Pyrantel pamoate
•
Mebendaz ole Albendazol e
50-60μm x 20-32μm Tin walled ovoid and flattened on one side “D” shaped
stool exam intestinal biopsy eggs: larva and or adult worm Eggs are peanut shaped Measure 36-45μm in length x 21 μm in width (+) inconspicuous polar “plugs” and a striated shell
•
•
personal hygienelaunderi ng of bedding
MICROBIOLOGY By: eis, mel, mr
Strongyloidias is
INTESTINAL NEMATODES Dra. De Castro
• • •
• • Female
Male
Stongyloides stercoralis Smallest of intestinal nematodes Rural areas, institutional settings, lower socioeconomic group Acquired thru direct contact\ct of skin with soil dwelling larvae or ingestion of filariform contaminated food Facultative parasite Parasitic Free living Delicate filariform 2.2mm esophagus: 1/3 or 2/5 of the anterior part of the body parthenogenetic
Smaller 1mm short and stout double bulbed muscular esophageal pharynx
None
Broadly fusiform tail pointed and curved
Page 4 of 7 Dec 13, 2007
• •
• •
•
•
ventrad • • • • • •
frequently asymptomatic 3 phases of infection o Invasion of skin filariform o Migration of larvae thru the body o Penetration of intestinal mucosa by adult female worms Light infection: no intestinal symptom Moderate Infection: diarrhea alternating with constipation Heavy infection: intractable painless intermittent diarrhea numerous thin watery bloody Complication: edema, emaciation, loss of appetite, anemia, labor pneumonia, malabsorption Frequently asymptomatic GIT symptoms: epigastric pain, diarrhea Pulmonary symptoms: Loefller’s syndrome Pulmonary migration of filariform larvae Dermatology: urticarial rash in buttocks or waist area Massive huyperinfection/dissemin ted strongloides o Immunosuppres sed patient o Severe enterocoltis and widespread
•
• • • • • •
• •
• •
• • • •
Peptic ulcer like pain associated with peripheral eosinophilia strongly suggest diagnosis of stongyloidiassis Microscopy: larvae (rhabditifrom, filariform) Stool or duodenal fluid Wet mounts: Baermann funnel technique Harada Mori filter paper technique Culture: agar plate Enterotest string: duodenal aspiration Larva: sputum patient with disseminated strongyloidiasis Morphology of parasitic Filariform larvae o Long esophagus o No constriction of the esophagus o Long intestine o Esophagus equal in length to the intestine o Longer and more slender than rhabditoid o Nonsheathed Rhabditiform larva in wet mount after fixation in 10% Formalin Diagnostic characteristic Length 200-250μm Shot buccal cavity Prominent genital primordium Rhabditiform
• •
Ivermectin Albendazol e
•
•
Medical personn el caring for patients with hyperinfe ction syndrom es would wear gowns and gloves as stool, saliva, vomitus and body fluids may contain infectiou s filariform larvae Patients who have resided in an endemic area should be examine d for presence of this parasite before and during steroid treatmen t or immunos
MICROBIOLOGY By: eis, mel, mr
INTESTINAL NEMATODES Dra. De Castro
Page 5 of 7 Dec 13, 2007
o
o
dissemination to heart, lungs and CNS Abdominal pain distention, shock, pulmonary and neurologic complications septicemia Blood eosinophila: acute/chronic stage; (-) in dissemination
•
•
•
• • •
• •
Trichchuriasis
• • • • • • •
Tirchuris trichura Human whipworm Adult whipworm: 0-50mm in length Anterior 2/3 is thin and threadlike Posterior end is bulbous Tail; male-coiled: female – straight Tropical weather and poor sanitation practices
• • •
Most are asymptomatic Heavy infection GIT problem: o Abdominal pain, diarrhea, rectal prolapse, growth retardation
• • •
• • •
•
esophagus clearly visible in the larva Consists of a club shaped anterior portion, a post median constriction and a posterior bulb Antibody detection
uppressi ve therapy
Immunodiagnostic test: indicated when infection is suspected and organism cannot be demonstrated by duodenal aspiration \, string test or stool exam Derived from S. stercolais filariform larva EIIA 90% sensitivity (+) in immunocmopromised with disseminated stronglyoidiassis Cross reaction with filariasis and some nematode infection Ab levels decrease within 6 months post treatment Stool concentration methods to recover the eggs Moderate eosinophlia Rectal mucosa: protoscopy Trichuris eggs (wet preparation) has typical barrel shape 2 polar plugs that are unstained Size 50-54μm The external layer of the shell of the eggs is yellow brown in contrast to the clear polar plug
• •
Mebendaz ole Albendazol e
MICROBIOLOGY By: eis, mel, mr
Hookworm Infection
INTESTINAL NEMATODES Dra. De Castro
• •
•
Ancylostoma duodenale: old world hookworm Necator americanus: new world hookworm
Female
• • • •
Page 6 of 7 Dec 13, 2007
A. duodenale
N. americanus
10-13mm
9-11mm
Male
8-11mm
7-9mm
Transmissio n
Oral; percutaneou s
Percutaneo us
Temperatur e
Eggs and development al stages more tolerant of low T
Sensitive to low T
Infect: 900M Moist warm climate Local distribution: agricultural areas, rice field, vegetable garden Prevalence: 40-45% nationwide Factors that contribute to transmission o Suitable environment: damp, sandy or friable soil with decaying vegetation T 24-32 C o Mode and extent of fecal pollution of the soil unsanitary disposal of human feces use of night soil for fertilizer o Mode and extent of contact between infected soil and skin or mouth
•
• •
•
• •
Iron deficiency anemia: microcytic, hypochromic moderate of heavy chronic infection blood loss at the site of intestinal attachment of adult worm with cardiac complication Blood eosinophlia : 3060% GIT, nutritional, metabolic symptom, abdominal pain, steatorrhea, bloody/mucoid stools, edema, albuminuria Skin manifestation/ground itch/dew itch: penetration of filariform (L3) larvae (+) itching edema, erythema papulovesciular eruption x 2 weeks Respiratory symptom: pulmonary migration of larvae Bronchitis or pneumonitis, (+) minute hemorrhage with esonisohpilic and leukocytic infiltration
•
Eggs: unembryonated as eggs are passed in the stool
• •
adults: pinkish white head often curved in a direction opposite that of the body Males: unique fan shaped copulatory bursa Oral cavity: o A. duodenale: 4 sharp toothlike structure o N. americanus: dorsal and ventral cutting plates DFS (direct fecal smear) o Only when infection is heavy o May not detect parasite in light infection (400 eggs/gm feces) concentration methods: detect presence of egg o zinc sulfate centrifugal flotation o formalin ether method culture (harada mori): determine species Eggs are 57-76μm x 3547μm Oral or ellipsoidal shape Thin shells (Picture) The embryo began cellular division and is t an early
• •
•
•
• • • • •
•
• • • •
prioritize: pregnant women, children and patients with malnuitritio n, pulmonary TB and anemia Albendazol e Mebendaz ole Pyrantel pamoate Correct anemia: iron therapy
•
•
•
•
•
•
•
sanitary disposal of human feces wear shoes, slippers, boots health educatio n: personal, family and communi ty hygiene treatmen t of affected individua l mass chemoth erapy when incidenc e >50% protectio n of suscepti ble individua l natural food preserva tive substanc es: salt, sugar, acetic
MICROBIOLOGY By: eis, mel, mr
INTESTINAL NEMATODES Dra. De Castro
Page 7 of 7 Dec 13, 2007
•
• •
•
•
• • •
(gastrula) developmental stage Hookworm rhabdtiform larva on wet preparation has long buccal cavity, small genital primordium, constriction of esophagus It is larger than stornglyoides rhtabditoid More attenuated posteriorly than strongyloides rhabditiform Non-sheathed Hookworm filariform larva on wet prep has short esophagus, no constriction of the esophagus, long intestine Ration: esophagus intestine, 1:4 Longer and more slender than rhabtidoid stage (+) striations on the surface sheath
acid, onion garlic, mustard pepper spices: lethal to eggs and larvae
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