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Common name of nematodes
Roundworms
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General look of adult nematodes
- Smooth
- Tapered ends
- Non-pigmented (pale)
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Polyparisitism
- Multiple nematode infections in endemic areas per patient
- Very common
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What lab values are associated with helminth infections?
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Filariform
- Nematode has esophagus of uniform caliber throughout
- Infective
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Rhabditiform
Nematode esophagus is expanded posteriorly into a bulb
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Ascaris lumbricoides - Where?
- Termperate and tropical areas
- 1/4 of world population infected
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Ascaris lumbricoides - Life Cycle?
- Infective egg containing larva ingested
- Larva bores into tissues to lungs
- Matures in lungs --> passed to intestine
- Adults are sexual reproducers
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Ascaris lumbricoides - Presentation?
- Pneumonitis possible when in lungs
- Lactose maldigestion
- Abdominal distention, tenderness
- Obstructed bowel***
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Ascaris lumbricoides - Diagnosis?
- O&P in stool
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Ascaris lumbricoides - Treatment?
Albendazole or mebendezole
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Enterobius vermicularis
Pinworm
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Enterobius vermicularis - Where?
- Temperate regions mostly
- Tropics also
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Enterobius vermicularis - Life cycle?
- Egg ingested, hatches in duodenum
- Lava develops in small intestine
- Adults live in cecum
- Female pass out anus to deposit eggs (frequent autoinfection)
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Enterobius vermicularis - Presentation?
- Anal pruritus
- Usually asymptomatic in GI
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Enterobius vermicularis - Diagnosis?
- O&P of stool
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Enterobius vermicularis - Treatment?
- Tap water enemas
- Albendazole
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Ancyclostoma duodenale
- Old World Hookworm
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Ancyclostoma duodenale - Where?
36N to 30S
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Ancyclostoma duodenale - Life Cycle?
- Filariform larva penetrates skin
- Matures in lungs
- Adults attach in small intestine
- Eggs passed in feces produce rhabditiform larva
- Molts in soil to filariform larva
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Ancyclostoma duodenale - Presentation?
- Flatulence and abdominal discomfort
- Nausea, diarrhea
- Anemia
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Ancyclostoma duodenale - Diagnosis?
- O&P of stool
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Ancyclostoma duodenale - Treatment?
Albendazole or mebendazole
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Necator americanus
- New World hookworm
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Necator americanus - Where?
Americas, Africa, India, S.E. Asia, Australia
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Necator americanus - Life Cycle?
- Filariform larva penetrates skin
- Matures in lungs
- Adults attach in small intestine
- Eggs passed in feces produce rhabditiform larva
- Molts in soil to filariform larva
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Necator americanus - Presentation?
- Pruritis at penetration
- Flatulence, abdominal discomfort
- Nausea, diarrhea
- Anemia
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Necator americanus - Diagnosis?
O&P of stool
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Necator americanus - Treatment?
Albendazole or mebendazole
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Cutaneous Larva Migrans
- Intense pruritus and creeping eruption from non-human hookworm penetration of skin
- Treat with albendazole or oral ivermectin
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Strongyloides stercoralis - Where?
- Worldwide
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Strongyloides stercoralis - Life Cycle?
- Free-living nematode
- Larva passed in feces
- Filariform larva penetrate skin --> lungs
- Adults live in intestinal tract, lay eggs
- Frequent autoinfection
- Can infect via breast milk
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What differentiates strongyloides from hookworm?
Stongyloides has shorter buccal cavity
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Strongyloides stercoralis - Presentation?
- Itch at penetration site
- Pneumonitis
- Diarrhea, malabsorption
- Melena
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Hyperinfection syndrome
Strongyloides involving only lungs and GI
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Disseminated strongyloidiasis
Seen in immunocompromised individuals
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Strongyloides stercoralis - Diagnosis?
- Serology
- Multiple stool O&P
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Zoonotic strongyloidiasis
Creeping eruption of skin penetrating non-human strongyloides
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Capillaria philippinensis - Where?
SE Asia
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Capillaria philippinensis - Presentation?
- Adult worms in jejunum
- Autoinfection
- Abdominal pain, gurgling, diarrhea
- Anasarca
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Capillaria philippinensis - Diagnosis?
Stool O&P
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Capillaria philippinensis - Treatment?
Albendazole or mebendazole
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Trichuris trichiura
- Whipworm
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Trichuris trichiura - Where?
Tropics worldwide
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Trichuris trichiura - Life cycle?
- Infective egg ingested - hatches in intestine
- Adults attach in cecum
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Trichuris trichiura - Presentation?
- Abdominal pain, distention
- Bloody or mucoid diarrhea
- Malabsorption
- Anemia
- Appendicitis via blockage
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Trichuris trichiura - Diagnosis?
Football shaped eggs in stool
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Trichuris trichiura - Treatment?
Albendazole or mebendazole
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Ivermectin treats?
Strongyloides and Ascaris
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Anisakiasis
- Infection with larval stages
- From consumtion of infected fish
- Treated with albendazole
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