Helminthes Table
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Cestodes (tapeworms/segmented) Cestodes Diphyllobothrium latum English name Fish tapeworm Mode of transmission to human and infective form Eating improperly cooked fish/crustaceans containing larvae Larvae grow to mature tapeworm in small intestine in 3 mo. Can be 10 meters Migration within human Production of pathology Diagnosis Definitive host Intermediate host Form transmitted from human Geographic foci Treatment T saginata Adult T solium Egg/larvae T solium Beef tapeworm Pork tapeworm Cysticercosis Ingesting fleas infected with larvae Ingesting larval form in undercooked beef Ingesting larval form in undercooked pork Ingesting egg ONLY from human feces Ingesting eggs ONLY from (canid) dog feces Grows in small intestine Grows in small intestine Grows in small intestine Penetrates GIany organ Penetrates GIhydatid cyst in lungs, liver, etc. -megaloblastic anemia, caused by ↓ B12 -abdominal discomfort, pruritic and diarrhea -appendicitis or cholangitis (from passage of eggs through GI) cystercosisskin, skeletal muscle, brain (10% of ER seizures) -hepatic/pulmonary involvement -rupture of cyst uticaria, eosinophilia Eggs/proglottids (operculated with knob at bottom) Eggs/proglottids in feces (colorless egg packets) Eggs or “gravid” proglottids in feces Ab detection, IgE, eosinophilia Ab detection, ultrasonography to look for hydatid cyst Humans, carnivores Humans, dog Humans Humans Humans Dogs Water flea and fish Fleas Ox, cattle Humans & pigs Humans & pigs Humans and livestock Fecal eggs Fecal eggs Fecal eggs Fecal eggs Worldwide worldwide worldwide worldwide worldwide Most frequent in sheep raising countries prazyquantel Surgery to remove cysterci, antiseizure medications Surgery to remove cyst, danger if cyst rupturesIgE/eosinophi lia prazyquantel Dipylidium caninum Helminthes- Hooman Golfeiz prazyquantel prazyquantel -appendicitis or cholangitis (from passage of eggs through GI) Eggs or “gravid” proglottids in feces Echinococcus granulosus Trematodes (flukes/nonsegmented) Trematodes S.mansoni & S.japonicum S. haematobium Faciola hepatica Lung fluke Liver fluke By contact through the skin by cercariae (from fresh water) Ingestion of raw crustaceans containing metacercariae Ingestion of metacercariae on water plants By contact with cercariae Penetrate skin (via HLA) lose tail to form schistosomulaeget in blood lay eggs in liverintestinal lumen/bladder Penetrate intestinal wallmigrate to lungs and lay eggssputumcan be swallowed & enter feces Penetrate walladults in hepatic biliary ducts Penetrate skinfail to form functional schistosomulum and die -acute: diarrhea, enalrged liver -chronic: intermittent block of biliary duct Inflammatory reaction in skin (small red spots) English name Mode of transmission to human and infective form Migration within human Production of pathology By contact through the skin by cercariae (from fresh water) Penetrate skin (via HLA)lose tail to form schistosomulaeget in bloodlay eggs in liverintestinal lumen/bladder -pathology caused by inflammatory response to dead eggs -portal hypertension, ascites, esophageal varices, liver fibrosis Cercarial dermatitis Wander Schistosoma Paragonimus westermani Hematuria in early disease, fibrosis of bladder and obstructive uropathy, renal failure, hydronephrosis -acute (invasion and migration): diarrhea, cough, IgE, eosinophilia -chronic (Pulmonary): discoloration of sputum from eggs -Eggs in stool/sputum -Immunodiagnosis possible DD from TB Diagnosis Eggs in feces Eggs in urine Definitive host Humans Humans Humans Humans, sheep, cattle Intermediate host Snails Snails Snails Snails Form transmitted from human Eggs (eggs produce proteases allowing tissue migration) Eggs (50% of eggs die within host tissue causing most of the pathology) Eggs Eggs Southeast Asia and Japan Sheep, cattle, consumption of raw watercress Pond swimmers prazyquantel Triclabendazole Antiinflammatory drugs Geographic foci Treatment prazyquantel prazyquantel Eggs in stool Birds Nematodes (roundworms/nonsegmented) Nematodes Enterovious Vermicularis Trichuris trichiura Ascaris lumbricoides Trichinella spiralis Dracunculus medinensis Necator/ancylostoma English name Pinworm Whipworm Largest worm Trichinosis Guinea worm Hookworm Ingestion of larvae in pork meat Ingestion of unfiltered water containing L3 larvae Flariform larvae penetrate skin Mode of transmission to human and infective form Migration within human Production of pathology Diagnosis Ingestion of Ingestion of embryonated Ingestion of embryonated eggs eggs embryonated eggs (eggs take ~6 hrs to (eggs take 3-4 (eggs take 2-4 wks to become mature) days to become become mature) mature) Intestinemigrate Intestinestay in Intestinelung/liver to perianal regions to cecum and lay tracheaepiglottis lay eggs eggs there swallowedintestine - often -often asymptomatic, -large numbers can asymptomatic, anemia, bloody cause pneumonitis and perianal pruritis diarrhea, mucous liver enlargement specially at night with heavy -IgE, eosinophilia infections -Eggs (purple) on -eggs in feces (thick -presence of eggs anal skin (scotchshell with (football) in tape test) mammillated layer) feces, NOT in -Sometimes also in -occasionally whole perianal region feces worms expelled Geographic foci Treatment -predilection for striated muscle, myocarditis potentially fatal, eosinophilia -based on clinical Sx (myositis) and IgE, eosinophilia -EIA, biopsy -skinmigrate via lung epiglottisswallowed -penetrate ~Ascaris & westermani GIfertilized female migrates -cutaneous-ground itch to surface of -pulmonary phase- local skinblister hemorrhage, and discharges eosinophilia larvae -intestinal phase-iron deficiency, anemia, pica -Eggs (ovoid with -painful blister, transparent shell) in with worm stool emerging as a -eosinophilia in whitish filament migratory phase -Humans, pork, mice Definitive host Intermediate host Form from human -small intestine mucosastriated muscle (tissue) Direct life cycle Direct life cycle Eggs Eggs The most common helminthic infection in the U.S. -temperate climate Pyrantel pamoate, Mebendazole, Albendazole -tropical climate, southern U.S. Mebendazole Direct life cycle Eggs, Largest nematode Most common helminthic infection worldwide -tropical climate -No drug once migrated, Mebendazole Larvae from blister Eggs Home-raised pork, wild boar, polar bear, fox Narrow belt of African countries Moist climates Steroids, Mebendazole, Albendazole Mechanically extract of worm Albendazole, Mebendazole, Pyrantel pamoate Nematodes English name Mode of transmission to human and infective form Migration within human Production of pathology Strongyloides stercoralis Wuchereria bancrofti Onchocerca volvulus Anisakiasis Toxocara cani/cati A. braziliense/A. caninum Threadworm Elephantiasis River blindness Wander worm Wander worm Wander hookworm Flariform larvae penetrate skin Transmission of larvae by mosquito bite Transmission of larvae by blackfly bite Ingestion of infection fish with larvae By ingestion of larvae By contact (dog/cat) BitesubQ nodules Produce microfilariaeskin and lymphs Larvae penetrates gastric and intestinal mucosa Tissue infection Punctuate keratitis, blindness, subQ nodules, Abdominal pain, severe eosinophilia Resembles Crohn’s disease Microfilariae in peripheral blood by Kit, marked eosinophilia in CBC -Microfilariae in skin snip biopsy, Ag/Ab -DEC patch testMazzotti rxn Gastroscopic examination and biopsy asymptomatic -Eosinophilia and + serology Ivermectin, doxycycline, surgery of hydrocele, elephantiasis Ivermectin, nodulectomy Surgical removal Albendazole Bitelymph - skinmigrate via lung Produce epiglottisswallowed microfilariaeblood -similar to hookworm and lymph except: eggs hatch in intestine before they are Hydrocelechyluria passed to feces, larvae Elephantiasis, can mature into tropical pulmonary flariforms in eosinophilia intestineautoinfection Diagnosis Rhabtidiform larvae in feces (NO eggs) Definitive host -Visceral larva migrans (fever, wheezing, hepatomegaly eosinophilia) -cutaneous larva migrans ( intensely pruritic) Monkeys, dogs Intermediate host Form transmitted from human Geographic foci Rhabtidiform larvae in feces Tropical, southern U.S. Treatment Ivermectin Self-limiting
