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USTMED ’07 Sec C – AsM
TRICHURIS TRICHIURIA
MORPHOLOGY:
• ADULT WORM
o Color: Flesh or pinkish colored slender worms
o Size:
1. Female – 3.5 to 5.5 cm
2. Male = 3.0 to 3.5 cm
Male is smaller than female
3. Anterior 3/5 o f the worm – fine
hair-like structure which forms the
esophagus
LIFE CYCLE OF TRICHURIS TRICHIURIA
Esophagus – is characteristically
embedded in glandular cells called
stichocytes
4. Posterior 2/5 of the worm contain
the intestine and reproductive
organs
Tail end:
Female – straight and blunt
Male – usually curved at 360o
• EGG
o Shape
- Barrel-shaped egg
- thick, smooth
brown egg shell and
2 transparent plugs
protruding from
both poles
o Size – measures 50 to 54
microns by 22 to 23 After copulation in the cecum
microns
1. Fertilized egg
Female worms start to lay eggs w/c are passed out with
feces and deposited in the stool in unsegmented form
2. Embryonated egg
Note:
Whipworms inhabit the large intestine where the entire
whiplike portion is deeply inserted into the wall of large
intestine. Because of this mode of attachment, it is much
harder to expel whipworm than ascaris by anti helmintics
DIAGNOSIS:
In the Philippines
- prevalence of trichiuris is 80-90% almost parallel with
Ascaris LIFE CYCLE OF CAPILLARIA PHILIPPINENSIS
- Most infections are light to moderate and seldom
produce clinical symptoms
- Trichiuris eggs are less resistant to adverse reaction than
Ascaris eggs
TREATMENT
A. Albendazole
- Dose – 400 mgs single dose
B. Mebendazole
- Dose – 500 mgs single dose or 100 mgs twice a day
for 3 days
C. Oxantel-Pyrantel
- Dose – 10-20 mgs per kg/body weight single dose
CAPILLARIA PHILIPPINENSIS
• intestinal capillariasis is a disease characterized by: Adult worms inhabit primarily in the jejunum and are
1. intestinal malabsortion threaded into the mucosa (Larvae and eggs are produced
2. chronic diarrhea by typical and atypical female worms)
3. Borborygmi
• first recognized in the Philippines in 1963 where the first
human case died in PGH
Eggs passed out in the feces embryonate in the fresh
• Origin: Bacarra Ilocos Norte
water in 3 to 5 days
• Order Trichurida
• Prevalence
1. Philippines
- Ilocos Norte Upon ingestion by fresh water fish, hatch in the intestine
- Ilocos Sur of fish. Larvae are found mostly in the gastric mucosa
- Cagayan and Intestines
- La Union
- Pangasinan
- Zambales
- Agusan del Norte When infected fish is ingested the worm’s mature in the
- Leyte host’s small intestine
2. Thailand
3. Japan
4. Iran
5. Egypt In 2 weeks, atypical females start producing larvae then
6. Taiwan grow into mature adult worms
MORPHOLOGY:
PATHOLOGY AND CLNICAL MANIFESTATIONS
• ADULT WORM
o Small worm A. Disease is characterized by:
1. Borborygmi or gurgling stomach
1. Female worm
2. Abdominal pain
• size: 2.3 to 5.3 mm by
3. Diarrhea
length
• larger than male B. Without Treatment the patient may experience
2. Male worm 1. Weight loss
• size: 1.5 to 3.9 mm by 2. Dehydration
3. Malaise o Matured encysted larvae have digestive tracts
4. Anorexia although the reproductive are not fully
5. Vomiting developed.
6. Anasarca
7. Muscle wasting
8. Cachexia
DIAGNOSIS
C. Other Manifestations
1. Malabsorption of fats and sugar • Clinical Diagnosis
2. Protein-losing enteropathy o History of eating raw or inadequetly cooked or
3. Low level of K, Ca++, Carotene improperly processed meat usually pork
4. Low plasma level of total protein o History of intestinal flu or rheumatic pain
o Marked eosinophilia in blood
D. Death is attributed to massive parasitic infection
resulting to: o Swollen eyelids or severe conjunctivitis
1. Electrolyte loss • Specific Diagnosis
2. Heart failure o Biopsy - free larvae or encapsulated larvae in
3. Septicemia secondary to bacterial infection skeletal muscle
o Xenodiagnosis
• PATHOLOGIC CHANGES o Bachman Intradermal test
a. Atrophy of the crypts of Liberkuhn
b. Flattened villi with lamina propia infiltrated by TREATMENT
plasma cells, lymphocytes and macrophages
• No established specific treatment
DIAGNOSIS: A. Thiabendazole
• by finding characteristic - Dose: 50 mg/kg/body weight
o eggs - Effect:
o larvae - may prevent the appearance of symptoms
o adult worms in stool if given from the second day after
• eggs can readily be seen in a simple fecal smear ingestion of infected meat
o concentration technique acid ether or - greatly mitigate the illness if drug is
formalin ether method given between the fifth and ninth day
after ingestion
B. ACTH or corticosteroid
EPIDEMIOLOGY: - treatment of allergic reaction
C. Mebendazole
- first recognized in 1963 - lethal effect
- 1,800 confirmed cases w/ 108 deaths LIFE CYCLE OF TRICHINELLA SPIRALIS
- male is affected twice than females
- Peak age: 20-49 years old
TREATMENT:
A. Mebendazole
- Dose: 200 mgs twice daily for 20 days
B. Albendazole
- Dose: 400 mgs daily for 60 days
TRICHINELLA SPIRALIS
• diseases:
a. Trichinosis
b. Trichiniasis
c. Trichinelliasis
MORPHOLOGY
• ADULT WORM
o Small worm
o Size
1. Male – 1.50 mm by 0.04 mm
2. Female – 3.50 mm by 0.50 by 0.06
mm
o Shape
- thread-like appearance
o characteristics
1. Anterior end
o provided w/ a small orbicular,
non-papillated mouth
o in female, Anterior fifth is
provided w/ a single ovary with
vulva and a long narrow
digestive system PATHOGENESIS
2. Posterior end
o Female: bluntly rounded
o Male: ventrally curved with 2 • Pathologic changes and the symptomatology are divided
lobular appendages into 3 stages:
• LARVAE 1. incubation or intestinal phase
o Has a spear-like burrowing tip at its tapering 2. acute or larval invasion
anterior end 3. chronic or encapsulated
o Measures 80-120 h by 5.6 u at birth
1. Intestinal Phase
- Inflammation of duodenal and jejunal mucosa: Early encapsulation 21 Myocarditis or
a. Malaise encephalitis appear
b. Nausea Intestine practically 23
c. Diarrhea free of adults
d. Abdominal cramps 26 Respiratory symptoms
Encapsulation 1 Month
2. Stage of Muscle Invasion practically complete
a. Fever 2 Fever subsides
b. Facial edema Maximum life of 3 Death from
c. Muscle pain, swelling and weakness worms in intestine myocarditis or
d. Peripheral eosinophilia encephalitis most
likely
• Less common symptoms: Cyst calcification may 6 Slow convalescence
a. headache begin
b. Flushing of face 8 Neurological
c. Conjunctivitis symptoms and
d. Pruritus myocarditis subside
e. Diaphoresis Cyst calcification may 1 year
f. Anorexia be complete
g. Thirst Larvae possibly still 6
viable w/in calcified
• Damage of muscle may cause difficulty in: capsules
a. Eye movement
b. Breathing PREVENTION
c. Chewing
d. Swallowing • smoking, drying and slating of meat are not effective
e. Speech
measures
f. Movement of extremities
A. Refrigeration at 5°F (-15°C) for not less than 20 days
• Myocarditis – appear as early as the second week but - at –10°F (for 10 days)
more ofteh after the third week. - at -20°F for 6 days
- Deep freezing
- Death from myocarditis usually occurs between the
fourth and eight weeks of infection. B. Avoid feeding raw garbage to hogs
- Encephalitis and meningitis may also occur at this C. Extermination of rats around the farms
stage D. Thorough cooking or deep freezing of all pork
3. Stages of Convalescence ENTEROBIUS VERMICUALRIS
- end of the 3rd week of infection where
encapsulation start to be seen • Seatworm or pinworm
• affecting 208 million population
• Habitat
o Cecum
o Appendix
o adjacent portion of ascending colon
o ileum
MORPHOLOGY
• ADULT WORMS
o Color: whitish or brownish
o Shape: spindle-shaped
SYMPTOMS
o Size: very small
1. Female: measures 8-13 mm by 0.3
1. Fever subsided to 0.5 mm
2. Muscular symptoms begin to decline 2. Male: 2 to 5 mm by 0.1 to 0.2 mm
3. If there is marked edemaàdiuresis may occur
4. Appetite return to normal
5. Malaise subsided
- myocarditis may still be present at this stage and
physical exertion may precipitate congestive heart
failure
- venous thrombosis and encephalitis
- eventually- when all symptoms subsided, the cyst wall
and larva itself calcify
o Posterior end
Biological Stage Beginning/Onset Clinical Conditions
1. Female: long sharp pointed end
Ingested larvae exist 2-4 hrs GI symptoms
in epithelium 24 2. Male: ventrally curved; has a single
Worms become 30 conspicuous copulatory spicule but
mature and mate lack gubernaculums
Females deposit 6 days
larvae, which invade o Anterior End
skeletal muscles - is a pair of lateral cuticular expansions
7 Edema of face and known as “lateral wings or cephalic alae”
fever - Another feature of pinworm adult is the
Maximum invasion of 10 Fever at max (40- presence of posterior esophageal bulb
muscle fibers 41oC)
11 Myositis and • EGGS
“rheumatic” pains o Size: 50-60 um by 20 to 30 um
Decrease in 14 Eosinophilia and o Shape: elongated, ovoid flattened on ventral
larviposting circulating antibody side giving a letter D appearance
Larvae in muscles 17 o Egg shell composed of 2 layers
fully differentiated 1. An outer thick hyaline albuminous
20 Eosinophilia reaches shell
maximum
2. Inner embryonic lipoidal membrane • Retroinfection, the eggs hatch in the perianal region and
the larvae migrate back into intestines
LIFE CYCLE OF ENTEROBIUS VERMICULARIS
TREATMENT
A. Mebendazole
- single dose of 100 mg tab for everyone above 2
years of age -à this is repeated after 2 weeks
B. Pyrantel pamoate
- Dose:
o 11 mg/kg orally (maximum of 1 g) as a single
dose
o a second dose should be given after 2 weeks
PREVENTION
1. Personal hygiene
2. Finger nail should be cut short.
3. Handwashing after using the toilet or before meal.
4. Bed linens and clothing of infected person should be
sterilized by boiling.
Adult worms inhabit the cecum where the head attached to
the intestinal wall
-fin-
In gravid female, the uteri packed with eggs and the body audsmartinez@gmail.com
becomes distended which makes the female releases its hold ustmedc3@yahoogroups.com
on the Intestinal wall and migrate down the colon and
out the anus to lay eggs on the perianal and perineal region
DIAGNOSIS
EPIDEMIOLOGY