Helmentic infections:

Dr.Mohamad Shaikhani.

Helmenths:
Roundworms(Nematodes).
Human intestinal nematodes(enterobius vermicularis,
Ascaris,Necator, Ancylostma, strongylodes).
Tapeworms(cestodes).
Intestinal: Tenia,diphylobothrium,hymenolepis.
Tissue cysts & worms: echiniccoccus(hydatid cysts),
tenia solum(cysticercosis).
Trematodes(flukes).
Blood:Shistosoma(bilharzia).
Lung:paragonimus.
Hepatobiliary:Fasciola.
Intestinal:Fasciolopsis.

Roundworms(Nematodes).
Thread worms(enterobius vermicularis)

Life cycle: mouth, small inetstine,

colon.
Clinial features: Ova around the
anus(pruritis),in females
genetalia,autoinfection common.
Diagnosis:Ova deteted by adhesive
celophane tape on perineum or perianal
swab.
Management: Treat all infected family,

Roundworms(Nematodes).
Round worms(asaris lumbricoides)
Life cycle: mouth, small
inetstine,lungs, small intestine.
Clinial features: abdominal pain, if
heavy malnutrition, I.O, Jaundice,
appendisitis, passed by mouth or
rectum.
Diagnosis:Ova in faeces, adult worm
passes or seen on OGD, Ba.
Management: Drugs, surgery for

Roundworms(Nematodes).
Round worms(asaris lumbricoides)

Roundworms(Nematodes).
Wip worms(Trichuris trichura)
Life cycle: mouth, small inetstine,
colon.
Clinial features: Asymptomatic,
diarrhea, rectal prolapse, growth
retardation.
Diagnosis:Ova in faeces, adult worm
passes or seen on OGD, Ba.
Management: Drugs, personal hygein.

Roundworms(Nematodes).
Hook worms( Ancylostomiasis)
Life cycle: larva in soil penitrate skin,
lungs, bronhi, swallowed, SI.
Clinial features: Dermatitis, pulmonary
infiltration with cough & even
hemoptysis, epigastric pain, ulcer like
symptoms, anemia due to blood loss,
malnutrition.
Diagnosis:Ova in faeces.
Management: Drugs, blood & iron.

Treatment for common intestinal

nematodes.
Asaris

Hook

E.V

+++

+++

Trichuri Strongyloid
es
s
-

Pyrante +++
l
Oxantel Mebendazol
++
e

++

+++

++

+++

+++
++

Albendazo
le

++

++

++

Thiabendaz
ole

++

++

++

+++

Piperazin
e

Cestodes(Tape worms).
Taenia saginata:
Acquired by eating uncooked beef meat.
Giant , several meters long.
Ova of T.saginata & solium are the same.
Adult worm live

in SI.
Mainly asymptomatic.
Segments are passed with stools or seen on clothes.
Praziquantel is the drug of choice.
Niclosamide is also used.
Prevention: beef inspection & Cooking .

Cestodes(Tape worms).
Taenia solium & cysticercosis:

Acquired by eating uncooked pork meat.

Smaller than saginata.
Adult worm live

in SI.
Mainly asymptomatic.
Segments are passed with stools or seen on clothes.
Praziquantel is the drug of choice for intestinal worms.
Niclosamide is also used.
Prevention: pork meat inspection & Cooking, personal hygiene to
avoid autoinfection by ova which leads to ystcercosis .

Cestodes(Tape worms).
Taenia solium & cysticercosis:

Cysticercosis: the larva acquired by ova autoinfetion or regurgitation

from the adult worm in the intestine ,may penitrate the stoamch wall &
go to develop as cysts in muscles, skin&brain(epilepsy,hydrocephalus).
Diagnosis: ova in stool, CT & MRI for brain cysts,ELISA test for
antibody detection.
Treatment of cysticercosis is by praziquantel or albendazole combined
with prednisolone to prevent brain edema & antiepilepti drugs are given
to prevent fits untill full recovery.

Cestodes(Tape worms).
Echinococcus granulosus &
multilocularis(hydatid cysts):

Acquired by ingesting ova passed with dogs(granulosus type) or wild

animal faeces( foxes, wolves in multilocularis type) into green

vegetables which develop into cysts in the liver, lungs, bones, brain or
any other body sites.
The multilocularis type behaves as malignant disease.
Prevention: Treatment of Domestic dogs, washing of vegetables.
Diagnosis: chest X ray, U/S, CT, MRI to detect cysts in tissues, CF test
& ELISA to detect parasite antigenes.
Surgery to remove cysts.

Cestodes(Tape worms).
Echinococcus granulosus &
multilocularis(hydatid cysts):

Drugs are not so effective, although albendazole in high doses for long

time & praziquantel are given perioperatively to reduce spillage & in

inoperable cases.

Humans
Accidental Intermediate Host

Cestodes(Tape worms).
Echinococcus granulosus &
multilocularis(hydatid cysts):

Cestodes(Tape worms).
Echinococcus granulosus &
multilocularis(hydatid cysts):
Taenia saginata
Adult worm

Scolex

Infected beef

D.

latum is the longest tapeworm in humans usually located in the

lower jejunum or upper ileum.
A typical worm is 415 m in length, 1020 mm in width.
It has an elongated scolex with two sucking grooves, a thin neck &
30004000 proglottids, produce up to 1 million eggs each day that
excreted into the intestinal lumen & passed in feces.
The life-cycle is relatively complex, involves larval stages that
develop in water & in two intermediate hosts, fresh water
crustaceans& fish.
Humans are infected by eating raw fish.

Human cases restricted to Northern Europe, Canada , Alaska.

Can be single or multiple& may result in symptoms as fatigue, weakness,

parasthesia, diarrhea&craving for salt.

2% develop vit B12 deficiency, because of B12 absorption by the adult
worms & interference with the ileal absorption of cobalamins.
Diagnosis: made by the detection of eggs in feces
Treated with a variety of drugs including praziquantel.
Prevention: The infective larval forms in fish (plerocercoids), can be
readily killed by cooking fish at 55C for 5 min or by freezing for 872 h.

Trematodes(Fluke).
Shistosomiasis (Bilharziasis):

One of the most common causes of morbidity & mortality in tropical

areas, S.Hematobium in Iraq & other areas of middle east, S.Mansoni in

Egypt & other parts of Africa & S. Japonicum & Mekonji in south east
Asia.
Acquired by walking bare feet in water containing the infective form
cercaria.
Patients excrete the eggs by urination in water whih are hatched &
develop in fresh water snails into the infective stage ceraria.
After penitrating the skin, it goes throught he lungs, then caried by the
blood to their definte site where they live, the vesial plexus of veins in
Hematobium & the portal system & liver in other types.

Trematodes(Fluke).
Shistosomiasis (Bilharziasis):

Trematodes(Fluke).

Shistosomiasis (Bilharziasis): pathogenesis & clinical

features.

Stage

Time

S.Hematobium

Other types.

Cercarial
penitration

Days

Papular dermatitis.

Same

Larval migration&
maturation.

Week
s

Pneumonitis,myositis,hep
atitis,fever,eosinophilia,s
eroconversion.

Same.

Early egg
deposition.

Month
s.

Cystitis, hematuria
Immune complex
glomerulonephritis.

Colitis,hepatitis, Portal
HT
Same.

Trematodes(Fluke).

Shistosomiasis (Bilharziasis): pathogenesis & clinical

features.

Stage

Time

S.Hematobium

Other types.

Late egg
deposition.

Years.

UB, ureters fibrosis

calcification,Ca
Infection,stones,hydronephro
sis.

Colonic polyposis &

strictures,periporta
l firosis, portal
hypertension.
Same.

Pulmonary granulomas &

pulmonary hypertension.

Trematodes(Fluke).

Shistosomiasis (Bilharziasis): Diagnosis.

Urine & stool exam for terminal spined eggs in hematobium & lateral

spined eggs in other types.

Retal spine biospsy through proctoscpe or biopsy through
sigmoidoscope for egg inspection.
Radiography & U/S for complications.
ELISA test of blood to detect shistosomal antigenes.

Trematodes(Fluke).

Shistosomiasis (Bilharziasis): Treatment.

Type

Praziquantel Oxamniquin
e

Metrifonate

Mansoni

40mg/kg
once

15mg/kg*2*
2
days

Not useful

Japonicum

40mg/kg*2
in one day

Not useful

Not useful

Not useful

7.5mg/kg every
2 weeks * 3

Hematobium 40mg/kg
once

Trematodes(Fluke).

Shistosomiasis (Bilharziasis): prevention.

Avoid urination & defecation in water.
Erradication of snails.
Wearing of boots when contacting water.
Store water for 3 days before use as cercaria will die in 3 days.
Mass treatment of population.
All these are not beneficial in japonicum as there are other animal

reservior of infection which contaminate water by eggs.

A: Acute liver granuloma around S mansoni egg in liver.

B: Chronic liver granuloma around the remains of a schistosome egg
in liver, with dominant fibrous tissue.

C: Macrohaematuria due to ulceration of the bladder wall in

urinary schistosomiasis.
D: Ultrasonography of irregular bladder wall and polyp;
E: IVP showing bilateral hydroureter and hydronephrosis.

F: Severe bloody diarrhoea due to S mansoni.

G: 6-year-old boy with gross hepatosplenomegaly.
H: 19-year-old man with symptoms of chronic fibrotic liver schistosomiasis
splenomegaly, external varices, ascites, growth retardation.
I: ultrasonography of advanced periportal fibrosis &portal venodilatation;