Uterine Bell In Macrocanthorhynchus Hirudinaceus

HtftOPHtfelAl hiORAfl F*0* ITWATKI H Tliilrtl

UOM ai iKiM a*mt l

HltUdriLAtlAt ÎÏMIiJT

FUirMM L4KVAI f1!«*Tf Ta HOUH »*Tt 0« ntimn* m- m tfer

larvae rriKTUTi INTO viutr or iKlftT iKrtT

U»VA[ THtH fflttAtl ' T1 THOKACIt MUItl,ii

MICROFILARIA

Figure 4-36. Life cycle of Onchocerca volvulus.

GENERAL CHARACTERISTICS

COMMON NAME: Dog heartworm.

GEOGRAPHICAL DISTRIBUTION: Worldwide, prevalent in tropics and subtropics. PATHOGENESIS: In dogs: chronic endocarditis; in humans: granulomas and pneumonitis. HABITAT: Heart and lungs. VECTOR: Mosquitoes.

RESERVOIR HOST: Dogs, which are the definitive hosts.

INFECTIVE FORM: Filariform larva.

MODE OF INFECTION: Inoculation.

PERIODICITY: None.

SPECIMEN OF CHOICE: Blood.

SPECIMEN PROCESSING: Giemsa's or Hematoxylin/Eosin stains.

MICROFILARIA

SIZE: 285 to 315 mcm. SHEATH: Absent. TAIL: Slender and pointed.

TERMINAL NUCLEI: Do not extend to the tip of the tail.

MICROFILARIA

Figure 4-37. Life cycle of Dirofilaria immitis.

GENERAL CHARACTERISTICS

A group of non-patent Dirofilariae. COMMON NAME: None.

GEOGRAPHICAL DISTRIBUTION: Worldwide, endemic in the USA. PATHOGENESIS: Tumors and abcesses in various anatomical sites not completely understood. HABITAT: Various anatomical sites. VECTOR: Mosquitoes.

RESERVOIR HOST: Raccoons and dogs, which are the definitive hosts.

INFECTIVE FORM: Filariform larva.

MODE OF INFECTION: Inoculation.

PERIODICITY: None.

SPECIMEN OF CHOICE: Biopsies.

SPECIMEN PROCESSING: Giemsa's or Hematoxylin/Eosin stains.

Microfilaria Life Cycle
Figure 4-38. Life cycle of Dirofilaria conjunctivae. MICROFILARIA

The identification criteria of this group of organisms have not been established because they vary within the species

Section II. PHYLUM ACANTHOCEPHELMINTHES

4-4. GENERAL DESCRIPTION

This phylum was once considered a class of the phylum Aschelminthes. The species in this phylum are all parasitic and there are two potential pathogens to man: Macracanthorhynchus hirudinaceus, and Moniliformis moniliformis. They are commonly known as thorny headed worms. Some writers believe that this phylum is an evolutionary link between the flat and the round worms. The worms have an anterior retractile armed proboscis with 5 to 6 rows of spines. The digestive tract is absent and they absorb nutrients through the skin. The cuticle is folded and creased showing some pseudosegmentation. Only Macracanthorhynchus hirudinaceus will be presented in this text.

legend female male cb copulatory bursa (retracti cg cement gland cr cement reservoir em embryo (acanthors) ova gl genital ligament hk hooks le lemnisci nb nucleus of body wall pb proboscis pr proboscis receptacle rm retractor muscles sp saefftigen s pouch te testis ub uterine bell ut uterus vg vagina cb copulatory bursa (retracti cg cement gland

Figure 4-39. Morphology of Acanthocephalans.

4-5. MACRACANTHORHYNCHUS HIRUDINACEUS

This organism has been called the giant thorny-headed worm. Although little clinical history is available concerning acanthocephalan infections in humans, varying degrees of inflammation along the intestinal mucosa have been described. Oleoresin of aspidium has been successfully employed as a treatment for adults, while mebendazole is recommended for children. The geographical distribution of this organism is worldwide.

HABITAT: Small intestines. INTERMEDIATE HOST: Beetle larvae (grubs). RESERVOIR HOST: Swine (usual definitive host). INFECTIVE FORM: Cystacanth. MODE OF INFECTION: Ingestion.

life cycle adults in small ' intestines of pigs, rarely ma matures to adult worm (5-12 weeks)

embryonated eggs passed in feces

cystacanth is ingested by host with white grub eggs develop in soil with mature acanthor

juvenile encysts and becomes a cystacanth eggs ingested by june bug larva (white grub)

acanthella develops into a juvenile mature acanthor hatches in gut (2 to 3 hours)

bores through gut wall and becomes acanthella

Figure 4-40. Life cycle of Macracanthorhynchus hirudinaceus.

Macracanthorhynchus hirdudinaceus (continued)

SHAPE: Ellipsoidal.

COLOR: Brown.

OPERCULUM: Absent.

CONTENT: Acanthor larva.

SHELL WALL: Heavy with three embryonic layers.

ADULT

SIZE

MALE: 50 to 100 by 4 mm. FEMALE: 200 to 650 by 7 mm.

SHAPE: Flattened ventrodorsally; cylindrical when preserved; pseudosegmented. COLOR: Milky white.

RETRACTILE ARMED PROBOSCIS: 5 to 6 rows of spines. DIGESTIVE SYSTEM: Absent. CUTICLE: Folded and creased.

Spirometra Eggs Size
Figure 4-41. Stages of Macracanthorhynchus hirudinaceus.

Section III. ARTHROPOD AND VECTORS

4-6 GENERAL COMMENTS

The role of various species of insects, lice, ticks, mites and other arthopods as vectors of disease, or as agents directly responsible for human discomfort, is of considerable significance in the study of parasites. Indeed, many of the parasites presented in the previous sections depend solely upon arthropods as a means of transmission from one host to another. For example, copepods are the intermediate hosts in the life cycles of the fish tapeworm, Diphyllobothrium latum, Spirometra species and the guinea worm, Dracunculus medinesis; the female anopheline mosquitoes are responsible for carrying the dreaded malarial parasites; African trypanosomiasis could not be transmitted without the lowly tsetse fly, and Chagas' disease would be nearly eradicated if it were not for the blood sucking family of reduviid bugs.

4-7. MORPHOLOGICAL CHARACTERISTICS

Because of their involvement in the establishment of various disease entities, it is desirable that the parasitology technician recognize the overt appearance of various arthropod species and be able to identify certain general morphological characteristics. The following pages contain illustrations of the prominent features of some of the most important arthropod vectors and agents.

Figure 4-42. Morphology of a Copepod.

ANTENNA

labrltm

abdomen wings

WINO VEINS

MANDIBLES

MANDIBLES

MAXfLLAE

coxa trochante* fe wuft

.TIBIA

f/fi

MAXfLLAE

TAFTS US

Figure 4-43. Diagram of a primitive insect.

Figure 4-44. Examples of common arthropod vectors.
Figure 4-45. Examples of common arthropod vectors.
Spindeldjur
Figure 4-46. Examples of common arthropod vectors. Continue with Exercises

EXERCISES, LESSON 4

INSTRUCTIONS: Answer the following exercises by marking the lettered response that best answers the exercise, by completing the incomplete statement, or by writing the answer in the space provided at the end of the exercise.

After you have completed all the exercises, turn to "Solutions to Exercises" at the end of the lesson and check your answers. For each exercise answered incorrectly, reread the material referenced with the solution.

1. Which of the following is true of members of the Phylum Acanthocephelminthes?

a. All are parasitic.

b. Lack digestive organs.

c. Are considered as a class of Phylum Aschelminthes.

d. All of the above.

2. The habitat of Macracanthorhynchus hirudinaceus is the:

a. Connective tissue.

b. Large intestine.

c. Small intestine.

3. Familiarity with the morphology of arthropod vectors is desirable because of their role in disease transmission.

a True.

b False.

4. Which of the following statements best describe a characteristic of the Class Nematoda?

a. The reproductive system is monoecious.

b. Contains most of the round worms parasitic to man.

c. The cuticle is used for attachment to the host.

d. The males are smaller than the females.

5. An indication of fertilization of the eggs of Ascaris lumbricoides is:

a. When the eggs become corticated.

b. When the yolk mass is pulled away from the shell wall.

c. When the eggs become decorticated.

d. When the yolk mass fills the egg.

6. The organism which is most prevalent in helminth infections is:

a. Trichuris trichiura.

b. Ascaris lumbricoides.

c. Necator americanus.

d. Taenia solium.

7. What is the infective form of Enterobius vermicularis?

a. Cercaria.

b. Embryonated egg.

c. Filariform larva.

d. Encysted larva.

8. The common name for Trichuris trichiura is:

a. Pinworm.

b. Hookworm.

c. Whipworm.

d. Threadworm.

9. The organism responsible for creeping eruption is:

a. Toxocara canis.

b. Strongyloides stercoralis.

c. Trichinella spiralis.

d. Ancylostoma species.

10. Which of the following organisms is frequently associated with visceral larval migrans?

a. Trichinella spiralis.

b. Toxocara species.

c. Dracunculus medinesis.

d. Trichostrongylus species.

11. A characteristic of blood and tissue nematodes is:

a. Specificity for human intestines.

b. A microfilaria stage.

c. A rhabditiform stage.

d. Cephalic cone.

12. The definitive host of Dirofilaria conjunctivae is a:

a. Raccoon.

b. Gorilla.

c. Mosquito.

d. Monkey.

13. Man acquires an infection of Necator americanus by:

a. Ingestion.

b. Inoculation.

c. Active penetration.

d. All of the above.

14. The nematode which is capable of two different life cycles is:

a. Strongyloides stercoralis.

b. Toxocara species.

d. Taenia solium.

15. Trichinella spiralis infections are most likely to occur in:

a. Tropical climates.

b. Pork eating countries.

c. The Western hemisphere.

d. Cold climates.

16. Which of the following characteristics helps to distinguish the filariform larvae of Trichostrongylus species?

a. A large genital primordium.

b. The caudal bulb.

c. A short buccal cavity.

d. None of the above.

17. Which of the following is a morphological characteristic of adult males of Capillaria philippinensis?

a. A light yellow color of the cuticle.

b. A sharp anterior spear process.

c. Caudal alae.

d. All of the above.

18. What is the specimen source required to recover the eggs of Capillaria hepatica?

a. Sputum.

c. Perianal swab.

d. Liver biopsy.

19. Adults of Ancylostoma duodenale exhibit:

a. Three prominent tips.

b. A pair of cutting plates.

c. Two prominent pairs of teeth.

d. All of the above.

20. What specimen would you obtain to recover identification forms of Dracunculus medinesis?

a. Exudate from irrigated lesions.

b. Liver biopsy.

c. Random fecal specimen.

d. None of the above.

21. One of the classic signs of disease caused by Bancroft's filaria is:

a. Periorbital edema.

b. Elephantiasis.

c. Creeping eruption.

d. Perianal irritation.

22. Specimens being processed for the identification of blood or tissue nematodes are frequently stained with:

a. Hematoxylin/Eosin stain.

b. Giemsa stain.

c. Hematoxylin/Eosin or Giemsa stain.

d. Hematoxylin/Eosin followed by Giemsa stain.

23. An unsheathed microfilaria with no somatic nuclei in the tip of the tail would be:

a. Mansonella ozzardi.

b. Brugia malayi.

c. Mansonella streptocerca.

d. Mansonella perstans.

24. The specimen of choice for the recovery of microfilaria of Mansonella streptocerca is:

a. Venous blood.

b. Skin biopsies.

c. Capillary blood.

d. Duodenal aspirates.

25. Which of the following characteristics aids in distinguishing adults of Macracanthorhynchus hirudinaceus from Ascaris lumbricoides?

a. Body shape tapers to a slender posterior region.

b. Proboscis with 5 to 6 rows of spines.

c. Cuticle with folds and creases.

d. All of the above.

Check Your Answers on Next Page

SOLUTIONS TO EXERCISES, LESSON 4

1.

a

(para 4-4)

2.

c

(para 4-5)

3.

a

(para 4-6)

4.

d

(para 4-1)

5.

b

(para 4-2A; org 1)

6.

b

(para 4-2A; org 1)

7.

b

(para 4-2A; org 3)

8.

c

(para 4-2A; org 2)

9.

d

(para 4-2B; org 2)

10.

b

(para 4-2B; org 1)

11.

b

(para 4-3)

12.

a

(para 4-3; org 9)

13.

c

(para 4-2A; org 7)

14.

a

(para 4-2A; org 8)

15.

b

(para 4-2B; org 4)

16.

b

(para 4-2A; org 4)

17.

d

(para 4-2A; org 5)

18.

d

(para 4-2B; org 3)

19.

c

para 4-2A; org 6)

20.

a

(para 4-3; org 5)

21.

b

(para 4-3; org 1)

22.

c

(para 4-3; org 1-5)

23.

a

(para 4-3; org 46)

24.

b

(para 4-3; org 66)

25.

d

(para 4-510)

End of Lesson 4

APPENDIX A Clinical Manifestations and Treatment of the Common Parasitic Diseases

INTESTINAL AND ATRIAL PROTOZOAN INFECTIONS

Amoebiasis amoebic dysentery.

Entamoeba histolytica (amoeba)

Amoebic dysentery. Dlentamoeba fragilis (flagellate)

Giardiasis.

Trichomoniasis.

Balantidiasis.

Coccidiosis.

Giardia lamblia (flagellate)

Trichomonas vaginalis (flagellate)

Balantidium coll (ciliate)

Isospora belli

(coccidians)

Asymptomatic (carriers) Incubation period (1-14 weeks) vague unlocalized discomfort.

Intestinal symptoms- abdominal pain, alternating diarrhea and constipation, dysentery (stools with blood, mucous). Chronic-ulcerative colitis: recurrent dysentery, gastrointestinal disturbances Extraintestinal symptoms: Fever (100° to 102° F), dehydration, toxemia, tenderness.

Usually asymptomatic. Gastrointestinal disturbances. Persistent diarrhea.

Usually asymptomatic, may be varied gastrointestinal symptoms, weight loss.

Usually asymptomatic, may be burning sensation, itching, frothy-creamy discharge.

Alternating diarrhea and constipation, mucous, blood, pus, tender colon.

Usually asymptomatic, may be abdominal pain and discomfort, diarrhea, undigested food, steatorrhea, fever and weakness.

Intestinal lesions: ulcerative process (flasklike), regenerative pro!iferation of cells, secondary bacterial infection; amoebic granulomas (amoebomas).

Extraintestinal: systemic amebiasis, amebic hepatitis (B5 percent in right lobe), pulmonary abscess, fistulas, fissures, abscesses of brain and spleen.

Inflammation of intestinal mucosa.

Catarrhal inflammation of mucosa, inhibits absorption of vitamin A and fats.

Persistent vaginitis (toxicity), nonspecific urethritis, prostato-vesiculitis.

Necrotic ulcers (flask-tike) abscesses of mucosa and submucosa, anemia.

Inflammation of the intestinal mucosa.

Metronidazole (Flagyl), tetracycline, di iodohydroxyquin.

Metronidazole dehydroemiti ne, emetine, plus chloroquine.

Di iodohydroxyquin tetracycline.

Qui nacrine Metronidazole.

Metronidazole (Flagyl).

Oxytetracyc1ine, Di i odohydroxy-quinoline, carbarsome or Chlortetracycline.

No chemotherapy. Rest and bland diet.

BLOOD AND TISSUE PROTOZOAN INFECTIONS

Visceral leishmaniasis Aa 1a azar.

Cutaneous leishmaniasis r oriental sore.

Mucocutaneous leishmaniasi s, Espundia, uta, Chiclero ulcer,

African trypanosomiasis ; sleeping sickness.

American trypanosomiasis ; Chagas' disease.

Toxoplasmosis.

Leishmania donovaM (flagellate)

Leishmania tropica (flagellate)

Leishmania braiilitn-

(flagallata)

JnfganoigjM brucal

and iMäSlUnsj} (flagellate)

Trypanosom cruil (flagellate)

Toiop 1asna gond i 1 (cocciúijn)

Chtlls, fewer, vomiting, malaise, Anemia, edema, hemorrhage of mucous protrusion of the abdomen, dyspnea, membranes, hepatosplenomegaly, leukopenia.

Chills and fever, skin irritation.

Halaise, itching, fever,, nasal obstruction.

General tied pain, headache, fever, cramps, weakness, swollen lymph nodes, W1nterbottoms1 sign, retardation, lethargy.

Small, red papule; plague-like lesions, diffused; nodules; cellular Infiltration; secondary lesions,

Small red papule, granular lesion, lesions on th» ear, ulceration of mucous membranes, necrosis, hypochromic anemia.

Central Nervous System disorders, paralysis, convulsions. Infiltration of tissue cells, diffused meningoencephalitis and mentngomyelitis, heart failure.

Chills; loss of strength, muscle Proliferative itiflanmatory reac-and bone pain; swollen regional tlons; anemia; nervous disorders; lymph nodes; swelling of preauricu- edema of eyelid and conjunctiva; lar lymph nodes (Romana's sign). megaesophagus or megacolon;

heart failure.

Usually asymptomatic. Congenital: stiff neck, retraction of head, spasticity, paralysis. Hild form: malaise, muscle pain, low fever.

Acute: rash, high fever, chills, prostration.

Chronic: vague, weakness, weight loss, headache, diarrhea.

Chorioretinitis, hydrocephaly, microcephaly, psychomotor disturbances, convulsions. Anemia, lymphadenopathy, lymphocytosis.

Meningoencephalitis, hepatitis, pneumonitis, myocarditis. Retinochoroidltti, posterior uveitis.

Ant imony compounds, stibogluconate, pentamidine.

Qulnacrine

Neostibosan

(advanced).

Neosti basan. Pentamidine.

Arsenicals, pentamidine or suramin (early), melarsoprol or tryparsamlde (late).

Chemotherapy not effective against tissue forms. Amlnoquinolines (blood forms); Bayer 2502 and n itrofurans, amphotericin B (promising).

Pyrimethamine plus

Trisulfapyrimi-dines.

6LÛÛD AND TISSUE PROTOZOAN INFECTIONS

Primary Amebic Henifigoencepha-

Mtil.

Malaria, ague, pa lud lis. Intermittent fevers, marsh fever.

Naegleria spp, Hartmanel ia SPP-

Acanthamoeba spp. (Amoeba)

Plasmodium vi van ovale malariae falciparum (sporozoan)

CESTOOE INFECTIONS

Taeniasls. beef tapeworm infection.

Taeniarhynchus saglnatus (tapeworm)

Severe frontal headache, sore throat, fever, blocked nose, Stiff neck. Kerning* sign; high WBC count.

Acute stage— intermittent febrile paroxysms (fever-thill cycle)

P. vivax - 45 hours P. ovale - 49 hours P. malariae - 12 hours P. falciparum - 36-4B hours; temperature 103e-106*; headache (periocular pain); lethargy; lack of appetite, vague pains (joints) .

Pernicious malar1a--F. falciparum: nausea; vomiting) cyiflOlls, kidney dysfunction {oliguria or anuria); hematuria (blackwater fever); Hemorrhages, cerebral involvement (coma, convulsions).

Chronic stages: relapses, latency (benign), acquired ijmunity.

Frequently asymptomatic.

Intestinal manifestations: abdominal pain and discomfort, diarrhea, loss of appetite (usually), nausea, vomiting.

CNS involvement with mortality in from 2-1 days; necrotic areas of meninges, brain and perivascular spaces.

Vascular Disorders: erythrocytic destruction, anemia, blockages of capillaries, anoxemia.

Tissue disorders:

splenomegaly, impairment of parenchymal cells, edematous lesions (kidney, brain, cardiac muscles).

Appendiceal mucosal lesions with secondary appendicitis, rare Intestinal obstruction, moderate eosinophilia.

Amphotericin B

Suppressive: Chloroquln* or amodiaqulne and primaquine.

Uncomplicated: Chloroquine or amodiaquinc,

Severe :

Chloroqulne hydro chloride or quinine dihydro-chloride.

Prevention of relapses: Primaquine,

Drug resistant: Quinine sulfate plus pyrmeth-araine.

Sulfadiazine. Dapsone. Fansidar. Mefloquine,

Niclosamide, or

Quinacrlne hydrochloride.

CESTOOE INFECTIONS

Taeniasis, pork tapeworm Infection, Cysticercosis.

Dwarf tapeworm infection.

Rat tapeworm infection.

Dlpy 1 idiasi s, dog tapeworm Infection .

Hydatid disease. Echinococcosis.

Taenia solium Frequently asymptomatic, (tapeworm and Intestinal manifestations: its larva) abdominal pain and discomfort, alternating diarrhea and constipation, loss of appetite Extralntestina1 manifestations: faulty nutrition; headache; nervous disorders. CystIcercosis: vague symptoms; muscular pain; disorientation; epilepsy.

Hymenolepis Often asymptomatic..

nana Intestinal manifestations:

(tapeworm) abdominal pain; vomiting; lack of appetite, Extraintestinal manifestations; general weakness (asthenia) headache and nervous disturbances.

Hymenalepis Generally asymptomatic, diminuta Vague intestinal disturbances

(tapeworm) of short duration.

Pipy 1Idium Usually asymptomatic, caninun Occassional^ vague symptoms

(tapeworm) 1n children.

Echinococcus Benign in early disease.

granulosus Increasing discomfort,

(unilocular dependent on location of cyst;

larval cyst) Upper epigastric pain with the

Echinococcus liver cysts; Coughing, dyspnea, multilocu- thoracic pain with the lung larls cysts; intracranial pressure,

(alveolar epi lepsy witfi cyst in the brain, larval cyst) kidney dysfunction, intermittent

(tapeworm pain and hematuria with renal larva) cysts. Anaphylactic symptoms with ruptured cysts.

Inflammation of intestinal mucosa, intestinal perforation, anemia, eoslnophilia, toxemia Cysticercal lesions (sequellae) fibrous capsules, CHS malfunction; chorioretinitis, blindness, lesions of brain; calcification in tissues.

Variable enteritis, secondary anemia, eosinophilia.

No significant pathology.

No significant pathology.

Varies with the location of cysts. Inflammatory reactions, fibrous cysts; hemorrhage; pressure necrosis of tissue, hepatic cysts often in the right lobe; cysts also in lung, kidneys, bones, brain, and other organs; may metastasize like a cancer; secondary infections, eosinophilia. prognosis-grave.

Niclosamide, or Quinacrine hydrochloride. Compazine as antiemetic. Paramomyc1n, Surgery for cysticercal lesions when possible.

Niclosamide, Paramomyc in.

Nielosamide, vermifuges.

Niclosamide, vermi fucjbs .

Surgery with accessible unilocular cysts. Chemotherapy and radiology ineffective.

CES 1 OUt INFECTIONS

Diphylloboth-riasls, fish tapeworm infection, dibothrio-cephalus anemia.

Sparganosis .

TRCMATOOÎ INFECTIONS

Opisthorchiasis

Diphylloboth-rium "latum (tapeworm)

Heterophyasi s.

Hctagoniiriasis.

Dicrocoeliasis-

Paragonimiasis pulmonary distomiasis.

Spi rometra

Spp. {tapeworm larva)

Opistorchis spp. (flukes)

Heterophyes heterophyes (fluke)

Metagonimus yokogawai {fluke)

Dicrocoelium dentri ticum {fluke)

Paragonimus westermani (fluke)

frequently asymptomatic. Intestinal manifestations: abdominal pain and discomfort digestive disorders, loss of appetite, nausea, vomiting. Extraintestinal manifestations: nervous disturbances, weakness, weight loss.

Localized pain in surrounding tissues, urticaria; erythema; chills and fever;

Indigestion, epigastric discomfort, weakness; loss of weight, anemia; liver enlarged and tender; diarrhea.

Usually mild symptoms. In heavy infections: abdominal pain, diarrhea.

Similar to H. heterophyes. In heavy infection; abdominal discomfort, diarrhea.

Digestive disturbances, flatulence; vomiting, biliary colic; epigastric pain; chronic constipation or diarrhea.

Dry cough (early), puimonary pain; rusty brown sputum {hemoptysis); low-grade fever.

Intestinal obstruction, eosinophilia, toxemia, malnutrition, vitamin B^j deficiency, pernicious anemia.

Inflammatory edema and necrosis of adjacent tissues; conjunctivitis; ocular inflaranation, eosinophilia.

Mechanical and toxic irritations, destruction of hepatic parenchyma, liver dysfunction, jaundice, adenomatous proliferation of tissue cells; liver cirrhosis.

in heavy infections: necrosis of Intestinal mucosa; eosinophilia; egg emboli* of heart or brain with varied tissue reactions.

Occassionally eggs may enter lymphatics or mesenteric venules causing granulomatous lesions in heart and nervous system.

Inflammation of biliary epithelium; biliary dysfunction, edema, toxemia.

Eosinophil^, fibrous tissue capsule, pleurisy, pneumonitis;

Niclosamide,

Quinaerine hydrochloride.

Surgical removal of plerocercoid 1 a rva,

Ch loroquine phosphate (inhibits egg production), Chemotherapy not satisfactory in heavy infections.

Tetrachlorethylene; bepheniunt-hydroxynaphthoate.

Tetrachlorethy-lene; bephenium-hydroxynaphthoate.

Chloroquine or

:Dehydroemet tne.

Bi thonol, chloroquine-phosphate.

TREMATODE INFECTIOUS

Fascioliasis, liver rot.

Fasciolopsiasis.

Fascio la hepatica (fluke)

fasc iolops is buski (fluke)

Amphistomiasis. Gastrod is^ coides hominis (fluke)""

Echinostomiasis, Echinostoma spp. (fluke)

Schi stosomiasis. Intestinal bilharziasis, Sc hi stosomaI dysentery.

Schistosoma mansoni (blood fluke)

Oriental schistosomiasis, Kata-yama disease.

Schi stosoma japon 1c um (blood fluke)

Multiplicity of symptoms.

Acute stage; headache, chills, fever, urticaria, tender liver.

Chronic stage; substernal pain, digestive disturbances, enlarged liver, jaundice.

Epigastric pain, nausea, vomiting, diarrhea.

Mild irritations, diarrhea.

Generally, no significant symptoms. Occassional abdominal pain and diarrhea.

Skin penetration—Initial signs:

itching ('swinmers itch"), rash. Intestinal manifestations; abdominal discomfort, diarrhea, occult blood. Chronic disease; varied symptoms, weight loss, lack of appetite, chills, fever, sweating, liver and spleen tenderness.

Skin penetration: dermatitis Intestinal manifestations: abdominal discomfort, diarrhea, occult blood. Chronic disease: varied symptoms, weight loss, anemia, liver and spleen involvement, neurological and pulmonary symptoms from invading eggs.

Eosinophi1ta; anemia (0.2 ml blood loss per worm per day), biliary obstruction, metabolic toxicity, adenomatous and fibrotic changes, parenchymal atrophy, cirrhosis (periportal).

Local inflammation, ulceration and abscesses; generalized massive edema obstruction; eosinophilia up to 35t.

Mucosal inflammation of cecum and ascending colon.

Heavy infections induce catarrhal inflammation.

Initial phase: transient pruritis, toxemia, eosinophi1ia .

Infiltration of vital organs; hemorrhages, anemia (hypochromic) hepatomegaly, liver cirrhosis, splenomegaly, cellular infiltration; fibrous tissue proliferation; ulcerations.

Initial phase: transient pruritis, toxic and allergic reactions, subcutaneous edema, eosinophilia Infiltration of vital organs: eggs, severe lesions (more severe than with S, mansoni). liver fibrosis, splenomegaly, systemic involvement (embolic eggs), cellular infiltration, ulcerations.

Bithinol. dehy-droemetine dihydrochloride.

Tetrathlorethylene; Hexylresorcinol.

Tetrachlorethylene.

Tetrachlorethylene.

Antimonials except in hepatic disease, Potassium or sodium antimony tartrate, Stibophen.

AntimoniaIs, Potass ium antimony tartrate.

CESTDDE INFECTIONS

Vesical schistosomiasis, urinary bilharziasls, Schistosoma 1 hematuria,

Schi stosoma haematobium (blood fluke)

Skin penetration: itching, suprapubic-urinary signs: pain, painful micturition. Chronic disease: temperature, varied symptoms.

Toxic irritations, eosinophilia, tissue changes, lesions of urinary bladder and genitalia; cystitis; occlusions (ureters, urethra), hematuria.

Ni ridazole, Antimony sodium dimercaptosucci-nate, Stibophen.

Schistosome dermatitis. Swimmer's itch, Clam digger's itch.

NEMATODE INFECTIONS

Schistosoma SPP.

Trichobi1 -harzla spp.

Microbilharzia spp. (larva of avian blood flukes)

Skin irritation, severe itching.

urticaria, acute inflammatioh in epithelial layers. Secondary bacterial infection.

Antipruritic and antihistamine lotions.

Enterobiasis, Pinworm infection .

Ascariasis, Roundworm infection.

Visceral larval migrans.

Trichuriasis, Wh i pwo rm infection.

Enterobius vermicular!s (roundworm)

Ascaris

1umbricoides (roundworm)

Ascaris spp.

Toxocara ( roundworm larva)

Trichuris trichiura (roundworm)

Perianal irritation, itching abdominal discomfort, weight loss.

Frequently asymptomatic. Intestinal manifestations: loss of appetite, abdominal pain and discomfort, nausea and vomiting, diarrhea or constipation, loss of weight.

Intermittent abdominal pair, chest pains; pain associated with other varied sites, fever, nausea and vomiting.

Frequently asymptomatic. But headache, fever, abdominal pain, nausea, vomiting, blood streaked diarrheic stools, and weight loss may occur in heavy infections._

Slight eosinophilia (4-12 percent); secondary inFections.

Enteritis-inflammation, obstruction; toxicity, eosinophilia, hemorrhage, trauma by penetrating adults.

Granulomatous lesions of liver, lungs and other organs; Eosinophilia; anemia; hepatomegaly; pneumonitis; dermatitis, neurologic disturbances, tumors of the eyes, spinal cord and heart in severe cases.

Eosinophilia, severe anemia, hemorrhage, rectal prolapse in extreme cases.

Pyrantel pamoate, Piperazine citrate, or Pyrvinium pamoate.

Piperazine citrate. Pyrantel pamoate »

Corticosteroids (prednisone), diethylcarba-mazire or thiabendazole.

Mebendazole, thiabendazole or dithiazanine enema or hexyl-resorsinal.

NEMATODE INFECTIONS

Hookwurm

Infection, Ancylostomiasis, Hecatorias is. Linie inarias is.

Strongyloidiasis. Cochin China dysentery ,

Trichostrongy-

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