Intestinal Nematodes: A Review.

Olushola S. Ayanda, M.Sc.1*; Omolola T. Ayanda, B.Sc.2;

and Folashade B. Adebayo, B.Sc.3
1
Department of Chemistry, University of Ilorin, PMB 1515, Ilorin, Nigeria, MD.
2
Medical Science Laboratory Department, College of Health Technology, Offa, Nigeria, MD.
3
Anu Dispensary and Maternity Centre, Oro, Kwara State, Nigeria, MD.
*
E-mail: holysholay04@gmail.com

ABSTRACT Burmeister in 1837. They were eventually

renamed Nematoda by K.M. Diesing in 1861.
A review of intestinal nematodes has been Nathan Cobb in 1919 argued that they should be
undertaken. The study provides a detailed review called Nemata or Nemates, and in English nemas
of nematodes, taxonomy and systematics, rather than nematodes, but Diesing’s revision has
location, adaptation, reproduction, various stuck [2].
species, and the general features of nematodes.
A study of intestinal nematodes such as Ascaris Due to a lack of knowledge regarding many
lumbricoides, Enterobius vermicularis, nematodes, their systematics is contentious.
Ancylostoma duodenale, Necator americanus, Traditionally, they are divided into two classes,
Strongyloides stercoralis, and Trichuris trichiura the Adenophorea and the Secernentea, and initial
was also carried out. Finally, the life cycle of DNA sequence studies suggested the existence
these intestinal nematodes was examined of five clades:
including their symptoms, diagnosis, prevention
and treatments. Dorylaimia
Enoplia
(Keywords: Ascaris lumbricoides, Enterobius Spirurina
vermicularis, Ancylostoma duodenale, Necator
Tylenchina
americanus, Strongyloides stercoralis, Trichuris
trichiura, intestinal roundworm, pinworm hookworm, Rhabditina
threadworm, whipworm, nematodes, life cycle)
The Secernentea are indeed a natural group of
closest relatives but the Adenophorea appear to
INTRODUCTION be a paraphyletic assemblage of roundworms
simply retaining a good number of ancestral traits.
Nematodes belong to the phylum nematoda [1, 2, The Enoplia do not seem to be monophyletic
3]. The name Nematoda means ―the thread-like either but to contain two distinct lineages. The old
ones‖, from Ancient Greek nema and -ode which group Chromadoria seems to be another
means ―thread‖ and ―like‖ respectively. They are paraphyletic assemblage, with the Monhysterida
the most diverse phylum of pseudocoelomates, representing a very ancient minor group of
and one of the most diverse of all animals. nematodes. Among the Secernentea, the
Nematode species are very difficult to distinguish; Diplogasteria may need to be united with the
over 80,000 have been described, of which over Rhabditia while the Tylenchia might be
15,000 are parasitic. It has been estimated that paraphyletic with the Rhabditia [2, 5]
the total number of described and undescribed
roundworms might be more than 500,000. Unlike
cnidarians or flatworms, roundworms have a Adaptation of Nematodes
digestive system that is like a tube at both ends
[2, 4]. Nematodes have successfully adapted to nearly
every ecological niche from marine to fresh water,
The group was originally established by Karl from the polar regions to the tropics, as well as
Rudolphi in 1808 under the name Nematoidea, the highest to the lowest of elevations. They are
but reclassified as family Nematodes by ubiquitous in freshwater, marine, and terrestrial

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environments, where they often outnumber other Nematodes Species
animals in both individual and species counts,
and are found in the locations as diverse as Nematodes can either be free-living or parasitic
Antarctica and oceanic trenches. They represent, [2, 7]. The free-living species feed on materials as
for example, 90% of all life on the seafloor of the varied as algae, fungi, small animals, fecal
Earth. The many parasitic forms include matter, dead organisms, and living tissues. Free-
pathogens in most plants and animals (including living marine nematodes are important and
humans). Some nematodes can undergo abundant members of the meiobenthos. They
cryptobiosis [2]. play an important role in the decomposition
process, aid in recycling of nutrients in marine
environments and are sensitive to changes in the
Reproduction of Nematodes environment caused by pollution. One roundworm
of note is Caenorhabditis elegans, which lives in
Reproduction is usually sexual. Males are usually the soil and has found much use as a model
smaller than females (often much smaller) and organism. C. elegans has had its entire genome
often have a characteristically bent tail for holding sequenced, as well as the developmental fate of
the female for copulation. During copulation, one every cell determined, and every neuron mapped.
or more chitinized spicules move out of the cloaca
and are inserted into genital pore of the female. Nematodes which are commonly parasitic on
Amoeboid sperm crawl along the spicule into the humans include ascarids (Ascaris), filarids,
female worm. Nematode sperm is thought to be hookworms, pinworms (Enterobius), and
the only eukaryotic cell without the globular whipworms (Trichuris trichiura). The species
protein G-actin [2]. Trichinella spiralis, commonly known as the
trichina worm, occurs in rats, pigs, and humans,
Eggs may be embryonated or unembryonated and is responsible for the disease trichinosis.
when passed by the female, meaning that their Baylisascaris usually infests wild animals but can
fertilized eggs may not yet be developed. In free- be deadly to humans as well. Haemonchus
living roundworms, the eggs hatch into larva, contortus is one of the most abundant infectious
which eventually grow into adults; in parasitic agents in sheep around the world, causing great
roundworms, the life cycle is often much more economic damage to sheep farms. In contrast,
complicated. entomopathogenic nematodes parasitize insects
and are considered by humans to be beneficial.
Nematodes, as a whole, possess a wide range of
modes of reproduction. Some nematodes, One form of nematode is entirely dependent upon
specifically Heterorhabditis sp., undergo a fig wasps, which are a major source of fig
process called endotokia matricida: intrauterine fertilization. They prey upon the wasps, riding
birth causing maternal death. Some nematodes, them from the ripe fig of the wasp's birth to the fig
like other animals (for example segmented flower of its death, where they kill the wasp, and
worms), are hermaphroditic. The hermaphroditic their offspring await the birth of the next
nematode keeps its self-fertilized eggs inside its generation of wasps as the fig ripens.
uterus until they hatch. The juvenile nematodes
will then ingest the parent nematode. This Plant parasitic nematodes include several groups
process is significantly promoted in environments causing severe crop losses. The most common
with a low or reducing food supply. genera are Aphelenchoides (foliar nematodes),
Ditylenchus, Globodera (potato cyst nematodes),
The nematode model species Caenorhabditis Heterodera (soybean cyst nematodes),
elegans and C. briggsae exhibit androdioecy, Longidorus, Meloidogyne (root-knot nematodes),
which is very rare among animals. The single Nacobbus, Pratylenchus (lesion nematodes),
genus Meloidogyne (root-knot nematodes) Trichodorus and Xiphinema (dagger nematodes).
exhibits a range of reproductive modes including
sexuality (amphimixis), facultative sexuality, Several phytoparasitic nematode species cause
meiotic parthenogenesis (automixis), and mitotic histological damages to roots, including the
parthenogenesis (apomixis) [6]. formation of visible galls (e.g. by root-knot
nematodes), which are useful characters for their
diagnostic in the field.

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Some nematode species transmit plant viruses GASTRO-INTESTINAL NEMATODES
through their feeding activity on roots [8]. One of
them is Xiphinema index, a vector of GFLV Intestinal Nematodes
(Grapevine Fanleaf Virus), an important disease
of grapes. Intestinal nematodes are a class in the animal
kingdom with more than 20,000 species
Other nematodes attack barks and forest trees. described. They have managed to live in a large
The most important representative of this group is variety of habitats. Most of these are parasites of
Bursaphelenchus xylophilus, the pine wood animal or humans. In veterinary medicine,
nematode, present in Asia and America and parasitic nematodes comprise an important group
recently discovered in Europe. of endoparasites. Their clinical importance relates
to the diseases they may cause in the animal
Depending on the species, a nematode may be host, as well as the zoonotic potential for pet
beneficial or detrimental to plant health. From an owners and others [1].
agricultural perspective, there are two categories
of nematode: predatory ones, which will kill
garden pests like cutworms, and pest nematodes, General Features of Intestinal Nematodes
like the root-knot nematode, which attack plants
[9]. The general features of intestinal nematodes
include [12]:
Predatory nematodes can be bred by soaking a
specific recipe of leaves and other detritus in Non-segmented, fusiform, cylindrical shape
water, in a dark, cool place, and can even be with a complete digestive system with oral
purchased as an organic form of pest control [7]. and anal openings

Separate sexes with female being larger than

Location of Nematodes the male;

Parasitic nematodes are either located in the Covered with a tough outer coating (cuticle)
intestine or tissues of their hosts and are referred that may be smooth or textured; generally
to as intestinal and tissue nematodes, cream white in color; size ranges from
respectively [10, 11]. millimeters to several centimeters.

Intestinal nematodes Life cycle usually involves an egg and one or

more larval stages some of which may be
Small intestine: Ascaris, Ancylostoma, free living.
Strongyloides etc.
Diagnosis is made by observing and
Large intestine: Enterobius, Trichuris etc. identifying the egg and larval stage found in
feces.
Tissue nematodes
Common Intestinal Nematode (Nematode
Lymphatic system: W. bancrofti Infections)
Subcutaneous tissue: O. volvulus, Loa loa, D. Common intestinal nematodes include:
medinesis
Enterobius (Oxyuris) vermicularis (Pinworm,
Muscles/lungs/brain: Trichinella (larva) seatworm, threadworm)
Toxocara canisnon Trichuris trichiura (whipworm)
human species larva
Ascaris lumbricoides (roundworm)
carried in blood to liver,
Ancylostoma duodenale & Necator
lung, brain, and eye.
americanus (hookworm)
Strongyloides stercoralis

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Ascaris lumbricoides - Large Intestinal burden can lead to intestinal obstruction,
Roundworm especially in children. Fever, ingestion of some
drugs and some anesthetic agents can induce
extra-intestinal migration of adult worms. Eight
weeks from ingestion of egg to adult form [12].

Enterobius vermicularis – Pinworm

Figure 1: Ascaris lumbricoides.

Distribution: temperate, subtropical and tropical

areas with poor sanitation.

Adults: F 20-35cmX0.5-1cm M <30cmX0.5cm

(curved tail). Figure 2: Enterobius vermicularis.

Infective stage: embryonated egg.

Distribution: most common in temperate areas
Diagnostic stage: egg in stool (10-15 days to with high sanitation standards.
become infective).
Adults: F 8-13 µm X 0.5 µm M 2-5 µm X 0.2
Fertile: round-broadly oval, 45-75µm X 35-50 µm µm.
bile stained, thick walled with round one celled
embryo; may have albuminoid mammillated outer Infective stage: embryonated egg.
coating.
Diagnostic stage: Egg can be observed in scotch
Infertile: more markedly oval, 40 µm X 90 µm, tape mount (infective within six hours) double
thinner wall surrounding undifferentiated yolk walled hyaline egg resembling under inflated
mass, may have albuminoid mammillated outer football, containing C shaped embryo; 50-60 µm
coating. X 20- .

Symptomatology: During larval migration phase Symptomatology: migration of adult females may
symptoms will vary depending on numbers; low cause anal pruritus; migration into the vagina can
numbers produce no definitive symptoms while produce local irritation. Majority of infected
large numbers of migrating larvae may provoke individuals remain asymptomatic. Egg ingests to
pneumonitis and asthma attacks in sensitive adult form within 4-7 weeks [12].
individuals. Low numbers of adults generally
produce few if any symptoms; a large worm

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Hookworms abdominal or epigastric pain, nausea and
vomiting. Chronic infections can result in
Hookworms can either be Ancylostoma significant blood loss especially for A. duodenale.
duodenale (old world) or Necator americanus Iron deficiency anemia may be seen among
(new world) [11, 12, 13]. undernourished individuals. Four to seven weeks
from larval penetration to adult form.

Strongyloides stercoralis -Thread worm

Figure 3: Hookworm.

Distribution: tropical and subtropical areas with

sandy soil and ample rainfall; major cause of
parasitic disease. Hookworms cannot be
differentiated based on the appearance of the
diagnostic stage (egg). Identification of species
depends on the recovery and identification of the
adult. This is not necessary for treatment
purposes.

Adults: A. duodenale M < 1 cm X 0.5, F larger Figure 4: Strongyloides stercoralis.

and thicker; oral cavity with two pairs of teeth. N.
americanus M 5-9mm, F 10mm; oral cavity with
two pairs of cutting plates. Distribution: same areas as hookworm but less
frequently observed.
Infective stage: filariform larva.
Adults: F 2-2.5mm X 0.4mm.
Diagnostic stage: embryonated egg (5-6 days to
reach infectivity) 56-60 µm X 36-40 µm (A.d.) 64- Infective stage: filariform larva (3-4 days to
76 µm X 36-40 µm (N.a.); oval shaped with a thin develop from rhabditiform larva).
hyaline shell surrounding 2-8 celled embryo.
Diagnostic stage: rhabditiform larva (filariform
Symptomatology: localized dermatitis following larva).
larval penetration ("ground itch"); pulmonary
symptoms are uncommon due to small size of Rhabditiform: short buccal cavity and prominent
migrating larvae. Adults may cause genital primordium.
gastrointestinal symptoms depending on
numbers. These can include diarrhea, flatulence,

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Filariform: esophagus approximately ½ length of children with very heavy infections. About three
body, notched tail. months from ingestion to adult form.

Symptomatology: localized dermatitis following Diagnosis: Symptomatology can include chronic

larval penetration; pneumonitis possible but not nonspecific pulmonary disease, splenomegaly,
common. Adults produce symptoms that vary eosinophilia and leukocytosis. Serologic tests are
from asymptomatic to severe diarrhea depending available for confirmation. Ocular toxocariasis-
on numbers present. Hyperinfection can result in visual difficulties due to migration of larvae into
fever, gastrointestinal problems, dyspnea, the eye; visceral symptoms are often absent.
hemoptysis and cough. Very high numbers of
migrating larvae can cause damage to liver, Agents: Toxocara canis, T. cati, Ancylostoma
kidney, heart and CNS; essentially disseminated caninum, and A. braziliense [11, 12].
strongyloidiasis. Four weeks from larval
penetration to adult form [12].
LIFE CYCLE OF INTESTINAL NEMATODES
Life cycle of Enterobius vermicularis (Oxyuris)
Trichuris trichiura – Whipworm
This parasite is cosmopolitan. There is no
intermediate host. Infection is via ingestion of
eggs. They accumulate in the ileocaecal region.
After copulation the males die. The females
migrate via the colon to the anus and lay their
eggs chiefly at night, as they creep over the peri-
anal skin. This explains the nightly itching. In rare
cases there is vaginal itch because the females
can also hide there. Sometimes the parasites are
found in the vermiform appendix. The eggs must
be sought not only in the faeces, but also on the
peri-anal skin (using Scotch tape or other
transparent sticky tape). In women the eggs may
be found in the urine, due to contamination.
Sometimes a small number of adult worms are
found in the vagina. Apart from the itch there are
Figure 5: Trichuris trichiura. few problems [13].

Distribution: worldwide, especially in area with

poor sanitation and hygiene (similar to Ascaris).

Adult: both sexes are characterized by a slender

anterior section and thickened posterior and
resembling a whip; male posterior end is tightly
coiled. Female 3-5 cm, Male <4cm.

Infective stage: embryonated egg (by ingestion).

Diagnostic stage: fertilized egg in stool (3 weeks

to become infective). Barrel shaped, bile stained
with hyaline polar plugs, thick walled.

Symptomatology: light infections are usually

without symptoms; heavier infections can lead to
abdominal pain, diarrhea and bloody stools.
Rectal prolapse is occasionally observed in Figure 6: Life Cycle of Enterobius vermicularis
(Oxyuris) [11].

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Treatment: Mebendazole 100 mg (Vermox®), to rectum, in which the worms can be seen on the
be repeated after 1 and 2 weeks. Albendazole is prolapsed mucosa.
also effective. Since the eggs can adhere to all
objects e.g. underclothing, sheets and so on, Diagnosis: Diagnosis is based on faecal
these should be changed. In a family it is best to examination. No concentration technique is
treat all the family members, even those without necessary for clinically relevant infections.
symptoms. Vanquin® (pyrvinium) may also be Sometimes the worms can be seen on the rectal
used as an alternative to mebendazole. The mucosa (rectoscopy or during anal prolapse).
faeces may discolor red.
Treatment: The use of Mebendazole (100 mg BD
x 3 days) and albendazole.
Life Cycle of Trichuris trichiura (Whipworm)

Whipworms are cosmopolitan. The eggs are Life Cycle of Ascaris lumbricoides
eliminated with the faeces. Infection is via the oral
route (direct anus-hand-mouth as in Enterobius or The eggs pass on to the ground via the faeces.
after maturation in the outside world). In one Fertilized eggs require 10 to 40 days in the
week it becomes an adult worm measuring 3 to 5 outside world to mature before they become
cm. Egg laying begins 2 months after infection. infectious. Direct self-infection is thus ruled out.
The adult worm has a thin whip-like head with Once they are mature the eggs are taken up once
which it buries itself in the mucosa of the large more (faeco-oral transmission) via infected food,
intestine. The worm survives for several years. drink, dirty hands or fingernails.
The parasite is possibly the same as Trichuris
suis, a parasite of pigs [13]. In the intestine small larvae emerge from the
eggs, and these bore through the intestinal wall.
In this way they reach the blood (portal vein
system). They are carried with the blood, through
the liver to the lungs (lung passage occurs 3 to 14
days after ingestion).

In the lungs the larvae make their way to the

bronchial lumen and climb via the respiratory
branches into the throat. They are swallowed, and
in this way they again reach the intestine. They
grow into adult worms in the jejunum. They do not
damage the intestinal wall.

Egg-laying begins two months after infection. The

adult worm survives on average for 1 year. The
creatures reach 15 to 40 cm. There is no animal
reservoir. Occasionally infections with Ascaris
suum occur (parasite of pigs), this worm
resembles Ascaris lumbricoides very closely and
some think the parasites are identical [13].
Figure 7: Life Cycle of Trichuris trichiura
(Whipworm) [11]. Epidemiology: This is the most common worm
infection in humans. It has a cosmopolitan
Symptoms: Most infected humans remain distribution. Children are most often infected. The
asymptomatic. Only in severe infections (> 1000 eggs are very resistant, which makes it possible
worms; >10,000 eggs per gram of faeces) do in certain circumstances for them to survive for a
symptoms occur: these include diarrhea long time in the outside world. The number of
(dysentery type), malnutrition or anaemia. In eggs which can be found in the soil is a measure
undernourished children with chronic diarrhea of the hygiene standard and degree of sanitation
and tenesmus there is sometimes prolapse of the of an area (faecal pollution of the ground).

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 lumbricoides also plays a role in the development
of pigbel (necrotising enteritis).

Malnutrition: Ascaris itself does not cause

malnutrition. In borderline malnutrition the
presence of numerous worms can have a
negative effect, however. It is also important to
know that many patients suffer from anorexia.
Humans infected with Ascaris are best treated
before they undergo intestinal surgery. Migration
of an Ascaris through an intestinal suture line is a
serious event. Pre-operative de-worming is
advised in endemic areas.

Diagnosis: Since an adult female lays up to

200,000 eggs per day, as a rule no concentration
technique is necessary to detect eggs in the
Figure 8: Life Cycle of Ascaris lumbricoides [11]. faeces. If infection is solely with one or more male
worms, then of course no eggs will be detected.
During lung passage there is significant
Symptoms: The vast majority are asymptomatic. eosinophilia. After lung passage there is no
Some people have various forms of intestinal longer appreciable eosinophilia. X-ray of the
discomfort or allergic symptoms. Serious intestine may show one or more adult worms. The
complications are rare. Nevertheless, in view of worm forms a long, thin dark area if using barium
the large number of infected persons, the contrast. Sometimes a central longitudinal radio-
morbidity and mortality should not be opaque line can be seen; this is the intestinal tract
disregarded. of the worm. Such a line is absent in tapeworms.
An ultrasound of the pancreas (Wirsung duct) or
The larvae undergo lung passage. This produces of the biliary tract and gall bladder sometimes
symptoms of mild to severe cough, dyspnoea, shows an ectopic migrating adult Ascaris.
thoracic pain, some fever. The clinical picture is
similar to asthma or pneumonia. On chest X-ray Treatment: Mebendazole (Vermox®): 100 mg BD
migratory infiltrates are observed. Eosinophilia is x 3 days, effective broad spectrum, Flubendazole
present. This whole phenomenon is called (Fluvermal®): 100 mg BD x 3 days, effective,
Loeffler's syndrome. The sputum contains many narrow spectrum, Albendazole, effective, broad
eosinophils, Charcot-Leyden crystals and spectrum, Piperazine (Adiver®): narrow spectrum
sometimes also larvae. The symptoms last for and Pyrantel (Antiminth®, Combantrin®)
some days or weeks.

When numerous adult worms are present, they Life Cycle of Hookworms
may form a tangle and cause mechanical
intestinal obstruction manifested by a bloated The adult worms are found in the small intestine.
abdomen, increased peristalsis with clangour, They measure approximately 1 cm. Adult
colicky pain, vomiting (bile, faecaloid) and dilated hookworms survive for several years, Necator
intestinal lumen on an abdominal X-ray. Migration longer than Ancylostoma. A few weeks or months
into the biliary tract may lead to biliary obstruction after infection eggs can be found in the faeces.
(cholestasis) with possibly infection (cholangitis, Once the eggs arrive in the outside world with the
liver abscess, pancreatitis). Sometimes there is faeces, they take one week to mature to
migration to the appendix with inflammation infectious larvae. At first they are rod-shaped =
(appendicitis). Sometimes an adult Ascaris is rhabditiform, later thread-shaped = filariform.
present in vomitus. Occasionally, an adult can They may survive for weeks or months (at an
penetrate the lacrimal duct. Recent surgical optimal temperature and humidity for as much as
intestinal sutures can be breached by an 2 years). A soil with neutral pH is optimal for their
inquisiting adult Ascaris, leading to bowel development, as is shade and a sufficiently high
perforation and peritonitis. Infection with Ascaris temperature (23°C to 30°C is ideal). If the faeces
mix with urine the eggs die.

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Frost, direct sunlight and a soil saturated with salt geophagia. In history, certain regions in the USA
or water, are unfavorable for the development of were famed for their "quality" clay and people
the young parasites. Infection occurs via the would cover great distances to eat this iron-
mouth (A. duodenale) or via the skin (A. containing soil. In 1920 someone even began a
duodenale and N. americanus). If they enter mail order business to send clay to people with
through the skin, the young parasites have to hookworms.
pass through the lungs. A new dimension in the
epidemiology of hookworm disease emerged Diagnosis: The eggs are found in fresh faeces.
when it was found that insufficiently cooked meat In an old stool (>24 hrs), the eggs will have
from paratenic hosts such as pigs, cattle, rabbits hatched and rhabditiform larvae can be seen (Gr.
and sheep can be responsible for transmission. rhabdos = rod). There is mild eosinophilia. Since
The adult hookworms bore a hole in the mucosa an adult hookworm lays approximately 25,000
of the duodenum and the small intestine and suck eggs per day, as a very rough estimate 100 eggs
blood. They adhere with hooked teeth in their per gram of faeces corresponds to 1 adult worm.
mouth (Ancylostoma) or with two buccal cutting
plates (Necator). A. duodenale sucks 5 to 10 Differential diagnosis: Differentiation from
times more blood than N. americanus Strongyloides larvae is based chiefly on the
(approximately 30 µl per day for Necator and 260 difference in morphology of the "head" end. The
µl for Ancylostoma). It is estimated that the life mouth is elongated in ancylostomes and shorter
span of adult worms is 5 to 15 years [13]. in Strongyloides. Sometimes, if intestinal transit
has been swift, eggs of Strongyloides stercoralis
may be found in the faeces. These too should be
differentiated from hookworm eggs. Ternidens
deminutus is a nematode which is generally non-
pathogenic, and which strongly resembles the
hookworm (although Ternidens eggs are
somewhat larger). Eggs of Oesophagostomum
are morphologically identical to those of
hookworms. Identification of the latter parasite
can only be made by coproculture (identification
of the typical stage 3 larvae).

Treatment: Mebendazole 2 x 100 mg/day for 3

days, Pyrantel 10 mg/kg for 3 days. Also give iron
supplementation and folic acid in anemia. Necator
is less sensitive to ivermectin, unlike Ancylostoma
duodenale. Albendazole may be used in
treatment and is generally effective.

Figure 9: Life Cycle of Hookworms [11]. Prevention: Mass chemotherapy, together with
health education and sanitary provisions are
strategies which are often used. The most heavily
Symptoms: At the site where the hookworms infected individuals are the chief target group.
penetrate, the skin develops a rash and itch. This Wearing footwear only partly prevents infection
is short-lived and rarely noticed. Lung passage because oral infection is also important for
also rarely produces symptoms, but may be Ancylostoma duodenale. Children are the main
accompanied by Loeffler’s syndrome. There are victims, rarely wear shoes and their whole skin is
few intestinal symptoms. Significant infections a portal of entry.
(>1000 worms) may result in pronounced anemia.
The haemoglobin level may sometimes be very
low. Children and pregnant women in whom the Life Cycle of Strongyloides stercoralis
iron supplies are already low, are particularly
affected. Hypoproteinaemia may also occur and The adult female worm, (average 2.7 mm) is
results in oedema. Protein deficiency also has found in the mucosa of the small intestine. Males
consequences for the production of cannot penetrate the intestinal mucosa and
immunoglobulines. Some patients exhibit

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perish. Reproduction is asexual via
parthenogenesis. The females lay eggs after 2-3
weeks, from which larvae are quickly produced.
Initially the larvae are described as rhabditiform.
These quickly develop into filariform (infectious)
larvae. These larvae may:

either penetrate back into the intestinal

mucosa.
or pass to the perianal skin and from there
again penetrate the body (auto re-infection).
In auto re-infection there is always another
lung passage. In this way an infection with
Strongyloides may persist for a very long time
(more than 30 years).
or pass to the outside world with the faeces.
From there, after molting, they may go in
either of two directions. The larvae either
again penetrate the skin of a human
(sometimes even via the mouth) or they
develop to adult worms in the outside world.
They may then via sexual reproduction in
their turn lay eggs, from which new larvae
Figure 10: Life Cycle of Strongyloides stercoralis
develop. The worm can thus survive without a
host. [11].

Some related parasites which seldom cause Symptoms: Mild infection is generally
infections in humans include: asymptomatic. In severe infections there may be
intestinal discomfort or diarrhea. During lung
I. Strongyloides fuelleborni (S. fulleborni) passage symptoms may occur, depending on the
in sub-Saharan Africa and Papua New number of larvae. Auto re-infection via the skin
Guinea. Larvae actively penetrate the may give rise to significant itching, chiefly peri-
skin. There is probably also anal. Migration of the larvae in the skin leads to
transmission via breast milk. In severe itching red swollen lines (on the rump, arms, face,
infections the patient may suffer heavy etc.). These lines may occur anywhere and
loss of protein via the intestine, leading progress swiftly (up to 10 cm per hour). The
to so-called protein-loosing swelling is the result of an urticarial reaction to the
enteropathy. Strongyloides kellyi is a migrating larva (the larva itself is only 0.5 mm
nematode which is only known in long). These lesion disappear spontaneously a
Papua New Guinea. Transmammary few hours later, to reappear once more at a
transmission is very probable. different site.

II. Strongyloides papillosus, S. ransomi Immune suppression (especially HTLV-1

and S. westeri: cosmopolitan. Larvae infection), achlorhydria, haematological
may be found in the skin. malignancies including lymphoma, cytotoxic
medication, nephrosis, burns and especially the
III. Strongyloides canis, S. cebus, S. felis, long-term use of systemic corticoids, all increase
S. myopotami, S. planiceps, S. the risk of hyperinfection. In such cases there is
procyonis and S. simiae can cause extensive multiplication with spread of the larvae
experimental infections. Natural to all organs. Symptoms include purpura-like skin
infections with these parasites are (as lesions (initially often peri-umbilical), severe
yet) unknown [13]. diarrhea, pulmonary symptoms (dyspnoea,
bronchospasms, bloody sputum) and meningo-
encephalitis.

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Hyperinfection with Strongyloides stercoralis may CONCLUSION
be accompanied by bacterial septicaemia.
Usually Gram-negative bacteria are involved. In conclusion, Nematodes constitute a very
Mixed infection may occur. This probably homogeneous group as far as anatomical and
depends on mechanical damage to the colon morphological features are concerned, but exhibit
wall, adhesion of intestinal bacteria to the outside very diverse living habits. Nematodes are either
of migrating larvae and excretion of bacteria from located in the intestine or tissues of the host and
the intestinal system of the parasite. are referred to as intestinal and tissue nematodes
Hyperinfection has a high mortality (75%). In respectively. Many of them live as parasites;
chronic and persistent infection, an underlying especially large intestinal roundworm, pinworm,
infection with HTLV-1 or use of glucocorticoids hookworms, threadworm, whipworm and other
should be considered. There have been fewer roundworms are enemies and detrimental to Man
hyperinfections in AIDS patients than one would and domestic animals. The generalized life cycle
expect at first sight. of intestinal nematodes could be represented in
Figure 11 below [14]:
Diagnosis: The eggs hatch very rapidly in the
intestine and are often not found in a faecal
specimen. Larvae are found in the faeces. Often
the numbers are not so high and a concentration
technique, called the Baermann method, needs to
be used. Larvae can also be detected via
duodenal intubation. Differentiation from
hookworm larvae is necessary. Eosinophilia is
almost always present, except when immune
suppression exists. A history of larva currens is
suggestive of strongyloidosis and is enough to
start treatment even if no larvae are found in the
faeces. In hyperinfection larvae may be found in
the sputum or in broncho-alveolar lavage fluid.
The sputum must be regarded as infectious. If
this sputum is cultured on blood agar, bacterial
colonies can be seen which form a curvilinear
pattern, reminiscent of a pearl necklace. This
follows the migration of a larva on the agar plate,
with translocation of the bacteria.

Therapy: Thiabendazole was used in the past,

but had many side effects. Albendazole is only
moderately effective. Mebendazole is not active. Figure 11: Generalized Life Cycle of Intestinal
Ivermectin is easy to use and effective and at Nematodes.
present is the first line treatment. If
immunosuppression is present, the cure rate with
ivermectin is lower, certainly if cortisone has been REFERENCES
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4. Mandell, G.L., J.E. Bennet, and R. Dolin. 2007. chemistry, analytical chemistry, environmental
―Chapter 285 – Intestinal Nematodes chemistry, and solid mineral processing.
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8. Ingham, R.E. 1990. ―Biology and Control of Root- Ayanda, O.S., O.T. Ayanda, and F.B. Adebayo.
Knot Nematodes of Potato—Research Report‖. 2010. ―Intestinal Nematodes: A Review‖. Pacific
Proceedings of the Oregon Potato Conference and Journal of Science and Technology. 11(1):466-
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9. Dropkin, V.H. 1980. Introduction to Plant
Nematology. John Wiley and Sons: New York, NY. Pacific Journal of Science and Technology
38–44, 242–246, 256.

10. Harrison’s Practice. McGraw Hill: New York.

http://www.harrisonspractice.com/practice/ub/view/Harrison's_
Principles_of_Internal_Medicine_17th_Edition/Intestinal_Nem
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11. Rafiaa. 2009. ―Introduction: Intestinal Nematodes‖.

Kansas State University.
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13. ITG. 2009. ―Helminthiasis: 6 Woms, Localization‖.

http://www.itg.be/itg/DistanceLearning/LectureNotesVandenE
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14. Baron, S. 1996. Medical Microbiology, 4 Edition.
University of Texas at Galveston, Medical Branch:
Galveston, TX.

ABOUT THE AUTHORS

Olushola Ayanda holds a Master of Science

degree (M.Sc.) in Industrial Chemistry. He is
currently a Ph.D. student of the University of
Ilorin, Ilorin, Nigeria. He is a member of the
Institute of Chartered Chemist of Nigeria
(ICCON). His research interests are in medicinal

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