1. Nematoda

2. Ascaris lumbricoides
The longest intestinal nematoda of human, (Look like lumbricus)
Male:15-30 cm
Female: cm

3. Adult worm of A. lumbricoides

4. Morphology Covered with cuticle Digestive system (3 lips in mouth)
Reproductive system

5. Ascaris lips

6. Ascaris - female cross section diagram

7. Life cycle 200,000 egg/day Liver, heart, lung 2-3 weeks 4 molting
2-2.5 months to have oviposition worm

8. Ascaris
Fully embryonated eggs are swallowed and L2 hatches in the stomach and penetrate stomach or duodenal mucosa
Larvae enter blood stream and leave through alveoli into lung
Larvae molt several times in the lungs L3/L4 move up and get swallowed
2-3 months after infection the adult worms start laying eggs (200,000 daily)
Eggs are shed with the feces and embryonate within 2-3 weeks

9. Ascaris egg Fertile egg unfertile egg
Can survive for 7-8 months in an ambient condition (21-30 oC)
unfertile egg
1- albuminoidal layer 2- Thick hyaline layer, 3-thin lipoidal membrane

10. Unfertile egg Longer and narrower Thin shell
Irregular coating of albumin
Filled with an amorphous mass of protoplasm with refractile granules

11. Ascaris
Infection depends on fecal contamination of food, water or soil
Eggs are sensitive to sun light but otherwise extraordinarily resistant.
(50 C kills egg in 1 hour, but eggs can survive at -8 to -12 C)

12. Sign and symptoms Ascariasis
During the lung phase of larval migration:
(4- 14 days after infection)
Cough (Asthma attacks)
dyspnea
hemoptysis
eosinophilic pneumonitis, edema of lips
(Loeffler’s syndrome)
last for days.

13. Signs and symptoms Adult worm in intestine:
adult worms usually cause no acute symptoms
Vague abdominal pain
Rebound tenderness
Gnashing, Vomiting
Obstruction of intestine (in children)
Migrating adult worms may cause symptomatic occlusion of the biliary tract or oral expulsion (Biliary ascariasis, cholangitis, Appendicitis, Peritonitis).
Maltose misdigestion and intolerance

14. Ascariasis
Fever, anesthetic drugs, other drugs

15. Ascariasis

16. Epidemiology
Highest prevalence in tropical and subtropical regions, and areas with inadequate sanitation
1.3 billion people infected worldwide, 500 million in China (18000 tons of Ascaris egg!!)
One of the most prevalent helminthes in Iran
In Iran 5-6%, in some area up to 49% of people (children, 5-9 ys) are infected
Contaminated vegetables, but not water, and soils are the main source of infection.
Ascaris suum can infect human

18. Ascariasis in Iran Ascaris محل سال محقق 0.7 مهد كودكهاي تهران 1371
بهمن رخ
17.8
لاهيجان-روستاها
رضائيان
23.68
كنگاور
1373
اشرفي
3.4
كرمانشاه-كلينيك
نظري
16.3
تنكابن- شهر و روستا
1375
0.9
كاشان-كاركنان مواد غذايي
1376
والي
2.7
زنجان-مراكز درماني
عطائيان 49
همدان-مدارس
1378
طاهرخاني

19. Ascariasis in Iran 1.5 اراك 1378 اسلامي 2.5 شهريار 1379 شهابي 0.4
ساري-روستاها
1380
روحاني
39.6
همدان-روستايي
سعيدي جم
0.18
اراك-مادران مراكز بهداشتي
دوامي
0.7
اصفهان-كاركنان اشپزخانه
كتابي
0.6
شهرري
نائيني
0.3
اسلامشهر
1381
عسگري
39.2
همدان-كودكان عقب مانده
طاهرخاني 1
ورامين-كاركنان مواد غذايي
1382
امين زاده
53995 نمونه از كل ايران
سياري 3
دامغان-مهد كودكها
حيدري

20. Treatment
Albendazole (adult: 400 mg/kg, children 200 mg/kg; single dose)
In all nematodes exp strongyloides
(Bind irreversibly to tubulin, blocking microtubule assembly and inhibiting glucose uptake)
Mebendazole: 100 mg/day, 2 times; 3 days)
Pyrantel pamoate 11mg/kg (single dose) (no effect on strongyloides and Trichocephalus)
(Depolarizesthe myoneural junction in worm, paralyzing them in a spastic condition)

21. Prevention and control

22. Entrobius vermicularis
Pin worm, Oxyurus
Worldwide distribution
Humans are considered to be the only hosts of E. vermicularis

23. Morphology Thread like and white Male: 2-5 mm Female: 8-15 mm
Cephalic ale
Bulb of esophagus

24. Entrobius vermicularis
Female

25. Enterobius vermicularis

26. Life cycle of E. vermicularis
The time interval from ingestion of infective eggs to oviposition by the adult females is about one month.
Adult worm in caecum, colon or rectum
4- 6 hours
The life span of the adults is about two months.

27. Transmission Autoinfection/ Retroinfection
Person-to-person transmission can occur through handling of contaminated clothes or bed linens. 
Through surfaces in the environment that are contaminated with pinworm eggs (e.g., curtains, carpeting). 
Some small number of eggs may become airborne and inhaled. 

28. Transmission
Autoinfection
Retroinfection
Cross infection
Inhalation

30. Clinical Features (Entrobiasis, oxyuriasis)
Enterobiasis is frequently asymptomatic.
The most typical symptom is perianal pruritis, especially at night.
Occasionally, invasion of the female genital tract with vulvovaginitis and pelvic or peritoneal granulomas can occur.
Other symptoms include anorexia, irritability, and abdominal pain (migration to appendice).
Ectopic infection (liver, csf, eye)

31. Entrobious vermicularis فريدون كنارمازندران- شهر و روستا
Epidemiology
infections more frequent in school- or preschool- children and in crowded conditions.
Entrobious vermicularis
محل
سال
محقق
54.9
رامسر
1378
راستي
4.71
فريدون كنارمازندران- شهر و روستا
رضويون 52
ايرانشهر
داوودي
8.15
گناباد مهد كودك
1380
فاني

32. Laboratory Diagnosis
Microscopic identification of eggs collected in the perianal area.
 This must be done in the morning, by pressing transparent adhesive tape ("Scotch tape test", cellulose-tape slide test) on the perianal skin and then examining the tape placed on a slide (Graham Method).
Anal swab
Nail finger (in 1/3 of infected children)

33. Eggs
Uterus of each female worm contain about eggs

34. Eggs

35. Treatment
Albendazole (adult: 400 mg/kg, children 200 mg/kg; single dose)
Pyrantel pamoate: 11mg/kg (single dose)

36. Trichuris trichiura (Trichocephalus, Whipworm)
live in the cecum and ascending colon
3-4 cm
Tail
Head

37. Trichuris trichiura

38. Trichuris trichiura
Stichocytes

39. Trichuris trichiura

40. Trichuris trichiura
The adult worms are fixed in cecum and colon, with the anterior portions threaded into the mucosa.

41. Trichuris trichiura
Female
Male

42. Trichuris trichiura On of the most common round worm of humans.
Human is the main host (Infection reported from monkey and pigs as well)
It is estimated that 800 million people are infected worldwide.  Distribution is similar to Ascaris.
Infections more frequent in areas with tropical weather and poor sanitation practices, and among children. 

43. Trichuriasis in Iran Trichuris trichiura محل سال محقق 0.1
مهد كودكهاي تهران
1371
بهمن رخ
26.8
لاهيجان-روستاها
رضائيان
11.26
كنگاور
1373
اشرفي
0.9
كرمانشاه-كلينيك
نظري
22.5
تنكابن- شهر و روستا
1375
0.4
زنجان-مراكز درماني
1376
عطائيان 1
همدان-مدارس
1378
طاهرخاني
5.6
رامسر
راستي
1.1
ايرانشهر
داوودي
شهريار
1379
شهابي
0.5
بندپي بابل-ابتدائي
1380
قهرمانلو
0.7
اصفهان-كاركنان اشپزخانه
كتابي
شهرري
نائيني
اسلامشهر
1381
عسگري
همدان-عقب مانده
4.8
دامغان-مهد كودكها
1382
حيدري

44. Life cycle
Larva stay for 3-10 days in intestine and then migrate to cecum
eggs become infective in 15 to 30 days
The females begin to oviposit 60 to 90 days after infection.
3,000 to 20,000 eggs per day

45. Clinical Features of trichuriasis
Most frequently asymptomatic.
  Heavy infections, especially in small children, can cause:
abdominal pain, (migration to appendice which induce bacterial infection)
diarrhea, sometimes bloody or mucoid)
Tenesmus
rectal prolapse
Weight loss, weakness, anemia growth retardation.
Each worm waste 5 µl of blood each day, lifespan 4-6 ys
Disease is similar to IBS

47. Trichuris trichiura

48. Diagnosis
Concentration (flotation with zinc sulphate) is a useful method for diagnosis)

49. Treatment
Albendazole (drug of choice; adult: 400 mg/kg, children 200 mg/kg; single dose)
Mebendazole: 100 mg/day, 2 times; 3 days) or 500 mg single dose