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It is worldwide in distribution and most prevalent through out the tropics, sub-tropics and more prevalent in the countryside than in the cityI. Morphology: I. Morphology Adult: The adults are cylindrical in shape, creamy-white or pinkish in color. The female averages 20 - 35cm in length, the largest 49cm. The male is smaller, averaging 15 - 31cm in length and distinctly more slender than the female. The typical curled tail with a pair sickle like copulatory spines. On the tip of the head there are three lips, arranged as a Chinese word “ 品 ” . They have a complete digestive tract. Reproductive organs are tubular. male has a single reproductive tubule. The female has two reproductive tubules and the vulva is ventrally located at the posterior part of the anterior 1/3 of the body.Ascaris lumbricoides: Ascaris lumbricoides Female MaleAscaris lumbricoides cont.: Ascaris lumbricoides cont. Female vagina genital pore uterus gut oviductAscaris lumbricoides cont.: Ascaris lumbricoides cont. Female vagina genital pore uterus gut oviductAscaris lumbricoides cont.: Ascaris lumbricoides cont. seminal vesicle sperm duct testes gut MaleLumbricus cont.: Lumbricus cont. clitellumLumbricus cont.: Lumbricus cont. spermathecae gizzard seminal vesicle crop septaLumbricus cont.: Lumbricus cont. nephridium ventral nerve cord Intestine with chlorogogue cells septumPowerPoint Presentation: Adult worm of A. lumbricoidesThe lips of Ascaris lumbricoides: The lips of Ascaris lumbricoides The three lips are seen at the anterior end. The margin of each lip is lined with minute teeth which are not visible at this magnification.PowerPoint Presentation: Egg: There are three kinds of the eggs. They are fertilized eggs, unfertilized eggs and decorticated eggs. We usually describe an egg in 5 aspects: size, color, shape, shell and content. 1. Fertilized eggs: broad oval in shape, brown in color, an average size 60× 45 µm . The shell is thicker and consists of ascaroside, chitinous layer, fertilizing membrane and mammillated albuminous coat stained brown by bile. The content is a fertilized ovum. There is a new-moon(crescent) shaped clear space at the each end inside the shell. 2. Unfertilized egg: Longer and slender than a fertilized egg. The chitinous layer and albuminous coat are thinner than those of the fertilized eggs without ascaroside and fertilizing membrane. The content is made of many refractable granules various in size. 3. Decorticated eggs: Both fertilized and unfertilized eggs sometimes may lack their outer albuminous coats and are colorless .Fertilized Ascaris Egg: Fertilized Ascaris Egg A fertilized Ascaris egg, still at the unicellular stage, as they are when passed in stool . Eggs are normally at this stage when passed in the stoolUnfertilized egg: Unfertilized egg The chitinous layer and albuminous coat are thinner than those of the fertilized eggs without ascaroside and fertilizing membrane. The content is made of many refractable granules various in size.II Life Cycle: II Life Cycle 1. Site of inhabitation: small intestine 2. Infetive stage: embryonated eggs 3. Route of infection: by mouth 4. No intermediate and reservoir hosts 5. Life span of the adult: about 1 year This worm lives in the lumen of small intestine, feeding on the intestinal contents, where the fertilized female lays eggs. An adult female can produce approximately 240,000 eggs per day, which are passed in feces. When passed, the eggs are unsegmented and require outside development of about three weeks until a motile embryo is formed within the egg.PowerPoint Presentation: After the ingestion of embryonated eggs in contaminated food or drink or from contaminated fingers, host digestive juices acts on the egg shell and liberate the larva into the small intestine. These larvae penetrate the intestinal mucosa and enter lymphatics and mesenteric vessels. They are carried by circulation to the liver, right heart and finally to the lungs where they penetrate the capillaries into the alveoli in which they molt twice and stay for 10-14days and then they are carried, or migrate, up the bronchioles, bronchi, and trachea to the epiglottis. When swallowed, the larvae pass down into the small intestine where they develop into adults. The time from the ingestion of embryonated eggs to oviposition by the females is about 60-75 days. The adult worms live for about one year. The ascarid life cycle is as the following diagram.III. Pathogenesis: III. Pathogenesis There are two phase in ascariasis: 1. The blood-lung migration phase of the larvae: During the migration through the lungs, the larvae may cause a pneumonia. The symptoms of the pneumonia are low fever, cough, blood-tinged sputum, asthma. Large numbers of worms may give rise to allergic symptoms. Eosionophilia is generally present. These clinical manifestation is also called Loeffler’s syndrome.PowerPoint Presentation: 2. The intestinal phase of the adults. The presence of a few adult worms in the lumen of the small intestine usually produces no symptoms, but may give rise to vague abdominal pains or intermittent colic, especially in children. A heavy worm burden can result in malnutrition. More serious manifestations have been observed. Wandering adults may block the appendical lumen or the common bile duct and even perforate the intestinal wall. Thus complications of ascariasis, such as intestinal obstruction, appendicitis, biliary ascariasis, perforation of the intestine, cholecystitis, pancreatitis and peritonitis, etc., may occur, in which biliary ascariasis is the most common complication.Iii. Diagnosis: Iii. Diagnosis The symptoms and signs are for reference only. The confirmative diagnosis depends on the recovery and identification of the worm or its egg. 1. Ascaris pneumonitis: examination of sputum for Ascaris larvae is sometimes successful. 2. Intestinal ascariasis: feces are examined for the ascaris eggs. (1) direct fecal film: it is simple and effective. The eggs are easily found using this way due to a large number of the female oviposition, approximately 240,000 eggs per worm per day. So this method is the first choice . (2) brine-floatation method: (3) recovery of adult worms: when adults or adolescents are found in feces or vomit and tissues and organs from the human infected with ascarids , the diagnosis may be defined.V. Epidemiology: V. Epidemiology World wide distribution, very common in China, especially in the countryside. Factors favoring the spread of the transmission: 1. Simple life cycle. 2. Enormous egg production ( 240,000 eggs/ day/ female ). 3. These eggs are highly resistant to ordinary disinfectants( due to the ascroside). The eggs may remain viable for several years. 4. Social customs and living habits. 5. Disposal of feces is unsuitable.VI. Prevention and Treatment: VI. Prevention and Treatment 1.Treatment to ascariasis: Mebendazole, Albendazole and Levamizole are effective. 2.Sanitary disposal of feces. 3.Hygienic habits such as cleaning of hands before meals. 4.Health education.Ascaris: AscarisFasciola hepatica: Fasciola hepatica Lovish guptaIntroduction: Introduction Phylum: Platyhelminthes Flat worm Liver fluke Effects sheep, cattle, and sometimes humansInteresting Facts: Interesting Facts Eggs found in mummies 1 st fluke or trematode to be reported 1379 Reported in Publication ( Le Bon Berger ) 1 st discovered in sheepF. hepatica: F. hepatica Definitive host: Sheep Cattle Humans (Accidental) Other Mammals Intermediate host Fresh Water Snail Geographic Range Cosmopolitan; anywhere sheep and cattle are raisedMorphology: Morphology Adult fluke Flat leaf like body 20-30mm long 8-15mm wideSite of Infection: Site of Infection Ingestion Metacercariae Ex-cyst in Duodenum Burrows through Intestinal Wall Enters Peritoneal Cavity Migrates to LiverPowerPoint Presentation: Egg Miracidia Cercariae MetacercariaeSymptoms: Symptoms Abdominal Pain Anemia Hepatic Tenderness Hepatomegaly resulting from Edema Intermittent Fever Jaundice Lethargy Nausea Prolonged High Fever Secondary Infections VomittingSymptoms: Symptoms Acute More common in sheep 10,000+ Metacercariea consumed at one time Dramatic Liver Inflamation, Frequently Resulting in Death Chronic More Common and Rarely Fatal Nonspecific Symptoms Halzoun Eating raw, infected liver Infects pharynx Causes swelling and obstructs breathingDiagnosis: Diagnosis Stool Samples Yellow-Brown Eggs Eggs Don’t Show for 4 Months Duodenal or Biliary Aspirate Antibody Test Can detect 2 Weeks After Infection Ultrasound Visualize Adults in Bile Duct CT Scan Reveals Burrows in LiverTreatment: Treatment Bithional Highly Effective Large Dose High Cost Long Treatment Period Triclabendazole Easier to Use 1-2 Oral Doses in 24 hrs Virtually 100% Effective SurgeryControl Methods: Control Methods Eduaction Cheapest and Most Cost Effective Way Wash Aquatic Vegetables in 6% Vinegar for 5-10 minutes Better herding practices Keep herds away from aquatic areas Moluskicide Controls Intermediate Snail HostPhoto Album: Photo Album Lovish gupta You do not have the permission to view this presentation. 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