NEMATODESNEMATODES

Classification of medically Classification of medically significant nematodessignificant nematodes

A. Based on the presence of absence of caudalA. Based on the presence of absence of caudal

receptor.receptor.

a. Class Enoplea- with caudal receptor a. Class Enoplea- with caudal receptor and with caudal glands.and with caudal glands.

- trichuris trichura- trichuris trichura

- trichinella spiralis- trichinella spiralis

- capillaria philipinensis- capillaria philipinensis

2. Class Rhabditea- with caudal receptor but without 2. Class Rhabditea- with caudal receptor but without caudal glandscaudal glands

- ascaris lumbricoides- ascaris lumbricoides- stronglyloides stercoralis- stronglyloides stercoralis- enterobius vermicularis- enterobius vermicularis- filarial worms- filarial worms- hookworms- hookworms- dracunculus medinensis- dracunculus medinensis- anglostrongylus cantonensis- anglostrongylus cantonensis

Based of habitatBased of habitat

A.A. Intestinal nematodesIntestinal nematodes1. Small intestine1. Small intestine

- ascaris lumbricoides- ascaris lumbricoides- capillaria philipinensis- capillaria philipinensis- hookworms- hookworms- strongyloides stercoralis- strongyloides stercoralis

2. large intestine2. large intestine- trichuris trichura- trichuris trichura- enterobius vermicularis- enterobius vermicularis

b. Extra intestinal Nematodesb. Extra intestinal Nematodes

1.1. Trichinella spiralis- muscleTrichinella spiralis- muscle

2.2. Filarial worms- lymphatic tissueFilarial worms- lymphatic tissue

3.3. Dracunculus medinensis- tissueDracunculus medinensis- tissue

4.4. Anglostrongylus cantonensis- brainAnglostrongylus cantonensis- brain

ASCARIS LUMBRICOIDESASCARIS LUMBRICOIDES Giant intestinal roundwormGiant intestinal roundworm Disease- human ascariasisDisease- human ascariasis AdultAdult

- largest and most common- largest and most common- 15-30 cm by 3 mm male- 15-30 cm by 3 mm male- 20-40 cm by 5 mm female- 20-40 cm by 5 mm female- cylindrical, elongated, tapering in the end- cylindrical, elongated, tapering in the end- containing lateral lines seen as whitish streak along - containing lateral lines seen as whitish streak along

the entire length of the bodythe entire length of the body- terminal mouth with trilobate lips with a small - terminal mouth with trilobate lips with a small

triangular buccal cavitytriangular buccal cavity

OvaOva

Fertilized ovaFertilized ova Broadly ovoid, golden brown in colorBroadly ovoid, golden brown in color 45-75 by 35-45 micron with 3 thick transparent 45-75 by 35-45 micron with 3 thick transparent

layerslayers Vitelline membrane- inner non permeableVitelline membrane- inner non permeable Glycogen membrane- thick transparent middle layerGlycogen membrane- thick transparent middle layer Albuminous/ mammilary coat- outermost layerAlbuminous/ mammilary coat- outermost layer

Fertilized ovaFertilized ova

Decorticated fertilized Decorticated fertilized ovaova

Unfertilized ovaUnfertilized ova Larger, longer, elongated or sometimes irregular in Larger, longer, elongated or sometimes irregular in

shapeshape 88-94 microns88-94 microns Two layersTwo layers

Glycogen membraneGlycogen membrane Albuminous layerAlbuminous layer * vitelline layer is absent* vitelline layer is absent

Unfertilzed OvaUnfertilzed Ova

Life cycleLife cycle

Adult in small intestineAdult in small intestine Eggs passes out in the fecesEggs passes out in the feces Embryonation in 1-2 weeksEmbryonation in 1-2 weeks Fully embryonayed egss ingested by manFully embryonayed egss ingested by man In the small intestine, larva penetrate the mucosa and In the small intestine, larva penetrate the mucosa and

enters the blood circulationenters the blood circulation Heart and lung migration, molt twiceHeart and lung migration, molt twice Larvae ascend respiratory tree and swallowed, Larvae ascend respiratory tree and swallowed,

descend to the small intestine to maturedescend to the small intestine to mature

Pathology Pathology

AdultAdult Feeds on intestinal contentsFeeds on intestinal contents abdominal pain, diarrhea, nausea, loss of appetiteabdominal pain, diarrhea, nausea, loss of appetite Due to eratic migration might lead to regurgitation Due to eratic migration might lead to regurgitation

and escape through the nostriland escape through the nostril Vomited ascaris may pass the larynx and might lead Vomited ascaris may pass the larynx and might lead

to suffocation or reach the lung producing gangreneto suffocation or reach the lung producing gangrene might enter the eustachian tube and provole otitis might enter the eustachian tube and provole otitis

mediamedia

Extra intestinal pathologyExtra intestinal pathology May invade bile duct, gall bladder, appendixMay invade bile duct, gall bladder, appendix May cause hemorrhagic pancreatitisMay cause hemorrhagic pancreatitis Migration to the peritoneal cavity leads to peritonitisMigration to the peritoneal cavity leads to peritonitis Even the worms cause little or no traumatic damage Even the worms cause little or no traumatic damage

the by product of living or dead worms may rarely the by product of living or dead worms may rarely produced toxic manifestation such as edema and produced toxic manifestation such as edema and urticaria accompanied by loss of appetite and weight urticaria accompanied by loss of appetite and weight

Diagnosis Diagnosis

Direct fecal smearDirect fecal smear Kato-thickKato-thick Kato- katzKato- katz Concentration techniqueConcentration technique

Treatment Treatment

Piperazine citratePiperazine citrate Pyrantel pamoatePyrantel pamoate MebendazoleMebendazole AlbendazoleAlbendazole

*piperazine and pyrantel pamoate with *piperazine and pyrantel pamoate with neuromuscular blocking effect that paralyses the neuromuscular blocking effect that paralyses the parasites.parasites.

Prevention and controlPrevention and control

Treatment of infected individualTreatment of infected individual Sanitary waste disposalSanitary waste disposal Hand washing before mealsHand washing before meals Proper personal hygieneProper personal hygiene Thorough washing and cooking of foodThorough washing and cooking of food Avoid using human excreta as fertilizerAvoid using human excreta as fertilizer

TRICHURIS TRICHURATRICHURIS TRICHURA

WhipwormWhipworm TrichuriasisTrichuriasis AdultsAdults

Attached to the wall of the caecumAttached to the wall of the caecum Whiplike and posterior end is more robustWhiplike and posterior end is more robust Female- 3.5- 5 cmFemale- 3.5- 5 cm Male- 3-4.5 cm and coiled posterior endMale- 3-4.5 cm and coiled posterior end

Ova Ova

Unsegmented, barrel shaped, lemon, football Unsegmented, barrel shaped, lemon, football shaped ovashaped ova

Bi-polar plugsBi-polar plugs With 3 layersWith 3 layers Embryonation takes place in the soil where the Embryonation takes place in the soil where the

first stage larvae is formed within 3 weeksfirst stage larvae is formed within 3 weeks

Life cycleLife cycle

Adult worms attached to the wall of the Adult worms attached to the wall of the caecumcaecum

Eggs passes out of the fecesEggs passes out of the feces Embryonate in 2-3 weeksEmbryonate in 2-3 weeks Embryonated eggs ingested by manEmbryonated eggs ingested by man Larvae hatch in the intestineLarvae hatch in the intestine

Pathology Pathology

Small streaked diarrheic stoolSmall streaked diarrheic stool Abdominal pain and tendernessAbdominal pain and tenderness Nausea and vomitingNausea and vomiting Hypochromic anemiaHypochromic anemia Weight loss Weight loss Rectal prolapseRectal prolapse

Diagnosis Diagnosis

Direct fecal smear analysisDirect fecal smear analysis Kato-thick or kato Katz Kato-thick or kato Katz Concentration techniqueConcentration technique

Treatment Treatment

AlbendazoleAlbendazole MebendazoleMebendazole Pyrantel pamoatePyrantel pamoate

Prevention and controlPrevention and control

Treatment of infected individualTreatment of infected individual Sanitary waste disposalSanitary waste disposal Hand washing before mealsHand washing before meals Proper personal hygieneProper personal hygiene Thorough washing and cooking of foodThorough washing and cooking of food Avoid using human excreta as fertilizerAvoid using human excreta as fertilizer

Enterobius vermicularisEnterobius vermicularis

Pinworm or seatwormPinworm or seatworm Enterobiasis or oxyuriasisEnterobiasis or oxyuriasis AdultsAdults

Small whitish or brown in colorSmall whitish or brown in color Male- 2-5 mm coiled tail endMale- 2-5 mm coiled tail end Female- 8-13mm pointed tail endFemale- 8-13mm pointed tail end Diagnostic in the presence of cephalic alae and Diagnostic in the presence of cephalic alae and

distinct or prominent esophageal bulb.distinct or prominent esophageal bulb.

Ova Ova

ElongatedElongated 50-80 by 20-30 microns50-80 by 20-30 microns Flattened lateral side, lopsided DFlattened lateral side, lopsided D Two egg-shell layerTwo egg-shell layer

Albuminous layer- outerAlbuminous layer- outer Embryonic or lipoidal membrane- innerEmbryonic or lipoidal membrane- inner Embryonated when laidEmbryonated when laid Resistant to disinfectant Resistant to disinfectant Under favorable condition, it remains viable for 13 daysUnder favorable condition, it remains viable for 13 days

Life cycleLife cycle

Adults in the caecumAdults in the caecum Gravid females migrate to the perianal area to Gravid females migrate to the perianal area to

deposit embryonated eggdeposit embryonated egg Ova are infective to man 6hrs after depositionOva are infective to man 6hrs after deposition Ova are ingest of inhaled by manOva are ingest of inhaled by man Larvae hatch in the duodenumLarvae hatch in the duodenum Migrate to its final habitat in the large intestineMigrate to its final habitat in the large intestine

Pathology Pathology

Poor appetitePoor appetite InsomiaInsomia Weight lossWeight loss IrritabilityIrritability Grinding of teethGrinding of teeth NauseaNausea VomitingVomiting Pruritus aniPruritus ani

Diagnosis Diagnosis

Scotch tape swabScotch tape swab

Treatment Treatment

AlbendazoleAlbendazole MebendazoleMebendazole Pyrantel pamoatePyrantel pamoate

Transmission Transmission

Hand to mouthHand to mouth InhalationInhalation autoinfectionautoinfection

Trichinella spiralisTrichinella spiralis

Trichina wormTrichina worm TrichinosisTrichinosis Adult Adult

MinuteMinute Male-1.5 by 0.04 mm with single testis near the Male-1.5 by 0.04 mm with single testis near the

posterior endposterior end Female- 3.6 by 0.06 mm with single ovaryFemale- 3.6 by 0.06 mm with single ovary The female is viviparous or larviparous capable of The female is viviparous or larviparous capable of

producing 1,500 larvaeproducing 1,500 larvae

LarvaeLarvae 80-120 micron by 5.6 microns at birth80-120 micron by 5.6 microns at birth 900-1300 micron by 35-40 microns900-1300 micron by 35-40 microns Spear like burrowing anteriorSpear like burrowing anterior

Life cycleLife cycle Encysted larvae in pig Encysted larvae in pig

musclemuscle Ingestion of improperly Ingestion of improperly

cooked porkcooked pork Infected flesh is digested by Infected flesh is digested by

gastric juicegastric juice Adults in the duodenumAdults in the duodenum Larviparous female burrows Larviparous female burrows

into mucosa and deposit into mucosa and deposit larvaelarvae

Larvae enters the circulationLarvae enters the circulation Encyst in striated muscleEncyst in striated muscle Dead end cycleDead end cycle

Pathology Pathology

Incubation and intestinal invasionIncubation and intestinal invasion Includes diarrhrea, constipation, vomiting Includes diarrhrea, constipation, vomiting

abdominal cramps, nauseaabdominal cramps, nausea Larval migration muscle invasionLarval migration muscle invasion

Fever, facial edema, urticaria, pain and swelling Fever, facial edema, urticaria, pain and swelling weaknessweakness

Splenomegaly, gastric and intestinal hemorrhagesSplenomegaly, gastric and intestinal hemorrhages Encysment and encapsulationEncysment and encapsulation

Fever, weak, painFever, weak, pain

Diagnosis Diagnosis

Muscle biopsyMuscle biopsy Serological- ELISASerological- ELISA

Treatment Treatment

Thiabendazole during the first weekThiabendazole during the first week Mebedazole larvicidalMebedazole larvicidal

Prevention and controlPrevention and control

Cook meat 77 C 177 FCook meat 77 C 177 F Freezing- - 15C for 20 days or -30 C for 6 Freezing- - 15C for 20 days or -30 C for 6

daysdays Smoking, salting, or drying is not effectiveSmoking, salting, or drying is not effective

Hookworms Hookworms

Necator americanus- New World HookwormNecator americanus- New World Hookworm Ancylostoma duodenale- old world hookwormAncylostoma duodenale- old world hookworm Ancylostoma braziliense- cat hookwormAncylostoma braziliense- cat hookworm Ancylostoma caninum- dog hookwormAncylostoma caninum- dog hookworm

Necator americanusNecator americanus

S-shapedS-shaped Buccal capsule id provided with semilunar Buccal capsule id provided with semilunar

cutting platecutting plate With amphidial gland that secretes With amphidial gland that secretes

anticoagulantanticoagulant Copulatory bursa is longer than broad with Copulatory bursa is longer than broad with

bipartite dorsal ray and a long slender bipartite dorsal ray and a long slender copulatory spicules that is fused at the tip copulatory spicules that is fused at the tip forming a delicate barb.forming a delicate barb.

Necator americanusNecator americanus

Adult necatorAdult necator

Tail- endTail- end

Necator OvaNecator Ova

Ancylostoma duodenaleAncylostoma duodenale

Stout, body contour into letter cStout, body contour into letter c 2 pairs of ventral teeth2 pairs of ventral teeth With copulatory bursa characterized as bristle With copulatory bursa characterized as bristle

like with tridigitate dorsal raylike with tridigitate dorsal ray

Ancylostoma duodenaleAncylostoma duodenale

Ova Ova

Ancylostoma brazilienzeAncylostoma brazilienze

With a pair of teeth and a pair o f With a pair of teeth and a pair o f inconspicuous median teeth in the buccal inconspicuous median teeth in the buccal capsulecapsule

Broad and long copulatory bursa with short Broad and long copulatory bursa with short lateral rayslateral rays

Filariform, rhabditiformFilariform, rhabditiform

Ova Ova

Ancylostoma caninumAncylostoma caninum

With 3 pair of ventral teethWith 3 pair of ventral teeth Secretes anticoagulant that delays the Secretes anticoagulant that delays the

coagulation of blood.coagulation of blood.

Ancylostoma caninumAncylostoma caninum

Ova Ova

Larval stageLarval stage

RhabditiformRhabditiform Long narrow buccal cavityLong narrow buccal cavity Flask shaped esophagus Flask shaped esophagus With inconspicuous genital primordiumWith inconspicuous genital primordium Open mouthOpen mouth Feeding stageFeeding stage

FilariformFilariform Longer and slender with pointed posterior endLonger and slender with pointed posterior end Closed mouth with protective coveringClosed mouth with protective covering Non feeding stageNon feeding stage Infective stageInfective stage

Life cycleLife cycle Adults in the small intestineAdults in the small intestine Ova in fecesOva in feces Rhabditiform larvae 1-2 daysRhabditiform larvae 1-2 days Filariform 5-8 daysFilariform 5-8 days Filariform penetrate the skinFilariform penetrate the skin Enters the circulationEnters the circulation LungsLungs TracheaTrachea SwallowedSwallowed EsophagusEsophagus

PathologyPathology

Ground itch- pruritus, secondary bacterial Ground itch- pruritus, secondary bacterial infectioninfection

Pulmonary lesion- Wakana diseasePulmonary lesion- Wakana disease Creeping eruption- dermatitis characterized by Creeping eruption- dermatitis characterized by

intracutaneous lesionintracutaneous lesion Hookwrom anemia- microcytic hypochromicHookwrom anemia- microcytic hypochromic Albuminea- low level of albumin due to Albuminea- low level of albumin due to

combined loss of blood, lymph and proteincombined loss of blood, lymph and protein

Diagnosis Diagnosis

Direct fecal smearDirect fecal smear Harada-moriHarada-mori

Treatment Treatment

MebendazoleMebendazole AlbendazoleAlbendazole Thiabendazole Thiabendazole

Strongyloides stercoralisStrongyloides stercoralis

ThreadwormThreadworm Cochin-china diarrhea Cochin-china diarrhea Capable of both free living and parasitic Capable of both free living and parasitic 2-7 mm and 30-40um in width2-7 mm and 30-40um in width Colorless, semitransparent nematodeColorless, semitransparent nematode

Larvae Larvae

Rhabditiform- short buccal cavity, elongated Rhabditiform- short buccal cavity, elongated esophagus with pyriform posterior bulb and esophagus with pyriform posterior bulb and conspicuous genital primodiumconspicuous genital primodium

Filariform- long delicate larvae with long Filariform- long delicate larvae with long esophagus and forked or notched tailesophagus and forked or notched tail

Life cycleLife cycle Small intestineSmall intestine Ova in fecesOva in feces Rhabditiform larvae-------------filariform—adult free living---Rhabditiform larvae-------------filariform—adult free living--- Filariform --ova---rhabditiform---filariform-----hostFilariform --ova---rhabditiform---filariform-----host SkinSkin ----adult----adult CirculationCirculation HeartHeart LungsLungs TracheaTrachea esophagusesophagus

Prevention Prevention

Proper waste disposalProper waste disposal Personal hygienePersonal hygiene Avoid being barefooted on suspected infected Avoid being barefooted on suspected infected

areaarea medicationmedication

Treatment Treatment

MebendazoleMebendazole AlbendazoleAlbendazole thiabendazolethiabendazole

Precaution Precaution

Administration of ORS to prevent dehydration Administration of ORS to prevent dehydration and loss of electrolytesand loss of electrolytes

Filarial wormsFilarial worms Arthropod transmittedArthropod transmitted Invades circulatory system, muscle, serous cavities, Invades circulatory system, muscle, serous cavities,

lymphatic systemlymphatic system 2-50cm with inconspicuous buccal cavity2-50cm with inconspicuous buccal cavity Males with two copulatory spiculeMales with two copulatory spicule Viviparous females gives birth to prelarval Viviparous females gives birth to prelarval

microfilariamicrofilaria Microfilaria is motile , snakelike with dark staining Microfilaria is motile , snakelike with dark staining

nuclei occupying most of the entire bodynuclei occupying most of the entire body Sheathed ( with embryonic sheath )Sheathed ( with embryonic sheath ) Unsheated ( with no embryonic sheath ) Unsheated ( with no embryonic sheath )

Periodicity Periodicity

NoctunalNoctunal DiurnalDiurnal SubperiodicSubperiodic Subpeiodic diurnalSubpeiodic diurnal Subperiodic nocturnalSubperiodic nocturnal

Wuchereria Bancrofti Wuchereria Bancrofti

Bancroft’s filarial wormBancroft’s filarial worm elephantiasiselephantiasis Males- 2-4 cmMales- 2-4 cm Females- 8-10 cmFemales- 8-10 cm Microfilaria is nocturnal with curvatures and graceful Microfilaria is nocturnal with curvatures and graceful

appearance, tapering tail with no terminal nucleiappearance, tapering tail with no terminal nuclei Lower lmphaticsLower lmphatics ElephantiasisElephantiasis

Microfilaria ( wuchereria bancrofti )Microfilaria ( wuchereria bancrofti )

Pathology Pathology

Tropical pumonary eosinophiliaTropical pumonary eosinophilia Granuloma of the spleenGranuloma of the spleen In the lymph nodes they promote In the lymph nodes they promote

pseudotubercular granulomatous reactions, pseudotubercular granulomatous reactions, leads to edema, vascular and lymphatic leads to edema, vascular and lymphatic hyperplasia, fibrosis and caesationhyperplasia, fibrosis and caesation

Elephantiasis- scrotum, vulva, enlargement of Elephantiasis- scrotum, vulva, enlargement of the genitals and lower lymphaticsthe genitals and lower lymphatics

Diagnosis and treatmentDiagnosis and treatment

Blood smear ( check periodicity )Blood smear ( check periodicity ) TreatmentTreatment

DEC- Diethyl carbamazineDEC- Diethyl carbamazine

AedesAedes

AnophelesAnopheles

Brugia malayiBrugia malayi

Malayan filarial wormMalayan filarial worm Malayan filariasisMalayan filariasis Male- 13-23 mmMale- 13-23 mm Female- 43-55 mmFemale- 43-55 mm With two distinct or discrete nuclei at the tip With two distinct or discrete nuclei at the tip

of the tailof the tail

Vector Mansonia uniformisVector Mansonia uniformis

Treatment Treatment

DECDEC

Loa LoaLoa Loa

African Eye wormAfrican Eye worm Calabar swellingCalabar swelling Sheathed microfilariaSheathed microfilaria Subcutaneous tissue ( Habitat )Subcutaneous tissue ( Habitat ) Vector- chrysopsVector- chrysops

Disease Disease

Calabar swellingCalabar swelling Conjunctiva granulomaConjunctiva granuloma Bug eye- painless edema of the eyelidsBug eye- painless edema of the eyelids Protopsis- bug eyeProtopsis- bug eye

Calabar swellingCalabar swelling

Treatment and controlTreatment and control

Protection from the bite of the vectorsProtection from the bite of the vectors Control of the vectorControl of the vector Chemotherapy with diethylcarbamazineChemotherapy with diethylcarbamazine

Onchocerca volvulusOnchocerca volvulus

Convoluted filariaConvoluted filaria River blindnessRiver blindness Nodules in the subcutaneous tissueNodules in the subcutaneous tissue Males- 19-42 mmMales- 19-42 mm Females- 33.5-50mmFemales- 33.5-50mm Vector simuliumVector simulium

Pathology Pathology

FeverFever EosinophiliaEosinophilia UrticariaUrticaria BlindnessBlindness PruritusPruritus HyperkeratosisHyperkeratosis Hanging groinHanging groin

Diagnosis and treatmentDiagnosis and treatment

Skin snip of the subcutaneous nodulesSkin snip of the subcutaneous nodules Not found on the blood but can be found on Not found on the blood but can be found on

the urinethe urine Surgical removal of the noduleSurgical removal of the nodule DEC followed by suraminDEC followed by suramin Mebendazole as an alternate drug of choiceMebendazole as an alternate drug of choice

Toxocara canis and CatiToxocara canis and Cati

Dog and cat ascarisDog and cat ascaris Normal habitat- cats and dogs, human Normal habitat- cats and dogs, human

accidental hostaccidental host Visceral larval migransVisceral larval migrans Life cycle- same as humansLife cycle- same as humans

PathologyPathology Visceral larval migrationVisceral larval migration HemorrhageHemorrhage Necrosis and granulomaNecrosis and granuloma EosinophiliaEosinophilia Liver damageLiver damage Pulmonary inflammationPulmonary inflammation Ocular problemsOcular problems

Diagnosis and TreatmentDiagnosis and Treatment

Marked eosinophiliaMarked eosinophilia HepatomegalyHepatomegaly HyperglobulinemiaHyperglobulinemia Direct fecal smearDirect fecal smear TxTx

Thiabendazole Thiabendazole

Prevention and controlPrevention and control

Avoid contact with infected animalsAvoid contact with infected animals Animal under 6 mos. Should be dewormed Animal under 6 mos. Should be dewormed

with piperazinewith piperazine Proper waste disposal of animal droppingsProper waste disposal of animal droppings

Toxocara canis ovaToxocara canis ova

Toxocara catiToxocara cati

Toxocara canis ovaToxocara canis ova

Capillaria philipinensisCapillaria philipinensis

Pudoc wormPudoc worm BorborygamyBorborygamy Diarrheal diseaseDiarrheal disease dehydrationdehydration

Capillaria ovaCapillaria ova

Other nematodesOther nematodes

Angiostrongylus cantonensisAngiostrongylus cantonensis Rat lungwormRat lungworm Pila, planaria, fresh water prawns are intermediate Pila, planaria, fresh water prawns are intermediate

hosthost Infection to rats involves lungs for developmentInfection to rats involves lungs for development In humans stays in the brainIn humans stays in the brain

Pila AfricanaPila Africana

Planaria Planaria

Dracunculus medinensisDracunculus medinensis

Guinea worm, dragon worm, fiery serpent Guinea worm, dragon worm, fiery serpent worm of the israelitesworm of the israelites

Inhabits the tissueInhabits the tissue Female 70-120cmFemale 70-120cm

Life cycleLife cycle Adults in the cutaneous tissueAdults in the cutaneous tissue Larva escapes from skin blister 1Larva escapes from skin blister 1stst stage stage Free swimming ( rhabditiform )Free swimming ( rhabditiform ) Ingested by cyclops, copepodsIngested by cyclops, copepods Body cavity of cyclops or copepodsBody cavity of cyclops or copepods Infective stage ( filariform )Infective stage ( filariform ) Ingested by manIngested by man Adults in the tissueAdults in the tissue

Diagnosis includes flooding of the ulceration Diagnosis includes flooding of the ulceration on the skinon the skin

Treatment- niridazole, metronidazole and Treatment- niridazole, metronidazole and thiabendazolethiabendazole

Copepods Copepods

Cyclops Cyclops