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Allied Health Microbiology: 19.6 Helminthic Infections of the Gastrointestinal Tract

Allied Health Microbiology
19.6 Helminthic Infections of the Gastrointestinal Tract
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table of contents
  1. Cover
  2. Title Page
  3. Copyright
  4. Table Of Contents
  5. Preface
  6. Forward
  7. Chapter 1: An Invisible World
    1. 1.1 What Our Ancestors Knew
    2. 1.2 A Systematic Approach
    3. 1.3 Types of Microorganisms
    4. Summary
  8. Chapter 2: The Cell
    1. 2.1 Spontaneous Generation
    2. 2.2 Foundations of Modern Cell Theory
    3. 2.3 Unique Characteristics of Prokaryotic Cells
    4. Summary
  9. Chapter 3: Prokaryotic Diversity
    1. 3.1 Prokaryote Habitats, Relationships, and Microbiomes
    2. Summary
  10. Chapter 4: The Eukaryotes of Microbiology
    1. 4.1 Unicellular Eukaryotic Parasites
    2. 4.2 Parasitic Helminths
    3. 4.3 Fungi
    4. Summary
  11. Chapter 5: Acellular Pathogens
    1. 5.1 Viruses
    2. 5.2 The Viral Life Cycle
    3. 5.3 Prions
    4. Summary
  12. Chapter 6: Microbial Biochemistry
    1. 6.1 Microbial Biochemistry
    2. Summary
  13. Chapter 7: Microbial Growth
    1. 7.1 How Microbes Grow
    2. 7.2 Oxygen Requirements for Microbial Growth
    3. 7.3 The Effects of pH on Microbial Growth
    4. 7.4 Temperature and Microbial Growth
    5. Summary
  14. Chapter 8: Modern Applications of Microbial Genetics
    1. 8.1 Whole Genome Methods and Pharmaceutical Applications of Genetic Engineering
    2. 8.2 Gene Therapy
    3. Summary
  15. Chapter 9: Control of Microbial Growth
    1. 9.1 Controlling Microbial Growth
    2. 9.2 Testing the Effectiveness of Antiseptics and Disinfectants
    3. Summary
  16. Chapter 10: Antimicrobial Drugs
    1. 10.1 Fundamentals of Antimicrobial Chemotherapy
    2. 10.2 Mechanisms of Antibacterial Drugs
    3. 10.3 Mechanisms of Other Antimicrobial Drugs
    4. 10.4 Drug Resistance
    5. 10.5 Testing the Effectiveness of Antimicrobials
    6. 10.6 Current Strategies for Antimicrobial Discovery
    7. Summary
  17. Chapter 11: Microbial Mechanisms of Pathogenicity
    1. 11.1 Characteristics of Infectious Disease
    2. 11.2 How Pathogens Cause Disease
    3. 11.3 Virulence Factors of Bacterial and Viral Pathogens
    4. Summary
  18. Chapter 12: Disease and Epidemiology
    1. 12.1 The Language of Epidemiologists
    2. 12.2 Tracking Infectious Diseases
    3. 12.3 Modes of Disease Transmission
    4. 12.4 Global Public Health
    5. Summary
  19. Chapter 13: Innate Nonspecific Host Defenses
    1. 13.1 Physical Defenses
    2. 13.2 Chemical Defenses
    3. 13.3 Cellular Defenses
    4. 13.4 Pathogen Recognition and Phagocytosis
    5. 13.5 Inflammation and Fever
    6. Summary
  20. Chapter 14: Adaptive Specific Host Defenses
    1. 14.1 Overview of Specific Adaptive Immunity
    2. 14.2 Major Histocompatibility Complexes and Antigen-Presenting Cells
    3. 14.3 T Lymphocytes and Cellular Immunity
    4. 14.4 B Lymphocytes and Humoral Immunity
    5. 14.5 Vaccines
    6. Summary
  21. Chapter 15: Diseases of the Immune System
    1. 15.1 Hypersensitivities
    2. 15.2 Autoimmune Disorders
    3. 15.3 Organ Transplantation and Rejection
    4. Summary
  22. Chapter 16: Skin and Eye Infections
    1. 16.1 Anatomy and Normal Microbiota of the Skin and Eyes
    2. 16.2 Bacterial Infections of the Skin and Eyes
    3. 16.3 Viral Infections of the Skin and Eyes
    4. 16.4 Mycoses of the Skin
    5. 16.5 Helminthic Infections of the Skin and Eyes
    6. Summary
  23. Chapter 17: Respiratory System Infections
    1. 17.1 Anatomy and Normal Microbiota of the Respiratory Tract
    2. 17.2 Bacterial Infections of the Respiratory Tract
    3. 17.3 Viral Infections of the Respiratory Tract
    4. Summary
  24. Chapter 18: Urogenital System Infections
    1. 18.1 Anatomy and Normal Microbiota of the Urogenital Tract
    2. 18.2 Bacterial Infections of the Urinary System
    3. 18.3 Bacterial Infections of the Reproductive System
    4. 18.4 Viral Infections of the Reproductive System
    5. 18.5 Fungal Infections of the Reproductive System
    6. 18.6 Protozoan Infections of the Urogenital System
    7. Summary
  25. Chapter 19: Digestive System Infections
    1. 19.1 Anatomy and Normal Microbiota of the Digestive System
    2. 19.2 Microbial Diseases of the Mouth and Oral Cavity
    3. 19.3 Bacterial Infections of the Gastrointestinal Tract
    4. 19.4 Viral Infections of the Gastrointestinal Tract
    5. 19.5 Protozoan Infections of the Gastrointestinal Tract
    6. 19.6 Helminthic Infections of the Gastrointestinal Tract
    7. Summary
  26. Chapter 20: Circulatory and Lymphatic System Infections
    1. 20.1 Anatomy of the Circulatory and Lymphatic Systems
    2. 20.2 Bacterial Infections of the Circulatory and Lymphatic Systems
    3. 20.3 Viral Infections of the Circulatory and Lymphatic Systems
    4. 20.4 Parasitic Infections of the Circulatory and Lymphatic Systems
    5. Summary
  27. Chapter 21: Nervous System Infections
    1. 21.1 Anatomy of the Nervous System
    2. 21.2 Bacterial Diseases of the Nervous System
    3. 21.3 Acellular Diseases of the Nervous System
    4. Summary
  28. Creative Commons License
  29. Recommended Citations
  30. Versioning

19.6 Helminthic Infections of the Gastrointestinal Tract

Learning Objectives

  • Identify the most common helminths that cause infections of the GI tract
  • Compare the major characteristics of specific helminthic diseases affecting GI tract

Helminths are widespread intestinal parasites. These parasites can be divided into three common groups: round- bodied worms also described as nematodes, flat-bodied worms that are segmented (also described as cestodes), and flat-bodied worms that are non-segmented (also described as trematodes). The nematodes include roundworms, pinworms, hookworms, and whipworms. Cestodes include beef, pork, and fish tapeworms. Trematodes are collectively called flukes and more uniquely identified with the body site where the adult flukes are located. Although infection can have serious consequences, many of these parasites are so well adapted to the human host that there is little obvious disease.

Ascariasis

Infections caused by the large nematode roundworm Ascaris lumbricoides, a soil-transmitted helminth, are called ascariasis. Over 800 million to 1 billion people are estimated to be infected worldwide.[1] Infections are most common in warmer climates and at warmer times of year. At present, infections are uncommon in the United States. The eggs of the worms are transmitted through contaminated food and water. This may happen if food is grown in contaminated soil, including when manure is used as fertilizer.

When an individual consumes embryonated eggs (those with a developing embryo), the eggs travel to the intestine and the larvae are able to hatch. Ascaris is able to produce proteases that allow for penetration and degradation of host tissue. The juvenile worms can then enter the circulatory system and migrate to the lungs where they enter the alveoli (air sacs). From here they crawl to the pharynx and then follow the gut lumen to return to the small intestine, where they mature into adult roundworms. Females in the host will produce and release eggs that leave the host via feces. In some cases, the worms can block ducts such as those of the pancreas or gallbladder.

The infection is commonly asymptomatic. When signs and symptoms are present, they include shortness of breath, cough, nausea, diarrhea, blood in the stool, abdominal pain, weight loss, and fatigue. The roundworms may be visible in the stool. In severe cases, children with substantial infections may experience intestinal blockage.

The eggs can be identified by microscopic examination of the stool (Figure 19.17). In some cases, the worms themselves may be identified if coughed up or excreted in stool. They can also sometimes be identified by X-rays, ultrasounds, or MRIs.

Ascariasis is self-limiting, but can last one to two years because the worms can inhibit the body’s inflammatory response. The first line of treatment is mebendazole or albendazole. In some severe cases, surgery may be required.

(a) Adult Ascaris lumbricoides roundworms can cause intestinal blockage. (b) This mass of A. lumbricoides worms was excreted by a child. (c) A micrograph of a fertilized egg of A. lumbricoides. Fertilized eggs can be distinguished from unfertilized eggs because they are round rather than elongated and have a thicker cell wall.
Figure 19.17 (a) Adult Ascaris lumbricoides roundworms can cause intestinal blockage. (b) This mass of A. lumbricoides worms was excreted by a child. (c) A micrograph of a fertilized egg of A. lumbricoides. Fertilized eggs can be distinguished from unfertilized eggs because they are round rather than elongated and have a thicker cell wall. (credit a: modification of work by South African Medical Research Council; credit b: modification of work by James Gathany, Centers for Disease Control and Prevention; credit c: modification of work by Centers for Disease Control and Prevention)

  • Describe the route by which A. lumbricoides reaches the host’s intestines as an adult worm.

Pinworms (Enterobiasis)

Enterobius vermicularis, commonly called pinworms, are tiny (2–13 mm) nematodes that cause enterobiasis. Of all helminthic infections, enterobiasis is the most common in the United States, affecting as many as one-third of American children.[2] Although the signs and symptoms are generally mild, patients may experience abdominal pain and insomnia from itching of the perianal region, which frequently occurs at night when worms leave the anus to lay eggs. The itching contributes to transmission, as the disease is transmitted through the fecal-oral route. When an infected individual scratches the anal area, eggs may get under the fingernails and later be deposited near the individual’s mouth, causing reinfection, or on fomites, where they can be transferred to new hosts. After being ingested, the larvae hatch within the small intestine and then take up residence in the colon and develop into adults. From the colon, the female adult exits the body at night to lay eggs (Figure 19.18).

Infection is diagnosed in any of three ways. First, because the worms emerge at night to lay eggs, it is possible to inspect the perianal region for worms while an individual is asleep. An alternative is to use transparent tape to remove eggs from the area around the anus first thing in the morning for three days to yield eggs for microscopic examination. Finally, it may be possible to detect eggs through examination of samples from under the fingernails, where eggs may lodge due to scratching. Once diagnosis has been made, mebendazole, albendazole, and pyrantel pamoate are effective for treatment.

(a) E. vermicularis are tiny nematodes commonly called pinworms. (b) This micrograph shows pinworm eggs.
Figure 19.18 (a) E. vermicularis are tiny nematodes commonly called pinworms. (b) This micrograph shows pinworm eggs.

Disease Profile

Helminthic Gastrointestinal Infections

Numerous helminths are capable of colonizing the GI tract. Many such infections are asymptomatic, but others may cause signs and symptoms ranging from mild GI stress to severe systemic infection. Helminths have complex and unique life cycles that dictate their specific modes of transmission. Most helminthic infections can be treated with medications.

Figure 19.19 Details associated with common helminthic infections of the GI tract.
Figure 19.19 Details associated with common helminthic infections of the GI tract.

  1. Centers for Disease Control and Prevention. “Parasites–Ascariasis.” Updated May 24, 2016. http://www.cdc.gov/parasites/ascariasis/index.html. ↵
  2. “Roundworms.” University of Maryland Medical Center Medical Reference Guide. Last reviewed December 9, 2014. https://umm.edu/health/medical/altmed/condition/roundworms. ↵

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