Nematode Infections Clinical Presentation

Several clinical signs and symptoms can occur in patients with nematode infections.

• Lung invasion - Löeffler or Löefflerlike syndrome (ascariasis, hookworm infections, strongyloidiasis)

  • Fever
  • Cough
  • Blood-tinged sputum
  • Wheezing
  • Rales
  • Dyspnea
  • Substernal pain
  • Pulmonary consolidations
  • Eosinophilia
  • Urticaria
  • Asthma
  • Angioneurotic edema
• Intestinal invasion

  • May be asymptomatic (small number)
  • Abdominal pain (usually vague)
  • Abdominal cramps/colic
  • Diarrhea
  • Vomiting (rarely)
  • Constipation (occasionally)
• Muscle and other tissue invasion - Trichinosis

  • Myalgias
  • Fever
  • Edema and spasm
  • Periorbital and facial edema
  • Photophobia
  • Sweating
  • Conjunctivitis
  • Weakness or prostration
  • Pain upon swallowing
  • Subconjunctival, retinal, and ungual hemorrhages
  • Rashes and formication
  • Encephalitis, myocarditis, nephritis
  • Pneumonia, meningitis, neuropathy
• Lymphatic filariasis -W bancrofti, B malayi, B timori

  • Inflammatory signs (pain, tenderness, swelling, erythema)
  • Lymphadenitis/lymphangitis
  • Orchitis
  • Fever
  • Abscesses
  • Obstructive signs (lymphatic varices, hydrocele)
  • Lymphedema and elephantiasis
  • Chyluria
  • Hypereosinophilia
• Loiasis -Loa loa

  • Calabar swellings (recurrent subcutaneous inflammation/swelling)
  • Eye worm (adults or larvae migrating under conjunctiva)
  • Eosinophilia (may exceed 70%)
  • Fever, irritability, urticaria, and pruritus
• Onchocerciasis -O volvulus

  • Dermatitis
  • Nodules
  • Lymphadenitis
  • Ocular changes
    • Intraocular microfilariae
    • Punctate keratitis
    • Sclerosing keratitis
    • Anterior uveitis chorioretinitis
    • Optic neuritis
    • Optic atrophy
    • Glaucoma
    • Blindness (river blindness)
• Dracunculiasis -D medinensis, Guinea worm disease

  • Allergic manifestations
    • Erythema
    • Urticaria
    • Pruritus
    • Nausea
    • Vomiting
    • Giddiness
    • Syncope
    • Fever (occasionally)
  • Local lesions
    • Papule
    • Sterile blister
    • Ulceration
    • Abscesses
  • Worm protrusion from skin
• Toxocariasis -Toxocara canis/Toxocara cati, visceral or ocular larva migrans

  • Eosinophilia
  • Visceral larva migrans
  • Ocular larva migrans
• Cutaneous larva migrans -Ancylostoma braziliense, creeping eruption

  • Itching and red papules
  • Serpiginous track
  • Edema and acute inflammation
  • Scars
  • Secondary infection

• T trichiura infections: In heavily infected people, trichuriasis appears to manifest as mild anemia, eosinophilia, bloody diarrhea (classic trichuris dysentery syndrome), growth retardation (chronic trichuris colitis with growth retardation), abdominal pain, finger clubbing, and rectal prolapse (especially in children). See the image below. A typical Trichuris trichiura egg in feces.
• E vermicularis infection (pinworm): The most common symptom of pinworm infection is nocturnal perianal pruritus. Occasionally, the migration of the parasite produces ectopic disease (eg, appendicitis, chronic salpingitis, ulcerative lesions in the small or large bowel). Enuresis has been blamed on the pinworm.
• A lumbricoides infection

  • A more serious complication of ascariasis is encountered when a mass of worms obstructs the lumen of the small bowel. This acute abdominal condition is commonly observed in children with heavy infections. The presentation is similar to that of acute intestinal obstruction, with vomiting, abdominal distention, and cramps.
  • Another obstructive syndrome is encountered when Ascaris worms invade the biliary duct and cause pancreatic-biliary ascariasis. The most common presenting feature is abdominal pain, observed in 98% of patients. Less common features include ascending cholangitis, acute pancreatitis, and, rarely, obstructive jaundice.
  • Ascariasis in pregnant women results in intrauterine growth retardation. See the image below.Ascaris lumbricoides egg in feces (formalin-ethyl acetate sedimentation method).
• Hookworms

  • The major manifestations of hookworm disease include iron deficiency anemia and chronic protein energy malnutrition. The development of these clinical features depends not only on the worm burden but also on the amount of absorbable dietary iron.
  • During the phase of worm attachment to small intestine mucosa, abdominal pain, diarrhea, and weight loss may be noted. In addition, malabsorption has been reported in children and, less commonly, in adults.
• S stercoralis infection

  • Burning or colicky abdominal pain, often epigastric, occurs and is associated with diarrhea and the passage of mucus.
  • Some patients with strongyloidiasis report nausea, vomiting, and weight loss, with evidence of malabsorption or of protein-losing enteropathy.
  • Massive larval invasion of the lungs and other tissues may occur with hyperinfection, usually in immunocompromised hosts. In this syndrome, the worm is able to complete its entire life cycle in the human, and the symptoms are related to the large burden of larvae migrating in the host.
  • Severe generalized abdominal pain, diffuse pulmonary infiltrates, ileus, shock, and meningitis or sepsis due to gram-negative bacilli may occur. See the image below. Strongyloides eggs in native examination from feces of a newborn.
• T spiralis infection : Myositis with pain, swelling, and weakness is common; it usually first develops in the extraocular muscles and then involves the masseters, neck muscles, limb flexors, and lumbar muscles. Some patients report headache, cough, shortness of breath, hoarseness, and dysphagia.

• Ingestion of mature eggs in fecally contaminated food or drink
• Larval penetration of skin (hookworms and S stercoralis)
• Larvae introduced into human host by arthropod vector (mosquitoes for filariasis and flies for O volvulus)