in this video I will teach you all of the high yield information that you need to know about the intestinal nematodes most often medical students PA students NP students where wherever you are in your training most people have difficulty committing the highi old information about intestinal nematodes to their brain and my theory for that is because a lot of the bacteria a lot of the viruses that information shows up on exams a lot more often and so people spend so much time and effort memorizing bacteria and viruses that by the time they get to the helminthic infections and the helminthic pathogens they really struggle to conceptualize this information and find a compartment in their brain to store all of this information and so my goal in this video today is to one I'll go through all of the intestinal nematodes that you see on this slide and I'll teach you in a traditional way what you need to know what's high yield what buzzwords you should know how it's treated the epidemiology Etc but then at the very end of this video I will give you my really cool pneumonic which is spoiler alert it's actually a poem it's an eight- sentence poem that you can say in about 15 to 20 seconds which if you're really struggling to memorize things you can recite it back on test day and it might clue you into some of the really high yield bits of information that you need to know so in this video we'll start by talking about all of the intestinal nematodes that you see on this slide enterobius vermicularis ascaris lumbricoides stales stercoralis analista dual necator americanus tricinella spiralis and trius trua let's start with a brief overview just to establish and create a compartment or category for what we're talking about so all of the intestinal nematodes are known as helminthic organisms which is a scientific way of saying that these are parasitic worms almost all of these worms are tubular they have tubular digestive systems with openings at both ends and as you'll see the majority reside in the top soil and so often times the way that humans get infected with these helminthic intestinal nemat is we come in contact with soil that has some trace of the organism now the important thing to know about the intestinal nematodes is that the way that the human immune system fights them off is by utilizing eosinophils and on your exam you should understand that this could involve a type one or a type two hypers sensitivity reaction type one involving neutralization with histamine and lucrin and type two involving e cilic attachment via IG not too much to know there but just keep in the back of your mind that if you're taking your exam and you get a lab print out with a high level of eosinophils you want to potentially associate that with fending off a helminthic organism or a helminthic infection let's get started with enterobius vermicularis so it's the ingestion of the pinworm eggs that causes the infection so we're talking about feal oral transmission here the big buzzword and the big clinical symptom that you need to keep in the back of your mind is perianal puitis in other words itching around the anal opening what happens here is that when the human who's infected with enterobius goes to sleep at night the adult female worm in the intestine will migrate to the anal opening and there they will deposit thousands of eggs so from the human's perspective what that feels like is itching in the perianal area and so the way that this is diagnosed is with the cellophane tape test and literally what happens is a piece of tape is placed over the anal opening and in the morning that piece of tape is examined and if there are eggs seen on that piece of cellophane tape that's a positive tape test which is to say we know that an adult female worm must have laid eggs egg on that piece of tape at night and that would be how enterobius vermicularis is diagnosed the treatment is going to be bendol so the big thing that you want to take away from this slide for the purposes of exams is perianal purtis diagnosed by the cellophane tape test that is enterobius ascaris lumbricoides you want to associate this with obstruction of tubular structures and by tubular structures I mean areas that stem from different organs with material passing through so we're talking about things like pancreatitis or inflammation of the pancreas due to obstruction of the tubular Lumen that leaves the pancreas chitis due to inflammation of the gallbladder because of obstruction of the tubular Lumen that leaves the gallbladder etc etc so ascaris lumbricoides think obstruction of any kind of lum this can also cause pneumonitis if the eggs migrate to the lungs and of course expect to see eosinophilia like like I talked about in the overview slide transmission here feal oral and diagnosis is going to be made from the stool exam for OVA and parasites so literally we will be looking at the feces looking at the stool and trying to determine if there are OVA and parasites in the stool this is also treated with bendol so the big takeaway for ascaris lumbricoides is obstruction of tubular structure so you can get inflammation of various organs like the pancreas like the gallbladder you can get a small bow obstruction because the Lumin that leave or are part of inherently those organs get obstructed and that causes inflammation that is a Scaris lumbricoides now let's move on to Str strong aloides stir Paralis so as I talked about in the overview slide a lot of the infection of intestinal nematodes is due to contaminated soil and so here is an example of transcutaneous infection so the larvae are in fecal contaminated soil and when a human walks on top of that fecal contaminated soil the larvae will penetrate the skin and cause infection so the big things you want to look out for here with strong aloides are GI symptoms and respiratory symptoms now the GI symptoms tend to be non-specific and there's no individual symptom you necessarily need to memorize same for the respiratory symptoms it's going to be things like cough basically if you see somebody struggling with diarrhea abdominal pain or cough and some systemic symptoms that's sort of non-specifically referring to GI and respiratory symptoms so you would want to think about strong aloides there's no pathon numic buzzword here that you necessarily need to know the one thing that I would point out and it's not necessarily attributable or pathon neumon just to strong aloides is something called ller syndrome which is basic which is basically eosinophilic pneumonia this can also cause a super infection so what I'm hinting at here is that with Str strong aloides St caralis there's no clinical symptom that I want you to necessarily memorize more so just understand that the route of infection is transcutaneous due to fecal contaminated soil some risk factors for strong aloides that could help you if you're really struggling on your exam are immunosuppressed patients patients with HIV patients with htlv1 and patients with a history of alcoholism these are all risk factors so if you're really gunning for a perfect score then perhaps you memorize these but otherwise I wouldn't concern yourself too much with that information because the infection is transcutaneous and it comes through the soil there are also occupational risk factors so anybody who Farms mines or does General field work are more likely to step on fecal contaminated soil and therefore get the infection and the treatment here is going to be bendol and if you can't use bendol you can use Ivermectin so strong aloides when you're memorizing this for your exam I would really just focus on the transcutaneous piece know that anybody who works in soil is more likely to get it otherwise I wouldn't concern yourself too much with any other buzzwords now we'll move on to ankl esto dual and necator americanos so just like we just talked about these two are an example of transcutaneous infection where fecal contaminated soil comes in contact with human skin and then the infection penetrates the skin and that is the way that it gets into the human the way that this works is that it's an ascending infection so it works its way up because most people get it first in their skin usually in their feet but not always it works its way up and eventually it makes its way to the respiratory tree then the human will cough bringing it up at the junction of the trachea and the esophagus the patient or the human will swallow and then that puts the infection into the GI system causing the systemic manifestations so there are two things that you want to look out for with both ankle a stoa duali and necator americanas one is called cutaneous larvae migr which is a really fancy way of saying an itchy snake likee rash and specifically that rash is going to be where the skin contacts the soil so if on your exam you see an image of a snake like which is serpiginous rash that's a little bit erupted meaning that some parts of it are raised and in the vignette they tell you it's puic or itchy that is screaming at you that it's an intestinal nematode and you want to think about ankle AOA or americanas the other thing to keep in mind is anemia and protein loss so because again this is an ascending infection when it makes its way to the intestinal phase once it's in the G eye system these worms the adult worms literally attach to the intestinal capillaries and cause them to rupture and when we rupture capillaries that means we have problems absorbing things so we see protein loss and it means that we have problem regulating hemoglobin because blood flow is affected and therefore we have anemia so anemia and protein loss are because the adult worms latch onto and bite the intestinal capillaries treatment here bendol if you can't use bendol pyal pamoate so the bottom line here for ankos and americanus both are grouped together you want to know two things one The Itchy snake-like slightly erupted Rash where the soil that's infected or contaminated I should say meets the skin and two anemia and protein loss because of worms literally biting onto and rupturing the intestinal capillaries that is ankala dual and necator americanas now let's move on to Tri canella spirales this is caused by consuming raw or undercooked pork it can be from some other meats and other game but generally on your exam on USMLE or comlex it's going to be pork the infection occurs in two phases there's the anic phase and there's the systemic phase the anic phase is caused by pepsin and hydrochloric acid causing the release of the larae then there's the systemic phase where the larae will travel through the lymphatics through the blood and ultimately find its way into some muscle tissue that muscle tissue will either be in The myocardium the brain or the skeletal muscle and the reason that it's going to end up in the heart the brain or the skeletal muscle is because those organs or those areas have an extremely high oxygen content that tricinella needs to survive so what you're going to see on your exam clinically are non-specific GI symptoms but the big one and the one that you absolutely need to know or memorize is mygas because this is going to find its way to muscle tissue muscle equals myalgia muscle cramps you absolutely need to know that you can get some non-specific symptoms like fever chills fatigue but another big one is periorbital edema so if you're looking at this slide and you're like dude just tell me what I should memorize my answer is muscle tissue myalgia and periorbital edema if you can keep those three things associated with trinis spiralis in your brain you're golden so again I'll say it one more time because I'm hammering it into your neurons TR canellis spiralis think myocardium brain and skeletal muscle those are all tissues with very high oxygen content because TR canella is going to muscle you're going to see myalgia also back of your mind periorbital edema treatment for TR canella bendals and that's it so let's just move on remember muscles myalgia edema now we'll talk about trious trua it's a pretty curious name no pun intended so this is feal oral transmission most often in warm humid and hot climates two things you want to look at on your exam for trious trua rectal bleeding and rectal prolapse rectal bleeding and rectal prolapse especially in children rectal prolapse that's the big buzzword here if you see rectal prolapse as it relates to a nematode the ansers tri curious Tri curia and you're done you can see some other GI symptoms like nocturnal passage of stools painful diarrhea painful defecation and mucusy stools but on your exam they're going to give you rectile prolapse if they want you to pick Tri curious Tria if things are really severe you can see anemia poar malnutrition and failure to thrive but again they're going to give you rectal prolapse so that's what you want want to know treatment is bendol so if you have made it through the roughly 15 20 minutes however long that information took me to deliver to you and you're like I'm sorry I I just can't memorize that I need a pneumonic here is my nematode poem so I'm going to do this in my best Shakespeare voice um because I think that if you can't find the brain space you can just memorize this poem what you'll notice here is that it is one nematode per line of the poem The nematode is highlighted in red and the key buzzword or key symptom that you need to associate with the nematode is highlighted in blue in the same line so here we go enter eggs in the anus will make it itchy pork makes you spiral the muscle gets glitchy strong from the soil causes poops and coughs the ankle of America makes capillary sloth Tri curious indeed the prolapse protrudes them Lumber in the tubes this will include them the nematode poem that is all treat all of these worms with bendol and I want you to notice that we're talking about the intestinal nematodes and line by line you can associate the words in red with the corresponding nematode so for example enter eggs in the anus will make it itchy enter for enterobius eggs in the anus will make it itchy that's helping you remember that the key buzzword or the key Association is perianal purtis and so go through my poem and memorize this if you want to because it gives you the one key buzzword that I think you should memorize so one more time for everybody at home enter eggs in the anus will make it itchy pork makes you spiral the muscle gets glitchy wrong from the soil causes poops and coughs the ankle of America makes capillary sloth Tri curious indeed the prolapse protrudes then Lumber in the tubes this will olude them the nematode poem that is all treat all of these worms with bendol good luck