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This article is about the organism. For the infection caused by this organism, see Helminthiasis.
Hookworms attached to the intestinal mucosa
Image showing life cycle inside and outside of the human body of one fairly typical and well described helminth: Ascaris lumbricoides

Helminths (/ˈhɛlmɪnθs/), also commonly known as parasitic worms, are large multicellular organisms, which when mature can generally be seen with the naked eye. They are often referred to as intestinal worms even though not all helminths reside in the intestines; for example Schistosomes are not intestinal worms, but rather resides in blood vessels. There is no clear consensus on the taxonomy of helminths, it is more of a commonly used term to describe certain worms with superficial similarities. These are plathelminths (cestodes and trematodes) and nemathelminths (nematodes) - both of these are parasitic worm types – and the annelida, which is not parasitic or at the most ectoparasites like the leeches.[1]

Many, but not all, of the worms referred to as helminths belong to the group of intestinal parasites. An infection by a helminth is known as helminthiasis, soil-transmitted helminthiasis, helminth infection or intestinal worm infection. The same naming convention applies to all helminths whereby the ending "-asis" (or in veterinary science the ending "-osis") at the end of the name of the worm is added to signify the infection with that particular worm, e.g. Ascaris is the name of a particular helminth, and Ascariasis is the name of the infectious disease caused by this helminth.

Helminths are worm-like organisms living in and feeding on living hosts, receiving nourishment and protection while disrupting their hosts' nutrient absorption, causing weakness and disease. Those that live inside the digestive tract are called intestinal parasites. They can live inside humans and other animals. In their adult form, helminths cannot multiply in humans.[2] Helminths are able to survive in their mammalian hosts for many years due to their ability to manipulate the immune response by secreting immunomodulatory products.[3] Helminth ova (or eggs) have a strong shell that protects the eggs against a range of environmental conditions.

Helminthology is the study of parasitic worms and their effects on their hosts. The word helminth comes from Greek hélmins, a kind of worm.


There is no real consensus on the taxonomy (or groupings) of the helminths, particularly with the nematodes.[4] The term "helminth" contains a number of phyla, many of which are completely unrelated. However, for practical considerations the term is still used nowadays to describe four groups with superficial similarities, the phyla Annelida, Platyhelminths, Nematoda and Acanthocephala.[4]

There is in fact no helminth classification, it is an “artificial” term.[5][6]

The most important helminths in the sanitation field are the human parasites, which is why most people relate the term helminth to them, where they are classified as nemathelminthes (nematodes) and platyhelminthes, depending on whether they possess a round or flat-shaped body respectively. The latter are further divided into cestodes and trematodes depending on whether or not they have a segmented body.[7]

Ringworm (dermatophytosis) is actually caused by various fungi and not by a parasitic worm.

Common characteristics[edit]

Helminths are a group of evolutionary unrelated organisms which share a similar form. Helminths include members of the following taxa: monogeneans, cestodes (tapeworms), nematodes (roundworms), and trematodes (flukes).

Characteristics that are common for all helminths include:

The following table shows the principal morphological distinctions for three of these helminth groups:

Tapeworms (Cestodes)Flukes (Trematodes)Roundworms (Nematodes)
Species (examples)Taenia solium, Taenia saginata, Hymenolepis spp., Echinoccocus granulosus, Multiceps multicepsSchistosoma mansoni, Schistosoma japonicum,

Fasciola hepatica

Ascaris, Onchocera, Rhabditis, Trichuris, Necator americanus, Anchylostoma duodenale
Example diseases in humansTapeworm infectionSchistosomiasis, swimmer's itchAscariasis, dracunculiasis (guinea worm), elephantiasis, enterobiasis (pinworm), filariasis, hookworm infection (includes Necatoriasis and Ancylostoma duodenale infection), onchocerciasis, trichinosis, trichuriasis (whipworm)
ShapeSegmented planeUnsegmented planeCylindrical
Body cavityNonoPresent
Body coveringTegumentTegumentCuticle
Digestive tubeNoEnds in cecumEnds in anus
SexHermaphroditicHermaphroditic, except schistosomes which are dioeciousDioecious
Attachment organsSucker or bothridia, and rostellum with hooksOral sucker and ventral sucker or acetabulumLips, teeth, filariform extremities, and dentary plates

Number of species

6000[9]Estimated > 15,000[10] and 9,000[11] registered800,000 to 1,000,000 estimated

25,000 registered [10]

Number of species known to infect humans40[9]16[10]> 12,000[10]
Eggs laid in one event700,000[9]250,000[10]240,000[10]
LifetimeSeveral years (parasitic worms are able to survive in their mammalian hosts for many years due to their ability to manipulate the immune response by secreting immunomodulatory products)[3]

Use in medicine[edit]

Main article: Helminthic therapy

Parasitic worms have been used as a medical treatment for various diseases, particularly those involving an overactive immune response.[12] As humans have evolved with parasitic worms, proponents argue they are needed for a healthy immune system.[12] Scientists are looking for a connection between the prevention and control of parasitic worms and the increase in allergies such as hay-fever in developed countries.[12] Parasitic worms may be able to damp down the immune system of their host, making it easier for them to live in the intestine without coming under attack.[12] This may be one mechanism for their proposed medicinal effect.

One study suggests a link between the rising rates of metabolic syndrome in the developed worlds and the largely successful efforts of Westerners to eliminate intestinal parasites. The work suggests eosinophils (a type of white blood cell) in fat tissue play an important role in preventing insulin resistance by secreting interleukin 4, which in turn switches macrophages into "alternative activation". Alternatively-activated macrophages are important to maintaining glucose homeostasis (i.e., blood sugar regulation). Helminth infection causes an increase in eosinophils. In the study, the authors fed rodents a high-fat diet to induce metabolic syndrome, and then injected them with helminths. Helminth infestation improved the rodents' metabolism.[13] The authors concluded:

Although sparse in blood of persons in developed countries, eosinophils are often elevated in individuals in rural developing countries where intestinal parasitism is prevalent and metabolic syndrome rare. We speculate that eosinophils may have evolved to optimize metabolic homeostasis during chronic infections by ubiquitous intestinal parasites….[13]


Indicator organism[edit]

Analysing for helminth eggs in samples of feces from a dry toilet in Kenya
Processed helminth eggs samples from a dry toilet in Kenya

Helminth eggs (or ova) are a good indicator organism to assess the safety of sanitation and reuse systems because they are the most environmentally resistant pathogens of all pathogens (viruses, bacteria, protozoa and helminths) and can in extreme cases survive for several years in soil.[14] Therefore, the presence or absence of viable helminth eggs ("viable helminth egg" means that a larva would be able to hatch from the egg) in a sample of dried faecal matter, compost or faecal sludge is often used as an indicator to assess the efficiency of diverse wastewater and sludge treatment processes in terms of pathogen removal. In particular, the number of viable Ascaris eggs is often taken as an indicator organism for all helminth eggs in treatment processes as they are very common in many parts of the world and relatively easy to identify under the microscope. However, the exact inactivation characteristics may vary for different types of helminth eggs.[7]

Helminth eggs are regarded as the main biological health risk when applying sewage sludge, faecal sludge or faecal matter on agricultural soils.[14] The eggs are the infective stage of the helminths’ life cycle for causing the disease helminthiasis.

The detection of viable helminth eggs in samples of wastewater, sludge or fresh feces (as a diagnostic tool for the infection helminthiasis) is not straight forward and many laboratories in developing countries lack the right equipment or the skilled staff required to do so.

Most of the complications in standard protocols for looking for Ascaris eggs in samples from various sanitation systems are due to finding one egg in a large amount of water or soil, but Ascaris eggs in the feces of infected persons when collected in dry toilets are already concentrated and they do not get diluted by water. Each adult female Ascaris produces 200,000 eggs per day. Therefore, the techniques to concentrate the eggs may be less important if the local laboratory is not equipped to do them and simple searches in samples from sanitation systems with dry toilets, e.g. from the faeces vault of a urine-diverting dry toilet (UDDT) could be done quite simply, and if none are found these biosolids can be considered safe. This only applies if Acaris worms commonly infect the users of such toilets.

Removal in wastewater treatment[edit]

Helminth ova (or eggs) have a strong shell that protects the eggs very well against a range of environmental conditions. This shell consists of three layers: a lipoidal inner layer, a chitinous middle layer and outer proteinic layer.[8] Helminth eggs of concern in wastewater used for irrigation have a size between 20 and 80 mm and a relative density of 1.06–1.15.[8] It is very difficult to inactivate them, unless temperature is increased above 40 °C or moisture is reduced to less than 5%.[8] Thus, in conventional wastewater treatment processes the helminth ova are not inactivated but only removed from the wastewater. This is done by processes that remove particles through sedimentation or filtration such as in waste stabilization ponds (lagoons), storage bassins, constructed wetlands, coagulation-flocculation, rapid filtration and upflow anaerobic sludge blanket (UASB) reactors.

Inactivation in sludge treatment processes[edit]

Inactivation of helminth ova can be achieved in sludge treatment where the temperature is increased over 40 °C or moisture is reduced to less than 5%.[8]


  1. ^ University of Texas, Medical Branch (1996), Medical Microbiology, ed. Samuel Baron, 4th Edition, Galveston Texas, USA
  2. ^ "CDC Centers for Disease Control and Prevention, about parasites". CDC. Retrieved 28 November 2014. 
  3. ^ a b c E. Jirillo, T. Magrone, G. Miragliotta (2014) Immunomodulation by Parasitic Helminths and its Therapeutic Exploitation. In: M.A. Pineda and W. Harnett (Eds), Immune Response to Parasitic Infections (Vol 2, pp. 175-212), Bentham eBooks, DOI: 10.2174/97816080598501140201, ISBN 978-1-60805-985-0, 2014
  4. ^ a b "Schistosomiasis Research Group, University of Cambridge, UK". Retrieved 19 December 2014. 
  5. ^ "Navigating the Phylogeny Wing, University of Berkeley, USA". Retrieved 19 December 2014. 
  6. ^ "Tree of Life web project". Retrieved 19 December 2014. 
  7. ^ a b Maya, C.; Torner-Morales, F.J.; Lucario, E.S.; Hernández, E.; Jiménez, B. (2012). "Viability of six species of larval and non-larval helminth eggs for different conditions of temperature, pH and dryness". Water Research 46 (15): 4770–4782. doi:10.1016/j.watres.2012.06.014. 
  8. ^ a b c d e Jimenez, B. (2007) Helminth ova removal from wastewater for agriculture and aquaculture reuse, Water Science & Technology Vol 55 No 1–2 pp 485–493, IWA Publishing, doi:10.2166/wst.2007.046
  9. ^ a b c Lamonthe Argumedo, R. Garcia Prieto, L. (1988) Human Helminthiasis in Mexico, A.G.T. Editor, S.A., 1st edition, Mexico.
  10. ^ a b c d e f Pumarola, A; Rodríguez-Torres, A; García, R.J.A. y Piedrola, A.G. (1987) Medical Microbiology and Parasitology (in Spanish), Ediciones Científicas y Técnicas, S. A., Barcelona, Spain, pp. 850- 880
  11. ^ "Animal diversity web". September 2001. Retrieved 17 December 2014. 
  12. ^ a b c d "Eat worms - feel better". BBC News. 3 December 2003. Retrieved 13 July 2011. 
  13. ^ a b Wu, Davina; et al. (8 April 2011). "Eosinophils Sustain Adipose Alternatively Activated Macrophages Associated with Glucose Homeostasis". Science 332 (6026): 243–247. doi:10.1126/science.1201475. PMC 3144160. PMID 21436399. Retrieved 18 April 2011. 
  14. ^ a b WHO (2006). Guidelines for the Safe Use of Wastewater, Excreta and Greywater, Volume 4 Excreta and Greywater Use in Agriculture. (third ed.). Geneva: World Health Organization. ISBN 9241546859. 

External links[edit]

Further reading[edit]