MIDTERM I TREMATODES I 2ND SEMESTER

TREMATODES List of trematodes

FLUKES LIVER FLUKES
1. Fasciola hepatica
TREMATODES GENERAL CHARACTERISTIC 2. Fasciola gigantica
1. Hermaphroditic 3. Clonorchis sinensis
(except for Schistosoma spp.) 4. Opistorchis felineus
2. All eggs are operculated 5. Opistorchis viverrini
(except for Schistosoma spp.)
3. Lack respiratory system INTESTINAL FLUKES
4. Excretory system are governed by 1. Fasciolopsis buski
flame cells and excretory tubules 2. Echinostoma ilocanum
5. Incomplete digestive system 3. Heterophyes heterophyes
6. Self fertilization
7. ADULT WORM: Leaf like or lancet like
PANCREATIC FLUKE
8. Sexual organs are highly developed
9. Oral suckers (used for feeding), Ventral sucker (used for 1. Eurytrema pancreaticum
attachment),
Genital sucker LUNG FLUKE
10. Need 2 intermediate host (except for Schistosoma spp.) 1. Paragonimus westermani
1st IH: Snail
2nd IH: Another snail, aquatic vegetation/fruit, BLOOD FLUKES (SCHISTOSOMES)
fresh water fish or crustacean 1. Schistosoma japonicum
2. Schistosoma mansoni
3. Schistosoma haematobium
4. Schistosoma mekongi
5. Schistosoma interculatum

Fasciola hepatica
Also known as “SHEEP
LIVER FLUKE” or
“TEMPERATE LIVER
FLUKE”
11.Do not possess anus
12.Adult stages are found in man & animals
13. Larval stages are found in the intermediate host HABITAT : liver and bile ducts
14. Nervous system is governed by ganglia INFECTIVE : Metacercaria
15. INFECTIVE STAGE: Metacercaria, except for STAGE
Schistosomes (cercaria-skin penetration) DIAGNOSTIC : Operculated ova
STAGE
INFECTION : Fascioliasis
LIFE CYCLE 1ST I.H: Lymnea spp (Lymnea philippinensis,
Egg stage → Larval stage → Adult stage
Lymnea auricularia rubiginosa)
Miracidium → Sporocyst → Redia(Mother redia(I) →
2ND I.H: Ipomea obscura, Nasturtium
Daughter redia (II))→Cercaria →Metacercaria
officinale ( Water cress)
FINAL HOST : Sheep, cattle
Miracidium:
ACCIDENTAL : Man
Enters the snail
HOST
Cercaria:
Goes out the body of the snail → 2nd IH→ Metacercaria (IS)
→ Man
For Schistosomes:
Cercaria→ Schistosomulum → Adult worm

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PATHOLOGY • Eggs resemble an old-fashion
ACUTE : Affect intestinal wall electric light bulb
STAGE
SYMPTOMS : Necrotic lesions, Hepatomegaly, fever
with eosinophilia
CHRONIC : Infect bile ducts
STAGE
SYMPTOMS : Severe jaundice, obstruction and abcsess
SYMPTOMS
formation, can be ectopic.
1. Fatigue
Symptoms & diagnosis
2. Weakness
1. Biliary colic
1. Stool examination 3. Weightloss
2. Jaundice
2. Concentration 4. Hepatomegaly
3. Abdominal pain
Technique 5. Liver cirrhosis
4. Cholecystitis
3. Serological Test 6. Eosinophilia
5. Cholelithiasis
4. Radiological test 7. Cholangiocarcinoma
6. Bloody diarrhea
5. PCR
7. Liver cirrhosis
DIAGNOSIS
1. Stool examination
2. String test/ Enterotest
Fasciola gigantica 3. Complement Fixation
“GIANT LIVER FLUKE” 4. Intradermal Test
“ TROPICAL LIVER FLUKE”
Halzoun Opisthorchis felineus
Syndrome
Known as “CAT LIVER
FLUKE”
FINAL HOST: cat
ACCDENTAL HOST: Man
1ST I.H: Bulimus
tentaculata, Bithymia
Clonorchis sinensis 2ND I.H: Fresh water fish
“CHINESE LIVER FLUKE” (Tinca tinca, Barbus
or “ORIENTAL LIVER barbus)
FLUKE”
Opisthorchis viverrini
“Most important liver Known as “ SOUTHEAST
fluke of man” ASIAN LIVER FLUKE”
Can cause gallstone
INFECTION : Clonorchiasis formation in man
HABITAT : Liver, bileducts and gallbladder
INFECTIVE : Metacercaria
STAGE
DIAGNOSTIC : Mature ova
STAGE
MOT : Ingestion of 2nd IH
1ST IH: Bulimus fuchsiana, Alocinma sp.,
Parafossarulus sp.
2ND IH: Ctenopharyngodon idaellus,
Cobitidae fishes
ACCIDENTAL : Man
HOST

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Fasciolopsis buski PATHOLOGY
\ • Intestinal obstruction
• Intoxication
• Vitamin B12 malabsorption

Echinostoma ilocanum

Adult fluke of Fasciolopsis buski.

AKA : Giant intestinal fluke Also known as “Garrison’s fluke”
“Largest fluke Parasitizing Man” HABITAT : Small intestine
DISEASE : Fasciolopsiasis 1ST IH: Gyraulus convexiusculus, Hippeutis
HABITAT : Intestine (Duodenum & Jejunum) umbilicus
DEFINITIVE : Pig & humans 2ND IH: Pila luzonica, Curbicularia spp.,
HOST 1st Intermediate host: snail (Segmentina / Vivipara angularis
Hippeutis) FINAL HOST : Man
2nd Intermediate host: Water chestnuts & MOT : Ingestion of 2nd IH
lotus (Trapa bicornis, Eliocharis tuberosa, 1ST IH: Bulimus fuchsiana, Alocinma sp.,
Ipomea obscura) Parafossarulus sp.
MOT : Ingestion of 2nd IH 2ND IH: Ctenopharyngodon idaellus,
1ST IH: Bulimus fuchsiana, Alocinma sp., Cobitidae fishes
Parafossarulus sp. ACCIDENTAL : Man
2ND IH: Ctenopharyngodon idaellus, HOST
Cobitidae fishes
ACCIDENTAL : Man •Ellipsoidal, yellow to yellow-brown eggs
HOST •Contains yolk- body
•Measures 83-116 u x 58-69 um

Pathology
• Inflammation of small intestines
• IN HEAVY INFECTION: Severe diarrhea and intoxication
• TOXEMIA

TREATMENT
• Praziquantel
Egg of F. buski: eggs are ellipsoidal, with a thin shell, and a
usually small, indistinct operculum. Heterophyes heterophyes
In this particular egg, the operculum is open. Also known as “VON SIEBOLD’S FLUKE”
“Smallest fluke of man”
SYMPTOMS “Deadliest fluke of man”
• Colic Member of Heterophyid flukes (Metagonimus yokogawai)
• Diarrhea 1st IH: Pironella conica
• Vomiting 2ND IH: Fish (Mugil cephalus, Tilapia nilotica)
• Edema
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 MIDTERM I TREMATODES I 2ND SEMESTER
PATHOLOGY: Egg of P. westermani: The average egg size is 85 μm by 53
1. Abdominal pain μm (range: 68 to 118 μm by 39 to 67 μm). They are yellow-
2. Cardiac failure brown, ovoidal or elongate, with a thick shell, and often
3. Neurologic symptoms (Epilepsy) asymmetrical with one end slightly flattened. At the large
end, the operculum is clearly visible. The opposite
Eurytrema pancreaticum (abopercular) end is thickened.
Pathology
1. Lung abscess
2. Abscess in ectopic sites (SUBCUTANEOUS CREEPING
ERUPTION)
3. Toxemia
4. Jacksonian epilepsy

SYMPTOMS
HABITAT : Pancreas, bile & pancreatic duct 1. Chest pain
1ST IH: Snail (Macrochlamys indica) 2. Hemoptyis
2nd IH: Ant (Technomyrmex deterquens) 3. Eosinophilia
FINAL HOST : Water buffalo 4. Sputum rusty brown
5. Fever
ACCIDENTAL : Man
6. Sweating
HOST
DIAGNOSIS
Paragonimus westermani 1. Stool examination
AKA: “Oriental Lung Fluke” 2. Concentration exam
DISEASE : Paragonimiasis, Pulmonary distomiasis, 3. Sputum analysis:
Lung fluke disease, Parasitic/Endemic 3% NaOH + Sputum → Centrifuge → Examine
hemoptysis sediment
HABITAT : Lungs 4. Chest x-ray
PORTAL OF : Mouth 5. Serological test
ENTRY
DEFINITIVE : Humans & a variety of carnivores Blood flukes
HOST (Schistosoma spp.)
“Most Romantic Parasite”
Paragonimus westermani
1st IH: Freshwater snail (Antemelania aspirate,
Antemalania ductylus)
2nd IH: Freshwater crab (Parathelphusa philippina) or
Crayfish (Cambarus, Astacus), Mountain crab
Source of infection: consumption of raw or undercooked
infected freshwater crustaceans
Lab Dx: eggs in sputum & stool

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Schistosoma japonicum CERCARIA
Also known as “ ORIENTAL BLOOD FLUKE”
DISEASE : Schistosomiasis, Katayama fever,
Yangtze Valley River fever, Hankaw
fever

HABITAT : Superior Mesenteric Veins in the

small intestine
MOT : Skin penetration
DEFINITIVE HOST : humans, dogs, cats, horses, pigs,
cattle, deer & rodents
INTERMEDIATE : Snail (Oncomelania hupensis, O.
HOST quadrasi)

INFECTIVE STAGE : Cercariae

LAB DX

Oncomelania
hupensis spp.

Onchomolenia
quadrasi spp.

SYMPTOMS & PATHOLOGY

S. japonicum egg: typically oval 1. Dermatitis: Cercarial itch, Swimmer’s itch, Gulf coast
or subspherical, and has a itch, Clam diggers itch
vestigial spine (smaller than those 2. Pneumonitis
of the other species) Knob-like 3. Weakness
protrusion 4. Trauma in the intestinal wall
5. Hepatitis
6. Eosinophilia
7. Toxemia
8. Adults in copula can lay eggs in ectopic site (results in
tubercle formation)
9. Ascites
10. Hepatosplenomegaly

DIAGNOSIS
• Stool examination
• Kato-Katz
• COPT (Circum Oval Precipitin Test)
• Culture Technique (Faust and Meleney Egg Hatching
Technique)
• Serological Test
- Complement Fixation
- Cercarial Agglutination
- ELISA
- IHAT

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 MIDTERM I TREMATODES I 2ND SEMESTER
Schistosoma mansoni Male and female
Also known “ Manson’s blood fluke” schistosomes.
Smallest blood fluke
DISEASE : Schistosomiasis, intestinal
schistosomiasis, bilharziasis “snail
fever”

HABITAT : Mesenteric veins of the colon,

rectum
MOT : Skin penetration
DEFINITIVE HOST : humans, baboons & rodents

INTERMEDIATE : Snail (Biomphalaria sp & Tropicorbis

HOST sp)
LAB DX : eggs in stool; rectal or liver biopsy Schistosoma haematobium

Biomphalaria spp. DISEASE : Urinary schistosomiasis, schistosomal

hematuria, urinary bilharziasis
HABITAT : Veins of urinary bladder
MOT : Skin penetration
DEFINITIVE HOST : humans, monkeys & baboons
INTERMEDIATE : snail (Bulinus, Physopsis, and
HOST Biomphalaria sp)
LAB DX :eggs in urine; cystoscopy
Schistosoma mansoni
eggs: large (length 114 Bulinus spp.
to 180 μm) and have
acharacteristic shape,
with a prominent
LATERAL SPINE near the
posterior end. The
anterior end is tapered
and slightly curved.
When the eggs are
excreted, they contain a
mature miracidium

S. haematobium eggs: large and have a prominent

TERMINAL SPINE at the posterior end

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S.haematobium: adult
schistosomes live in pairs
in the pelvic veins
(especially in the venous
plexus surrounding the
bladder); males are 10-
15 mm in lenght by 0,8-1
mm in diameter, and
have a ventral infolding
from the ventral sucker
to the posterior end
forming the
gynecophoric canal.
Adult male with female
in the copulatory groove.
PATHOLOGY & SYMPTOMS
1. Lesions in urinary bladder (Hematuria)
2. Burning sensation when urinating
3. Develop Urogenital malignant tumor

DIAGNOSIS
• Perform routine urinalysis
• Perform Circum Oval Precipitin Test (COPT)

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