Scientific Name Common Name

Adult General Characteristics

Fasciola hepatica Giant/Sheep Liver Fluke Cephalic cone (only trematode) Highly branched intestinal ceca Broadly pointed posterior Dendritic testes in tandem Single dendritic ovary

Fasciolopsis buski Giant Intestinal Fluke Without cephalic cone Elongated & Oval shape Oral sucker smaller Unbranched and wavy intestinal ceca Dendritic testes in tandem Branched ovary Ellipsoidal Immature Round at both ends Smaller than Fasciola

Ova

1st Intermediate Host [SNAILS!!! ]

Yellow brown No species identification Large Ovoid Operculated HENs EGG Rounded posterior Lymnaea philippinensis Lymnaea swinhoe Radix rubiginosa Ipomoea aquatic (kangkong/Swap cabbage) Ipomoea obscura(Obscure Morning Glory) Nasturtium officinale(Watercress) Sheep, Cattle Man Acute Phase Migration from intestine to liver Dyspnea, anorexia, fever, gastrointestinal disturbances Chronic Phase Obstruction and hypertrophy of bile ducts, inflammation, fibrosis HALZOUN migration to lungs causing suffocation

Clonorchis sinensis Chinese/Oriental Liver Fluke Flat, elongated Tapered anterior Somewhat rounded posterior Ventral sucker smaller than oral sucker Simple intestine Deeply branched testes in tandem Single, small and lobed ovary Yellow brown Convex operculum Distinct opercular shoulder With protuberance in its end OLD FASHIONED ELECTRIC BULB shape CHINESE LANTERN EGG Parafossarulus Bulimus Alcocinma Thiara Melanoides Fish from Cyprinidae family (Carps and Minnows)

Opistorchis felineus & viverrini Cat Liver Fluke Lancet-shaped Reddish yellow Tapering anterior with somewhat rounded posterior Oral sucker smaller than ventral sucker Lobate testes, obliquely in tandem Lobed ovary Same with Clonorchis Smaller Cannot be differentiated from C. sinensis, and H. heterophyes

Segmentina Hippeutis

Bithynia leachi

2 Intermediate Host Reservoir Host Final Host

nd

Diseases

Trapa bicornis(Water Caltrop) Eliocharis tuberosa(Water Chestnut) Ipomoea obscura(Obscure Morning Glory) Nymphaea lotus (Lotus) Pigs, Dogs, Rabbits Man, Pigs Inflammation and Ulceration Intestinal Obstruction Intoxication absorption of worm metabolites by the host Edema

Fish from Cyprinidae family (Carps and Minnows)

Cats, Pigs, Dogs Man Gallstones (calculi) Periductal fibrosis Cholangitis, Hepatitis, Pancreatitis Cirrhosis and portal hypertension Adenocarcinoma of the gallbladder, liver cancer, cholangiocarcinoma Eosinophilia

Cats, Pigs, Dogs Man Hepatitis Autonomic dysregulation of the cardiovascular system Cholangiocarcinoma, liver cancer

Scientific Name Common Name

Adult General Characteristics

Echinostoma ilocanum Garrisons Fluke Covered with plaque-like scales Oral sucker equipped with CIRCUMORAL DISC (collar of 49 51 spines) Lobed testes arrange din tandem; dumbbell-shaped

Heterophye sheterophyes Heterophyd worm, Von Siebold's Smallest yet deadliest trematode Pyriform in shape With scalelike spines With 3rd genital sucker (GONOTYL) Round testes in tandem

Paragonimus westermani Oriental Lung Fluke Reddish brown Roundly anterior, tapering posteriorly Covered with spines Deeply lobed testes Posterior ovary to ventral sucker with 6 long unbranched lobes

Schistosoma Distinct from other flukes: Diecious Not operculated (without lids) Portal of entry: skin penetration Have no metacercaria Has only one intermediate host Adult Males: shorter and stouter Adult Females: longer and slender Life Span: 3 10 years Has oral and ventral suckers ingests RBC and absorbs nutrients in blood for survival GYNECOPHORAL CANAL Cercaria with bifurcated tail S. mansoni Lateral spine (roses thorn) S. haematobium S. japonicum S.intercalatum S.mekongi Terminal spine With knoblike protuberance Terminal bent spine Lateral spine

Smaller, thinner and inconspicuous operculum with germ ball (abopercular knob)

Operculated Embryonated

Golden Brown Oval with Flattened operculum With thickened abopercular portion Can be recovered in stool or sputum

Ova

Can be found in stool or urine (S. japonicum and haematobium) 1 Intermediate Host [SNAILS!!! ] 2nd Intermediate Host Reservoir Host Final Host
st

Gyraulusconvexiusculus Hippeutis umbilicus

Melanoides juncea Thiara riquetti

Brotia asperata Antemelania asperata

Oncomelania hupensis quadrasi(S. japonicum) Biomphalaria (S. mansoni) Bulimus (S. haematobium and intercalatum) Tricula (S. mekongi)

Pila luzonica Pila conica(Kuhol) Man, Cats, Pigs, Rats, Dogs Ulceration Diarrhea (sometimes bloody) Intoxication

Fishes such as Chanos chanos (Milkfish/Bangus) Man, Cats, Dogs Colicky abdominal pain Peptic ulcer disease Acid peptic disease Upper abdominal discomfort Gurgling abdomen Heart failure, sensory and motor loss, and intracerebral hemorrhage (if eggs and adults migrate to the heart, spinal cord and brain)

Sundathelpusa philippina(Talangka) Other crustaceans Man, Cats, Dogs Dry cough BLOOD-STAINED SPUTUM Chest pain, Dyspnea, hemoptysis Bronchitis Cerebral involvement most serious complication Man SEE OTHER PAGE

Diseases

Sputum Exam Add 3% NaOH, centrifuge, demonstration fo eggs in sediment X-Ray, Serology, Intradermal tests

Diagnosis

Direct Fecal Smear (DFS) Urinalysis (hematuria) S. haematobium (ova) Concentration Techniques Formalin Ether Concentration Technique (FECT) Merthiolate Iodine CT (MICT) Advantage a. Eggs will sediment b. Fecal debris can be removed

c. Procedure can be interrupted anytime Faust Malloney Egg Hatching Technique Stool is diluted with water Schistosoma eggs will hatch and miracidia will ascend to the upper layer of the water Biopsies Rectal biopsy may show mucosal inflammation with eosinophilic infiltration Liver (open wedge biopsy) rule out other comorbid conditions like Hep B or C or alcoholic cirrhosis Ultrasound Not only diagnose Schistosomes induced liver disease but determine the grade of hepatic fibrosis Serodiagnosis CPT or Circumoval Precipitin Test: a special precipitation technique which uses lyophilized S. egg (antigen) as reagent Procedure: Mix reagent and serum on a glass slide which is glass beads (for space elevation). Seal with coverslip in paraffin stand overnight. Positive result: Bleb formation occurs when antibiotics for schistosome are present in serum.

Trematodes Flukes/Flatworms Flat and leaf like, unsegmented No pseudocoele No excretory pore With complicated life cycle due to various larval stages and various intermediate hosts SNAILS are always the 1st Intermediate hosts Have an incomplete digestive system (unlike nematodes) Except for Schistosoma, all flukes are: 1. Hermaphroditic organ of male and female are in one adult (monoecious) 2. Have operculated egg (lid/cover) 3. Requires a 2nd intermediate host 4. MOT: ingestion of 2nd intermediate host 5. Metacercaria(final larval stage) = Infective Stage Except for Heterophyes, all have 2 suckers: 1. Oral sucker mouth 2. Ventral sucker (acetabulum) for attachment Heterophyeshave a 3rd sucker (genital sucker/gonotyl) General life Cycle: Egg (larval stages of) MiracidiumSporocystRediaCercariaMetacercaria Adult Can be classified as: 1. Blood flukes Schistosoma 2. Lung flukes Paragonimus 3. Liver flukes Fasciola, Clonorchis, Opistorchis 4. Intestinal Flukes Fasciolopsis, Heterophyes, Echinostoma, Metagonimus Eggs: Mature eggs (CHOS!) Schistosoma Clonorchis Opistorchis Heterophyes Immature eggs (PEFF!) Paragonimus Fasciola Fasciolopsis Echinostoma Disease (Schistosomiasis) Schistosome dermatitis Immediate itching and urticaria Swimmers itch Penetration of nonhuman schistosomecercaria Katayama fever Acute onset on infection Fever, myalgia, headache, nausea, diarrhea, etc.

Egg granuloma Observed in eggs trapped in tissues Intestinal schistosomiasis S. mansoni, S. japonicum, S. mekongi In mesenteric veins Intermittent and bloody diarrhea Most common symptom Colonic polyps and inflammatory pseudopolyps confused with Crohns disease (granulomatous colitis) Colon cancer in chronic infection Hepatosplenicschistosomiasis S. japonicum, S. mekongi Through portal circulation Hepatosplenomegaly Portal hypertension Symmers clay pipe stem fibrosis Filled with dense collagen, resembling clay pipe Hepatocellular carcinoma (chronic infection) Involvement of the lungs - S. haematobium - Through the caval system, reaching the pulmonary cappilaries through the right side of the heart - Pulmonary embolism - Pulmonary arterial hypertension - Corpolmunale (right-sided heart failure) - Change in the structure and function of the right ventricle Neuroschistosomiasis - Migration of adult worms and entry of eggs in vertebral and cerebral venous plexuses - Cerebral migration (S. japonicum and S. mansoni) - Vertebral migration (S. haematobium) - Increases intercranial pressure (transverse myelitis) - Inflammation of the gray and white mater in the spinal cord (seizures) Genitourinary involvement - S. haematobium - Lower urinary tract Polypoid lesions cause obstructive neuropathy - These lesions become acellular and fibrotic (sandy patches) - Hematuria and proteinuria - Chronic glomerulonephritis - Squamous cell carcinoma - Predisposes to recurrent UTI, particularly salmonella