INTESTINAL FLUKES - Testes: Two lobed and obliquely oriented

1. Fasciolopsis buski 2. Metagonimus yokogawai

Known as the “Giant intestinal fluke” - common in the Far East
MOT: Ingestion Synonyms:
IS to Human: Metacercaria -- In 1912, Kobayashi gave the name Loxotrema ovatum
1st IH: Snails (Genus Segmentina, Gyraulus, Polypilus and Hippeutis) -- In 1913, Yokogawa gave the name Metagonimus ovatus
2nd IH: Water chestnut (Eliocharis tuberosa), Bufallo Nuts (Trapa natan/Trapa Common name: Yokogawat Fluke
bicornis) Disease: Metagonimiasis
TREATMENT: Praziquantel DH: Human, Cats, Dogs, Hogs
DIAGNOSIS: Finding the egg in the feces or stool MOT: Ingestion of Raw/freshwater fishes
- Can cause eosinophilia as a symptom IS: Metacercaria
- Preventive Measure: Immerse aquatic vegetable in boiling water for a few seconds Diagnosis: Finding eggs in the stool
then wash with cool and clean water. 1st IH: Snails (Semisulcospira libertina, Thiara, Hua ningpoensis)
2nd IH: Salmonoid fishes (Plectoglossus alpitvelis, Salmo perryi)
2. Echinostoma ilocanum Testes: One big, one small
Known as “Garrison’s Fluke”
-Discovered by Garrison 3. Haplorchis yokogawai
-Discovered from a native in Luzon (an Ilocano) 1st IH: Egypt: Pirenella conica; Japan: Cerithidea; Thiara
-A parasite of aquatic birds(Definitive Host) 2nd IH: Egypt: Tilapia masomhica; Philippines: Biya; Japan: Acanthogobius
- Not a parasite of humans; human only becomes an accidental host Testes: One big testis
MOT: Ingestion of Metacercaria
IS: Metacercaria LUNG FLUKE
Diagnosis: Finding of eggs in stool 1. Paragonimus westermani
Testes: Dumbbell in tandem Known as “Oriental Lung Fluke”
1st IH: Snail (Gyraulus convexiusculus; Hippeutis umbilicaris) -common among oriental countries (Asian countries e.g. Japan, Philippines)
2nd IH: Freshwater fish (Pila luzonica) -not very common but once you see the symptoms, it is almost always mistaken as
tuberculosis
HETEROPHYIDS/HETEROPHYID FLUKES MOT: Ingestion
- known to be the smallest but deadliest, causing hemorrhagic brain convulsion, IS: Metacercaria
cardiac Beri Beri and paralysis 1st IH: Snails (Thiara granifera, Semisulcospira libertina, Brotia asperata)
2nd IH: Freshwater crabs and crayfish (Parathelphusa grapsoides, Potamon dehaani,
1. Heterophyes heterophyes Sesarma amurensis, Astarcus)
MOT: Ingestion of raw or fresh mullets or fessikh (known as salted mullets) pickled Disease: Paragonimiasis
for less than 14 days Symptom: Dry Cough; Production of blood strip sputum (tenacious rusty brown
IS: Metacercaria sputum)
DH: Humans, Dogs, Cats Hemoptysis – spitting of blood from the lungs ; sputum-containing blood
Disease: Heterophyiasis coming from the lungs (Rusty tenacious brown sputum)
Diagnosis: Finding eggs in the stool Hematemesis- Spitting of blood from the stomach
- Common among fish-eating mammals and fish-eating birds (pelicans) DIAGNOSIS: Eggs in the stool and sputum
1st IH: Brackish water snails (Egypt: Pirenella conica; Japan: Cerithidea) Lifecycle: Ingestion of crayfish containing metacercaria – intestine – peritoneal
2nd IH: Freshwater fishes (Egypt: Tilapia masomhica; Japan: Acanthogobius) cavity (immature worm) – lungs (mature and produce eggs)
Specimen: Stool or sputum -- The parasite usually goes into the mesenteric veins.
EXAMINATION: The sputum needs to be centrifuged. The sediment will be treated
with NaOH and examined for the ova microscopically
Preventive measure: Proper cooking of crabs and cleaning of crabs before cooking. Differences of the three species of Schistosomes
-When found in the brain, it may cause Jacksonian Epilepsy - Testes
-The person may also experience chest pain, irritation of the bronchi S. japonicum – 7 to 9 in rows
-When it migrates to the brain, it can cause Cerebral Paragonimiasis that may lead S. haematobium – 4 to 5 in clusters
to neurologic condition. S. mansoni – 6 to 9 in clusters
-The patient may experience seizure, vision difficulties, decrease precision of the
motor skills
1. Schistosoma japonicum
. - discovered by Katsurada in 1904
-Known as “Oriental Blood Fluke”
SCHISTOSOMES MOT: Skin Penetration to invade the circulatory system
Phases IS: Cercaria
1. Migratory Phase – the time from penetration until maturity and egg production. 1ST IH: Oncomelania quadrasi (Philippines); Oncomelania formosana (Japan);
(The term penetration means invasion of the cercariae into the skin). This phase is Oncomelania hupensis (Southeastern China)
asymptomatic. It causes dermatitis because the cercaria penetrates the skin (only 2ND IH:
the head gets in and the tail remains outside). RESERVOIR HOST: Rats, mice, cats, dogs, horses, cows, water buffalo, and swine
2. Acute Phase/Katayama Fever – when schistosomes begin to produce eggs. HABITAT: Superior Mesenteric Vein
Symptoms include chills, fever, fatigue, headache, muscle ache, and increase of DIAGNOSIS: Eggs in stool; Rectal Biopsy in chronic cases
eosinophilia. SYMPTOMS: Severe anemia, bulging of the stomach
3. Chronic Phase LIFESPAN: 20 years
-- S. mansoni: mild chronic bloody diarrhea DISCOVERER: Katsurada (1904)
-- S. haematobium: pain on urination with blood in the urine FEMALE ADULT: 1.2-2.6 cm x 3mm in diameter
-- S. japonicum: eggs reach the brain more often MALE ADULT: 0.6-2.2 cm
EGGS: 55-85 micrometer x 40-60 nm with minute lateral spine
* If the schistosome passes through the lungs, it can cause Pneumonia. TESTES: 7-9 in rows
* Causes Swimmer’s itch or Clam digger’s itch -Endemic in Yangtze River Valley in Central China
Lifespan: 20 years
Diagnosis: Specimens used are stool, blood, biopsy (e.g. rectal biopsy especially for Main clinical sign: Diarrhea (as S. japonicum is an intestinal schistosome)
S. haematobium, liver biopsy, bladder biopsy). For the examination of stool Main symptom: Bulging of the stomach
specimen, aside from DFS, it should be augmented with Concentration method. Disease can also be called as Katayama’s Disease or Oriental schistosomiasis
In some cases, modern techniques are used (e.g. Strips like of pregnancy and drug
test that will show two lines if you are positive for schistosomiasis). 2. Schistosoma haematobium
-Urinary Schistomiasis
-- From the egg, the parasites develop into a ciliated miracidium which is found in the GEOGRAPHICAL LOCATION: Africa and Middle East
water. The miracidium becomes infective to the 1st IH (Snail). In the snail, the stages MOT: Skin Penetration to invade the circulatory system
will develop until it becomes cercariae, and the cercariae will come out of the snail IS: Cercaria
and be found swimming in the water. Then, the cercariae will eventually penetrate DIAGNOSIS: Recovery of eggs by Centrifugator or Sedimentation of Urine; Eggs in
the skin of humans. biopsy material from the bladder wall
-- Upon penetrating the skin, it can migrate into the liver of the human host. DISEASE: Schistosomal Hematuria, Urinary Bilharziasis
HABITAT: Urinary Bladder
SYMPTOMS: Hematuria, painful micturition, elephantoid condition of penis and
scrotum (Painful micturition with Hematuria (as its habitat is in the Urinary bladder);
Elephantoid condition of the penis and scrotum)
LIFESPAN: 20 years (20 to 25 years)
1ST IH: Snail (Bulinus) (Species: Bulinus globosus, B. forskalii, B. nasutus, B.
nyassanus, and B. truncatus)
ADULT FEMALE: 2 cm
ADULT MALE: 1.5 cm
EGGS: 112-170 micrometers x 40-70 micrometers with conspicuous terminal spine
TESTES: 4-5 in clusters
-Associated with Splendore-hoeppli phenomenon (the eosinophilic antigen-
antibody precipitation around the egg)
- Disease: Urinary schistosomiasis or Bilharziasis (named after its discoverer -
Bilharz)
TREATMENT: Praziquantel
DISCOVERER: Theodor Bilharz (1851)

3. Schistosoma mansoni
- Aside from Africa, it is also found in the Western hemisphere which includes Latin
countries (e.g. Brazil, Venezuela and Puerto Rico)
MOT: Skin Penetration to invade the circulatory system
IS: Cercaria
GEOGRAPHICAL DISTRIBUTION: Africa, Western Hemisphere (Brazil, Venezuela,
Puerto Rico, Caribbean Islands)
1ST IH: Snail (Biomphalaria alexandrina in African continent; Australorbis glabratus in
the Western hemisphere)
HABITAT: Inferior Mesenteric Vein
SYMPTOMS: Loss of Weight, Enlarged liver and spleen
LIFESPAN: 20-30 years
DISCOVERER: Louis Westenra Sambon (1907)
TESTES: 6-9 in clusters
DISEASE: Hepato-Intestinal Schistosomiasis
Symptom: Enlarged liver and spleen