 Dorso-ventrally flat

 Unsegmented
 With integument
 With holes in their
body Suckers
(oral/ventral)
 Shape:
- flat, leaf – like in shape,
lanceolate, spatulate
- slender anteriorly & broad
posteriorly
 Sex:monoecious
(hermaphrodite) except the
Schistosomes which are
diecious

 Adult forms are oviparous

 Oral sucker
 Sex:monoecious
Esophagus
 Morphology
Pharynx

Intestinal
ceca
Ventral sucker
Male
Ovary
Female Flame cells
Testes
Excretory bladder

Excretory pore
 Ovaare operculated, EXCEPT the
Schistosomes which are non-
operculated but spinous
 Ova

OPERCULATED
EMBRYONATED
NON-EMBRYONATED

NON-OPERCULATED
EMBRYONATED
SPINOUS
Operculated, Operculated, Non-
non- embryonated operculated,
embryonated embryonated

F. hepatica C. sinensis S. japonicum

F. buski O. felineus S. mansoni
E. ilocanum H. heterophyes S. hematobium
P. westermani M. yokogawai
H. yokogawai
 Types of Cercaria Parasite
Lophocercus simple F. hepatica, F. buski, E.
tailed ilocanum
Lophocercus keel C. sinensis, O. felineus, H.
tailed heterophyes, M. yokogawai,
H. yokogawai
Microcercus P. westermani
Fork tailed S. japonicum, S. mansoni, S.
hematobium
 Clonorchis Schistosoma
 Cercaria sinensis japonicum
Opistorchis Schistosoma
felineus mansoni
Heterophyes Schistosoma
flukes hematobium
Lophocercus,
simple tailed
Fork
Lophocercus, tailed
keel tailed
Fasciola
hepatica
Fasciolopsis
buski
Echinostoma Microcercus
ilocanum Paragonimus
westermani
 requires
2 intermediate hosts to
complete the life cycle EXCEPT
Schistosomes that require 1
intermediate host
Intermediate Hosts Parasite
Snail- aquatic F. hepatica, F.buski
vegetation
Snail-fish C. sinensis, O. felineus, H.
heterophyes, M. yokogawai,
H. yokogawai
Snail-snail E. ilocanum
Snail-crabs or P. westermani
crayfish
Snail only S. japonicum, S. mansoni, S,
hematobium
 The infective stage of all
Trematodes  metacercaria
EXCEPT Schistosoma spp  fork-
tailed cercaria
 Sporocyst – Redia – cercaria
 Clonorchis sinensis
 Opistorchis felineus

 Paragonimus westermani
 Sporocyst – redia I – redia II –
cercaria
 Fasciola hepatica
 Fasciolopsis buski
 Sporocyst– redia – cercaria /
Sporocyst – redia I – Redia II –
cercaria
 Heterophyes heterophyes
 Metagonimus yokogawai

 Haplorchis yokogawai
 Redia I – redia II – cercaria
 Echinostoma ilocanum

 Sporocyst I – sporocyst II –
cercaria
 Schistosoma japonicum
 Schistosoma mansoni

 Schistosoma hematobium
 A. S–R–C
 B. S – R1 – R2 – C
 C. R1 – R2 – C
 D. S1 – S2 – C

C. Sinensis
O. Felineus
O. Viverrini
H. Heterophyes S. Japonicum F. Hepatica
E.
M. Yokogawai P. Westermani
S. mansoni F. buski
H. yokogawai E. ilocanum
S. haematobium
INTESTINAL CECA
Simple C. sinensis, O. felineus,
E. ilocanum, H.
heterophyes, M.
yokogawai, H.
yokogawai
Simple, zigzag pattern P. westermani
Branched F. hepatica, F. buski
VITELLARIA
Branched F. hepatica, F. buski, P.
westermani
Delicately granular C. sinensis
Medium-sized E. ilocanum
Transversely O. felineus
compressed
Large, polygonal H. heterophyes, M.
yokogawai, H. yokogawai
 Intestinal ceca

 Vitellaria/Vitelline follicles
TESTES
Branched, one on top of the other F. hepatica, F. buski, C.
sinensis
Irregularly lobulated (side by side) P. westermani
Deeply lobular, one on top of the E. ilocanum
other
Lobular, obliquely arranged to O. felineus
each other
Spherical, unequal size, lying side H. heterophyes
by side
Ovoid, unequal size, lying side by M. yokogawai
side
Single, spherical testes H. yokogawai
OVARY

Ovoid E. ilocanum
Spherical/globular H. heterophyes, M.
yokogawai, H. yokogawai

Branched F. hepatica, F. buski

Lobular C. sinensis, O. felineus,
P. westermani
 Testes

 Ovary
 Ingestion of improperly cooked
2nd intermediate host containing
the metacercaria
 Skin penetration by fork tailed
cercaria
 Fasciola hepatica
Clonorchis sinensis
 Liver Flukes Opistorchis felineus
 Intestinal Flukes Opistorchis viverrini
 Lung Fluke
 Blood Flukes Fasciolopsis buski
Echinostoma ilocanum
Heterophyes heterophyes
Metagonimus yokogawai
Haplorchis yokogawi

Schistosoma japonicum
S. haematobium
S. mansoni
Paragonimus westermani
 PARASITE COMMON NAME

Fasciola hepatica Sheep liver fluke

Clonorchis sinensis Oriental or Chinese liver fluke

Opistorchis felineus Cat liver fluke

Opistorchis viverinni

Fasciolopsis buski Giant intestinal fluke

Echinostoma ilocanum Garrison’s fluke

Heterophyes heterophyes von Siebold’s fluke

Metagonimus yokogawai Yokogawa’s fluke

Haplorchis yokogawai
 Fasciola
hepatica

Clonorchis sinensis
 Paragonimu
s
wesermani

Fasciolopsis
buski
 F. C. sinensis O. felineus O.
hepatica viverrini
Common Sheep liver Chinese liver Oriental liver
name fluke fluke fluke
Distribu- South China, Korea China, Korea Thailand
tion America
Disease Fascioliasis Clonorchiasis Opischloriasis
Infective Metacer- Metacercaria metacercaria Metacer-
stage caria caria
MOT ingestion ingestion ingestion ingestion

Habitat Proximal Distal biliary Distal biliary

biliary passage passage
passage/
liver
LIVER FLUKES
 Parasite Common Name Disease
Produced
Fasciola Sheep liver fluke Fascioliasis
hepatica Temperate liver Sheep Liver
fluke Rot
Clonorchis Chinese liver fluke Clonorchiasis
sinensis Oriental liver fluke

Opistrochis Cat liver fluke Opistorchiasis

felineus felineus
Opistorchis Opistorchiasis
viverrini viverrini
 Found in the liver & biliary
passages
 2 species:
- F. hepatica – temperate liver
fluke
-F. gigantica – tropical liver fluke
Duodenum

Visceral cavity

Glisson’s capsule

Liver parenchyma

Hepatic duct

Proximal biliary
passage

Gall bladder
Pancreatic
duct
Blood vessel

Soft tissues, Skin

Lungs
 1st intermediate host  snails
(Lymnaedae)
- L. philippinensis
- L. auricularia rubiginosa

 2nd
intermediate host  aquatic
plants
- Ipomea obscura (kangkong)
- Nasturtium officinale
(watercress)
 Trapa spp.

 Kangkong

2nd Intermediate Hosts

Watercress Kangkong
 Distribution
– Central and Latin
America, South America, Middle
East, France, England, etc.
2 stages:
1. Acute/ invasive stage – larval
migration & worm maturation in
the liver tissues
2. Chronic stage – persistence of
Fasciola worms in the biliary
ducts
 Period of liver invasion  trauma &
necrosis
 Can be asymptomatic  bile ducts
acute symptoms (2-6wks) 
dyspepsia, fever, N & V, RUQ pain
 Clinical triad  high fever,
hepatomegaly, marked eosinophilia
 Worm may cause obstruction 
inflammation of biliary epithelium
 fibrosis  less bile passed out
 Heavy infections  atrophy of
liver & cirrhosis  worm re-enter
liver  abscess
 Halzoun or Marrara
 Due to ingestion of raw fasciola-
infected liver  fluke survive
mastication  attach to posterior
pharynx  hemorrhagic
nasopharyngitis & dysphagia
 Cholelithiasis
 Hemobilia
 Biliary
cirrhosis
 Acute pancreatitis – rare
 Extrahepatic sites (lungs, brain,
subcutaneous tissue, orbit) 
abscess or fibrotic lesions
 Skin migratory purpuric &
painful subcutaneous nodules up
to 6 cms

 brain,
orbit, lungs, heart etc. 
abscess formation
 Liver involvement
 Skin involvement
 Halzoun/Marrara

Ductal epithelial hyperplasia,

Marked destruction and
infiltration, dilatation and
inflammation of liver tissue,
periductal fibrosis
capsular hematoma, and pockets
Biliary obstruction: cholecystitis,
of abscesses to fibrosis.
cholangitis and cholelithiasis
Subcutaneous nodules
associated with erratic
migration of juvenile
Fasciola hepatica
 Stoolexamination
 Serodiagnosis
 Imaging
 Praziquantel
 Bithionol
 Triclabendazole
 Health education
 Proper hygiene & sanitation
 Protection of watercress beds
 Thorough cooking of vegetables,
boiling of water
 Anti-molluscicides to destroy snail
hosts
 Acute viral hepatitis
 Schistosomiasis
 Visceral toxocariasis
 Biliary tract diseases
 Hepatic amoebiasis
 Parasites of the bile duct &
gallbladder of humans & fish-
eating animals
 There are many fish species that
can serve as intermediate host 
most common  Cyprinidae
 Distribution:
Southeast Asia,
China, Korea, Taiwan etc.
 Distribution:Central, eastern and
Southern Europe, USSR, Siberia,
Far East: Japan, Korea,
Philippines, Vietnam, India,
Hongkong
 Opistrochis
felineus

Clonorchis
sinensis
2nd Intermediate
Hosts
Pickled fish
Smoked fish
Salted fish
Dried fish
Raw fish
Duodenum

Sphincter of
Oddi

Distal biliary
Passage

Hepatic duct

Gall bladder

Pancreatic
duct
 Gross picture of adult
worms, liver tissue and
x-section of thickened
ducts

X-section of the dilated

biliary duct containing 2
adult worms within the
lumen of the duct with
proliferation of the
epithelial lining
X-section of the biliary duct with adult
worm. Note enlarged, dilated, tortuous
thickening of the duct with proliferated
epithelial lining
 Acute phase:
• Appears 10 – 26 days after
ingestion of infected fish
• Low grade fever, anorexia,
diarrhea, enlarged tender liver
• hepatic or epigastric pain
 Flatulence & indigestion
 Increasing worm burden  low
grade fever, progressive
hepatomegaly, RUQ tenderness,
intermittent RUQ & epigastric
pain, gall bladder dilatation &
dysfunction, weakness, anorexia
& diarrhea
Consideration:
• Leukocystosis
• eosinophilia

Eggs (-) in the feces 3 to 4 weeks

after onset
 Cholelithiasis
 Pyogenic cholangitis
 Biliary obstruction
 Abscess formation
 Mild to severe pacreatitis
 Cholangiocarcinoma (high in
Opistrochiasis)
 Hepatocellular carcinoma (high in
Clonorchiasis)
1.Stool examination,
duodenal or biliary
aspirate
2.Serology
3.Imaging of the liver
4.Histopathology of
malignant growth
 F. C. sinensis O. O.
hepatica felineus viverrini

Ova Operculated, Operculated Same as Same

non- embryonated Clonorchis
embryonated (old bulb)
(hen’s egg)
I. Host Snail-aquatic Snail- fresh Same as Same
combina- vegetation brackish Clonorchis
tion water fish
Type of Lophocercus, Lophocercus, same same
cercaria simple tailed keel tailed
Intramollus- S-R1-R2-C S-R-C or S- same same
can dev’t R1-R2-C
 F. C. sinensis O. O.
hepatica felineus viverrini
Pathology Epithelial & Epithelial & Epithelial &
endothelial endothelial endothelial
proliferation proliferation, proliferation,
- cystic cystic cystic
dilatation of dilatation of dilatation of
biliary biliary biliary
passages passages passages

Other - abscesses HepatoCA > HepatoCA <

Pathology in the liver cholangio- cholangio-
- Halzoun carcinoma carcinoma
- Reddish
nodule in SC
tissues &
skin
 F. C. sinensis O. O.
hepatica felineus viverrini
S/S RUQ pain, fever, RUQ pain, RUQ pain,
jaundice, easy Jaundice, Jaundice,
fatigability fever, easy fever, easy
- Halzoun fatigability fatigability
- Painful skin - S/S - S/S
nodule/indura- associated associated
tion with with with
swelling malignancies malignancies

Lab. Hx & PE Hx & PE Hx & PE

dx Stool exam Stool exam Stool exam
Serology Serology Serology
Imaging of liver Imaging of Imaging of
liver liver
Histopath Histopath
 F. C. sinensis O. O.
hepatica felineus viverrini

Treatment Triclaben- Praziquantel Praziquantel

dazole
Bithionol
Prevention - Hygiene & - Hygiene & same same
sanitation sanitation
- Health - Health
education education
- Protection - Cook fish
of H2Ocress thoroughly
beds Destroy snail
- Cook liver host Cu2So4)
adequately - Avoid using
-vaccination night soil as
fertilizer