Introduction to Trematodes and Intestinal Flukes Dr.

Mateo

Note: Italicized text were taken from the notes of the transcriber

TREMATODES unembryonated when first passed, containing early

cleavage stages
 Body is generally FLAT and LEAF-LIKE except for
Schistosomes which are elongated.
 One or more VENTRAL SUCKERS are always present
on ventral surface.
 Heterophide have GENITAL SUCKER (GONOTYL)
 The alimentary canal consists of a short median
anterior portion which bifurcates to form 2
posterior portions
 The anterior portion of the gut has a muscular
pharynx EXCEPT for Schistosomes in which the
pharynx is absent
 The posterior portions end blindly and therefore
known as CAECA. The caeca are usually unbranched
although some species have many branches
 They are MONOECIOUS except for Schistosoomes
 All Heterogenous (more than 1 host)
 DEFINITIVE HOST: Man Figure 1. Life Cycle of Fasciolopsis buski
 1st INTERMEDIATE HOST: Snail UNEMBRYONATED EGG passed in feces  EMBRYONATED
 2nd INTERMEDIATE HOST: Water Chestnut EGG in water MIRACIDIUM hatches from egg and
(Eliocharis tuberosa), mullet, Freshwater fish, snail, penetrates SNAIL Miracidium in snail develops into
crab
SPOROCYST  REDIAE  CERCARIAE free swimming
 INFECTIVE LARVA: Metacercaria
CERCRIA Cercaria encyst on WATER PLANTS; secretes cyst
 INFECTIVE LARVA OF SCHISTOSOMES: Cercaria
wall  becomes METACERCARIAE MAN eats waterplants
with METACERCARIAE Cyst digested, worm attaches to
FASCIOLOPSIS BUSKI INTESTINAL MUCOSA
 GIANT INTESTINAL FLUKE
 Disease caused: Fasciolopsiasis  SYMPTOMS AND PATHOGENESIS
 Found in China (including Taiwan), Vietnam, o Attachment to bowel to mucosa  local
Thailand, and in parts of Indonesia, Malaysia and inflammation and ulceration, sometimes
Indian subcontinent accompanied by hemorrhage
 Adult worm live attached to the bowel primarily the o Heaver infection  abdominal pain 
DUODENUM and JEJUNUM; In heavy infection = suggestive of duodenal ulcer and diarrhea;
throughout the intestinal tract stools profuse, light yellow color and contain
 Life span seldom exceeds six months much undigested food suggestive of
 Infection is acquired by ingestion of metacercaria malabsorptive process
encysted in freshwater vegetation such as bamboo o Vitamin B12 absorption impaired
shoots or water chestnuts, which may be consumed o Intestinal obstruction occurs
raw or peeled with teeth. o Edema and Ascites may develop in severe
 RESERVOIR HOST: pigs, dogs, rabbits cases
 ADULT WORM is elongated, oval in shape,
measures 20-75 mm in length, 8-20 mm in width. It Figure 2. Adult Fasciolopsis buski.
does not have a cephalic cone and its intestinal  Thick fleshy, ovate, fleshy-
caeca are unbranched and reach up to posterior colored
end.  2 dendritic testes in tandem
 Two testes are dendritic and are arranged in  Single Branched Ovary
tandem in the posterior half of the body.  Convuluted Uterus
 The branched ovary lies to the right of the midline.  Vitellaria lateral to the ceca
Fine vitelline follicles are situated throughout the in the middle of the body
lateral margin of the body.  Oral sucker ¼ the size of the
 The EGG is large, operculated and indistinguishable ventral sucker
from the eggs of Fasciolopsis gigantica and  Cuticle with small spine
Fasciolopsis hepatica. Measures 130-140 um,
yellow brown in color; shell is transparent;

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Note: Italicized text were taken from the notes of the transcriber

Figure 3. F. buski Egg

 Yellowish, ellipsoidal
 Clear Thin Shell with operculum
at one end
 Undeveloped when passed in
the feces

HETEROPHYES HETEROPHYES
 VON SEIBOLD’S FLUKE
 Disease caused: Heterophyiasis
 EPIDEMIOLOGY
o Parasite may be found in Egypt, Greece, Israel,
Central and South China, Japan, Korea, Taiwan
and Philippines
o Mode of Transmission: ingestion of
metacercaria encysted in fish
o ADULT FLUKE is elongated, oval, or pyriform
and measures <2mm in length. Integument
has fine, scale-like spines. Some species have a
gonotyl or genital sucker that is located near
the left posterior border of the ventral sucker
o Testes variously arranged are in the posterior
end of the body
o Ovary is globular or slightly lobed and is
located sub-median, pre or post-testicular
o The EGG is light brown in color, ovoid in
shape, operculated, measures 20-30 um by
15-17 um. A fully developed symmetrical
miracidium present within the eggs when it is
deposited by adult worm. Operculum fits into
eggshell smoothly and it does not have an
abopercular protuberance in contrast to liver
flukes
 1st INTERMEDIATE HOST: snail hosts freshwater
brackish water or marine species H. taichui and
Procerverum calderoni, Melania juncea, and Thiara
riquetti
 2nd INTERMEDIATE HOST: Mullet (Mugil cephalus)
 SYMPTOMS AND PATHOGENESIS
o Inflammation at sites where worm is attached
to or burrowed in the mucosa
o Excessive mucus production, sloughing off of
the superficial layers may occur
o Colicky pain and mucoid diarrhea may be
present
o EGGS and ADULT of Heterophyes has been
observed in heart and brain of patients who
died of heart failure and inter-cerebral
hemorrhage. Eggs dislodged in spinal cord
may result to sensory and motor losses at the
level of the lesion
 TREATMENT: Praziquantel (BIltricide) 25 mg/kg TID
for one day
Figure 4. Heterophyes heterophyes Life Cycle
EMBRYONATED EGGS each with a fully developed
MIRACIDIUM are passed out in feces and reach water 
Ingested by fresh water SNAIL (1st IH)  MIRACIDIUM
develops into SPOROCYST  REDIAE  Free swimming
CERCARIAE  Cercaria penetrate the skin of
freshwater/brackish FISH and encyst as METACERCARIAE in
the tissue of the fish  HOST becomes infected by ingesting
undercooked fish containing metacercariae
Figure 5. Adult Heterophyes heterophyes
 Pyriform, grayish fluke
 Oral sucker with short pharynx,
large ventral sucker
 2 Ovoid Testes
 Subglobose ovary
 Vitellaria with large polygonal
follicles in lateral posterior 3rd
 Cuticle with scale-like spine
Figure 6. H. heterophyes Egg
 Light brown, ovoid
 Thick shell
 Operculated
 Fully developed miracidia at
oviposition
 Slight shoulder at rim of
operculum and sometimes a
knob at posterior pole
ECHINOSTOMA ILOCANUM
 GARRISON’S FLUKE
 Disease caused: Echinostomiasis
 Mode of Transmission: ingestion of metacercaria
encysted in snails
 1st INTERMEDIATE HOST: Snail (Gyraulus
convexiusculus, Hippentis umbilicus)

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Note: Italicized text were taken from the notes of the transcriber

 2nd INTERMEDIATE HOST: Snail (Pila conica  Figure 8. Adult Echinostoma ilocanum
kuhol; Vivipara angulares  susong pampang  Reddish grey
 ADULT WORM is reddish and measures 2.5-6.6mm  Tested deeply lobed and in
in length and 1-1.35 mm in width tandem
 Worm is tapered at the posterior end and has 49-51  Ovary in front of testes
cellar species  Crescent-shaped vitellaria
 ORAL SUCKER lies in the center of the circumoral  Oral sucker at centrer, ventral
disk (with 49-51 spines) and the VENTRAL SUCKER sucker at anterior 5th
is situated at the anterior fifth of the body  Anterior end with circumoral
 The two testes are deeply lobed, arranged in disk
tandem at the third quarter of the body  Plaque-like scales
 Ovary is located in front of the anterior testes
 Follicular vitellaria are located in the posterior half
of the body Figure 9. Echinostoma ilocanum egg
 Uterine coils are found between the ovary and the  straw colored
ventral sucker  Operculated
 Intestinal ceaca are simple  Immature when passed in
 EGG is straw colored, operculated, and ovoid feces
measuring 83-116 um by 58-69 um.
 PATHOGENESIS AND CLINICAL MANIFESTATION
o Inflammation at the site of attachment of
adult worms to the intestinal wall Intestinal Flukes 1st intermediate host 2nd intermediate host
o HEAVY INFECTION: Diarrhea (sometimes
bloody) Fasciolopsis buski Planorbid snails Eliocharis tuberos
o Abdominal Pain may develop (Segmentina, (water chestnut),
o Absorption of worm metabolites  Hippeutis, Gyraulus) Trapa (water caltrop),
general intoxication ZIzania (water
bamboo), Kangkong
Heterophyes Brackish water snails, Mugil (mullet), Tilapia
heterophyes Pirenella, Cerithidae
Metagonimus Semisculospira, Thiara, Plecoglossus, Salmo
yokogawai Hua, LIbertine (freshwater salmoid
fish), Altivelis Perryl
Echinostoma ilocanum Gyraulus Pila luzonica, Pila
convexiusculus, conica, Vivipira
Hippentis umbilicis angulares

METAGONIMUS YOKOGAWAI
 YOKOGAWA’S FLUKE
 Disease caused: Metagonimiasis
 DEFINITIVE HOST: Man, domesticated and wild fish-
eating mammal
 1st INTERMEDIATE HOST: Semisulcospira, Thiara,
Hua
Figure 7. Echinostoma ilocanum Life Cycle  2nd INTERMEDIATE HOST: Fresh water salmonoid
fish (Plecoglossus, and Salmo), and Cyprinoid
UNEMBRYONATED EGGS are passed in the feces  (Richardsonian and Odontobuntis)
EMBRYONATED EGGS in water  MIRACIDIA hatch and
penetrate SNAIL (1st INTERMEDIATE HOST) SPOROCYST 
REDIAE  CERCARIAE  Free swimming cercariae invade 2nd
INTERMEDIATE HOST  METACERCARIAE in 2nd intermediate
host Eaten by HUMAN

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Note: Italicized text were taken from the notes of the transcriber

Figure 10. Life Cycle of Metagonimus yokogawai

 EMBRYONATED EGGS each with a fully-developed
MIRACIDIUM are passed in feces  Snail host
ingests eggs  MIRACIDIUM emerge from eggs and
penetrate snail intestine  SPOROCYST  REDIAE
 CERCARIAE  Cercariae released from snail 
Cercariae penetrate the skin of brackish water FISH
and encyst as METACERCARIAE in the small
intestine

Figure 11.
Metagonimus
yokogawai
Adult Form

 Pyriform shape, rounded posterior and tapering end

 Large ventral sucker with a genital opening
 2 Oval testes obliquely
 Globose ovary at junction of mid and lower 3rd of
body
 Coarse vitellaria in Fan shape
 Scale-like spines

Figure 12. M. yokogawai Egg

 Light yellow
 Thin shell
 Operculated
 Nodular thickening on posterior end
 Mature miracidia at oviposition

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