rayoussef@uqu.edu.

sa
raafath2001@yahoo.com

Learning Outcomes
Taxonomy of parasites
Upon completion of this lecture, the learner will be able to:
• Parasites are classified into 2 sub-kingdoms:
■ Classify the parasites. ➢ Protozoa (unicellular)
■ Mention the taxonomy of metazoa (Helminths) .
➢ Metazoa (multicellular)
■ Explain the general characteristics of platyhelminths.
■ Explain the general characteristics of trematodes.
■ Mention the geographical distribution of fascioliasis. • Metazoa (multicellular) parasites:
■ Describe the morphology of Fasciola stages, life cycle, Include both:
Pathogenesis, mode of infection, symptomatology & ➢ Helminths (worms).
pathology, diagnosis.
➢ Arthropods (posses an external skeleton) e.g. ticks, lice.
■ Discuss the diagnosis of parasitic infection.
■ Explain the strategies of prevention and control ❑ Protozoa (unicellular parasites): Classified according to
morphology and means of locomotion.

Taxonomic classification of Metazoa

Helminths
(Helminths)
Sub Phylum Class Genus – examples
kingdom
Metazoa Nematodes Ascaris (round worm)
Trichuris (whip worm)
(Worms) Unsegmented; cross
section is rounded, Ancylostoma (hook
bilateral symmetry, sexes worm)
is separate, body cavities, Necator (hook worm)
a straight alimentary
Enterobius (pinworm )
canal and anus
Strongyloides

(Flat worms) Taenia (tape worm)

Platyhelminthes
(Round worms or ▪ Flat worms; flattened
dorsoventrally,
thread worms) ▪ No body cavity,
▪ Alimentary canal is
blind ending
(Tape worms) (Flukes)
Cestodes
▪ Flattened, ribbon-or tape-
like segmented,
▪ no alimentary canal,
▪ no body cavity,
hermaphrodite,
▪ scolex, neck, strobila
Trematodes Fasciola hepatica
▪ Leaf-like, flattened Schistosoma spp.
dorsoventrally, bilateral
symmetry, simple
alimentary tract, blind
caeca, hermaphrodite
(except Schistosomes).
 General characteristics of Platyhelminths General characteristics of Platyhelminths (cont.)

❑ Flattened dorsoventrally with Phylum Platyhelminthes includes

bilateral symmetry. two classes:
❑Mostly hermaphrodites (contain ❑Trematoda (flukes, leaf-like
both male and female sexual worms).
organs).
❑ Cestoda (tape-segmented worms).
❑ No body cavity, various systems
are embedded in parenchymatous
tissue.

Fasicola hepatica
Diphyllobothrium latum (Mature
Intestinal fluke (Fasciolopsis buski) Segments)

Trematodes (flukes)
o Leaf-like, flattened dorsoventrally with bilateral
symmetry.
oThe size varies from few millimeters (Heterophyes) to
several centimeters (Fasciola).
1 o The alimentary tract is simple, the oesophagus
bifurcates into 2 blind intestinal caeca.

Trematodes (flukes) Development of trematodes

o Have two suckers
(organs of fixation and o Fertilized eggs are usually oval in shape,
movement):
operculated except Schistosoma sp.
Oral sucker around
mouth opening. o Eggs may contain immature embryo e.g.
Ventral sucker. Fasciola or mature embryo (miracidium) e.g.
In Heterophyes, genital Schistosoma and Heterophyes.
sucker
o Hermaphrodite o Eggs usually need fresh water for maturation
(except
Schistosomes).
and completion of life cycle.
 Operculated eggs Non operculated eggs

Fasciola Paragonimus Fasciolopsis

hepatica westermani buski
Schistosoma Schistosoma Schistosoma
japonicum mansoni haematobium

Development of trematodes (cont.) Classification of class Trematoda

Egg: usually diagnostic according to habitat
stage.
• Miracidium: hatches from Liver Lung Intestinal Blood
egg. fluke
fluke fluke fluke
• Snail: intermediate host (IH)
in which asexual generations
Fasciola Paragonimous Fasciolopsis Schistosoma
occur and formation of hepatica westermani buski mansoni
sporocyst then redia.
• Cercariae: infective stage in
Schistosoma spp. Fasciola Heterophyes
gigentica
S. heamatobium
heterophyes
• Metacercaria: infective
stage in other species.
• Adult worms: in DH and RH. S. japonicum

Introduction
❑ Fascioliasis: Zoonotic disease (infects various mammals including
humans).

❑ Causative agents: Fasciola hepatica (The liver fluke of major

importance) and F. gigantica (parasites of herbivores infecting humans
occasionally).

❑ Habitat: The flukes inhabiting the biliary passages of the liver.

❑ DH: Human

❑ RH: Herbivorous animals (Sheep, cattle, goats ..)

Animal fascioliasis has been reported in Saudi Arabia among imported

and local sheep.

❑First IH: Snails (Lymnaea cailliaudi, L. truncatula).

❑ Second IH: Vegetation.

 Geographical distribution Morphology
Adult
Fasciola hepatica is cosmopolitan throughout many ▪ Flat,
leaf-like, distinct
sheep and cattle raising countries of the world anterior cone.
especially in temperate regions. F. gigantica causes
outbreaks in tropical areas of southern Asia, Southeast ▪ Size: about 3x1 cm.
Asia, and Africa. ▪ The cuticle is covered
by spines.
▪ An oral & ventral
suckers.
▪ An esophagus divided
into two caeca ending
blindly.
▪ Highly branched caeca
F. hepatica Sheep Cattle & testes

Morphology Eggs Life cycle and epidemiology

• Eggs pass in the feces of humans
o Shape: oval, operculated. “DH”, and sheep & cattle “RH” to the
soil and water source.
o Size: about 150x75 μ. • If the water contains snails, they are
infected with miracidia, which hatch
oColor: yellowish green in in two weeks.
colour (bile-stained). • Leptocercus cercariae (having a
simple tail) produced in the snail are
oThin-shelled, shed and encyst as metacercariae
unembryonated. (infective stage) on vegetation.
•Infection to sheep, cattle and human
occurs after ingestion of raw
vegetation contaminated by
encysted metacercariae.
Diagnostic stage: Eggs pass out with feces.

Pathogenesis
➢ Ingested metacercariae excyst and penetrate
the duodenal wall, becomes free in the
peritoneal cavity, migrate to the liver, penetrate
the capsule, and burrow through the liver
parenchyma, established in the biliary ducts,
and develop into adult flukes in about 3 months.

➢ Eggs produced pass down the bile duct into

the intestine, appear in stool 3 months after
infection.
Both migrating larvae (metacercariae)
and adult flukes produce pathology
 Mode of infection
Mode of infection
➢ Source of
infection:
Raw (Uncooked)
vegetables with
encysted metacercaria.
➢ Method of infection:
Ingestion of encysted
metacercariae with raw
(Uncooked) vegetables.

Symptomatology & Pathology Symptomatology & Pathology (cont.)

Clinical signs appears 2 weeks after the infection.
A. Acute or invasive stage:
❖ The incubation period for fascioliasis can range from a
few days to a few months.
❖ Patients may be symptomatic during the first weeks of
infection, but no eggs are found in the stool until the
worms mature, which takes 8 weeks.
❖ Metacercarial Larvae migrate through the liver
parenchyma: Fever, epigastric pain and right upper
quadrant pain and urticaria.
Laboratory features: eosinophilia and anemia.
Levels of IgG, IgM, and IgE in serum are usually elevated.
B. Chronic fascioliasis:
❖ Migration of immature worms causes extensive
hemorrhages and massive destruction of liver tissue.
❖ Once the worms have established in the bile ducts and
become mature, considerable damage due to mechanical
irritation by the spiny cuticle causing hyperplasia and cystic
dilatation, fibrosis with biliary obstruction.
❖ Epigastric pain, hepatomegaly,
jaundice, cholangitis & eosinophilia.
❖ Eggs appear in stool.
Fibrosis & biliary obstruction

Symptomatology & Pathology (cont.) Diagnosis

C. Ectopic fascioliasis:
❖ Immature worms may be found in ectopic
foci after penetrating the peritoneal cavity
before reaching the liver. Most frequently in
the lungs and subcutaneous tissues.
D. Halzoun Syndrome (Pharyngeal
fascioliasis):
❖ In areas of endemicity where uncooked
sheep livers may be eaten, such as Lebanon,
living adult Fasciola spp. may attach to the
pharyngeal mucosa, causing suffocation,
dyspnea, edema and congestion of the soft
palate.
➢ 1. Stool examinations and ELISA are
recommended for presumptive diagnosis, while
radiographic techniques and MRI are used for
confirmation and follow-up.
➢ Stool examination, direct fecal smears, Kato-
Katz thick smears and duodenal aspirate for
eggs.
➢ The sedimentation concentration (formalin-ethyl-
acetate technique) should be used; because the
eggs are operculated.
Liver of cattle ➢ Multiple stool examinations may be needed to
infected detect light infections because egg shedding is
with F. gigantica
irregular from day to day.
➢ Immunodiagnostic tests to detect Fasciola
coproantigens in stool may be used.
Diagnosis (cont.) Diagnosis (cont.)
➢ 2. Radiologic Screening: US, CT Spurious Fascioliasis Infection.
scan, MRI may show tunnels
Eggs may be detected in the stools of individuals who
caused by migrating larvae & adult have eaten F. hepatica-infected liver, thereby yielding an
flukes in gall bladder or bile duct.
erroneous laboratory result (not a true human infection).
➢ 3. Liver biopsy: may be important in True infection and spurious infection can be
diagnosing fascioliasis, particularly differentiated by maintaining the patient on a liver-free
for asymptomatic disease diet for at least 3 days. If the patient continues to pass
eggs in the stool, the infection is probably genuine.
➢ 4. Liver biopsy :
Various PCR-based methods have
been developed to detect egg
trematode DNA in stool samples or Parasitic cholangitis in bovine liver
metacercariae in the second
intermediate host.

Prevention and Control

o Diagnosis and treatment of patients
(Triclabendazole) and infected animal
reservoir.

o Avoid eating improperly washed raw

vegetables contaminated by
metacercariae.

o Preventing the contamination of water

with feces of animals or people where
aquqtic plants are used as food.

o Snail (IH) control.

Snail control