Schistosomes (Blood Flukes)

Thread-like

Dioecious

Clinical Significance: Schistosomiasis, also known as snail fever, swamp fever, or Bilharziasis. Swimmer’s
itch: dermatitis with pruritus and localized the reaction caused by cercarial penetration

Schistosomiasis is the 2nd most prevalent disease worldwide

Mode of transmission: Skin Penetration

Nonoperculated egg – requires 1 Intermediate Host

Diagnostic Stage: embryonated egg

- most romantic parasite, adults are in copula

Morphology

 Difference from other trematodes

- Dioecious adults
- Nonoperculated egg
- Bifurcated (forked) cercaria invades the final host by skin
- Adults parasitize blood vessels
- Male (15 mm length) < female (22 mm)
- Oral sucker < ventral sucker
- 2 paralleled guts form a blind caecum in the posterior ends
- 7 testes in the male and single ovary with a tubule uterus in the female
- Gynecophoric canal (male) in which female repose
Male: shorter and more robust

Female: slender and long; can lay eggs 8x a day

Diagnostic Feature: Presence of gynecophoric canal

- used by male carrying the female

- most romantic pairs among the parasites

Eggs: Bigger than Ascaris egg with bottleneck appearance (miracidium)

Cercaria: Fork-tailed

Diagnosis: stool exam (MIEC, Kato Kats Technique)

Rectal/liver biopsy

Concentration technique

Blood Test

Immunodiagnosis

-intradermal Test
 - immunohemaglutination

- circumoval precipitin test (COPT)

- ELISA

Common signs of Schistosomiasis

- Dermatitis due to cercarial penetration

- Adult may live in the venules of mesenteric veins > feed on whole blood >
hypochromic microcytic anemia

3 Species of Schistosoma

 Schistosoma japonicum
 Schistosoma haematobium
 Schistosoma mansoni

Schistosome egg

S. japonicum S. mansoni
S. haematobium
 S. japonicum S. mansoni S. haematobium

Geographical China, Indonesia, Africa, South America Africa, Middle East

Distribution Japan, Phil.
Common name Oriental blood fluke Manson’s blood fluke Vesical blood fluke
Habitat Superior mesenteric Inferior mesenteric Vesical veins
veins veins
Pathogenesis Oriental Intestinal bilharziasis/ Urinary bilharziasis/
Schistosomiasis/ Schistosomal dysentery Schistosomal
Katayama’s dse. hematuria
Snail IH Oncomelania Biomphalaria spp/ Bulinus/ Physopsis
quadrasil/ O. hupensis Planorbis/ Tropicorbis
quadrasi
Ova With lateral spine/knob With lateral spine With terminal spine
Adult skin Smooth Course tuberculation Fine tuberculation
Number of testes 6-7 4-5 8-9
(male)
Location of the ovary Median Anterior Posterior
(female)
Uterus (female) Long and well- short long
developed
Number of eggs 50-100 20-30 1-4
Specimen for Dx. Stool Stool Urine

Life Cycle
Swimmer’s itch
Cercarial Dermatitis

schistosomiasis

Main Points in the Life Cycle

Residing Site: mesenteric vein

Intermediate Host (only one): Oncomelania hupensis

No metacercaria and redia stage

Two generations of sporocyst

Infective stage: Cercaria

Route of infection: skin penetration

Oncomelania sp., the intermediate host for S. japonicum.

Skin penetration of cercaria > first

The appearance of eggs: 30 – 35 days

Life spans in humans: 4-5 years, longest: 35 years

Tissue egg

- The egg which can develop and live in the tissue

Significance of tissue egg

- Major pathogenic stage, inflammation, and granuloma around the egg

- Diagnosis and evaluation of therapeutic efficacy

Immunity

Concomitant immunity

Host carrying an initial infection of adult schistosomes shows the protection against a cercarial
challenge infection and this protective immunity will disappear with the eradication of schistosomes in
the host

Immunity-evasion – an ability by which schistosome adult can evade the host immune response. The
possible mechanism of evasion.

- Acquire host antigen on its surface

- Host-like antigen produced by the parasite
- Changing of tegument very quickly
- Parasite may inactivate or down-regulate immune effectors

Pathogenesis

Schistosomiasis at each stage of the life cycle in the human body

 Cercaria (skin-penetration)
- Dermatitis
 Schistosomula (migration)
- Larva migrans
 Adult: (immunocomplex)
- Immuno-nephropathy
 Advanced Schistosomiasis patient with portal hypertension and ascites

Schistosome (Blood flukes): S. japonicum, S. mansoni, S. haematobium

Transmission: direct penetration of the skin by fork-tailed cercaria in water

Pathogenic potential: high, based on worm populations and location in veins, the capability of eggs to
erode tissue, other

Clinical signs: none early or if worm number is low, transient skin reaction at entry, malaise, fever, skin
rashes, cough, acute hepatitis, abscesses, hepatomegaly, cardiomyopathy, haematuria

S. japonicum, S. mansoni, S. haematobium

Prevalence: distribution worldwide in tropical, subtropical, and temperate regions; human infections
nearly equal to prevalence of malaria

Diagnosis: microscopic ID of ova in feces, urine or biopsy specimen

Treatment: Praziquantel, oxamniquin, bilarcil

Schistosoma japonicum

1. Rectal biopsy, liver biopsy

2. Stool examination (MIFT, Kato Katz Tech.)
3. Immunodiagnosis – to demonstrate antibodies
- Intradermal test
- Immunohemaglutination
- Circumoval precipitin test
- ELISA
Common signs of Schistosoma japonicum

 Dermatitis due to cercarial penetration

 Hypochromic microcytic anemia – since adult worm lives in vesicles and mesenteric veins, they
feed on the whole blood

Factors of transmission and Prevention

 Factors
- Source of infection: patients and reservoir host
- Intermediate host: Oncomelania
- Contact with cercaria-infected water

Prevention and control: proper human waste disposal and control of the snail population, primarily their
breeding areas, prompt diagnosis and treatment of infected persons, the avoidance of human contact
with potentially contaminated water, and educational programs for the inhabitants of known endemic
areas.

The current focus is on anthelmintic chemotherapy with praziquantel