Clinical Parasitology

Trematodes (FLUKES)
• Schistosoma spp - blood flukes
• Heterophyid flukes
• Paragonimus westermani
• Fasciola spp
• Fasciolopsis buski
• Clonorchis sinensis
• Echinostoma ilocanum
• Opistorchis spp

General Characteristics of Trematodes:

1. Leaf-like and hermaphroditic-both female and male in one body, except BLOOD FLUKES
2. Eggs are operculated, except: BLOOD FLUKES
3. Infective stage is metacercaria, except: BLOOD FLUKES
4. Mode of transmission is through ingestion, except: BLOOD FLUKES
5. Requires two intermediate host, except: BLOOD FLUKES
6. First intermediate host is always: SNAIL
7. Generally has two suckers: ORAL AND VENTRAL SUCKER

Schistosoma spp – Blood Flukes

• Schistosoma mansoni
Common Name: Intestinal Schistosome
Egg: large, lateral, spine
Habitat of Adult: inferior mesenteric veins of lower colon, specifically the large intestine
Intermediate Host: Biomphalaria snail

• Schistosoma haematobium
Common Name: Urinary Schistosome
Egg: large, terminal, spine
Habitat of Adult: veins of the urinary bladder
Intermediate Host: Bulinus snail
 • Schistosoma japonicum
Common Name: Oriental Blood Fluke
Egg: minute, spine, knob
Habitat of Adult: superior mesenteric veins, adjacent to small intestines
Intermediate Host: Oncomelania Snail
- Swimmer’s itch due to dermatitis penetration
• Schistosoma mekongi
- Resemble S. japonicum but smaller, causes
milder disease and has different intermediate
host.
• Schistosoma intercalatum
- Adults in mesenteric vein; eggs resemble S.
haematobium, except that spine is slightly
bent; egss are acid fast

Schistosoma spp.
Mode of Transmission: skin penetration
Infective Stage: Cercariae (if there is already fork tail appearance)
Diagnostic Stage: Ova in stool (S.mansoni or S.japonicum), ova in urine (S.haematobium)
Intermediate host: Snails
Paragonimus westermani
Common Name: Lung Flukes
Disease Associated: Pulmonary Distosomiasis
Mode of Transmission: Ingestion
Infective Stage: Metacercariae in Human, Miracidia in Snail
Diagnostic Stage: Ova in sputum or stool
Intermediate host
First IH: Snails (Antemalania asperata and Antemalania dactilus)
Second IH: Crab (Sundathelphusa philippina)
Fasciolopsis buski
Common Name: Giant Intestinal Fluke
Mode of Transmission: ingestion
Infective Stage: Metacercariae in Human
Diagnostic Stage: ova in stool
Intermediate host
First IH: Snail
Second IH: Aquatic Vegetation – Kangkong, water lily
- Need to wash properly the aquatic vegetation before consuming
Fasciola hepatica and Fasciola gigantica
Common Name: Temperate Liver Fluke, Tropical Liver Fluke
Mode of Transmission: Ingestion
Infective Stage: Metacercariae
Diagnostic Stage: Ova in stool
Intermediate host
First IH: Snail
 Second IH: Aquatic vegetation

Echinostoma ilocanum
Mode of Transmission: Ingestion
Infective Stage: Metacercariae
Diagnostic Stage: ova in stool
Intermediate host
First IH: Snail (Gyraulus and Hippeutis)
Second IH: Snail (Kuhol - Tila luzonica and Susong Pangpang - Vivipara angularis)

Clonorchis sinensis
Common Name: Chinese Liver Fluke, discovered in China
Mode of Transmission: Ingestion
Infective Stage: Metacercariae
Diagnostic Stage: ova in stool
Intermediate host
First IH: Snails
Second IH: Fish
Disease associated: Cholangiocarcinoma – cancer in bile duct
- Eggs are described as old fashion light bulb because of the appearance

Opistorchis spp
Scientific Name: Opisthorchis felineus, Opisthorchis viverrini
Mode of Transmission: Ingestion
Infective Stage: Metacercariae
Diagnostic Stage: ova in stool
Intermediate host
First IH: Snail
Second IH: Fish