TREMATODES

PART 2

Dr. Josephine M. Bandalan

BLOOD TREMATODES
SCHISTOSOMES
 GENERAL CHARACTERISTICS

• Adult worm
• Cylindrical body, separate
sexes, oral and ventral
suckers
• Female measures 2 cm
• Male 1.5 cm;
gynecophoric canal
where female is lodged
 GENERAL CHARACTERISTICS

• Ovum
• Nonoperculate, fully embryonated when laid

• Larvae
• Miracidium mother sporocyst daughter
spororocyst cercaria (bifid tail)
 GENERAL CHARACTERISTICS

• First intermediate host: snail

• Mode of infection
• Skin penetration of cercaria
SCHISTOSOMES

• Schistosoma haematobium
• Schistosoma mansoni
• Schistosoma japonicum
• Schistosoma mekongi
• Schistosoma intercalatum
 Basis Schistosomes Other Flukes
Reproductive Diecious Monoecious
system
Intestinal ceca Simple, reunite to Simple/branched
a single cecum ends blindly (2)

Redia Absent Present

Cercaria (tail) Forked/bifid Straight/tapered
Infective stage Cercaria Metacercaria
Portal of entry Skin Mouth
Ovum Non-operculated Operculated
Intermediate host Only one (snail) 1st and 2nd IH
 S. haematobium S. mansoni S. japonicum

Common Vesical blood fluke Manson’s Oriental blood

name blood fluke fluke
Disease Vesical schisto- Intestinal Oriental
somiaisis schistosomia schistosomiasis
sis
Distribution Africa, Middle East, Africa, South Japan, Phils.
S. Europe America Thailand, China
Natural Man Man, rodents Man, domesti-
hosts monkeys, cated animals
Snail host Bulinus Biomphalaria Oncomelania
Habitat in Vesical/pelvic Mesenteric Radicles of
man – venous plexuses venules – superior mes.
adult lower venules
intestine
 S. haematobium S. mansoni S. japonicum

Ovum Found in urine, Found in Found in feces

occas. in feces feces occas.
in urine
Adult Finely tuberculate Grossly Non
integument tuberculate tuberculate
Egg output/ 239 300 3000
worm/day
Ovum Spindle shape w/ Elongate, Oval to
shape terminal spine ovoidal w/ rounded w/
long lateral short lateral
spine tubercle
Life span of 30 20 20-25
adult
(years)
Schistosoma mansoni
S. haematobium
SCHISTOSOMA JAPONICUM
 SCHISTOSOMA JAPONICUM

• Distribution in Philippines – Leyte, Samar, Bohol,

Sorsogon, Mindoro, almost all provinces Mindanao

• Disease: Schistosomiasis japonica, Katayama fever,

Oriental schistosomiasis
 S. JAPONICUM LIFE CYCLE

u DH: man, most domestic animals, wild animals

u Portal of entry – skin
u Infective stage – cercaria
u Habitat of adult – superior mesenteric veins
u Portal of exit – feces
u Stage excreted – fully embryonated ova
u IH: Oncomelania hupensis quadrasi
u Larval stages – miracidium, 1st and 2nd gen., sporocyst, cercaria
S. japonicum
Oncomelania
Biomphalaria Bulinus
 PATHOGENESIS AND CLINICAL
INFECTION

• 3 stages in pathologic processes

• Incubation
• Egg deposition and extrusion
• Tissue proliferation and repair
PATHOGENESIS AND CLINICAL INFECTION

uIncubation
u Dermatitis
u Traumatic infiltrative changes in the lungs
u Acute hepatitis
u Hyperemia in the wall of the small blood vessels
u Trauma with hemorrhage – eggs escape from venules to
intestinal lumen
u Eosinophilia
u Cell mediated response of host continues through out the life
of the worms
u Urticarial rash accompanied by fever – 5th day after exposure
u Diarrhea
PATHOGENESIS AND CLINICAL INFECTION

uEgg deposition and extrusion

u Profuse dysentery with eggs in feces
u Secondary anemia, leukopenia, less eosinophil
u Fever, epigastric pain, enlarged liver and spleen, loss of
weight and appetite – 3-10 weeks
u Infiltration of eggs in tissues – intestine, liver, other organs –
pseudotubercle develop around the egg
u Liver enlarges – miliary lesions around the infiltrated eggs
u Spleen enlarges – congested
PATHOGENESIS AND CLINICAL INFECTION
uTissue proliferation and repair
u Liver decreases in size – scar tissue
u Spleen increases in size – mesentery and omentum binding
down the colon producing an upper and lower abdominal
distension
u Weakness, skin pallor, dyspnea on slight exertion
u Ascites - may or may not be conspicuous
u Granulomatous reaction around the eggs – fibrosis of
periportal tissues (pipe-stem fibrosis)
u Cerebral involvement
• Katayama fever
• Systemic hypersensitivity reaction to the
schistosomulae migrating through tissue
• Rapid onset of fever, nausea, myalgia, malaise, fatigue,
cough, diarrhea and eosinophilia occur 1-2 months
after exposure
• Common in people new to endemic areas

• Swimmer’s itch
• Dermatitis at site of entry
• Associated with nonhuman schistosomes
LABORATORY DIAGNOSIS

• Specific – recovery of characteristic eggs

from feces
• Direct examination
• Concentration method
• Proctoscopic aspiration and biopsy
 LABORATORY DIAGNOSIS

• Serologic tests (using adult and cercarial antigens)

• Complement fixation with adult antigen (CFA)
• Complement fixation with cercarial antigen (CFC)
• Slide flocculation with cercarial antigen (SFC)
• Cercarial agglutination test
 LABORATORY DIAGNOSIS
ØCircumoval precipitin test (COPT)
Ø Schistosome egg (rabbit) incubate with patient’s serum

Ø Intracutaneous test (skin test) – utilizes adult and larval

antigens
Ø WBC and differential count
 TREATMENT

• Praziquantel
• Heterocyclic prazinoisoquinoline compound
• 40-50 mg/kg in 2 doses for 2-3 days
• Significant reduction of egg output
• Reduction of portal hypertension,
hepatosplenomegaly and cerebral
manifestations
thank you!
STAY SAFE