BLOOD FLUKES

BLOOD FLUKES
 Characteristics
– Dioecious
– Males are shorter and stouter than females
– Lateral margins of males are folded ventrally to form a
gynecophoral canal in which females are received
– Suckers are armed with delicate spines
– There is no muscular pharynx
– Eggs are non-operculated
– Eggs are fully embryonated when laid
– Embryonated eggs have a ciliated embryo called miracidium
– Cercariae have bifid tails
– There is no encysted metacerciarial stage
– Infective Stage: cercaria penetrating the unbroken skin

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BLOOD FLUKES:
Schistosomes
 Schistosomes
– Schistosoma japonicum : Oriental blood
fluke
– Schistosoma haematobium: Vesical blood
fuke
– Schistosoma mansoni: Manson’s blood
fluke

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 Schistosoma hematobium

 Name of the disease: Bilhariziasis or Urinary

Bilhariziasis or Vesical Schistosomiasis.
 Habitate: lower mesenteric vein, pelvic vessels,
vesical plexus and portal vein and its branches
 The final host: - the human..
 Intermidate host: Physopssis & Bulinus
snail
 Geographical separation: - Africa, Iraq,
Egypt and the Arabian Peninsula.
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The shape of the worm: - The genera are separate
the male short and wide (10-15 mm) long and have a small
oral size - oral Sucker and a large ventral sucker carried on
the stalk to the posterior end of the worm consisting of
Gynocophoric. Canal in which the female settles when
mating and laying eggs The skin is provided with small
papillae and the reproductive system is formed from 4 to 5
testis, the female, is long and thin (20-25) mm, and put (100)
eggs, the two suckers are equal in size and the skin is
supplied with papillae that are limited to the posterior end of
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the worm.
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Egg shape: - Long oval in shape with a

terminal spine with a brown yellowish color and a

transparent shell, and not covered with a lid.

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Life Cycle: - Female worms lay partially mature eggs in the

small veins of the pelvic cystic plexus and sometimes in the

pulmonary arteries, as well as in the portal mesenteric veins and

mature in the veins, and when they excreted with the urine and

feces sometimes contain the full miracidium at the time of their

exit and result in pressure within the small vein and as a result of

lytic dissolution substances that mature through small holes in

the eggshell with the help of spine the eggs come out from the

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and pass through the walls of the bladder, reach their

cavity with the blood, and go out with the urine at the

end of urination. When the eggs come into contact with

the water, they hatch to the Micacidium, swim in the

water, and penetrate of Physopssis or Bulinus snils,

and during (4-8) weeks, it passes through two

generations of sporocystes
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Schistosome Miracidium
 Miracidium
– Hatches from the egg in
slightly alkaline clean
water with a temp.
between 25 0C to 310C
– Free swimming cilated
embryo liberated from
the egg
– Photactic
– Infect snails

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Schistosome Sporocysts
and Cercaria
 Mother sporocysts
develop from
miracidium within
the snail
 Daughter sporocyst
develops from
mother sporocyst
 Cercariae develop
from daughter
sporocyst
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. Finally, there is no redia, and finally cercaria,
with a divided tail that leaves the snail during
the day and is characterized by a long oval
body with a divided tail in two parts. Its body
contains an oral and ventral suckers, five pairs
of dissolved or penetrated glands, two pairs in
front of the ventral sucker and three pairs
behind the ventral sucker. Cearcaria leaving
the snail in the water after (1-3) days infecting
the definitive host When showering or wading
in water
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Schistosome Cercaria

 Cercaria
– Emerges from
daughter sporocysts
– Escapes from the
snail
– Has a body and a
forked tail
– Infects man by skin
penetration

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. 24 hours a small worm enters and is called
schistosomula )They are the bodies of cercaria s except
for the divided tail that is thrown into the skin
penetration point) and the Schistosomula goes to the
bloodstream that transports it to the right side of the
heart, and then to the lungs and needs several days to
reach the pulmonary veins that are carried to the left
side of the heart and from it to the systemic cycle and
reach the Hepatic portal cycle
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Schistosomulae
 Schistosomule
– Develops from cercaria
after skin penetration
– Adapted to survive in
serum or physiologic
saline at 37 0C
– Enter the pleural cavity-
--diaphragm---peritoneal
space---penetrate the
liver to reach the
intrahepatic portions of
the portal vein

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, And continue to grow after 3 weeks, the worms
begin to migrate (Somatic Migration) to reverse the
direction of blood flow and pass through the lower
mesenteric cycle and reach to the puberty phase in
the rectal veins where the male embraces the female
during puberty and walks it against the portal blood
stream to reach the places of her life where she
migrates to pelvic plexus. Worms live from (3-10 or
20 years) and remain persistent by puts eggs, and
eggs appear in the urine at a rate of (12-10) weeks.
They release 155 eggs daily
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Life Cycle

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Symptoms of the disease

When cercaria penetrates the skin, it

does not cause any harm, but when it
reaches the blood or the heart or the
lungs, it causes jaundice and bleeding in
the pulmonary capillaries and an increase
in the WBC especially acidophilus and
when it reach to the portal cercal causes
toxic effect and cause abdominal pain,
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Symptoms of the disease

when you start put the eggs, blood appears at

the end of urination without pain at the
beginning, and the condition continues for
several months. Then accompanied by ardor
urinae when urinating and between periods of
urination increases the number of times
urination, but the amount of urine decreases
and pain increases and damage is caused to
the walls of the urinary bladder

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, and that the mechanical and toxic effects of eggs and
chemical deposits lead to bladder cancer.
The disease causes males to have inflammation of the
sexual organs, fibrosis of the sexual organ cover, and
enlarged organ. It causes the blockage of the scrotal
lymphatic vessels. Bacteria may infect tissues around the
urethra and around the bladder and may lead to the
formation of abscesses or fistula that opens in the rectum
or scrotum.

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Diagnosis: -
1- Proofing the presence of the final spin eggs in the
urine and rarely in feces where there are large numbers
at the end of urination.
2- hatching eggs and getting to know mirasidium
3- Examine a piece of rectal tissue by disassembling it
with the needle and examining it after adding water.
4- the ray examination, which shows calcification in the
bladder and is an important feature for diagnosis.
5- Serological tests, the complement fixation test and the
skin test
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Schistosoma mansoni
 Schistosoma
mansoni male and
female
– Female inside the
gynecophoral canal
of male

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Name of the disease: Schistosomiasis
mansoni or Intestinal Schistosomiasis.
Geographical separation: Egypt, Africa,
Arabia, Brazil and Venezuela
Infection site: branches of the lower
mesenteric veins in the large intestine.
Middle host: Biomphalaria snail.

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worm shape: smaller than the previous type, male
length (6-13) mm, female (15-25) mm, a few eggs
(1-4) lay eggs each day, and distinct skin papillae.
The male contains (6-9) small testes that are
arranged in a cluster. It is located just behind the
ventral sucker and the ovary is located in the middle
of the first half and the uterus is short and contains a
small number of eggs.

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Schistosoma mansoni

 Eggs shape: - broad

oval with a lateral spin
and a yellowish brown
crust that is mature
when released with
feces.

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Life Cycle: Similar to Schistosoma hematobium
parasite, when it has completed its growth in the
hepatic portal system, it migrates to the lower
gastrointestinal veins in the large intestine and
reaches the intestinal rectum colon where females
lay eggs and excrete with feces and rarely with
urine.

Diagnosis: similar to the previous type

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Pathological symptoms: - when the larva enters like the
same others type of the other species, but after laying the
eggs, symptoms appear as inflammation, an increase in
W.B.Cs, false tuberculosis, small abscesses, blockages in
the small blood vessels, which leads to necrosis and
ulceration, abdominal pain, diarrhea accompanied by blood
and mucous, purulent substances.Eggs may reach the liver
and cause symptoms similar to the intestine, splenomegaly,
cirrhosis of the liver and intestine, abdominal dropsy,
papillomas in the large intestine, prolapse of the rectum,
eggs may reach the lungs and nervous system.
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Schistosoma japonicum
 Schistosoma
japonicum in
eternal copula
– Males have a
gynecophoral canal
which receives the
female during
copulation

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3. Schistosoma japanicum
the name of the disease is Schistosomiasis
japnicum: or Oiental Schistosomiasis.
Middle host: Onchomeline snail
Place of injury: The upper mesenteric veins
branch off into the hollow vein adjacent to the
intestine.
Geographical spread: - Japan, China, Philippine
Islands, Indonesia, Thailand.
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The shape of the worm: - The length of the male
(12-20) mm it contains 7 testes and there are no
skin papillae and the female has a length of (20-
30) mm. the eggs spherical and have a small fork
in the side of the site and release of (50-100)
eggs.

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Schistosoma japonicum
 Schistosoma japonicum
– Primarily parasites of
the portal vein and its
branches
– Embryonation takes
place within 10-12 days
– Eggs escape through
ulcerations in the
intestinal lumen and are
passed out with the
feces

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Schistosoma japonicum
 Schistosoma japonicum
– Life cycle involves
alternating parasitic
stages in mammalian
hosts and free living
stages
 Egg and miracidium
 First stage (mother)
sporocyst
 Second stage
(daughter) sporocyst
 cercaria
 Schistosomulum
 Adult schistosome

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Schistosoma japonicum
 Schistosoma japonicum
Ova
– Ovoidal, rounded or
pear-shaped
– Thin shell
– Pale yellow
– Curved hook or spine or
lateral knob
– Laid in the multicellular
stage and embryonte
within 10-12 days

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Symptoms of the disease: -Similar to
Schistosomiasis mansoni but damage the small
intestine more than the large and subtract the
number of eggs 10 times more than Schistosomiasis
mansoni. The incubation period is (4-5) weeks and
the eggs released are large compared to the two
types and occur major cirrhosis in the small intestine
and liver, liver poisoning, allergies, acidosis,
cirrhosis and ascites, enlarged spleen, lung fibrosis,
narrowing of the gastrointestinal tract, fever after
sunset, night sweats pain over the stomach, back,
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legs and rash.
Acute stage: dysentery, fever, pain above the
stomach, continued increase in liver size, loss
of appetite, weight loss, anemia, increased
cirrhosis, abdominal hypertrophy and edema,
acute weakness with poor breathing, fatigue
and inflammation of the heart muscle as a
result of eggs entering the heart wall and then
death.
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 Differentiating Features
of Schistosomes
Feature S. japonicum S. mansoni S. haematobium

Testes (male) 6-7 in a single file 8 -9 in a zigzag row 4 -5 in groups

Ovary In the middle of the Anterior to the middle Behind the middle of
(Female) body; contains 50 or of the body; contains 1- the body; contains 20
more eggs 3 eggs – 30 eggs
Intestine short longest long

Egg Lateral knob Lateral spine Terminal spine

Intermediate Oncomelania Biomphalaria and Bulimus (Physopsis)

Host Australorbis

Definitive Man and domestic Man Man

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Host animals
Blood Flukes: Schistosomiasis

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Distended belly is one of the symptoms of schistosomiasis

Blood Flukes: Diagnosis

 Schistosomiasis
– Eggs may not be demonstrable in the
feces

– Infections where there is scarring prevent

passage of eggs into the intestinal lumen

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Blood Flukes: Diagnosis

 Schistosomiasis
– Stool Examination Techniques
 Merthiolate-Iodine Formlin Concentration
Technique (MIFC)
– Sensitive for moderate and heavy infections
– Not adequate for light infections (less than 10
eggs/gram of stool)
 Kato KatzTechnique
– For enumeration of eggs
– Most commonly used for evaluating epidemiology,
effect of control measures, drug trials

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Blood Flukes: Diagnosis

 Schistosomiasis
 Immunodiagnosis
– Intradermal tests for immediate cutaneous
hypersensitivity using adult worm extracts
– Indirect hemagglutination using adult worm and
egg antigens
– Circumoval precipitin test
– Enzyme-Linked Immunosorbent Assay (ELISA)
using soluble antigens of adults and eggs

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Blood Flukes: Treatment
 Treatment
– Praziquantel
(heterocyclic
prazinoisoquinolone
compound)
– Single dose of 40-50
mg/kg
– 25 mg/kg in two
doses
– 20 mg/kg in three
doses
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Blood Flukes: Epidemiology

 In the Philippines
– 24 endemic provinces
 Sorsogon
 Oriental Mindoro

 Samar

 Leyte

 Bohol

 All provinces in Mindanao except Misamis

Oriental
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