TREMATODES - Body with holes - Presence of acetabula suckers DIECIOUS BLOOD FLUKE SPECIES Schistosoma japonicum Schistosoma mansoni

Schistosoma haematobium

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MONOECIOUS LIVER FLUKE Fasciola hepatica Clonorchis sinensis Opistorchis felineus Opistorchis viverrini

LUNG FLUKE Paragonimus westermani

INTESTINAL FLUKE Fasciolopsis buski Echinostoma ilocanum Heterophyes heterophyes Haplorchis yokogawai Metagonimus yokogawai

GENERAL APPEARANCE No. of Intermediate host Char of Eggs

Cylindrical bodies 1 Non-operculated, embryonated eggs (contains miracidium) Hatches in contact with water SSC

LARVAL DEVT

INFECTIVE STAGE

Intermediate Host: Miracidium Definitive: Fork-tail Cercaria (via skin penetration)

Flattened, leaf-shaped bodies 2, first is always a snail host Operculate eggs Mature (C.s., O.f.H.h., M.y., H.y.), or Immature (F.h., P.w., F.b., E.i.) when laid Mature: Hatches after ingestion of intermediate host Immature: Develops and hatches in water S R C = Clonorchis sinensis, Paragonymus westermani, Heterophyes heterophyes S R R C = Fasciola hepatica, Fasciolopsis buski, Metagonimus yokogawai R R C = Echinostoma Ilocanum 1st Intermediate Host: Egg/ Miracidium Cercaria 2nd Intermediate host: Cercaria Metacercaria Definitive: Metacercaria

ORGAN SYSTEMS: 1. Nervous 2. Excretory

3. Digestive

4. Respiratory/ Circulatory 5. reproductive a. testes b. genital pore c. gynecophoral canal

Paired ganglion at anterior part, back of esophagus/ pharynx Nerve trunk sends fibers to back, lateral, ventral sides of the body Bilaterally symmetrical Opens dorsal and posterior Solenocyte Flame cell basic unit Oral sucker oral cavity pre-pharyngeal tube muscular pharynx esophagus intestinal ceca w/ blind ends usually inverted Y shape NO ANUS! waste excreted through regurgitation, may be branched or straight ABSENT Oxygen taken via Skin Separate sexes Both male and female reproductive organs present in one organism multiple Paired present in both sexes Common opening for male and female reproductive organs present Absent

Clonorchis sinensis, Opistorchis felineus, Metagonymus yokogawai, Heterophyes heterophyes Fish Paragonymus westermani crabs/ crayfish Fasciolopsis buski, Fasciola Hepatica Aquatic vegetation (water cress) Echinostoma ilocanum snail

BLOOD FLUKES: SCHISTOSOMA SPECIES COMMON NAME DISEASE PRODUCED Schistosoma haematobium Vesical blood fluke Vesical schistosomiasis Schistosomal haematobium Schistosomiasis haematobium Urinary bilharziasis Africa and Middle East Vesical plexus Pelvic plexus (drains bladder) Veins of rectum Bulinus Late Intermediate Fine Single 4-5, in cluster Behind ventral sucker Posterior to midpoint Longest 20-30 20-290 Terminal spine Urine > Stool ALL Praziquantel Schistosoma mansoni Mansonis blood fluke Mansonis intestinal schistosomiasis Schistosomiasis mansoni Bilharziasis Africa, South America, Caribbean Inferior mesenteric plexus (drains LI) Vesical plexus (sometimes) Biomphalaria Early Longest Coarse Single 6-9 Posterior and behind ventral sucker Anterior to midpoint Shortest 1-2 100-300 Lateral Spine Stool > Urine ALL Praziquantel Schistosoma japonicum Oriental blood fluke Oriental Schistosomiasis Schistosomiasis japonica Katayama Dse Far East (except Japan & Taiwan) - Bicol, Samar, Leyte, Mindanao Superior mesenteric plexus (drains SI, stomach) Oncomelania quadrasi Very Late Shortest None Double 6-8, in columns/ rows/ clusters midpoint In between 50 1,500-3,000 Abbreviated rudimentary spine Stool ALL Praziquantel

GEOGRAPHICAL DIST. HABITAT

INTERMEDIATE HOST UNION OF INTESTINAL CECA LENGTH OF POST. CECA TUBERCULATION ESOPHAGEAL BULB TESTES OVARIES LENGTH OF UTERUS UTERINE CAPACITY No. OF EGGS/FEMALE/DAY CHAR. Of EGGS DIAGNOSIS PATHOGENIC STAGE TREATMENT

SCHISTOSOMIASIS STAGES STAGE I Stage of Invasion DURATION 0-4 weeks PARASITE STAGE Cercaria skin penetration PATHOLOGY Cellular infiltration CLINICAL Mx Itchiness, redness, edema, congestion, dermatitis, swimmers itch, clam diggers itch Cough, fever Puritus, rashes, urticarial, cough, fever, bronchial asthma, diarrhea GI disturbances, colic pain, nausea, vomiting, diarrhea, dysentery LAB Dx IDT (+)

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CHR (+/-)

Schistosomule migrating II Maturation 4-6 weeks Adults in copula Female starts laying eggs

Inflammatory Reaction Allergy

IDT (+) CHR (+)

SE (+/-)

III Established Infection

*Progresses to stage IV if: - Malnourished - Alcoholic - Superinfection

>6 weeks

Massive egg-laying

Pseudogranuloma Fibrosis (small scarring of involved organ) Parasitic Hepatitis

IDT (+) CHR (+) SE (+)

LFT (+/-) COPT (+/-)

IV Late Infection/ Chronic

Uncertain

Decreased egg production

Fibrosis of organ involved Granuloma formation Parasitic Cirrhosis

Portal Hypertension Ascites Hemorrhoids Esophagus Caput Medusa

IDT (+) CHR (+) LFT (+) COPT (+) Biopsy (+)

SE (+/-)

IDT = Intradermal Test; LFT = Liver Function Test; SE = Stool Exam; CHR = Cercaria Huellen Reaction(serum+cercaria) + = shrinking; COPT = Circum Oval Precipitin Test (serum+egg) + = >24 H blebs around egg; >72 H precipitation of filaments; Biopsy = of rectal mucosa (liver = dangerous)