TREMATODES

GENERAL
CHARACTERISTICS
Also known as flukes
Leaf-like
2 suckers (oral & ventral)
Snail is always the 1st intermediate host
Two intermediate hosts except schistosomes
Hermaphroditic except schistosomes
Operculated eggs except schistosomes
Infective stage metacercaria except
schistosomes(cercaria)

03/22/15

Paragonimus westermani
Common Name: Lung fluke
M.O.T. : Ingestion
Infectious stage: metecercaria
1st IH: Snail (Antemelania asperata/ductylus)
2nd IH: Crab (fresh H2O crab)(Sundathelphusa
philippina)
Definitive Host: Humans & fish eating mammals
Location: lungs

03/22/15

LIFE CYCLE

03/22/15

Eggs are excreted unembryonated in sputum/feces

embryonated in the external environment
miracidia hatches and penetrates the 1st I.H.(snail)
undergoes developmental stages inside
(sporocysts,rediae,cercariae)
cercaria invade the 2nd I.H. (crustacean)
where they develop further into metacercaria
human infection occurs by eating undercooked/raw/pickled infected
crustaceans(crabs/crayfish)
metacercaria excyst in the duodenum-->intestinal wall--> peritoneal
cavity-->abdominal wall-->diaphragm--> lungs where they become
adults

 Disease: Paragonimiasis
Breathing difficulty, chronic cough, sputum w/ blood
streaks
Migration to the heart may cause heart failure
Migration to the brain may cause blindness, paralysis,
disequilibrium, sudden onset of epilepsy.
Adults in lungs stimulate inflammatory responses resulting
in granulomas.
Sundathelphusa philippina

egg in lung

DIAGNOSIS, TREATMENT &

PREVENTION

Diagnosis: Eggs in sputum or in stool

Eggs closely resembles D.latum
Unlike D.latum eggs, P.westermani eggs have opercular
shoulders and a marked thickening at the
abopercular end
Adults may be found in lungs
Treatment: Praziquantel
Prevention:
Avoid eating undercooked / raw crustaceans
Cook food properly

Fasciolopsis buski
Common Name: Giant intestinal fluke
M.O.T. : Ingestion
Infectious stage: metecercaria
1st IH: Snail (Segmentina/Hippeutis)
2nd IH: Aquatic vegetation : Lotus(Nympnea lotus)
Water caltrop(Trapabiconis)
Definitive Host: Humans & pigs
Location: small intestines
Probably the largest trematode specie to infect
humans

LIFE CYCLE
03/22/15

immature eggs discharged into

stool
eggs embryonate in the external
environment
miracidia hatches and
penetrates 1st I.H.
inside, they further develop into
several stages (sporocyst,
rediae,cercariae)
cercariae are released from the
snail and encyst as metacercaia
in aquatic plants
mammals get infected by eating
the aquatic plants
metacercaia excyst in
duodenum and attaches to
intestinal wall and become
adults

 Disease: faciolopsiasis
Symptoms may include nausea and chronic
diarrhea, abdominal pain, fever
May obstruct intestines
Interfere with food absorption
Most infections are light and asymptomatic

Hippeutis snail

DIAGNOSIS, TREATMENT &

PREVENTION

Diagnosis: Eggs in stool

Eggs are large, brown, oval thin-shelled with inconspicuous
operculum
Closely resembles that of Faciola sp. eggs and are difficult
to differentiate
Treatment: praziquantel
Prevention:
Cook all aquatic plants well before eating them (in boiling
water)
prevent fecal contamination (from humans or pigs) of water
where aquatic plants are grown.
Avoid eating raw / undercooked aquatic plants in endemic
areas

Faciola hepatica &

gigantica
Common Name:
Temperate(hepatica) liver fluke
Tropical(gigantica) liver fluke
M.O.T. : Ingestion (water or aquatic vegetation)
Infectious stage: metecercaria
1st IH: Aquatic snails (Lymnaea)
2nd IH: Aquatic vegetation :
kangkong(Ipomea obscura)
Water cress(Nasturtium officinale)
Definitive Host: Humans & herbivorous
animals
Location: liver
size: hepatica(30mmx13mm), gigantica(upto

LIFE CYCLE
03/22/15

Immature eggs discharged in the

biliary ducts & into the stool
eggs become embryonated in
external environment
miracidia are released and
penetrates 1st I.H.
parasite undergoes several
developmental stages (sporocyst,
rediae, cercariae)
cercaria are released and encyst
on aquatic vegetation as
metacercaria
mammals acquire infection by
ingestion of these vegetation
after ingestion, in humans,
metacercaria migrate towards the
biliary ducts where they develop
into adults

 Disease: Fascioliasis
Feeds on cells of the liver and blood
Adults cause edema and inflammation of bile
duct
Causes anemia, jaundice, cirrhosis similar to
other liver diseases

DIAGNOSIS, TREATMENT &

PREVENTION

Diagnosis: Eggs in feces, History, ELISA

Treatment: Triclabendaole drug of choice for both
humans &
livestock
Prevention:
Individual people can protect themselves by not eating
raw watercress and other water plants
travelers to areas with poor sanitation should avoid food
and water that might be contaminated
Vegetables grown in fields that might have been
irrigated with polluted water should be thoroughly
cooked

Clonorchis sinensis
Common Name: Chinese liver fluke or Oriental
liver fluke
M.O.T. : Ingestion (water or aquatic vegetation)
Infectious stage: metecercaria
1st IH: snail(Parafossarulus,Bulimus,Alocinma)
2nd IH: fish (Cyprinidae:carps/crayfish)
Salted, pickled or dried
Definitive Host:Humans, pigs, dogs, cats and
other
fish eating mammal
Location: Liver
Testes: Dendritic/Branchy

LIFE CYCLE

Embryonated eggs are dischared

from biliary tract and into stool
eggs are ingested by snail(1st IH)
parasite undergoes developental
stages (miracidia,sporocyst,
rediae, cercaiae)
cercaria are released and attach
in the skin/flesh of fresh water fish
where they encyst as
metacercaria
fish are eaten undercooked/raw
by humans
metacercaria excyst in duodenum
and ascends the biliary tract

03/22/15

 Disease: Clonorchiasis, cholangiocarcinoma

Causes erosion of epithelium lining ducts
Most damage is due to immune response in the liver
Eggs are surrounded by granulomas, reducing liver
function
Frequently causes liver cance
Jaundice, indigestion, diarrhea, hepatomegaly, weight
loss, ascites(accumulation of fluid in abdominal cavity)
Severity of infection depends on the number of adult
worms

DIAGNOSIS, TREATMENT &

PREVENTION
Diagnosis: Eggs in feces
Old fashioned light bulb
Treatment: Praziquantel
Prevention:
Do not eat raw or undercooked freshwater fish.

Opisthorchis sp.
Opistorchis Viverrini (southeast asian
liver fluke)
Opistorchis Felinus (cat liver fluke)
M.O.T. : Ingestion
Infectious stage: metecercaria
1st IH: snail (Bithynia)
2nd IH: fish (Cypridae, Cobitidae)
Definitive Host: Humans & other fish
eating mammals
Similar morphology, lifecycle &
pathology to Clonorchis sinensis

03/22/15

Disease: Opisthorchiasis
indistinguishable with clonorchiasis (caused by
C.sinensis)
the disease is thus referred to as clonorchiasis
mostly asymtomatic
pathogenisis, signs and symptoms are similar
that of C.sinensis

DIAGNOSIS, TREATMENT &

PREVENTION
Diagnosis: Eggs in stool
indistinguishable to those of C.sinensis
Treatment: Praziquantel drug of choice
Prevention: that of Clonorchis sinensis

Heterophyes heterophyes
Common Name: small intestinal fluke
M.O.T. : Ingestion (encysted metacercaria in fish)
Infectious stage: metecercaria
1st IH: aquatic snails (Thiara riquetti)
2nd IH: Fish
Definitive Host: Humans & other fish-eating
mammals
Location: small intestine
Other heterophids
Metagonimus
Haplorchis

LIFE CYCLE

embryonated egg with developed

miracidium are passed in feces
ingested by 1st I.H.(snail)
eggs hatch and release miracidia
w/c undergoes several
developmental stages
cercaria are released and
penetrate the skin of fresh water
fish and encyst as metacercaria in
its tissue
Host becomes infected by
ingesting undercooked/raw fish
metacercaria excyst and attaches
to the small intestine

03/22/15

 Disease: Heterophyiasis
Mild inflammatory response
Heavy infection may damage the mucosa and
penetrate it and migration can occur to other
areas(heart, brain lymph nodes, etc.)

DIAGNOSIS, TREATMENT &

PREVENTION
Diagnosis: Eggs in stool
Resembles that of opistorchis & clonorchis
Treatment: Praziquantel
Prevention:
Care in ingesting raw, or undercooked fish.
Incompletely salted or pickled fish also are
infectious

Echinostoma ilocanum
Common Name: no known common name
Wide variety of Echinostoma species
M.O.T. : Ingestion (water or aquatic vegetation)
Infectious stage: metecercaria
1st IH: snail (Gyraulus, Hippeutis)
2nd IH: snail: kuhol(Pila luzonica)
susong papang(Vivipara angularis)
Definitive Host: Humans & aquatic birds
Location: intestines or bile duct

LIFE CYCLE

unembryonated eggs passed

out in feces
develops in the external
environment
miracidia hatches and
penetrates snail and undergoes
several developmental stages
cercaria is released and enters
the second host
the second I.H is then eaten by
humans or birds
metacercaia excyst in the
duodenum
adults reside in the small
intestine

03/22/15

 Disease: Echinostomiasis
heavy infections, nausea, vomiting, diarrhea,
fever and abdominal pain may occur.
Catarrhal inflammation often occurs due to the
penetration of the sharp-spined collar into the
intestinal mucosa
Most dont show symptoms

DIAGNOSIS, TREATMENT &

PREVENTION

Diagnosis: Eggs in stool

Large in size
Refractile dots may be seen
Specie differentiation requires morphological study
of adults
Treatment: Praziquantel drug most commonly used
for treatment
Prevention:
Avoid eating undercooked / raw snails

03/22/15

SCHISTOSOMES
Blood Flukes

03/22/15

Schistosoma japonicum
Common Name: oriental blood fluke
M.O.T. : skin penetration
Infectious stage: cercaria
1st IH: snail(oncomelania quadrasi)
Definitive Host: humans, wild animals
Location: veins of small intestine
Has 3 openings: oral, ventral & gonophore
*more pathogenic than other sp.

03/22/15

Schistosoma mansoni
Common Name: Intestinal schistosoma
M.O.T. : skin penetration
Infectious stage: cercaria
1st IH: snail
Definitive Host: humans, wild animals
Location: portal veins of large intestine

03/22/15

Schistosoma haematobium
Common Name: Urinary schistosome
M.O.T. : skin penetration
Infectious stage: cercaria
1st IH: aquatic snail
Definitive Host: humans (host specific)
Location: veins of the urinary bladder, urethra, ureters

03/22/15

03/22/15

DISEASE
Schistosomiasis/ Bilharziasis
Migratory- usually asymptomatic, cercaria migrates to its right
place
Acute- adults start making eggs, gastrointestinal discomfort,
muscle aches, headache, fatigue, fever, chills
Chronic- occurs where parasite is endemic, ascites,
hepatomegaly, splenomegaly, dwarfism, eggs may lodge in the
brain causing neurological damage

Granulumatous reaction(granulomatosis) due to the spines

Swimmers itch- derma.infxn due to penetration of cercaria

03/22/15

DIAGNOSIS &TREATMENT
DIAGNOSIS
EGGS:
S. japonicum- minute lateral spine
S. haematobium- large terminal spine (eggs found in urine)
S. mansoni- large lateral spine
SEROLOGICAL TESTS
COPT
ELISA
TREATMENT
PRAZIQUANTEL

S.haematobium
03/22/15

S.japonicum

S. mansoni

03/22/15

PREVENTION & CONTROL

PREVENTION:
Avoid swimming in bodies of water in endemic areas
Killing of snail host
Proper sanitation
CONTROL:
EDUCATION
VECTOR CONTROL

03/22/15

OTHER SCHISTOSOMES
S. mekongi smaller than S. japonicum
S. intercalatum- like S. haematobium but bent terminal spine
Acid fast