TREMATODES

Noemie N. Ardiente, RMT, MSMT

 ADULT:
 Flat, leaf-like, elongated, ovoid, conical or cylindrical, non-
segmented.
 With two muscular, cup-shaped suckers (oral and ventral)

General  except Heterophyes heterophyes (3: oral, ventral, gonotyle)

 Intestine maybe branched/dendritic or simple.

Characteristics  Testes (2), except for Haplorchis (1) which vary in shape:
globular, lobate, tubular, dendritic/branched
 Ovary (1), which vary in shape: lobed, dendritic, globular,
round
 1. Hermaproditic (self-fertilizing)
2. Dioecious – blood flukes/ schistosomes
TREMATODES
 Typical
LIFE CYCLE
of Trematodes
Fasciola spp.
 Fasciola spp
Fasciola hepatica CN: Temperate liver fluke
Fasciola gigantica CN: Tropical liver fluke
MOT Ingestion of metacercariae encysted on edible aquatic plants/ drinking
water with viable metacercariae
1st IH F. hepatica : snails (Lymnaea truncatula, Lymnaea bulmoides,
Lymnaea tomentosa, Planorbidae)

F. gigantica : snail (L. auricularia, L. acuminate, L. natalensis)

F. spp: snail host (Philippines): L.philippinensis, L. auricularia

rubiginosa
2nd IH Aquatic plants: Ipomea obscura (morning glory/ kangkong), Nasturtium
officinale (watercress)
DH Humans, herbivorous mammal
 Fasciola hepatica Fasciola gigantica
ADULT
Size 18 to 51 mm by 4 to 13 mm 25 to 75 mm by 3 to 12 mm
Cephalic cone Present Present (shorter)
“shoulders” Prominent Present (less developed)
Testes and ovary Branched and dendritic Branched and dendritic
Intestinal ceca Branched/dendritic More branched
Fasciola hepatica adult
Source: CDC - DPDx - Fascioliasis
 Fasciola hepatica Fasciola gigantica
EGGS
Size 140 to 180 µm by 63 to 160 to 190 µm by 70 to 90
90µm µm
Color Yellowish brown Yellowish brown
Features Ovoidal, operculated, Ovoidal, operculated,
immature, well-rounded immature, well-rounded
posterior end -“hen-egg posterior end
shaped”
Source: WHO Benchaids for Diagnosis for Intestinal Parasites
Life cycle
 • Fascioliasis; Acute (invasive) or Chronic (latent) phase
Clinical • Halzoun disease (Lebanon)
Manifestation • Marrara disease (Sudan)
(Fasciola spp)
 • Presence of ova in stool, duodenal aspirates, bile
aspirates.
• Recovery of worms during surgery, after treatment or at
autopsy.

DIAGNOSIS • ELISA
(Fasciola spp) • Western Blot
• CT Scan
• Endoscopic retrograde cholangiopancreatography
(ERCP)
Fasciola spp.

Adult of F. hepatica observed with ERCP

imaging in the common bile duct of a
human patient.
Source: CDC - DPDx - Fascioliasis
 • Triclabendazole (DOC)
TREATMENT • Bithionol
(Fasciola spp)
 • Thorough washing and cooking of vegetables
• Boiling of water in areas where infections are endemic
• Control measures for the elimination of snail intermediate
host (application of CuSO4, and killing the parasite in
Prevention & reservoir host via chemotheraphy

Control • Vaccination of animals with Fasciola antigen: Fatty acid

binding protein (FABP) – Fh12, glutathiome-S-
transferase (GST), cathepsin L (CatL)
proteinase,hemoglobin (Hb)
  Worldwide-distribution (2.4 to 17 million est cases)
 Bolivia (360,000 est. cases)
 Ecuador (830,000)
EPIDEMIOLOGY  Iran (10,000)
(Fasciola spp)  Peru (742,000)
 Yemen (37,000)
Fasciolopsis buski
CN:Large Intestinal Fluke
Fasciolopsis buski
1st IH Snails: (Segmentina, Hippeutis)
2nd IH Aquatic plants: Trapa bicornis (water caltrop),
Eliocharis tuberosa (water chesnut),
Ipomea obscura (morning glory/kangkong),
Nymphaea lotus (lotus)
DF Pigs and humans
Habitat Intestine
MOT Ingestion
IH: Segmentina spp & Hippeutis spp
Source: CDC - DPDx - Fasciolopsiasis
Fasciolopsis buski

ADULT

Size 20 to 75 mm by 8 to 20 mm

Shape Elongated, oval

Cephalic cone Absent

Intestinal ceca Unbranched, Simple, wavy

Testes & ovary (2) Dendritic testes; branched

ovary
Fasciolopsis buski

EGGS

Size 130 to 140 µm by 80 to 85 µm

Features Operculated
Unembryonated
Ellipsoidal
Rounded at both ends
LIFE CYCLE
Fasciolopsis buski

Pathology Fasciolopsiasis
Intestinal obstruction, inflammation, ulcerations

Diagnosis Presence of parasite eggs in stool

Treatment Praziquantel (25mg/kg 3xday)

Epidemiology Endemic in SEA, China, Korea and India

Prevention & Control Sanitation

Adequate washing and cooking of plants
Echinostoma
ilocanum
CN: Garrison’s fluke
 Echinostoma ilocanum Artyfechinostomum malayanum
1st IH • Gyraulus convexiusculus Not yet identified
• Hippeutis umbilicalis

2nd IH • Pila luzonica (kuhol) • Lymnnae (syn. Bullastra) cumingiana

• Vivipara angularis (susong (birabid)
pampang • Ampullaris canaliculatus (golden apple
snail)

MOT Ingestion Ingestion

DH Human, dogs, cats, rats, pigs Human, dogs, cats, rats, pigs
Habitat Small intestine Small intestine
Lymnnae spp Pila spp
 Echinostoma ilocanum Artyfechinostomum
malayanum
ADULT

Size 2.5 to 6.6 mm by 1 to 1.35 5 to 12 mm by 2 to 3 mm

mm
Features • 49 to 51 collar spines • 43 to 45 collar spines
• Tapered at the posterior • Rounded posterior end
end • Large testes with 6 to 9
• Deeply bilobed testes lobes arranged in tandem
• Simple Intestinal ceca • Small, rounded/oval ovary
 Echinostoma Artyfechinostomum
ilocanum malayanum
EGGS
Size 83 to 116 µm by 58 to 120 to 130 µm by 80 to
69 µm 90 µm
Color Straw-colored Golden- brown
Features • Ovoid • Ovoid
• Operculated • Operculated
• Immature • Immature
Life Cycle
 Echinostoma ilocanum & Artyfechinostomum malayanum
Clinical Manifestation • Intestinal inflammation, ulceration, diarrhea, abdominal pain,
intoxication due to absorption of metabolites from the worms

Diagnosis • Presence of ova in stool

Treatment • Praziquantel (25 mg/kg/day)
Epidemiology • SEA, East Asia
• E. ilocanum (endemic in Northern Luzon, Leyte, Samar,
Mindanao province)
• A. malayanum (Northern and Central Luzon)

Prevention and Control • Avoid ingestion of raw or improperly cooked 2nd intermediate
host associated with the parasites.
  Belisario, V (2004), Philippine textbook of Medical
Parasitology, UP-Manila Publications, Manila
 Zeibig, E. (2013), Clinical Parasitology A Practical

REFERENCES approach 2nd Ed, Elsevier Saunders

 Roberts, L. Janovy Jr., J. (2009) Foundations of
Parasitology 5th Ed, Mc Graw Hill Companies
 http://dpd.cdc.gov/dpdx/Default.htm