PLATYHELMINTHES

TREMATODA
 TREMATODA
Morphology:
- Leaf-shaped, flat worm

- unsegmented

- Size:Mm to cm

- Sucker (+)

- Tractus digestivus (+)

- Hermaphroditic, except Schistosoma

- operculated eggs, except Schistosoma

Life Cycle:
DH.: generally human
IH.: 2 IH., except Schistosoma
Portal of entry: mouth, except Schistosoma
Infective form: metacercaria, except
Schistosoma

Classification based on size:

- large Trematoda

- medium Trematoda

- small Trematoda
Classification based on habitat:
1. Intestinal Trematoda : - Fasciolopsis buski
- Heteropyes heteropyes
- Metagonimus yokogawai
- Echinostoma ilocanum
2. Hepatic Trematoda : - Fasciola spp.
- Eurytrema pancreaticum
- Dicroecoelium dendriticum
- Clonorchis sinensis
- Opisthorchis spp.
3. Pulmonary Trematoda : - Paragonimus spp.
4. Blood Trematoda : - Schistosoma spp.
IINTESTINAL TREMATODA
- Fasciolopsis buski
- Heteropyes heteropyes
- Metagonimus yokogawai
- Echinostoma ilocanum
Causal Agent:
Fasciolopsis buski, Largest trematoda that infected human being.

Life Cycle:
Immature eggs+ faeces (1)  water hatched (2).
miracidium(3)  snail (IH. I) (4).  sporocyst (4a),
redia (4b) dan cercaria (4c). Escape from snail (5)
 encyst/metacercaria on water plant (6). 
Mammalia eat waterplant that contain metacercaria.
 duodenum metacercaria excyst (7)  adult flukes
( 20 – 75 mm x 8 – 20 mm) (8).
Geographic Distribution:
Asia: China, Thailand, Malaysia,
Clinical Sign:
ussually mild.
severe infection : diarhhoe, abdominal
discomfort, fever, ascites, oedema anasarca
and obstruction.
Laboratory Diagnosis:
Eggs in faeces or vomit.
egg is similar to Fasciola hepatica’s

The adult flukes are rarely found

Treatment:
Praziquantel*(drug of choice). 
A: Fasciolopsis buski’s egg, B: adult Fasciolopsis buski :
 Similar to Fasciola hepatica’s. 20 - 75 mm x 8 - 20 mm. 
  oval shaped,
thin wall, and operculated
(operculum is open).
 Heterophyes heterophyes

 Distribution : Middle East Asia

 Habitat : small intestine
 Morphology : very small, less than 2 mm,
piriformis,
 3 sucker  Oral Sucker, Ventral Sucker &
Genital Sucker.
 Testis oblique.
Echinostoma ilocanum
Geographic Distribution: Filipina, Indonesia.
Morphology:
Adult: 2,5 - 6,5 mm x 1 – 1,3 mm
OS>VS
OS  circum oral disc

Egg: Oval
thin-shelled
Operculum +
Unembryonated
Life Cycle:
IH I: Water snail
IH II: Water snail, fish, waterplants 
depend on spesies.
Infective form: metacercaria
Pathogenesis, symptom, diagnosis are similar
to the other Intestinal Trematoda.
Therapy: Tetrachlorethylene
Praziquantel
HEPATIC TREMATODA
- Fasciola spp.
- Eurytrema pancreaticum
- Dicroecoelium dendriticum
- Clonorchis sinensis
- Opisthorchis spp.
Causal Agents: Fasciola hepatica ANDFasciola gigantica  parasit from herbivora.
Life Cycle:
 Life Cycle:
 Eggs immature in bile duct  faeces (1). 
water (2) miracidium (3),  snail (IH. I / genus
Lymnea)(4).  sporocysts (4a), rediae(4b), 
cercariae (4c)  watercress 
encyst/metacercaria (5)  Mamalia consume
water plant + metacercaria (6).  excyst in
duodenum (7)  penetrate intestinal wall 
cavum peritonium  and hepatic parenchym, to
bile duct  adult (8). 
Geographic Distribution:
Cosmopolitan,
Fasciola hepatica infect herbivora
Size:
Fasciola hepatica 30 mm x 13 mm
Fasciola gigantica 75 mm.
Adult Worm:
 cephalic cone
 VS > OS
 Lateral compound
branch Ceca
 Dendritic Testis in
tandem formation
Clinical sign:
 Acute phase: young flukes migration 
parenchym hepar, symptom: abdominal pain,
fever, vomit, diarrhoea, urticaria.
 Chronic phase : adult flukes in bile duct 
intermitten sign of bile duct obstruction,.
 Ectopic infection: e.g. in intestinal wall, lung,
subcutan tissue of mucosa pharynx.
Laboratory Diagnosis:
Eggs : - in faeces
- duodenal/biliary fluid.
Egg of Fasciola hepatica is similar to Fasciolopsis buski’s.
False Fascioliasis (pseudo fascioliasis): finding Fasciola’s
egg in faeces as the result of eating liver (that contains
faciola’s egg)  repeated exam and prohibition to eat liver
for days.
Immunologis/serologis examination is important esp. in
invasif stadium or in ectopic fascioliasis.
A, B, C: egg of Fasciola hepatica. Operculum (+) at one pole. New
egg still Unembryonated. ( 120 – 150 x 63 – 90 μ) 

Treatment:

Praziquantel unefective use Bithionol.

Eurytrema pancreaticum &
Dicrocoelium dendriticum

Similar to each other

Eurytrema pancreaticum
 Geographic Distribution : China, Thailand,
Japan, Malaysia, Hongkong, Africa
 Habitat: pancreaticum duct  dog’s .
bile duct  cow, goat, sheep
 Intermediate host : land snail,
ants/beetles
Morphologi of Eurytrema
pancreaticum
Life Cycle
Life Cycle :
 two intermediate host.
 eggs + faeces  land snail(IH I)  hatch
 miracidium  sporocysts I, II, and
cercariae  laid on plants.  ingested by
arthropoda (IH II)  metacercariae 
ingested by human/cattle  larva  bile
duct  adult.
 Dicrocoelium dendriticum
 D. lanceolatum, F. lanceolata, F. dendriticum
 Habitat : billiary passage  herbivora
 Intermediate host : land snail,
ants/beetles
Dicrocoelium dendriticum
Adult
• 5-15 x 3-5 mm.
• Slender, flat, aspinous
body.
• Note: Lancet shaped
appearance.
• 2 testes, lobus, situated
obliquely to each other
• small subglobose ovary.
• Highly coiled voluminous
uterus fill the posterior
two third of the worm.
Egg of Dicrocoelium dendriticum

 Egg:  42 X 28 µm, with a hard to see operculum .

Pathology:
Parasite live in bile duct  erosion of epithel and
periductal fibrous connective tissue.
Clinical sign:
symptom is usually mild: vomiting, biliary colic,
diarrhea
Diagnosis:
Egg in faeces /duodenal fluid
adult fluke  Endoscopy
Therapy:
Klorokuin
Praziquanthel
Causal Agent:
The trematode Clonorchis sinensis (Chinese or oriental liver fluke).
Life Cycle:
Embryonated eggs + faeces (1)  ingested by water
snail (IH. I) (2).  miracidium (2a),  sporocyst
(2b), redia (2c) and cercaria (2d).  escape from
snail  freshwater fish (IH II)  metacercaria (3).
Human eat half-cooked/raw freshwater fish (4). 
metacercaria excyst in duodenum (5)  bile duct (6)
 adult worm.
Adult fluke ( 10 – 25 mm x 3 – 5 mm) in bile duct.
Carnivora might be reservoir host.
Geographic Distribution:
Endemic area: Asia.  

Clinical Sign:
 Manifestation of inflammation reaction and

intermittent obstruction of bile duct.

 Acute phase: abdominal pain, nausea,

diarrhea
 Chronic Infection : cholangitis, cholelithiasis,

pancreatitis and cholangiocarcinoma.

Laboratory Diagnosis:
 Eggs in faeces or duodenal fluid.
adult fluke may be found in operation.
Treatment:
Praziquantel or albendazole* (drugs of choice).
Causal Agent:
 Opisthorchis viverrini (Southeast Asian liver
fluke), Thailand, Laos, and Kampuchea. 
 O. felineus (cat liver fluke), Europe and Asia.

Life Cycle: similar to Clonorchis sinensis

DH.: dog, cat, fish consumer, human
Clinical sign:
Similar to Clonorchis sinensis

Laboratory Diagnosis:
Egg in faeces or duodenal fluid.

Treatment:
Praziquantel or albendazole.
Morphology differences between Clonorchis
sinensis, Opisthorchis felineus and Opisthorchis
viverini
Causal Agent:
more than 30 species of Paragonimus, usually Paragonimus westermani, infect animal and human.

Life Cycle:
Unembryonated egg in sputum/faeces (1). 
escape  embryonated (2)  hatch  miracidium
 snail (IH. I)(3)  sporocyst (4a), redia (4b),
and cercaria (4c), escape from snail.  crustacea
(IH. II) (crab/crayfish)  metacercaria (5) 
ingested (6)  Excyst in duodenum (7), penetrate
intestinal wall  peritoneum  diaphragma  lung
 adult worm(8). (7,5 – 12 mm x 4 – 6 mm).
Clinical Sign:
 Pulmonary and extra-pulmonary
paragonimiasis
 Pulmonary paragonimiasis : Chronic cough,
lika pulmonary TBC
 extra-pulmonary paragonimiasis : enter any
organ of the body, such as liver, intestine,
peritoneum.
Laboratory Diagnosis:
Egg in sputum or faeces,
 2 – 3 months post infection

Treatment:
- Praziquantel (drug of choice).   
- Bithionol  
A: egg of Paragonimus westermani.  (85 µm x 53 µm). Brown-
yellow color , oval . Operculum at wide pole, thickened wall at
another pole. Unembryonated.
Causal Agents:
Schistosoma haematobium, S. japonicum, and S. mansoni.  Rare : S. mekongi and S.
intercalatum. 
Life Cycle:
Egg + faeces/urine (1)  hatch 
miracidium(2), penetrate snail (IH.)(3) 
sporocyst(4) cercaria(5)  penetrate
human skin (6)  shistosomulae (7) hepar
 migration (8,9)  plexus venosus
(species) adult(10).
Habitat:
(A) Schistosoma japonicum at Plexus mesentericus
superior,
(B) (B)Schistosoma mansoni at plexus venosus inferior
(C) (C) Schistosoma hematobium at plexus venosus
vesicalis.

 Female worm  Lay eggs in intestine (S.japonicum

and S.mansoni) or vesica urinaria (S.haematobium)
 faeces/urine.
 Female: long and slender 12-26 mm in length
diameter 0,3 mm
 Male: 6-22 mm in length, the body is flattened
behind the ventral sucker
 Characteristically: incurved ventrally to form a
gynecophoral canal in which the female
reposes
Geographic Distribution:
Schistosoma mansoni at South America and
Caribbia, Africa, and Middle East;
S. haematobium at Africa and Middle East;
S. japonicum at Far East, Indonesia. 
Clinical Sign and Symptoms:

 Cercaria → skin → local reaction (dermatitis)

 Toxic metabolites liberated during the growth of
schistosomulae → fever, urticaria, eosinophilia,
leucocytosis
 At the time of laying eggs → haematuria (S.
haematobium), diarrhea/dysentri (S.mansoni + S.
japonicum)
Laboratory Diagnosis:
Egg in faeces: S. mansoni and S. japonicum.
Egg in urine: S. haematobium (sedimen examination
after sentrifugation).

Treatment:
Praziquantel (drug of choice)
Schistosoma mansoni

A, B: Egg of Schistosoma mansoni C. Egg of Schistosoma

japonicum

Egg of Schistosoma haematobium