Trematodes

Schistosomatoidea
Flukes that have no second intermediate host in the life cycle mature in blood vascular system of definitive host Most are dioecious have a male and female 3 Schistosoma are clinically significance
S. haematobium S. mansoni S. japonicum

Schistosoma
Male is shorter and stouter than the female Ventral and longitudinal groove called gynecophoral canal where the female resides Have strong oral suckers around mouth No pharynx Sexual organs varies between species

Biology
Adult worms live in the veins that drain certain organs
S. haematobium veins of urinary bladder plexus S. mansoni portal veins draining large intestine S. japonicum veins of small intestine

Female in gynecophoral canal of male copulation takes place male moves them upstream to venules where the female lays the eggs Young transverse the venule wall and end up in area to be shed from the host, immune system may help to move the granuloma to either the gut or bladder where egg ends up in urine ot feces
Eosinophils Plasma cells Macrophages

Biology (cont.)
Eggs hatch in fresh water and miracidium is released Miracidium must enter a snail host that is specific for each strain In the snail, shed epithelium, begin to develop into a mother sporocyst that release daughter sporocyst which may move to another area, mother continues to make daughters Furcocercous cercaria emerge from daughter sporocyst
Cercaria have a head organ for penetration and a small ventral sucker

Swim to the surface and sink to the bottom until tthey find the appropriate host Wiggle around on the surface looking for a good place to penetrate and then they disappear rapidly, loose tail and end up in the vascular system, move thru the lungs to liver where they will stay for awhile and then move to the veins in the target organ

Life Cycle
Adult in mesenteric veins of definitive host eggs in feces miracidium penetrates Biomphalaria snail (1st intermediate host) mother sporocyst produces many daughter sporocysts which each produces many cercariae penetrate skin of definitive host schistosomulum migrates to liver, mates, migrates to mesenteric veins adult

Snail Vectors of Schistosomiasis

Epidemiology
Human waste in the water and the appropriate snail in the water will lead to human infection Level of infection based on exposure to contaminated water May develop immune response that prevents superinfection

Pathology
Pathogenesis is caused by the eggs and not the adult worms Lesion causes a delayed hypersensitivity reaction which is caused by the leaking of antigens from the granuloma formed around the egg 3 phases of the disease
Migratory penetration until matuartion Acute Katayama fever egg production and loosing antigen, Antigen-antibody complexes with increased eosinophilia in the blood Chronic dominated by macrophages, lymphocytes, fibroblasts and multinucleated giant cells makes small fibrous granulomas ot pseudotubercles

S. japonicum is the most fatal with brain and neurological disorders and S. haematobium is the least serious

Diagnosis and Treatment

Should see eggs in the urine or feces, may need to use concentration tests to get enough numbers for diagnosis Can also use serological tests that recognize the antigens and may not be super good due to the timing of the parasite Treat with trivalent antimonials in the old days but too toxic so now have praziquantel that works on all the Schistosoma species

Control
Education Control by chemotherapy Vector control Vaccination

Schistosoma mansoni
Adult worms acquired in Africa, S. America, and parts of the Caribbean when cercariae from Biomphalaria spp. snails penetrate through the skin Worms have separate sexes
The female is wrapped within the gynecophoral canal of the male

0.5 mm

Single egg within uterus of female

50 m

S. mansoni Eggs
Note the fully formed miracidium, which hatches immediately in fresh water through a tear in the shell The large lateral spine, which may be inconspicuous if pointing straight up, help identify the egg Transmitted in Africa, the Caribbean, and Brazil by snails in the genus Biomphalaria

50 m

6.17 Life cycle of Schistosoma mansoni. a. Adult worms in copula. b. Egg in feces. Eggs hatch immediately upon reaching fresh water, releasing a miracidium. c. Miracidium, which must penetrate into a susceptible snail within several hours. d. Miracidia penetrating head foot of Biomphalaria glabrata. Each miracidium transforms into a single mother sporocyst at the site of penetration. e. Mother sporocyst in tentacle of B. glabrata several weeks after penetration of the miracidium. f. Squash of tentacle infected with mother sporocyst, showing released daughter sporocysts. g. Higher magnification of daughter sporocyst, showing typical elongation and enlargement of anterior end. These migrate posteriorly to the digestive gland. h. Digestive gland of infected snail (green), largely replaced by daughter sporocysts (yellow). These give rise to cercariae. i. Cercaria, with characteristic forked tail. These attach to human skin, drop their tail, penetrate, and are then called schistosomula. j. Schistosomulum, which pairs with a worm of the opposite sex in the liver, develops to adulthood, and migrates to the mesenteric veins.

S. mansoni in Liver

200 m

50 m

Left - low magnification showing three granulomas Right - higher magnification of single granuloma surrounding an egg, which has a clearly visible lateral spine

Schistosoma haematobium Eggs

Found mainly in urine, because the adult worms inhabit veins surrounding the bladder, but eggs also are found in feces Identified by the terminal spine and fully formed miracidium Occurs in Africa and the Middle East In addition to hematuria and fibrosis of the bladder and ureters, infections are associated with bladder cancer

50 m

S. haematobium Eggs

0.5 mm

50 m

Wall of the urinary bladder Left large numbers of calcified eggs in the muscularis Right - higher magnification of eggs, terminal spines of the eggs are not visible in this section

Schistosoma japonicum
Fully formed miracidium Minute lateral spine, which is not apparent in several photographs Occurs in Asia Most pathogenic of the human-infecting schistosomes due to the high egg production by females and the tendency of the small eggs to pass through the liver and enter the systemic circulation, causing pathology in other organs, especially the central nervous system

50 m