CHAPTER FIVE

TREMATODES

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 Acknowledgements
 Addisa Ababa University
 Jimma University
 Hawassa University
 Haramaya University
 University of Gondar
 American Society for Clinical Pathology
 Center for Disease Control and Prevention-
Ethiopia
 Learning objective
 At the end of this section the student will be able to:
 Explain the general feature of trematodes
 Describe the general morphology of the different stage of
trematodes
 Explain the general reproduction and life cycle of
trematodes
 Explain the general feature of the different stage of the
trematodes
 Classify and list medically important trematodes
 Obj…
 Explain the general feature of blood fluke
 List the blood flukes of medical importance
 Explain the geographical distribution, Morphology,
differential characteristics, transmission, life Cycles
and pathogenesis of each species
 Apply the necessary laboratory procedure for
detection and identification of the liver fluke
 Outline
 General characteristics of trematodes
 General morphology
 Attachment organ
 Digestive tract
 General life cycle and reproduction of trematodes
 General feature of the different stage of trematodes
 Classification of trematodes

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 Out..
 General feature of the blood fluke
 List of the blood flukes of medical importance
 For each species of blood flukes
 Geographical distribution
 Morphology and differential characteristics,
 Transmission and life Cycles,
 Laboratory diagnosis and
 Prevention and control
 Class Trematoda
 Trematode parasites of man belong to Order Digenea
 Characters:
 Flattened dorsoventrally / leaf like (Schistosomes –
cylinderical)
 Bilaterally symmetrical
 Unsegmented
 Has no body cavity
 Cuticle covered with spines (help in fixation)
 Organs of fixation in the form of suckers
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 Class Trematoda

1. Oral sucker – at anterior end surrounding the mouth

2. Ventral sucker (acetabulum)– blind on the ventral surface

posterior to the oral sucker

3. Genital sucker – present in some species

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Hermaphroditic (A) and Bisexual (B) flukes

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 Class Trematoda

 Digestive system:
 Mouth at anterior end surrounded by the oral sucker
 It leads to an oesophagus having a muscular pharynx
 This divides infront of the ventral sucker into 2 intestinal
caeca ending blindly at the posterior end

Mouth (Oral sucker) ____ Oesophagus ___ Intestinal caeca

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 Class Trematoda

 Excretory system:
 Flame cells derive products, by the activity of their cilia, into
collecting tubules to a bladder, and are finally discharged
from an excretory pore at the posterior end

Flame cells (Cilia) ___ Collecting tubule ___ Bladder ___ Excretory
pore __ Discharged

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Trematodes – adult stage

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 Sexes of flukes

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 Trematodes - schistosomes

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 Class Trematoda

 The life cycle is passed in two hosts (alternation of hosts) and

has sexual and asexual stages (alternation of generations =
metamorphosis):
1. Final host: harbour the sexual stage of the parasite (adult
worm)
 Man (DH)
 Other animals (RH)
2. Intermediate host: harbour the asexual stages of the parasite

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Snail (molluscan host)
 General life cycle

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 Classification
1. Blood flukes:
1. Schistosoma spp. (S. mansoni, S. hematobium, S.
japonicum, S. intercalatum, S. mekongi)
2. Liver flukes:
1. Clonorchis sinensis,
2. Opistorchis spp.,
3. Fasciola spp. (F. hepatica, F. gigantica)
3. Lung flukes
1. Paragonimus westermani
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 Classification

4. Intestinal flukes
1. Fasciolopsis buski
2. Heterophyes heterophyes

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 Clas...
• Other flukes are classified based on the body site where they
resides on the hosts body:
1. Liver flukes – in the liver and biliary duct
2. Intestinal flukes – in the intestine
3. Lung flukes – in the lung
• The trematodes that infect liver, lung, and intestine are all food-
borne.
 Freshwater fish, crustaceans, and aquatic vegetation are the
sources of human infection.

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 Fasciola
 Among the Fasciolidae there are two human flukes:
 Fasciola hepatica, the most common and widely distributed,
and
 Fasciola gigantica, a fluke of much more focal distribution.
 Both have similar life cycles and produce similar human
disease, but F. gigantica can be recognized by its larger adult
and egg sizes.

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 Fasciola hepatica

 It is also called as sheep liver fluke

 Distribution : cosmopolitan (esp. In cattle and sheep raising
countries, including the highlands of Ethiopia
 Morphology:
 Adult: fleshy, flat, leaflike
 Cone shaped prominent two ”shoulders”
 Genital pore anterior to the ventral sucker
 Highly branched testes
21  Branched and fan-shaped ovary
 Fasciola hepatica
 Eggs:
 Oval with rounded poles
 Have a small, barely distinct operculum.
 The operculum can be opened, for example when a slight
pressure is applied to the cover-slip.
 Have a thin shell which is slightly thicker at the abopercular
end.
 Passed unembryonated.
 Size range: 120 to 150 µm by 63 to 90 µm.
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 Fasciola hepatica

Egg with distinct Egg with an open

operculum operculum

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A B C
Life cycle of Fasciola hepatica

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 Pathogencity
 Light infections are usually asymptomatic
 In heavy infection:
 Local irritaion during migration of the young worms to the
liver
 Fever, sweating and abdominal pain
 Obstructive jaundice
 Acute epigastric pain and abdominal tenderness
 Persistent diarrhoea

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 Inflammation of the bile duct
 Fasciola hepatica in the bile duct

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 Prevention and control
 Avoid eating uncooked water plants
 Treating infected animals
 Destroying snail hosts
 Sanitary disposal of feces
 Treating infected individuals and giving health education

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 Laboratory diagnosis

 Eggs in the feces in chronic infection

 Eggs in aspirates and in bile if eggs are absent in feces
 Serological diagnosis by testing serum for antibodies
 Especially In the early stages of infection when the
immature flukes are migrating through the liver and
causing serious symptoms but before egg production.

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 Laboratory diagnosis

 False fascioliasis: due to ingestion of animal liver containing

Fasciola egg, with the passage of eggs in stool.
 This may be ruledout by keeping the patient on a liver
free diet for three days or more.
 If eggs continue to be passed in Fasciolopsis-free areas,
the infection is probably genuine (True fascioliasis).

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 Fasciola gigantica
 The giant liver fluke
 Morphology similar to F. Hepatica
 Difference:
Features F. Gigantica F. Hepatica
Size 6x1.5cm 3x1cm
Anterior cone Small Large
Lateral Parallel Converging
margins
Shoulders Less prominent More prominent
Suckers Oral smaller than Equal
ventral
Snail host Lymnaea cailliaudi Lymnaea
truncatula
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 2. Intestinal flukes

 Fasciolopsis buski
 Heterophyes heterophyes
 Metagonimus yokogawi

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 Fasciolopsis buski

 Also called the giant intestinal fluke

 Distribution: Thailand, Taiwan, Vietnam, Indonesia
 Morphology:
 Adult: large, fleshy flat worm
 Has no cephalic cone and shoulder
 Oral sucker is smaller than the ventral sucker
 Testes highly branched

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 Fasciolopsis buski
 Adult fluke of Fasciolopsis buski:
 The adult flukes range in size: 20 to 75 mm by 8 to 20
mm.

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 Fasciolopsis buski
 Eggs:
 Practically indistinguishable from those of Fasciola
hepatica.
 The eggs are ellipsoidal, with a thin shell, and a usually
small, indistinct operculum.
 The operculum is open.
 Eggs range in size: 130 to 159 mm by 78 to 98 mm.

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Life cycle of Fasciolopsis buski

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 Pathology

 Diarrhea
 Ulceration and inflammation of the intestine
 Malabsorption

Laboratory Diagnosis
 Eggs in feces
 Adult worms in the feces (occasional)

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 Prevention and control

 Avoid eating uncooked water plants

 Latrine construction
 Avoid use of human feces as fertilizers
 Destroy snail and their habitat
 Treating infected individuals and giving health education

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Other tissue flukes and their eggs

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