TREMATODES

(Flukes) Life Cycle - Complex

= requiring one or more intermediate host

Adult worm (sm. intestine of vertebrate host)

↓
lays egg
↓
excreted in water and hatch ingested by human
↓ ↑
miracidium liberated metacercaria
↓ ↑
General Charac.: enter 1st I.H. (snail) enters & encyst in tissue
All flukes: of 2nd I.H.
- leaf-like in appearance - Except Schistosomes (fish, water vegetation)
- generally Hermaphroditic (posses both male and (intramolluscan phase) ↑
female genitalia) - Except Schistosomes sporocyst → redia 1 → redia 2 → cercaria → swim
♦ cross-fertilization and self-insemination are
method of reproduction
- provided with oral and ventral suckers -
Except Schistosomes ; some flukes have genital
sucker (Gonotyl)
MOT
• oral ingestion of the infective stage: encysted
metacercaria, Except - Schistosomes
• requires 2 I.H. - Except Schistosomes
• egg operculated - Except Schistosomes
• terribly difficult to get rid of once infected, may
accumulate for 10-20 years

Morphology & Structures:

( Adult worm)
• flattened, leaf-shaped, unsegmented worms
• body covered with non-cellular integuments which
may be smooth or spiny
• musculature consist of outer circular, middle oblique
and an inner longitudinal integuments (serves to
alter the shaped of the worm)
• possess 2 cup-shaped muscular suckers bearing Classification of Trematodes:
spines or hooklets surrounding the mouth I. Species which inhabit the small intestine
♦ oral sucker (found anteriorly surrounding the a) Fasciolopsis buski
mouth) used for ingestion and procurement of food b) Echinostoma ilocanum
c) Echinostoma malayanum
♦ ventral sucker/ acetabulum - found posteriorly in d) Heterophyse heterophyse
the ventral surface (for attachment) e) Metagonimus yokogawai
• oral cavity leads to the muscular esophagus from
which the intestine branches to form 2 intestinal II. Specie that inhabit the lung
ceca which runs parallel to each other ending near a) Paragonimus westermani
the posterior end (figure of an inverted )
• no body cavity, most of the rest of the body is taken III. Specie that inhabit the liver
up by reproductive organ and some associated a) Clonorchis sinensis
structure b) Opisthorchis felineus
c) Opisthorchis vinerrini
• lack circulatory system d) Fasciola hepatica
• excretory system - bilaterally symmetrical and opens e) Fasciola gigantica
at posterior end of body f) Eurytrema pancreaticum
• nervous system - composed of paired lateral ganglia
in the region of pharynx which are directed to nerve IV. Species which inhabit the portal blood circulation
trunk a) Schistosoma japonicum
b) Schistosoma hematobium
• series of glandular structure (vetilaria) lying lateral to c) Schistosoma mansoni
the intestinal ceca
Intestinal Flukes
Egg:
• smooth, hard shell and operculated or with lid at one Fasciolopsis buski (Giant Intestinal Fluke)
end except (Schistosomes non-operculated) • common intestinal parasite of human and pigs in the
• generally yellow brown or brown colored Orient
• lives in the small intestine of its definitive host
rather than in the liver

Disease: Fasciolopsiasis

Geographical Distribution:
Central and South China, Taiwan, Vietnam, Thailand,
Indonesia and other parts of Orient

Morphology:
Adult worm:
• live attached to the bowel wall primarily in the
duodenum and jejunum
 • elongate, broadly ovoidal, large and fleshy
• anterior end narrower than posterior end
• integument – spinose
• absence cephalic cone or shoulder
• ventral sucker larger than oral sucker located close
to it
• dendritic testes at the posterior half of the body in
tanderm
• ovary branched and lies midline anterior to the
testes
• vitelaria extensive at the lateral site to the caudal
end
Ova
• hen’s egg shape (identical to that of F. hepatica)
• thin-shell with small operculum at one end
• unembryonated when laid
MOT: ingestion of metacercaria encysted on fresh water
vegetation (bamboo shoots or water chestnuts) which
may be consumed raw or peeled w/ the teeth
Pathogenesis and Clinical infection:
• pathological changes caused by the worm are
traumatic, obstructive and toxic to the intestinal
mucosa
• there is localized inflammation, ulceration, abscesses
formation and hemorrhages at the sites of worm
attachment
• diarrhea, abdominal pain, anorexia, nausea and
vomiting may occur
• malabsorption syndrome and impairment of Vit B12
absorption occur in some infected patient
Diagnosis: Demonstration of egg in stool
Treatment: Hexylresorcinol/Tetrachlor Ethylene/Praziquantel
30mg/kg body weight
Echinostoma ilocanum (Garrison’s fluke)
Geog. Distribution:
• Confirmed to be endemic in the Philippines
• Prevalent in Northern Luzon, Leyte, Samar and
Mindanao
• also found in Indonesia, India, China, Thailand, Japan,
Malaysia and Sumatra
Disease: Echinostomiasis
Morphology:
Adult worm:
• elongated, bluntly rounded
• integument covered with plaque-like scales
• anterior end rounded and provided with circumoral
disc
• oral sucker lies in the center of circumoral disc
surrounded with collarette of spines (distinguishing
characteristic)
• ventral sucker in the anterior fifth of the body
• 2 deeply lobed dumbell-shaped testes arranged in
tandem at the posterior half of the body
• vitellaria at the lateral side of the body
Ova
• ovoidal and operculated
• immature when passed in feces
Life Cycle:
= involves 2 snail
intermediate host
Pathogenesis and Clinical manif:
• adult worm attaches to the wall of the small
intestine producing inflammatory reaction leading to
diarrhea
• light infection usually asymptomatic
• heavy infection can result to mild ulceration of the
intestinal mucosa producing bloody diarrhea and
abdominal pain
• absorption of the metabolites of the worm may
result in general intoxication
• clinical manif.: abdominal colic, episodes of diarrhea,
restlessness and pruritus
Diagnosis: Demonstration of charac. ova in stool
Treatment: Tetrachlorethylene/Praziquantel/Hexylresorcinol
Prevention: Through cooking of the snail that serves as
the second intermediate host of the parasite
Echinostoma malayanum
Geographical distribution:
= Malay Peninsula, India, China, Sumatra
Morphology: Adult
• ovoid and bluntly rounded
• oral suckers surrounded with spines
• testes – deeply indented at tandem
• excretory system – Y- shape appearance and
pouch-like excretory bladder
Ova: yellow to yellowish brown
L. C.: = Same as E. ilocanum
1st I.H. (snail) Lymnae Lueleola
2nd I.H. (snail) Indoplanorbis
Pathology and Symptomatology: Same as E. ilocanum
Diagnosis: Finding ova in the stool
Treatment and Prevention: Same as E. ilocanum
Metagonimus yokogawai (Yokogawai fluke)
Disease: Metagonimiasis
Geographical distribution:
• Spain, Israel, USSR, Prevalent in the Far East
Morphology: Adult worm:
• pyriform-shape, broadly rounded posteriorly and
pointed anteriorly
• size somewhat larger than heterophyes
• ventral sucker deflected to the right
• vitellaria in a fan-shaped distribution
• 2 oval unequal size testes at posterior-third of the
body
Ova
• minute, ovoidal and operculated
• absence of knob at abopercular end
• fully embryonated when laid
Cercaria
• tail keeled, armed with spines
• pigmented eyespots
Pathology and Clinical Feature:
• causes mild inflammatory reaction in the intestine
• ectopic ova can cause granuloma in other organ
especially in the liver and brain
Lab. Diagnosis: Finding ova in the stool
Treatment:
= Tetrachlorethylene & Praziquantel
Bithionol & Niclosamide – have been shown to
decrease egg production
Prevention:
• Avoid eating raw or inadequately cooked fish
• Domestic animal should be prevented from eating
fish offal
Heterophyes heterophyes
= smallest of the fluke but the deadliest
Disease: Heterophyiasis
Geographical distribution:
• Egypt, Turkey,
• Prevalent in the Far East (Japan, Korea, Central &
South) China, Taiwan & Philippines
Morphology:
Adult worm:
• oval or pyriform-shaped, pointed anteriorly, rounded
post.
• integument covered with scale-like spines more
numerous near the anterior end
• 2 ovoid-shaped testes at the posterior fifth of the
body
• seminal receptacle retort shaped
• cirrus and cirrus sac absent
• provided with 3 suckers:
♦ ventral sucker – larger and thick-walled than
oral sucker
♦ genital sucker (gonotyl) – found posterior to
the ventral sucker (not present in Metagonimus)
♦ oral – smaller compared to ventral sucker
ova
• ovoid-shaped, operculated
• embryonated when oviposited
• fully developed miracidium present within the egg
when deposited by adult worm
cercaria
- tail keeled with arm spines
- pigmented eyespots
 Ova:
broadly ovoidal, thick-shelled with flattened
prominent operculum
measures 80 X 55u
unembryonated when laid

Cercaria:
ellipsoidal body with minute oral stylet
knob-shaped tail with spine
oral sucker larger than ventral sucker

Ova
Pathogenesis: cercaria
• mild local inflammatory reaction at site of
attachment causing damage to intestinal mucosa
• chronic intermittent diarrhea, nausea, colicky abd.
pain
• eggs of degenerating flukes are spilled into blood
stream and disseminate to different parts of the
body
♦ heart - provokes tissue reaction leading to
cardiac failure
♦ spinal cord - result in loss of motor and sensory
function at the level where lesions are located
♦ brain – fatal cerebral hemorrhage

Diagnosis: Recovery of eggs in stool

Treatment: Tetrachlorethylene & Praziquantel

Bithionol & Niclosamide – have been shown to
decrease egg production

Prevention
♦ Avoid eating raw or inadequately cooked fish
♦ Domestic animal should be prevented from eating
fish offal
♦ Thorough cooking kills the parasite
Lung Fluke
Paragonimus westermani (Oriental Lung fluke)
= most widely prevalent specie
Geog. Distribution:
o Endemic in Asia and India
o In U.S. occur in immigrants from these areas
Morphology:
Adult worm
o thick, fleshy, reddish-brown or coffee-bean color in
living specimen anteriorly rounded and tapering
posteriorly
o integuments covered with scale-like spines
o oral and ventral suckers are about equal in size
o 2 deeply lobed testes arranged side by side at the
posterior - third of the body
o ovary lobed located post. to the ventral sucker
o vitellaria extensively branched and covers the entire
length of the body
o cirrus and cirrus pouch absent
o uterus tightly coiled into a rosette found near the VS
Disease: Paragonimiasis/Endemic Hemoptysis
o acquired through ingestion of raw or undercooked
crab meat containing encysted metacercaria
o clinical manif.: nausea, sweating, chronic cough with
bloody sputum, dyspnea and pleuritic chest pain
o human are definitive host
o pulmonary infection is easily mistaken for pulmonary
TB
o invasion stage of the disease may cause few or no
symptoms
o once in the lung, worm stimulate inflammatory
response which enshrouds granulation of the lung
capsule which later ulcerate and heal slowly
o egg deposition may produce more pronounced tissue
reaction
Lab. Diagnosis: Finding the typical operculated egg in
sputum, pleural fluids and feces
Treatment: Praziquantel, Bithionol (alternate drug)
Prevention:
o Adequate cooking of crabs/crayfish before eating
o Proper disposal of human waste