PARASITE

DETAILS

Schistosoma mansoni
(South America, Africa)

BLOOD FLUKE (common name)

SCHISTOSOMIASIS (disease
produced) or BILHARZIASIS
schistosome means cleft bodied
intermediate host (1 only): Oncomelania
hupensis quadrasi (snail)
infective stage: CERCARIA
mode of transmission: CUTANEOUS
wide range of definitive hosts: dogs,
cats, pigs, carabaos, cows, wild
animals, men
more than 40 species of mammals as
reservoir hosts
miracidiums lifespan only lasts 1-2 days
if unable to find an intermediate host
no redia stage
free-living cercaria only lasts 2 days
50% eggs released in the feces, 50%
carried into the bloodstream towards
different body organs (liver, lungs,
brain)
live in veins of large instestines

Schistosoma
haematobium causes
red urine (bloody); Middle
East, Africa (largest
burden 80-90% of
cases)
Schistosoma japonicum
most virulent, most # of
eggs laid (usually in
clusters); Philippines,
China, and Sulawesi,
India (endemic)

ADULT

OVA
continuously produced by females

In copula:
inseparable male and
female

Male:
shorter but stouter,
has a gynephoric
canal
release molecules
that trigger females
reproductive maturity
live in veins of large
intestines

Female:
longer and slenderer
found lodged in the
gynephoric canal of
males
without males, it will
NOT reach sexual
maturity
continuously
produces eggs

LIFE CYCLE

1. Embryonated eggs are

passed through urine or
can be carried in the bloodstream
feces.
(mesenteric vein) and deposited into 2. Eggs reach freshwater, then 1.
the intestinal mucosa, lungs, liver
hatch into larva called
(most common), or brain (aberrant
miracidium (very motile
migration may cause cerebral
because of cilia).
schistosomiasis; severe)
3. Miracidium penetrates only 2.
IH Oncomelania
hupensis quadrasi
(Philippines only S.
japonicum).
4. Miracidium develops into
mother sporocyst that
has a lateral knob
produces germ balls, that
will produce daughter
very thin lining
3.
sporocysts.
with either multicellular stage or
5. Daughter sporocysts
miracidium inside
become [INFECTIVE
4.
STAGE] cercaria.
6. Cercaria undergoes asexual
reproduction inside the
snail.
5.
7. Cercaria exists from snail,
then penetrates the SKIN
of an unsuspecting human
or animal host, drawn by
thermal gradient.
8. Cercaria enters host, shed
their forked tails and
become schistosomulae.
9. Schistosomulae migrate
through several tissues
and stages to the
[HABITAT] veins, where
they mature into adults.
10. Adult worms are in
copula forever.
11. Female adult deposits its
eggs in the small
venules of the portal
(liver) and perivesical
(bladder) systems.
12. Eggs are moved
progressively towards
the intestinal lumen,
then released through
feces or urine (S.
hematobium).

PATHOLOGY

DIAGNOSIS

Pipe-stem Hepatic Fibrosis leading to

Portal Hypertension

diagnostic stage: EGG in

stool/urine
intrarectal collection of
feces in carabaos identify
who is infected
KATO KATZ technique

S. japonicum eggs in the body

responsible for pathology; as they
embryonate, more and more antigens
are produced
Lymphocytes are sensitized release
lymphokines and cytokines that will
attract cells to be able to form
granulomas around the eggs
delayed-type hypersensitivity (type IV);
immunopathologic condition: the
immune response of host is detrimental
to host instead of protective.
Granuloma formation will acculumate in
the liver, depending on the intensity of
infection.
Pipe-stem fibrosis pipe-shaped fibrosis
(thickening and scarring of CT) formed
around hepatic portal veins due to high
blood fluke egg burden
Portal hypertension

increased venous pressure

in portal circulation due to
compression, occlusion, or
fibrosis of the portal vein
leads to ascites and
collateral vessel formation
-venous circulation blockage
cause formulation of new
vessels
-esophageal varices (most
dangerous, death occurs
when ruptured), splenomegaly, blood vessels in
abdomen
[SEVERE]
caput medusae snakelike collateral vessel visible
just under the skin
hepato-splenic disease
colon
-acute: ulcerations
dysentery or diarrhea
-chronic: colonic
schistosomiasis (asymptomatic usually)

TREATMEN
T
Praziquantel
600 mg
(40mg/kg)
only kills the
adults; causes
eggs to hatch

DISTRIBUTION
Philippines
highest: Mindoro Oriental
2nd highest: Agusal del Sur
Caloocan not really an
endemic area (imported
cases)
Iloilo imported cases
Cagayan*, Mindoro,
Sorsogon, Leyte, Samar,
Negros Occidental*, Bohol,
Mindanao
*new endemic provinces
Bohol only province
targeted for elimination
Close to Elimination
Venezuela
Morocco
Algeria
Libya
Saudi Arabia
Iran
Oman
Tunisia
part of Indonesia
Large-scale control
ongoing (yellow)
Brazil
Egypt
China
Laos
Cambodia
Philippines
High Prevalence
Sierra Leone
Ghana
Mozambique
Tanzania
Madagascar
NOTES
higher in older age groups
(fishermen and farmers)
higher in men

PREVENTION
& CONTROL
Snail control
Chemotherapy
Sanitation
Safe water
supply
Health education

PARASITE
Fasciola hepatica
Fasciola gigantica

DETAILS

ADULT

most well-known liver fluke infection

FASCIOLIASIS found in 47 provinces
of Vietnam (26 South, 21 North)
LIVER ROT disease in livestock
most important parasites affecting
cattle, buffalos, sheep, goats and other
domestic ruminants
cosmopolitan distribution (spreads
everywhere)

Life span: 9-13 years

Lives in the biliary
passages of the liver

OVA

LIFE CYCLE

diagnostic stage
1. [MODE OF
immature eggs are carried by the bile
TRANSMISSION] 1 feces
into the intestine and subsequently
of livestock (normal host) 2
voided with the feces
ingestion of metacercariae
mature in water within 9-15 days,
encyted on edible aquatic forming a viable miracidium
plants 3 drinking water
miracidium escapes through the
with floating metacercariaeoperculum of the eggshell to seek out2. [UPON INGESTION] 1
first intermediate host
metacercariae excysts in
the duodenum or jejunum,
liberating the juvenile fluke
2 juvenile fluke penetrates
the intestinal wall to the peritoneal cavity until it
reaches the Glissons
capsule (liver capsule) 3 burrows into liver
parenchyma, enters the
bile ducts, becomes
sexually mature in 3-4
months
3. [ADULT WORM] life span 9-13 years, lives in the
biliary passages of the
liver
4. EGGS diagnostic stage carried by the bile into the
intestine and subsequentlyvoided with the feces
mature in water (9-15
days) forming a viable
miracidium miracidium
escapes through the
operculum of the eggshell
to seek out first
intermediate host
5. FIRST INTERMEDIATE
HOST [SNAILS family
Lymnaeidae] Lymnaea
philippinensis, L.
auricularia rubiginosa
in the snail
1 miracidium develops into
a sporocyst
2 sporocyst becomes
rediae
3 rediae produces
cercariae (asexual rep)
4 cercaria leaves snail
host by swimming in water
5 cercaria detaches its tail
and encysts in surfaces of
aquatic plants, forming
metacercaria
6. SECOND INTERMEDIATE
HOST [AQUATIC
PLANTS include
Ipomea obscura
(kangkong) and
Nasturtium officinale
(watercress) if no

PATHOLOGY

DIAGNOSIS

TREATMENT

DISTRIBUTION

inhabit the hepatobiliary system causing

considerable human morbidity dependent
on the number of worms and stage of
infection
persists for several weeks to months (3-4
months)
severe pathology results from parasite
migration or destruction of parenchymal
tissue causing toxic or allergic
reactions

EGG in feces

Triclabendazole
(10 mg or 20 mg
per kg of the
body)

In the Philippines, there is a

mixture of tropical liver fluke
(gigantic Africa) and
temperate liver fluke
(hepatica)

Ectopic Fascioliasis
may occur during any of the three phases
[acute, latent, chronic] of the disease but
is most common during the acute stage
caused by (1) juvenile that migrate out of
the intestine but do not locate in the liver
so they form ectopic lesions in many
abdominal tissues (2) juveniles that enter
the portal circulation so they are
distributed throughout the body
manifested as masses, abscesses,
migration tracks or hemorrhage
adult worm has changed so its not leafshaped anymore
often misdiagnosed as malignant ulcers or
tumors
exploratory abdominal surgery may be
needed to make the diagnosis
Due to F. hepatica
confined to liver
major inflammation chronic inflammation
of the bile ducts
important complications bleeding from
the bile ducts and rarely biliary cirrhosis
Halzoun
disease from eating raw liver of
slaughtered ruminant
adult worms cling to pharynx and cause
inflammation
asphyxiation, difficulty in swallowing

France, Portugal, Spain,

USSR, UK, Cuba, Peru,
Bolivia, Egypt, Iran

PREVENTION
& CONTROL
Case-finding
(Kato Katz)
Bithionol/Tricabe
ndazole
Cook food well.
Avoid using night
soil for fertilizers.
Avoid
promiscuous
defecation.
Washing does
not remove the
metacercariae.

aquatic plants, cercaria

can encyst into a
metacercaria in the water
(freely), skipping the
second intermediate host