TREMATODES

(Flukes)
Mikhail A. Valdescona, RMT, MPH
PAR 313 LEC
College of Medical Laboratory Science
Our Lady of Fatima University-Valenzuela

TREMATODES

1. Liver flukes
- Fasciola hepatica
- Fasciola gigantica
- Chlonorchis sinensis
- Opistorchis felineus

2. Lung fluke
- Paragonimus westermani
3. Intestinal flukes
- Fasciolopsis buski
- Metagonimus yokogawai
- Haplorchis yokogawai
- Heterophyes heterophyes
4. Blood flukes
- Schistosoma mansoni
- Schistosoma japonicum
- Schistosoma haematobium
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TREMATODES

GENERAL CHARACTERISTICS:
(except for Schistosomes)
1. Monoecious (hermaphrodite)
2. Has a primary and secondary intermediate host
3. Metacercaria is the infective stage
4. Ingestion is the mode of transmission
5. Eggs are operculated
6. Leaf-like
7. Has 2 suckers (oral sucker and ventral sucker/acetabulum)
Schistosomes
dioecious
one IH
cercaria
Skin penetration
elongated

Other Trematodes
monoecious
two IH
Metacercaria
ingestion
leaflike
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Fasciola hepatica & Fasciola gigantica

Common name

Final host
1st IH
2nd IH
Habitat
Infective stage
Pathology
Laboratory
Diagnosis

Drug of Choice

F. hepatica

F. gigantica

Sheep liver fluke

Giant liver fluke

Sheep
Local cattle, herbivores
(Snails) Lymnaea philippinensis, Lymnaea
auricularia rubiginosa
Ipomea obscura (kangkong) and Nasturtium
officinale (water cress)
Liver parenchyma , (gall bladder)
Metacercaria
Fascioliasis,or liver rot, liver atrophy, Halzoun
Stool exam, liver biopsy, PCR
Bithionol, Triclabendazole

MORPHOLOGY

Adult fluke
- large, broad, and flat body
- 20 to 50 mm in length, 6 to 12 mm in width
- * prominent cephalic cone
- - highly branched testis and dendritic ovary

MORPHOLOGY

Fasciola egg
- large, ovoidal, operculated and yellowish to brownish in
color
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LIFE CYCLE

PATHOLOGY
I.Human fascioliasis
A. Acute or invasive phase
- may appear to be asymptomatic, or may produce fever,
abdominal pain and hypereosinophilia
- migration of juvenile parasite from the intestine to the liver
- traumatic and necrotic lesions are produced when the parasite
burrows through the liver parenchyma
B. Chronic phase
- may only be diagnosed through surgical operation
- period where the parasites reached the bile ducts
- obstruction due to the adult worm may happen stimulating
inflammation and subsequently cause fibrosis
II. Halzoun (pharyngeal suffocation)
- suffocation as a result of temporary lodgement of the fluke in the
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pharynx

DIAGNOSIS
1.
2.
3.
4.

Stool exam (eggs)

Recovery of adult worms in duodenal contents and bile
Liver biopsy
Molecular methods (PCR)

PREVENTION AND CONTROL

1.
2.
3.
4.

Proper food preparation and handling

Killing of parasite in reservoir host through chemotherapy
Vaccination of animals with defined Fasciola antigens
Health education

Clonorchis sinensis & Opistorchis felineus

Common name
Final host
1st IH

C. sinensis

C. felineus

Oriental liver fluke

Chinese liver fluke

Cat liver fluke

Man and other fish-eating vertebrate

Genera Parafossarulus,
Bulimus, Semisulcospira,
Alocinma and Melanoides
(snail)

Genus Bithynia (snail)

2nd IH

Family Cyprinidae (fishes)

Habitat

Liver parenchyma

Infective stage

Metacercaria

Pathology

Bile duct obstruction, liver CA and gallbladder CA

Laboratory Diagnosis

Stool exam, serological tests, molecular tests

Drug of Choice

Praziquantel, albendazole
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MORPHOLOGY

Adult fluke
-leaf-like with
transparent
tegument

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MORPHOLOGY

Egg (C. sinensis, O. felineus)

- Yellowish-brown, ovoid
- Distinct convex operculum that fits to the thickened rim of the eggshell
- -small protuberance at the abopercular end
- * pitcher/old-fashioned light bulb-like
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LIFE CYCLE

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PATHOLOGY
1. Periductal fibrosis
- fatigue, weakness, weight loss and altered apetite
2. Gallbaldder and liver CA
3. Pancreatitis

PREVENTION AND
CONTROL

DIAGNOSIS
1. Stool exam (eggs)
2. Serologic tests (ELISA, EIA)
3. Molecular method (PCR)

1.
2.
3.
4.

Health education
Proper waste disposal
Proper food preparation
Fish irradiation at a dose of 0.15 kGy
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Paragonimus westermani
Common name

Oriental lung fluke

Final host
1st IH
2nd IH

Man
Brotia asperata (Antemelania asperata) - snail
Sundathelphusa philippina, Parathelpusa mistia
and P. grapsoides (crab)
Lungs
Metacercaria
Paragonimiasis,
Sputum exam, Serologic Test, X-ray exam, Stool
exam
Praziquantel

Habitat
Infective stage

Pathology
Laboratory
Diagnosis
Drug of Choice

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MORPHOLOGY

Adult fluke
- reddish-brown
- coffee bean shape
- tegument is covered with single-spaced spines

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MORPHOLOGY

P. westermani egg
- oval, yellowish-brown, thick-shelled egg
- - has a flattened but prominent operculum
- Has thicken abopercular portion
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LIFE CYCLE

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PATHOLOGY
I. Granulomatous formation in the lungs
- fibrotic encapsulation, dry cough, chest pains, dyspnea, hemoptysis
II. Erratic paragonimiasis
- worm migration sa abdominal wall, lymph nodes, omentum,
pericardium, myocardium and intestinal wall

DIAGNOSIS
1.
2.
3.
4.

Radiography (X-ray)
Sputum examination- definitive diagnosis (3% NaOH)
Intradermal test used as screening test
Serologic Test (CF, EIA, etc)

PREVENTION AND CONTROL

1. Proper food preparation and handling
2. Health education

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Schistosoma spp.
- Blood flukes
- Dioecious
- Presence of gynecorphoral canal or groove holds the
male penis during copulation
- In Perpetual copulation
- Ova is non-operculated
- Infective stage: cercaria
Species:
Schistosoma japonicum
Schistosoma mansoni
Schistosoma haematobium
Schistosoma mekongi
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Schistosoma spp.
Parameter

S. japonicum

S. mansoni

S. haematobium

Common
name

Oriental blood
fluke

Mansoni blood fluke

Vessical blood fluke

Habitat

superior
mesenteric veins
of the small
intestines

Inferior mesenteric
veins of the small
intestines extending
to the colon & rectum

Vesical, prostatic
uterine venous
plexuses

IH

Oncomelania
hupensis quadrasi

Biomphalaria and
Australorbis

Bulinus and Physopsis

Pathology

Oriental
schistosomiasis,
Katayama disease,
Snail fever

Intestinal bilharziasis

Urinary bilharziasis,
Egyptian hematuria

Ova

Lateral knob

Lateral spine

Terminal spine
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MORPHOLOGY

Adult fluke

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MORPHOLOGY

Schistosoma eggs
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LIFE CYCLE

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PATHOLOGY
I. Early Schistosomiasis
- itching, chills and fever
II. Colonic Schistosomiasis
- deposition of eggs in the colon (dysentery or diarrhea)
III. Hepatosplenic Schistosomiasis
- most serious consequence
- characterized by hepatosplenomegaly and ascites
IV. Pulmonary Schistosomiasis
- larval migration to the lungs
V. Cerebral Schistosomiasis
- meningoencephalitis, headache, confusion, lethargy and coma
SCHISTOSOMAL CERCARIAL DERMATITIS
- Swimmers itch
- Gulf Coast itch
- Clam diggers itch
- Cercarial itch

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DIAGNOSIS
1. Stool exam
2. Immunodiagnosis
A. Intradermal test
B. IHA
C. Circumoval Precipitin Test (COPT)
method of choice for definitive diagnosis
(+) bleb or septate precipitates attached to one or more
points on the egg surface after incubation of schistosome
eggs in pt. serum
D. ELISA
3. Faust- Meleney Egg Hatching Techinique

PREVENTION AND CONTROL

1.
2.
3.
4.
5.

Chemotherapy
Health Education
Control of Oncomelania Snails
Chemical control
Environmental sanitation

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