TREMATODES

(Flukes)

General Charac.:

All flukes:
- leaf-like in appearance - Except Schistosomes
- generally Hermaphroditic (posses both male and female
genitalia) - Except Schistosomes
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 Classification of Trematodes:
an inner longitudinal integuments (serves to alter the I. Species which inhabit the small intestine
shaped of the worm) a) Fasciolopsis buski
possess 2 cup-shaped muscular suckers bearing spines or b)Echinostoma ilocanum
hooklets surrounding the mouth c) Echinostoma malayanum
oral sucker (found anteriorly surrounding the mouth) d)Heterophyse heterophyse
used for ingestion and procurement of food e) Metagonimus yokogawai
ventral sucker/ acetabulum - found posteriorly in the
ventral surface (for attachment) II. Specie that inhabit the lung
oral cavity leads to the muscular esophagus from which a) Paragonimus westermani
the intestine branches to form 2 intestinal ceca which
III. Specie that inhabit the liver
runs parallel to each other ending near the posterior end
a) Clonorchis sinensis
(figure of an inverted )
b)Opisthorchis felineus
no body cavity, most of the rest of the body is taken up
c) Opisthorchis vinerrini
by reproductive organ and some associated structure
d)Fasciola hepatica
lack circulatory system e) Fasciola gigantica
excretory system - bilaterally symmetrical and opens at f) Eurytrema pancreaticum
posterior end of body
nervous system - composed of paired lateral ganglia in IV. Species which inhabit the portal blood circulation
the region of pharynx which are directed to nerve trunk a) Schistosoma japonicum
series of glandular structure (vetilaria) lying lateral to the b)Schistosoma hematobium
intestinal ceca c) Schistosoma mansoni

Egg: Intestinal Flukes

smooth, hard shell and operculated or with lid at one end
except (Schistosomes non-operculated)
generally yellow brown or brown colored
Fasciolopsis buski (Giant Intestinal Fluke)
common intestinal parasite of human and pigs in the
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
hens 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 (Garrisons 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
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: o oral and ventral suckers are about equal in size
ventral sucker larger and thick-walled than oral o 2 deeply lobed testes arranged side by side at the
sucker posterior - third of the body
genital sucker (gonotyl) found posterior to the o ovary lobed located post. to the ventral sucker
ventral sucker (not present in Metagonimus) o vitellaria extensively branched and covers the entire
oral smaller compared to ventral sucker length of the body
o cirrus and cirrus pouch absent
ova o uterus tightly coiled into a rosette found near the VS
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

Pathogenesis:
mild local inflammatory reaction at site of attachment
causing damage to intestinal mucosa Ova cercaria
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
Disease: Paragonimiasis/Endemic Hemoptysis
Lung Fluke o acquired through ingestion of raw or undercooked crab
Paragonimus westermani (Oriental Lung fluke) meat containing encysted metacercaria
= most widely prevalent specie o clinical manif.: nausea, sweating, chronic cough with
bloody sputum, dyspnea and pleuritic chest pain
Geog. Distribution: o human are definitive host
o Endemic in Asia and India o pulmonary infection is easily mistaken for pulmonary TB
o In U.S. occur in immigrants from these areas o invasion stage of the disease may cause few or no
symptoms
Morphology:
o once in the lung, worm stimulate inflammatory response
Adult worm
which enshrouds granulation of the lung capsule which
o thick, fleshy, reddish-brown or coffee-bean color in living
later ulcerate and heal slowly
specimen anteriorly rounded and tapering posteriorly
o egg deposition may produce more pronounced tissue
o integuments covered with scale-like spines
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