TREMATODES
VE GABRIEL MD
EUKARYOTES
UNICELLULAR MULTICELLULAR
Helminths
Nematodes Cestodes Trematodes
(roundworms) (Tapeworms) (leaf-like)
Liver Intestinal Lungs Blood
TREMATODES
• LIVER FLUKES
• Fasciola hepatica
• Fasciola gigantica
• Clonorchis sinensis
• Opistorchis felineus
• Opistorchis viverinii
• Dicrocoelium dendriticum
TREMATODES
A. Liver Flukes
EGG LARVA 1 LARVA 2 ADULT
HOST 1 HOST 2 HOST 3
Hatches Develops in Eaten by the Eaten by the
in water the first second Final host
to release the Intermediate host Intermediate host (Humans)
MIRACIDIUM (SNAILS) (water plants,
Fish or snails
Adult Trematodes
• Flat, elongated, leaf-
shaped
• Ovoid, conical or
cylindrical depending on
state of contraction
• Integument may be
covered with spines,
tubercles or ridges
(partially or completely)
Adult Trematodes (Prototype)
Oral sucker
Esophagus
Ventral sucker
Intestinal cecum
Vitellaria
1 ovary
2 testes
All trematodes are hermaphroditic EXCEPT the blood flukes (Schistosoma sp.)
Trematode Egg (Prototype)
• Contains a fertilized
ovum
• Shape, appearance and
size – depending on the
species
• Contains a cap-like
operculum, EXCEPT
Schistosoma sp.
TREMATODES
EGG LARVA 1 LARVA 2 ADULT
Hatches FIRST SECOND
in water INTERMEDIATE INTERMEDIATE
to release the HOST HOST FINAL HOST
Fish ,
MIRACIDIUM SNAIL crustaceans
Snails
Sporocyst
Aquatic plants
Redia I Metacercaria Adult
(encysted cercaria)
Redia II
Cercaria
All follow the above cycle, EXCEPT Schistosoma sp.
LIVER FLUKES
EGG LARVA 1 LARVA 2 ADULT
Hatches FIRST SECOND
in water INTERMEDIATE INTERMEDIATE
to release the HOST HOST FINAL HOST
MIRACIDIUM Fish ,
SNAIL crustaceans
Snails
Aquatic plants
Adult liver flukes that live
In the biliary passages irritate
the ducts. Adenomatous
proliferation can result to
partial obstruction.
Clonorchis sinensis
(Chinese Liver Fluke)
Oral sucker
Ventral sucker
smaller than oral sucker
uterus
Testes deeply lobulated
in tandem
Small lobate ovary
Intestinal ceca up
to the posterior end
Clonorchis sinensis
(Chinese Liver Fluke)
operculum
rimmed
Small protuberance
Thicker posterior end
Clonorchis sinensis
(Chinese Liver Fluke)
EGG LARVA 1 LARVA 2 ADULT
FIRST SECOND FINAL
INTERMEDIATE INTERMEDIATE HOST
HOST HOST
operculate snails of several fresh water fish
genera, including Alocinma of the family Cyprinidae , Humans get infected by:
and Parafossarulus, Ctenopharyngodon idellus >eating uncooked fish
Bithynia ( Bulimus), containing the infective
Semisulcospira, metacercaria
Melanoides tuberculatus > ingestion of the cysts
in drinking water
Clonorchis sinensis
(Chinese Liver Fluke)
• PATHOLOGY • bile ducts thicken and become
dilated and tortuous
• distal bile ducts are irritated
mechanically and by its toxic • adenomatous proliferation of
secretions the biliary epithelium
• slight leukocytosis and • fibrosis and destruction of
eosinophilia in early infection hepatic parenchyma
• enlarged tender liver • liver function is impaired
although SGPT and SGOT are
normal
Clonorchis sinensis
(Chinese Liver Fluke)
• SYMPTOMATOLOGY
• Light Infections • Heavy infections
– produce only mild symptoms or – complicated by cholelethiasis
go unnoticed and bouts of pyogenic cholangitis
• Moderate Infections
– indigestion
– Epigastric discomfort unrelated
to meals
– weakness
– loss of weight
Clonorchis sinensis
(Chinese Liver Fluke)
• CLINICAL DIAGNOSIS • LABORATORY DIAGNOSIS
• suggestive in patients from • finding the characteristic
endemic areas with: eggs in the feces or biliary
– history of eating uncooked drainage or duodenal
fish aspiration
– symptoms of biliary tract
disease
• intermittent jaundice • eggs to be differentiated
• bouts of fever from opistorchid and
• right upper quadrant pain
heterophyid flukes
Clonorchis sinensis
(Chinese Liver Fluke)
• TREATMENT • PREVENTION AND CONTROL
• chloroquine diphosphate
• thorough cooking of all
• praziquantel freshwater fish
Heavy infections complicated • sterilization of human feces by
by obstructive jaundice: storage or by the addition of
1. cholecystectomy with ammonium sulfate
2. choledocholithotomy
3. exploration of the common • Human and animal feces should
duct not be disposed in bodies of
4. drainage procedure such as water.
sphincteroplasty or
choledochoduodenostomy
Opistorchis felineus
(Cat Liver Fluke)
Oral sucker
subterminal
Ventral sucker
Same size as
oral sucker
2 testes lobed
Oblique to each other
Opistorchis felineus
(Cat Liver Fluke)
operculum
rimmed
Small protuberance
Resembles Clonorchis sinensis but:
1. is narrower and has more tapering ends
2. a pointed terminal knob
3. a less conspicuous operculum
Opistorchis felineus
(Cat Liver Fluke)
EGG LARVA 1 LARVA 2 ADULT
FIRST SECOND FINAL
INTERMEDIATE INTERMEDIATE HOST
HOST HOST
amnicolid snail fresh water fish
Bithynia(Bulimus) leachi (cyprinoid fish) Humans get infected by:
>eating uncooked fish
Tinca tinca, Idus melanotus, containing the infective
Barbus barbus, Cyprinus metacercaria
Carpio, Abramis brama,
A. sapa, Alburnus lucidus,
> ingestion of the cysts
Aspius aspius, Blicca in drinking water
bjorkna, Leuciscus rutilis
Scardiinius erythopthalmus
Bithynia funiculata
Opistorchis felineus
(Cat Liver Fluke)
• PATHOLOGY
• inflammatory and proliferative
changes of the biliary
epithelium
• fibrosis of the distal biliary
vessels
• pathologic changes may extend
to the proximal
bile ducts and gallbladder
periportal fibrosis
Opistorchis felineus
(Cat Liver Fluke)
• SYMPTOMATOLOGY
• Light Infections • Heavy Infections
– • invade the pancreas with digestive
Asymptomatic
disturbances
• bile stones may form around eggs as
• Moderate Infections nuclei and cause cholecystitis with
– moderate, painful colic
enlargement of the liver • loss of appetite as patient becomes
– passive congestion of the toxic
spleen • scar tissue around the bile ducts
– Icterus encroaches on liver cells and portal
– local eosinophilia in the wall vessels ---- collateral venous
of the bile ducts circulation, edema of the face and
limbs and at times ascitis
Opistorchis felineus
(Cat Liver Fluke)
• CLINICAL DIAGNOSIS • LABORATORY DIAGNOSIS
• suggestive in patients from • finding the characteristic
endemic areas with: eggs in the feces or biliary
– history of eating uncooked drainage or duodenal
fish aspiration
– symptoms of biliary tract
disease
• intermittent jaundice
• bouts of fever
• right upper quadrant pain
Opistorchis felineus
(Cat Liver Fluke)
• TREATMENT • PREVENTION AND CONTROL
• praziquantel
• thorough cooking of all
freshwater fish
• sterilization of human feces by
storage or by the addition of
ammonium sulfate
• Human and animal feces should
not be disposed in bodies of
water.
Opistorchis viverinii
Oral sucker
subterminal
Ventral sucker
Same size as
oral sucker
2 testes deeply lobulated
Oblique to each other
• Eggs are relatively short
operculum
and broad
rimmed
protuberance
Opistorchis viverinii
EGG LARVA 1 LARVA 2 ADULT
FIRST SECOND FINAL
INTERMEDIATE INTERMEDIATE HOST
HOST HOST
Snails : fresh water fish
Bithynia goniomphalus Humans get infected by:
Punteus orphoides >eating uncooked fish
Bithynia funiculateB Hampala dispar
ithynia laevis containing the infective
Cyclocheilichthys siaja
metacercaria
> ingestion of the cysts
in drinking water
Natural definitive hosts:
civet cat, cat, dog
and other fish- eating
mammals
MAN IS AN ACCIDENTAL HOST.
Opistorchis viverinii
• PATHOLOGY • further stimulated by
• dilatation and thickening of nitrosamines in local
bile duct walls fermented foods or by
nitrosocompounds
produced by activated
• presence of stones and
sludge in the gallbladder
• macrophages in chronically
affected tissues
• hyperplastic biliary
epithelium from presence
of worms • striking association with
cholangiocarcinoma
Opistorchis viverinii
• SYMPTOMATOLOGY
• Light to Moderate Heavy Infections
• abdominal distress
Infections
• epigastric pain
a few symptoms
• generalized malaise
Opistorchis viverinii
• CLINICAL DIAGNOSIS • LABORATORY DIAGNOSIS
• suggestive in patients from • finding the characteristic
endemic areas with: eggs in the feces or biliary
– history of eating uncooked drainage or duodenal
fish aspiration
– symptoms of biliary tract
disease
• intermittent jaundice • Ultrasonography to screen
• bouts of fever the presence of
• right upper quadrant pain
cholangiocarcinoma
Opistorchis viverinii
• TREATMENT • PREVENTION AND CONTROL
• praziquantel
• thorough cooking of all
freshwater fish
• sterilization of human feces by
storage or by the addition of
ammonium sulfate
• Human and animal feces should
not be disposed in bodies of
water.
Opistorchis viverinii
• TREATMENT • PREVENTION AND CONTROL
• praziquantel
• thorough cooking of all
freshwater fish
• sterilization of human feces by
storage or by the addition of
ammonium sulfate
• Human and animal feces should
not be disposed in bodies of
water.
