TREMATODES

Trematodes o Operculum – lidlike structure that opens to

 “Flukes” release larva
 Belong to Phylum Platyhelminthes class trematoda o Some have spines (like Schistosoma spp.)
 LARVAE:
 Flat, unsegmented
o Rarely encountered, occur outside human hosts
 First Intermediate Host for all Trematodes is SNAIL
 ADULTS:
 No Coelom, so they are flat
o Thin, non-segmented, leaf-like in shape and
 Filled with mesodermal parenchyma
thickness
 No blood vessels; simple ladder nervous system
o Typically 1 to 5 cm
 Incomplete digestive and circulatory system
o Two suckers (oral and ventral)
 All digenea are parasitic
o Simple digestive system and a genital tract
 Digenea has suckers used to attach to the host; oral o Uses its body surface for absorbing and excreting
sucker contains the mouth and ventral sucker nutrients and waste products
serves as the passageway for eggs
 Muscular pharynx – pumps food into blind ending General Life Cycle for Hermaphrodites/Organ-dwelling
gut flukes:
 Divided into two groups: 1. Egg – exits the FH via feces or sputum
Hermaphroditic flukes At Snail (First IH):
o Self-fertilizing 2. Miracidium – released by egg when in contact with
o Infect organs, foodborne fresh water
Blood flukes/Schistosomes 3. Sporocyst – sac-like larval form
o Dioecious 4. Rediae – larval stages that form inside sporocyst
o Infect by direct penetration 5. Cercaria – free-swimming, encysts on 2nd IH
Encysting at 2nd IH (crab, plant, snail, ant, etc):
Rules: 6. Metacercaria – encysted form of Trematodes
ALL EXCEPT FOR SCHISTOSOMES: Ingestion by Final host:
1. Are hermaphroditic (Schisto: dioecious) 7. Adult
2. Require 2 or more Intermediate Hosts (Schisto: 1 IH )
3. have metacercaria as the Infective Stage (S: *Schistosomule – emerges from cercaria following
cercaria) penetration of Schistosomes in humans
4. Transmitted through ingestion (S: skin penetration) *Schistosome eggs are released via urine or stool
5. have leaf-like appearance *Testis: appearance may be branching, simple or
6. have operculated eggs lobate. Arrangement may be oblique, in tandem, or
ALL EXCEPT FOR Heterophyes heterophyes: parallel.
7. Have two suckers
(Heterophyes has three suckers: oral, ventral and TREMATODES
genital/gonotyl) SCIENTIFIC NAME COMMON NAME
BLOOD FLUKES
MORPHOLOGY: Schistosoma japonicum Oriental Blood Fluke
 Pass through three forms: Eggs, Multiple Larva Schistosoma haematobium Vesical Blood Fluke
stages and adult Schistosoma mansoni Manson’s Blood Fluke
 EGGS: LIVER FLUKES
o Primary form recovered from human specimen Fasciola hepatica Sheep Liver Fluke/
Common Liver Fluke
Fasciola gigantica Giant Liver Fluke
Clonorchis sinensis Oriental/Chinese Liver symptoms and travel history is necessary to
Fluke diagnose the causative species
Opisthorchis viverrini Southeast Asian Liver
Fluke Life Cycle Notes:
Dicrocoelium dendriticum Lancet Liver Fluke  Immature eggs are oviposited in the biliary ducts
INTESTINAL FLUKES and released in stool
Fasciolopsis buski Giant/Large Intestinal  Embryonated in fresh water
Fluke  Miracidium – penetrates snail IH, develops into
Echinostoma ilocanum Garrison’s Fluke sporocyst, redia and cercaria
Heterophyes heterophyes Heterophid Fluke/Von  Cercaria encysts in aquatic plants and develop into
Siebold’s Fluke metacercaria
 Ingestion of metacercaria-infected aquatic plants
Metagonimus yokogawai Heterophid Fluke
introduces infection into humans
Haplorchis taichui ---
 Metacercaria excyst into duodenum, migrate
Gastrodiscoides hominis ---
through intestines, peritoneal cavity and liver
PULMONARY FLUKES
parenchyma
Paragonimus westermanii Oriental Lung Fluke
 Biliary ducts – where metacercaria develop into
adults (3-4 months)
A. LIVER FLUKES  Adults reside in LARGE biliary ducts

1. Fasciola hepatica Pathology:

Common Name: Sheep Liver Fluke  Halzoun
FH: Man, Sheep, other vertebrae o Pharyngeal Fascioliasis
IH 1: Snail (Lymnaea species) o Common in people eating raw liver
IH 2: Aquatic Plants  Hepatic Fascioliasis
Habitat: Biliary passages of the liver  “Sheep Liver Rot”
Diagnostic Stage: Unembryonated Eggs  Eosinophilia, jaundice, liver tenderness, anemia,
*Zoonotic – infections may come from animals diarrhea, and digestive discomfort are sometimes
*Take note of rules for MoT and IS seen
*Found worldwide, particularly in places where sheep  Inflammation in the biliary epithelium
and cattle are raised  Liver atrophy
*and where humans consume raw watercress,  Concomitant periductal cirrhosis
including Europe, the Middle East, and Asia
*Natural Host for completion: Sheep. Accidental Host Diagnosis:
– Man (according to book)  Patient preparation: Three days with liver-free diet
to avoid FALSE POSITIVE results
Morphology:  DFS/Kato-Katz/FECT
Adult  Duodenal/Bile Aspirate
 Cephalic cone: Unique to F. hepatica  Recovery of adult worms during surgery
 Broad shoulder  Entero Test (nylon string inside capsule), gel
 Intestinal ceca: branching diffusion
 Testis: Highly branching  Serology Test – Multidot ELISA
Egg  Polymerase Chain Reaction/PCR
 Operculated **WHO Standard: Three negative Kato-Katz AND
 Ovoidal, large, brownish-yellow in color three negative FECT to rule out Fascioliasis
 Hen’s egg appearance
 No species differentiation: report simply as Treatment:
Fasciola egg; information regarding patient  Bithionol, thiabendazole, Praziquantel
 Triclabendazole – more effective but not available  *Nitrosamine – a compound excreted by the
in the US worm related to development of cancer

2. Clonorchis sinensis Diagnosis:

Common Name: Chinese Liver Fluke  Stool Exam (DFS/KK/FECT)
FH: Man, Fish-eating mammals  Duodenal Aspirate
IH 1: Snail (Bulimus fuchsiana and Aloncima species)  Entero Test
IH 2: Fish (Cyprinidae species)  PCR
Habitat: Bile ducts and gallbladder  Liver Biopsy
Diagnostic Stage: Ova in the stool  Surgery/Autopsy – where rarely encountered
*Endemic areas are in Asia including Korea, China, adult worms are seen only
Taiwan, and Vietnam
*Reservoir hosts include carnivores like dogs and cats Treatment:
 Praziquantel
Morphology:  Albendazole
Adult:
 Spatulate 3. Opistorchis felineus
 Testis: Deeply branching, in tandem Common Name: Cat Liver Fluke, Siberian Liver Fluke
 Large oral sucker FH: Cat (Man can also be infected)
 Intestine: Simple IH 1: Bithynia spp.
Egg: IH 2: Cyprinidae fish
 Comma-shaped abopercular end/thickening Habitat: Biliary passages, gallbladder
 Opercular shoulders – where operculum rests Diagnostic Stage: Ova
 Old-fashioned light bulb/pitcher-like *Opistorchis viverrini is similar to this (CN: Southeast
 Hard to differentiate with heterophid eggs, so Asian Liver fluke)
report as HETEROPHID EGG
Morphology:
Life Cycle Notes: Adult:
 EMBRYONATED EGGS are discharged in the biliary  Lobate Testes , obliquely/diagonally patterned
ducts and in the stool Egg:
 Infection of humans occurs by ingestion of  No abopercular thickening
undercooked, salted, pickled, or smoked Life Cycle Notes:
freshwater fish  Almost the same as C. sinensis
 metacercariae excyst in the duodenum and Pathology:
ascend the biliary tract through the ampulla of  Opistorchiasis (colangiocarcinoma)
Vater Diagnosis:
 Maturation takes place in liver (1 month  Stool Exam, Entero Test, Duodenal Aspirate
maturation) Treatment:
 Adults reside in SMALL and MEDIUM sized biliary  Praziquantel
ducts

Pathology: 4. Dicrocoelium dendriticum (old name: Fasciola

 Bile duct obstruction (intensity is proportional to lanceolata)
worm load) Common Name: Lancet Fluke
 Liver carcinoma
 Colangiocarcinoma/Gallbladder carcinoma
FH: Cattle, Sheep, Other vertebrates (Man is AH)  Intestinal ceca: Unbranched
IH 1: Cionella lubrica (release slime balls: mass of  Testis: In tandem branching (2 dendritic testes)
cercaria) Egg:
IH 2: Formica fusca (ant)  Large, operculated
Habitat: biliary passages//hepatobiliary spaces in the  Indistinguishable from eggs of F. hepatica and F.
liver gigantica
Diagnostic Stage: ova
*herbivores are reservoir hosts Life Cycle Notes:
 Immature eggs are released via stool
Morphology:  Metacercaria excyst in duodenum
Adult:  Development into adult is in intestinal wall
 Lancet shaped (approx. 3 months)
 Testis: found on the anterior 1/3 portion; Lobate in  Adults’ life span = 1 year
tandem  Almost the same as F. hepatica; the only
Egg: difference is the habitat of adult
 Yellowish/brownish thick-walled with large
operculum, EMBRYONATED Pathology:
Life Cycle Notes:  Gland abscess
 Common in herbivores  Intestinal obstruction
 No redia stage  Patients may also suffer from malabsorption
Pathology: syndrome, similar in giardiasis
 Enlargement of the bile duct
 Portal cirrhosis Diagnosis:
 Periductal fibrosis  Stool Exam
Diagnosis:  Eggs are indistinguishable from F. hepatica
 Detection of eggs in stool/duodenal fluid
Treatment: Treatment:
 Praziquantel  Praziquantel, tetrachloroethylene
 Praziquantel should be taken with liquids during a
B. INTESTINAL FLUKES meal

1. Fasciolopsis buski 2. Echinostoma ilocanum

Common Name: Giant Intestinal Fluke Common Name: Garrison’s Fluke
FH: Man FH: Man, aquatic birds, carnivores, rodents
IH 1: Snail (Segmentina, Hippeutis, Gyraulus species) IH 1: Snail (Gyraulus convexiusculus, Hippeutis umbicalis)
IH 2: Water Plants (Eliocharis tuberosa/Water Chestnut, IH 2: Kuhol (Pila luzonica, Pila conica)
Eichornia species, Trapa species) Habitat: Small Intestine
Habitat: Small Intestine Diagnostic Stage: Ova
Diagnostic Stage: Ova
*Largest Intestinal Fluke of man
Morphology:
*limited to areas of the Far East (China, Thailand, Adult:
Taiwan, and Vietnam), India and Indonesia  Equipped with plaque-like scales instead of spines
*Reservoir hosts: Rabbits, pigs, dogs  Oral sucker is protected by the spine called
circumoral disk (“collar spine”)
Morphology:  Testis: Lobate, in tandem
Adult:  Intestinal ceca: unbranched
 Largest intestinal fluke
 With structures called vitelline glands or vitellaria  Indistinguishable from Metagonimus yokogawai;
Egg: shell is thicker than Metagonimus yokogawai but is
 Straw-colored (almost colorless) not enough for species differentiation
 Operculated  similar to Clonorchis sinensis but without
 Structure inside: “Germ Ball or Yolk” abopercular thickening
 Can be differentiated from other eggs in stool  Less distinct shoulders compared to Clonorchis
exam sinensis and lack the small terminal knob

Life Cycle Notes: Life Cycle Notes:

 Unembryonated eggs are released via feces  Adults release embryonated eggs passed through
 May have 1 or 2 generations of rediae the feces
 Metacercaria excyst in duodenum, and adults  Infection occurs after ingestion of raw/uncooked
reside in small intestine freshwater/brackish water fish contaminated with
metacercaria
Pathology:
 Heavy Infection Pathology:
 General intoxication  Abdominal pain and
 Diarrhea  chronic mucous diarrhea and eosinophilia
 Catarrhal inflammation due to the penetration of  The eggs have the ability to escape into the
the sharp-spined collar into the intestinal mucosa lymphatics or venules via intestinal wall
penetration and to migrate to other areas of the
Diagnosis: body, such as the heart or brain which result into
 Stool Exam granulomas in these areas

Treatment: Diagnosis:
 Praziquantel  Stool exam
 Species differentiation is difficult due to
3. Heterophyes heterophyes similarities with Clonorchis sinensis and
Common Name: Von Siebold’s Fluke/Heterophid Fluke Metagonimus yokogawai
FH: Man, fish-eating animals and birds (reservoir)
IH 1: Cerithidia, Pironella species Treatment:
IH 2: Tilapia and other fresh/brackish water fish  Praziquantel
Habitat: small intestine
Diagnostic Stage: Ova in stool 4. Metagonimus yokogawai
*smallest fluke infecting man Common Name: Heterophid fluke
FH: Humans, fish-eating mammals and birds
Morphology: IH 1: Semisulcospira species
Adult: IH 2: Fresh/brackish water fish
 grayish in color Habitat: Small Intestine
 protected by an outer layer of fine spines (scaly in Diagnostic Stage: Ova in stool
appearance *smallest human fluke (according to CDC)
 Has third sucker: the gonotyl or genital sucker
 Paired testes Morphology:
Egg: Adult:
 Operculated  pyriform in shape
 with tapering at the anterior end and rounding at Oxyresveratrol, a stilbenoid found in extracts
the posterior end of Artocarpus lakoocha is effective against H. taichui.
 with a tiny layer of scaly spines heavily distributed
over the anterior end
C. BLOOD FLUKES
 ventral sucker/genitoacetabulum - to the side of
*no metacercaria and redia stages
the midline and closely associated with the genital
pore
1. Schistosoma japonicum
Egg:
Common Name: Oriental Blood Fluke
 thinner shell than Heterophyes heterophyes; no
FH: Man and other vertebrates
species differentiation
IH: Snail (Oncomelania hupensis quadrasi)
Habitat: Superior mesenteric veins of small intestine
Life Cycle Notes:
Diagnostic Stage: Ova in stool
 Adults release embryonated eggs passed in the
*Take note of rules for MoT (skin penetration) and IS
feces
(fork-tailed cercaria)
*Host-permissive: can complete cycle in other
Pathology:
vertebrates
 diarrhea and colicky abdominal pain
*Reservoir hosts: dogs, cats, carabaos
 Same symptoms with Heterophyes heterophyes
*Most number of reservoir hosts among the
Schistosomes
Diagnosis:
*Endemic in the Philippines
 Stool exam

Morphology:
Treatment:
Adult:
 Praziquantel
 MALE: Hollow structure called gynecophoral
canal (receives female during copulation)
5. Gastrodiscoides hominis
 Testis: 6 to 7, behind the ventral sucker
(notes only, wala sa book and CDC)
 FEMALE: slender, with greatest egg production
- Pear-shaped: globular appearance
 When in copulation: described as Schistosoma in
> Discoid posterior
copula (perpetual copulation); most “romantic”
> Conical Anterior
parasites
- “Massive” acetabulum
 No integumentary tuberculation; aspinous (no
- Lay immature eggs
spines)
- Habitat: Small intestine
 Largest among Schistosoma species in man
- Life cycle: Not well studied
Egg:
- Pathology: Mucoid diarrhea, gastritis
 Ovoid/round/pear-shaped with minute lateral
- Egg: similar to heterophids
knob
- Treatment: Carbon Tetrachloride (CCl4)
- Praziquantel is ineffective
Life Cycle Notes:
 Eggs are released via feces
6. Haplorchis taichui
 Cercaria penetrate human skin and shed their
(wala ako mahanap info tungkol dito!)
forked tail, becoming schistosomule
From wiki:
 Females deposit eggs in the small venules of the
Haplorchis taichui is a species of intestinal flukes in the portal and perivesical systems
genus Haplorchis. It is a human parasite found in the
Philippines. Pathology:
Due to Adult:
 Katayama Disease - systemic hypersensitivity Diagnostic Stage: Ova in stool
reaction to the schistosomulae migrating through * Take note of rules for MoT (skin penetration) and IS
tissue (fork-tailed cercaria)
 Snail Fever *Endemic in Africa and South America
 Oriental Schistosomiasis
Due to Larva: Morphology:
 Swimmer’s Itch Adult:
 Male:
Diagnosis: o Prominent Integumentation
 Stool Exam o 8-9 testes, the most number of testes among
o WHO recommendation: Kato-Katz in three Schistosomes
stool samples for 3 consecutive days  Female:
 Rectal Biopsy, Liver Biopsy o Ovary – at the anterior part of the body
 Egg-hatching technique o Uterus – 1-4 eggs
 ELISA Egg:
 Ritchie Technique – to quantify eggs  Diagnostic Stage
 Serological Test: Detects three antigens:  With lateral spine
o Circulating Cathodal Antigen (CCA)
o Circulating Anodal Antigen (CAA) Life Cycle Notes:
o Soluble Egg Antigen (SEA)  Same as S. japonicum; the only difference is the
 COPT habitat of the adult
o Sensitive, cannot differentiate present from
previous infections Pathology:
o Confirmatory and definitive test for  Intestinal bilharziasis
Schistosomes in the Philippines Diagnosis:
o “Circumoral Precipitin Test”  COPT, Stool Exam, Egg Hatching Technique
o Reagent: Antigen – freeze-dried/lyophilized Treatment:
Schistosoma japonicum eggs  Praziquantel
o Specimen – Patient Serum
o Positive result: bleb formation 3. Schistosoma haematobium
o Liquefied petrolatum/wax/paraffin – used to Common Name: Vesical Blood Fluke
avoid evaporation and to seal the preparation FH: Man
o Glass beads/nail polish – to elevate the IH 1: Bulinus spp.
preparation Habitat: Vesical, Prostatic, Uterine, Venous Plexuses
o *Incubate at 36oC for 24 hours and examine of Urinary Bladder///Vesical Plexuses of the Venous
under microscope for blebs Circulation
Diagnostic Stage: Ova in urine
Treatment: *Urine is red in heavy Schistosoma haematobium
 Praziquantel infection, unlike in heavy filarial infections where urine
is milky/turbid.
2. Schistosoma mansoni *Endemic in Middle East and Africa
Common Name: Manson’s Blood Fluke
FH: Man Morphology:
IH 1: Biomphalaria spp. Adult:
Habitat: Inferior mesenteric veins of the large  Male:
intestines, colon, rectum o 4-5 testes
 o Fine tuberculations  Spines in the integument
 Female:
o Ovary is in the posterior end Egg:
o 20-3o eggs in the uterus  Ovoid, with flat, WIDE operculum (unlike in
Egg: Heterophid eggs)
 With prominent terminal spine  With abopercular thickening opposite of
operculum
Life Cycle Notes:  Brownish operculum
 Same as S. japonicum and S. mansoni, except for
habitat Life Cycle Notes:
 Discharged in urine instead of feces  Eggs are excreted unembroynated in the feces
and/or sputum
Pathology:  Metacercaria excyst in the duodenum
 Urinary Bilharziasis, Egyptian Schistosomiasis  The worms can also reach other organs and
tissues such as the brain and striated muscles.
Diagnosis: However, when this takes place, completion of
 Urine Exam, COPT, egg hatching technique the life cycles is not achieved, because the eggs
 Centrifuge urine, and look for eggs in the laid cannot exit these sites.
sediments. Concentration technique known as
Nucleopore Filtration Technique may be used
Pathology:
Treatment:
 TB-like symptoms
 Praziquantel
 Hemoptysis – expectorating/coughing blood
which originated from the lungs (differentiate
D. LUNG FLUKE
with hematemesis, in which blood is from the GI
tract)
Paragonimus westermani
 Jacksonial epilepsy
Common Name: Oriental Lung Fluke
 Pulmonary Distomiasis
FH: Man
 Cerebral Paragonimiasis, when there is migration
IH 1: Antemelania asperata
to the brain
IH 2: Sundathelphusa philippina (crab, one claw is
bigger)
Diagnosis:
Habitat: Lungs (encapsulated in pairs)
 Sputum Exam
Diagnostic Stage: Ova in sputum/stool
o 3X in different days, preferably in the morning
*Old name of Antemelania asperata is Broatia asperata
o Use NaOH, 10-30% HCl or NAL-C as mucolytic
*Endemic in Bicol, and one is given a direct sputum
agent (1 part sputum, 9 parts digestant)
smear in addition to Acid Fast staining when there are
o Centrifuge, then look for eggs in the sediment
TB-like symptoms
 Stool Exam
*Prawns - paratenic host
o Eggs are present when sputum is swallowed
o Can also confirm P. westermani
Morphology:
 Biopsy and Autopsy – the only way to remove or
Adult:
recover adult worms
 Reddish, spoon or coffee bean shaped
 Rounded anterior, ovoid posterior
Treatment:
 Testes – Deeply lobed obliquely in tandem
 Praziquantel, Bithionol (will kill the adult worm
 Large, broad and flat body
and cause fibrosis)
 Wavy intestinal ceca
E. PANCREATIC FLUKE Diagnosis:

Eurytrema pancreaticum Treatment:
(lab notes only, wala sa book and CDC) 
Common Name: Pancreatic Fluke
FH: Hogs, cattle (Man is AH)
IH 1: Macrochlamys indica
IH 2: Technomyrmex deterquens (ant) or grasshopper
Habitat: Pancreatic duct, biliary passages, gallbladder

Morphology:
Adult:
 Ruffle border
 2 notched testes
 1 notched ovary
Egg:
 Similar to D. dendriticum

Pathology:
 Eurytremiasis – destruction of pancreas; diabetes
mellitus
Diagnosis:
 Same as previous
Treatment:
 Praziquantel

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TEMPLATE (for reviewing)
Common Name:
FH:
IH 1:
IH 2:
Habitat:
Diagnostic Stage:
*

Morphology:
Adult:

Egg:

Life Cycle Notes:

Pathology:
