Hepatic Flukes

Name Fasciola Fasciola Chlonorchis Opisthorchis Opisthorchis Dicroelium

hepatica gigantica sinensis felineus viverni dendriticum
(Sheep liver (Giant liver (Chinese liver (Cat liver fluke) (Sea liver fluke)
fluke) fluke) fluke)
Temperate LF Tropical LF important in *eggs closely
*sheep* *cattle* *far east* resemble C. sinensis
Disease Fascioliasis Fascioliasis Liver may enlarge Cholangitis Cholangiocarcinoma Enlargement of
hepatica gigantica & tender depend Biliary cirrhosis (cancer of biliary bile ducts
(liver rot) *longer, less on worm Obstructive tract)
*develop Fibrosis & jaundice Fibrosis
shoulders destruction of Mark eosiniphilia
Short cephalic parenchyma Biliary Tract Portal
cone Obstruction cirrhosis

DH man Man, dogs, hog, Cats, dogs, foxes, Civet, cat,dog, fish- sheep
martin & hogs, human eating mammals
IH 1HS:Lymnaea 1HS:Lymnaea IH: Alocinma, IH: Abida,
cailiaudi trancatula Parafossarulus IH: Bithynia/ Bulimus Cochlicopa
2IH: Ipomea obscura (kangkong) Bulimus Helicella &
Melanoides 2IH: Fish family of cyprinadae (tilapia) Zebrina
Nastorium offcinale (water cress)
Semiculcopria (eat the flukes
eggs)
2IH: cyprinadae
2IH: Foraging
ant
Formica fusca
Habitat Bile ducts Distal Bile ducts Distal bile ducts Bile ducts Bile ducts
IS Metacercariae Metacercariae
DS  Unembryonated egg * Eggs in feces * Eggs in feces * Eggs in feces * Eggs in feces
 Eggs in stool & bile *Biliary drainage * duodenal apirate * duodenal apirate
 Duodenal content * ultrasound
 Recovery of adult worms screening for
 Positive complement-fixation cholangiocarcinoma
test
MOT Ingestion of metacercariae Ingestion of uncooked infected fish
Pathology Bile duct Dilation & (found in Asia,
Acute: invasive phase migration gradually thicken (found in Europe thickening of bile Africa, Europe
from instestine to liver (dilated & & Asia) duct & North &
Chronic/latent: asympthomatic tortourous) South America
Presence of stones
Halzoun/marrara: (found in Japan, in gall bladder *similar to
flukes surviving mastication in China, South hepatica*
pharynx Korea, Formusa, (found in Thailand
Vietnam) & Laos in
southeastern Asia)
Diarrhea Cholangitis
Hepatomegaly Biliary cirrhosis
RUQ pain Obstructive jaundice
Jaundice Mark eosiniphilia
Treatment Trictabendazole, Diclorophenol, Parziquantel
dehydroemetine
Ova immature: operculated stool
 Eggs operculated mature (electric bulb shape) Dark-brown
Hepatica: (140-150 x 85-90 micra)  Posterior has small knob (tea-pot lid-shape operculum)
 Eggs passed out via the common biliary duct thick shell
Gigantica: (160-190 x 70-90 Operculated egg
micra)
Operculum rest in (have more tapering end
 Light yellow biled stained rim w/ distinct & pointed terminal knob,
 Transparent w/ thin double walls shoulders in less operculated rim
 Contain Lecithin granules position contour
Adult  Small ventral  Slender, lancet
 Longer  Shorter sucker shape
cephalic cephalic zone  Bigger oral  Lobate highly branched testes &  Aspinaous body
zone w/ w/ conical sucker vitellaria  Two large
conical projection  Deeply lobed slightly lobed
projection testes in tandem testes
 Lobate ovary &  Voluminous
 Loosely coiled uterine coils
uterus (2/3)
Highly branched dendritic Unbranched
intestine intestine
 Intestinal Flukes
Name Fasciolopsis buski Echinostoma Heterophyes Metagonimus
(Giant Intestinal Fluke) Ilocanum heterophyes yokogawai
(Garrison’s Fluke) (Minute Fish Fluke) (Intestinal Fish Fluke)

*Arthfechinostomum
malayanum*
Disease Fasciolopiasis metagonimiasis
DH Human, hogs, dogs Rats & dogs Man & fish eating Humans, cats, dogs,
mammals pelican
IH
IH: planorbid snails IH: snail IH:brakish water snails IH: snail
(segmentina, Hippeutis, Gyraulus Pirenella in Egypt Semisulcospira
Gyraulus) Certhidea in Japan Thiara
Hua

2IH: water caltrop, 2IH:Viviparus 2IH: fish 2IH: freshwater

Trapa, water hyacinth, Pila Mullet salmonoid fishes
water chestnut, water Tilapia in egypt (Plectoglossus, Salmo)
bamboo
(cercariae-metacercariae) Cyprinoids
(Richardsonium,
Odontobutis)
Habitat Small Intestine Duodenum Middle part of small Upper & middle jejenum
(duodenum & jejunum) (attach to intestinal wall) intestine
IS metacercariae metacercariae metacercariae metacercariae
DS Eggs in feces Eggs in feces Embryonated eggs in Embryonated eggs in
feces feces
MOT Ingestion of metacercariae Ingestion of Ingestion of Ingestion of
metacercariae metacercariae metacercariae
Pathology Excessive mucus
Necrotic liver tissue from Sporocyst is abortive Excessive mucus production
liver to bile Rediae to cercariae production Sloughing off the
Hepatomegaly Sloughing off the superficial layers
RUQ pain Found: in China, India, superficial layers
Jaundice Korea, Southeast Asia Found: in Far East
Found: in East Asia & Found: in Egypt, Greece,
Southeast Asia Israel, Western India,
Central & South China,
Japan, Korea, Taiwan, &
Philippines

Peptic Ulcer disease

Polymerase Chain Reacion – used to sensitive

Treatment Praziquantel
niclosamide
Ova  Yellowish ellipsoidal
egg
 Clear & thin shell w/
operculum at one side
 Daily eggs per fluke
(25,000)
Adult  Largest Parasitic
trematode
 Two dendritic testes
 Lie tandem position in
the posterior half of the
worm
 2-7.5 cm x 0.8-2cm
 left border of ventral
 Yellow-brown
ellipsoidal egg
 Clear & thin shell
eggs
 Straw-colored
operculated egg
 Horseshoe-shaped of
collar of spines
 Dorsal & lateral sides
of the oral sucker
 Elongated &
moderate size
trematode
 Slightly tapering,
rounded extremities
 2.5-6.5 x 1.1 mm
diagnostic stool
Praziquantel
 Shell has a slight  Light brown
shoulder at the rim of color,ovoid shape
the operculum
 sometimes a knob at
the posterior pole
 no abopercular
protruberance
 Pyriform, grayish fluke  Pyriform shape
 Globuse ovary
 Cuticle with scalelike
spines  1.4 x 0.6 mm
 1.3 x 0.5 mm  Coarse vitellaria
 Large central sucker (fan-shaped
distribution)
 Genital sucker at the
sucker
 Blood Flukes
(most romantic worms)
Name Schistosoma Schistosoma mansoni Schistosoma Schistosome
haematobium (Manson’s Blood Fluke ) japonicum dermititis
(Vesical Blood Fluke) ( Oriental Blood Fluke )
*Arthfechinostomum
malayanum*
Disease Schistosomal hematuria Intestinal bilharziasis Oriental schistosomiasis Swimmer’s itch
Vesical schistosomiosis Schistosomiasis mansoni Katayama disease Clam digger’s itch
Urinary bilharziasis Schistosomiasis japonica
DH Rodents, monkeys, & Rats, mice, cats, dogs,
baboons (nature) horses, water buffalo,
swine
IH Snail hosts of
hematobium are Biomphalaria in Africa Ocomelania hepensis
nonperculate, reside in Biomphalaria snails
fresh water belong to: (Australorbis)
Bulimus, Physopsis, & Tropicorbis in South
Biomphalaria America
Habitat Pelvic veins Mesenteric veins of colon Mesenteric veins in small
& rectum intestine
IS Cercariae Cercariae Cercariae Cercariae

DS Eggs in the urine Eggs in stool Eggs in stool Eggs in stool

urinalysis
MOT skin penetration skin penetration skin penetration Cercariae skin
penetration
Pathology  Inflammatory  History contact w/
reaction to eggs in Found: in Nile Valley, Found: in Far East water & cutaneous
the bladder wall Eastern Africa, South rash
Amrica Yangtze River valley of
 Cases cancer in  Strangers in a land
Central China
urinary bladder -cercariae walled off
Smallest blood flukes
& destroyed the
 Hematuria- most epithelial layers in
characteristic skin
symptoms

Found: in Nile Valley,

Middle East

Treatment Metrifonate Antipruritic &

Praziquantel antihisminic lotions
Antibiotics for secondary
bacterial infection
Ova  Eggs are distributed  Lateral spine  Lateral knob
in the mucosa &
lesser extent in
mucosa
 Some occlude in
blood vessels
 Terminal spine
Adult Eggs-miracidia- Eggs-miracidia- Eggs-miracidia- Eggs-miracidia-
sporocyst-cercariae sporocyst-cercariae sporocyst-cercariae sporocyst-cercariae

Circumoval
precipitintest (COP)

Rectal/liver biopses

Paragonimus westermani (oriental lung fluke) - abopercular

-resembles coffee bean DS: eggs on feces

-equal size suckers IS: metacercariae