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https://doi.org/10.1042/ETLS20170111
Trematoda (flukes)
Rafael Toledo1 and Bernard Fried2
1
Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Av. Vicente Andrés Estellés s/n, 46100 Burjassot, Valencia, Spain; 2Department of Biology,
Lafayette College, Easton, PA 18042, U.S.A.
Correspondence: Rafael Toledo (rafael.toledo@uv.es)
The class Trematoda is the largest group of Platyhelminths and includes two subclasses:
Introduction
The class Trematoda constitutes a large group of Platyhelminthes parasites that is divided into two sub-
classes: the Aspidogastrea and the Digenea. The Aspidogastrea, also called aspidobothrea, is a small
group comprising 4 families, 12 genera and ∼80 species. In general, they are parasites of freshwater
and marine mollusks, and cartilaginous or bony fishes and turtles may serve as facultative or obligatory
hosts. Commonly, Aspidogastrea are external parasites of these hosts and have a single-generation life
cycles lacking asexual reproduction. Adults are conspicuous for having a large ventral disc often
divided into several compartments. There are no species of Aspidogastrea with medical or economic
importance. However, further information can be found in the works by Prof. Klaus Rhode [1,2].
In contrast, the subclass Digenea is a markedly larger group and has a significant medical, veterin-
ary and economic importance. Digeneans, also called digenetic trematodes or flukes, comprises more
than 18 000 species that are obligatory parasitic in invertebrate intermediate and vertebrate definitive
host [3]. Owing to their greater importance, this review will be focused on the subclass Digenea. Most
digenean species inhabit the intestine as adults, but several species colonize other habitats within the
vertebrate host. Digenetic trematode infections occur worldwide and over 100 species have been
recorded infecting humans causing serious problems in them. For example, it is estimated that almost
300 million people are currently infected with Schistosoma spp. causing ∼6,000 deaths annually [4].
Moreover, a large list of digenetic trematodes actually parasitize animals both of veterinary interest
and wildlife.
Apart from their medical and veterinary importance, digenetic trematodes have a vast interest in
Received: 11 September 2017 experimental biology due to many characteristics of these parasitic organisms: (i) the paradigmatic
Revised: 17 October 2017 systematics of this group of parasites in relation to the morphological similarity between members of
Accepted: 20 October 2017
different taxa and the inadequate or poor specific diagnosis (or both) of several newly established
Version of Record published: taxa. Furthermore, the absence or loss of type material for several taxa further complicates the situ-
22 December 2017 ation. As a result, this group has been characterized by a long history of synonymies and inadequate
© 2017 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society and the Royal Society of Biology 651
Emerging Topics in Life Sciences (2017) 1 651–657
https://doi.org/10.1042/ETLS20170111
diagnosis. (ii) The complexity of the life cycles that has led to the development of an important number of
adaptive strategies to enhance parasite survival and transmission converts these organisms to an excellent
model to study the evolutionary adaptation of an organism to an environment.
Biology of trematodes
One of the most relevant features of flukes is the complexity of their life cycle which are characterized by: (i)
alternation of several generations known as the adult, egg, miracidium, sporocyst, redia, cercariae and metacer-
caria; (ii) alternation of sexual and asexual multiplication; (iii) an intensive asexual multiplication enhancing
the transmission of the parasite and (iv) inclusion of two or three hosts, one invertebrate intermediate host
(usually a mollusk) in which asexual multiplication occurs and a vertebrate definitive host in which adult
652 © 2017 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society and the Royal Society of Biology
Emerging Topics in Life Sciences (2017) 1 651–657
https://doi.org/10.1042/ETLS20170111
worms reproduce sexually. All these characteristics enable the trematodes to be an excellent model to study the
parasite–host interactions in both invertebrate and vertebrate organisms [13,14].
Although each species has a unique life history, a general cycle is as follows. Adult worms produce eggs in
the vertebrate definitive host. Eggs are passed in the feces, urine or sputum, depending on the location of adult
worms, to reach the external environment. The eggs are either eaten by a mollusk and the miracidia hatch, and
invade this first intermediate host, or hatch in the external environment allowing the miracidium to locate and
penetrate the appropriate molluskan host. Within the mollusk first intermediate host, asexual multiplication
occurs, which is critical to enhance the transmission of the parasite. The miracidia produce sporocysts that
contain germ cells which will give rise to a large number of the subsequent generations of larval stages.
© 2017 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society and the Royal Society of Biology 653
Emerging Topics in Life Sciences (2017) 1 651–657
https://doi.org/10.1042/ETLS20170111
Sporocysts are asexual sacs containing a large number of germ cells each of which produces either a subsequent
generation of sporocysts or rediae. Rediae are similar to sporocysts, but have a mouth and pharynx to feed dir-
ectly on the host tissues. Rediae share the ability of sporocysts to produce a large number of the subsequent
generations and, ultimately, to cercariae that is the last stage produced in the mollusk and responsible for the
transmission to the next host in the life cycle. Although this ability of asexual multiplication may imply serious
damage for the molluskan host, it enhances the transmission of the parasite in spite of the difficulty entailed in
the encounter between miracidium and first intermediate host and the hostile environment by ensuring the
generation of a large number of the next infective, larval stage infective, from a single miracidium. For example,
it has been shown that an individual miracidium [15] of Echinostoma caproni infecting Biomphalaria glabrata
resulted in the production of almost 1500 cercariae during the first month of cercarial emission [8]. Cercaria,
the ultimate stage of asexual multiplication, is a tailed free-living stage that is released from the mollusk. In
some species (i.e. blood flukes), cercariae enter the vertebrate definitive host where they mature to adult worms.
In other species, cercariae penetrate, or are eaten by, the second intermediate host and encyst as metacercariae,
and the definitive host became infected after ingestion of the second intermediate host, harboring the metacer-
caria. Finally, in other species (i.e. Fasciola hepatica), cercariae swim in an aquatic environment to reach the
aquatic plants where they attach as metacercariae. The vertebrate host becomes infected by eating the
metacercariae.
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Emerging Topics in Life Sciences (2017) 1 651–657
https://doi.org/10.1042/ETLS20170111
countries, and where these diseases are common, they exacerbate poverty. Major features of these parasitic
infections have been recently compiled in the book edited by Toledo and Fried [19].
Blood flukes cause schistosomiasis or bilharziasis that is one of the most important parasitic diseases of
humans causing significant morbidity and mortality on several continents. Schistosomiasis is transmitted in
over 70 countries, throughout a wide belt of the tropics and subtropics [20,21]. The three major species causing
schistosomiasis are Schistosoma haematobium, S. mansoni and S. japonicum. It is difficult to determine the
number of schistosomiasis cases, but it has been estimated that ∼300 million people were infected in 2013
worldwide and ∼280,000 annual deaths occur [4,22]. Although the number of deaths caused by schistosomiasis
decreased from 1990 to 2013, the number of active infections increased 31% in the same period which is evi-
dence for the need to implement campaigns of control [4]. In addition to active infections, it is estimated that
almost 800 million people worldwide are at risk of infection [23].
It is estimated that ∼80 million people worldwide were infected with any species of food-borne trematodes
Conclusion
Trematodes, and particularly digenetic trematodes, constitute an amazing group of parasites for both their
medical and veterinary importance and their interest in more basic biological sciences. Trematode infections
have been considered for a long time as minor diseases confined to low-income countries and their importance
has been underestimated. However, their frequency is greater than previously considered and some of them
have relevant mortality and morbidity. Moreover, these diseases are re-emerging worldwide, including in devel-
oped countries in relation to the ‘globalized world’. Although considerable efforts are being made to control
these diseases, the emergent nature of them requires new epidemiological and pharmacological approaches.
Additionally, trematodes constitute an intriguing group of parasites in relation to the taxonomy and other
© 2017 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society and the Royal Society of Biology 655
Emerging Topics in Life Sciences (2017) 1 651–657
https://doi.org/10.1042/ETLS20170111
factors such as their complex life cycles and the evolutionary adaptations of these organisms to guarantee sur-
vival in different biological environments.
Summary
• The class Trematoda includes a large number of species of medical and veterinary interest.
• Further studies on the systematics and taxonomy of these organisms are required.
• This constitutes an intriguing group of organisms in relation to their complex life cycles and
the biological adaptations to enhance their survival.
Competing Interests
The Authors declare that there are no competing interests associated with the manuscript.
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