MEDICAL PARASITOLOGY SY 2020-2021

2ND SEMESTER
MEDINA & ALBANO | LECTURE & LABORATORY

OUTLINE

I. General Characteristics
II. Intestinal Trematodes
III. Liver Trematodes
IV. Lung Trematodes
V. Blood Trematodes
VI. Review Questions

I. GENERAL CHARACTERISTICS

● Belongs to Phylum Platyhelminthes

● Digenea, commonly known as Flukes
● Trematodes are a class of helminths pathogenic to humans and can infect many organs especially the
intestines, liver, and the lungs
● Characterized by flattened dorsoventrally body and are nonsegmented leaf-shaped helminths
● Hermaphroditic (having both male and female sets of reproductive organs; except the Schistosomes)
● Complex Life Cycles: 3 stages (Egg, larval stages, and the adult worm)
○ Miracidium - first larval stage that emerges from eggs and are ingested by snails (IH)
○ Cercariae - considered as juveniles; infective to humans, in whom they are acquired by swimming in
infested water
○ Metacercariae - infective stage; encysted form occurring in the 2nd IH (fish or crayfish)
○ Sporocyst - saclike structure containing the larva that emerges from the miracidium
○ Redia - intermediate larval stage occurring in the sporocyst
○ Schistosomulum - results when the cercaria penetrates human skin and loses its tail
● Morphology:
○ Suckers (Acetabula)
- Oral and ventral suckers
- One opens into the digestive tract, and one for attachment
○ Tegument
- External body surface
- Highly absorptive with digestive functions
○ Mitrotiches
- External structure for releasing waste products

❏ Infections may increase in other parts of the world via increased international travel and trade of fresh aquatic
foods from endemic areas

QUIZON 1
 MEDICAL PARASITOLOGY

II. INTESTINAL TREMATODES

Fasciola buski Heterophyes heterophyes Metagonimus yokogawai

CN Large Intestinal Fluke Heterophid Fluke

IH Snail 1ST: Snail

2ND: Freshwater Fish

DH Man, Pigs, Dogs Man, Fish-eating mammals, birds

HAB Small intestine

MOT Ingestion of infected aquatic plants Ingestion of infected raw or uncooked fish
(bamboo shoots, water chestnuts)

IS Metacercariae

DS Unembryonated eggs Embryonated eggs

DX Eggs in stool sample Eggs in stool sample Eggs in stool sample

Formalin-ethyl acetate sedimentation

(egg recovery)

DZ Fascioliasis Heterophyiasis Metagonimiasis

PATH Fascioliasis: Mucosal ulcers, Light INF: Asymptomatic

hypersecretion, and occasional
hemorrhage
Heavy INF: Edema, Eosinophilia,
Mucoid diarrhea, Anemia,
Malabsorption and even death
Heavy INF: Chronic mucoid diarrhea, abdominal pain and discomfort, eosinophilia,
Eggs have the ability to escape into the lymphatics or venules (intestinal penetration)
then migrates to other areas of the body (heart or brain) which leads to Granulomas

TX/PR Praziquantel Praziquantel

Niclosamide (alternative)
Avoidance of consuming undercooked fish
Cook aquatic plants well (boiling) Practice proper fecal disposal
Prevent fecal contamination Control snail population

MORPH Egg (oblong/ ellipsoidal, Egg (indistinguishable with C. sinensis; have shoulders but less distinct; lacks small
underdeveloped miracidium with terminal knob; exhibits an operculum) (Heterophyes eggs have much thicker shell
distinct operculum) than those of Metagonimus)

Adult (comparable size; equipped Adult (Heterophyes): small, pyriform, grayish, outer layer with fine spines (scaly)
with “shoulders”; rounded anterior
end) Adult (Metagonimus): Pyriform, tiny layer of scaly spines heavily (anterior end)

III. LUNG TREMATODES

Paragonimus westermani

CN Oriental Lung Fluke DZ Paragonimiasis

IH 1ST: Snail PATH Acute stage: migration of young flukes

2ND: Crustaceans Chronic stage: Adult flukes residing in a cyst
in the lung parenchyma; chronic chest pain,
cough, blood-tinged sputum (rusty-brown
sputum), lung infiltration, nodules, and
abscesses

Cerebral involvement causes symptoms of a

space-occupying lesion – most important form
of extrapulmonary paragonimiasis

Abdominal paragonimiasis (asymptomatic)

QUIZON 2
 MEDICAL PARASITOLOGY

DH Man TX/PR Praziquantel

Bithionol (alternative)

Avoid eating undercooked crayfish or crabs

Proper disposal of human waste products

HAB Lungs MORPH Eggs (yellow-brown, ovoid or elongated with

thick shell; asymmetrical with one end slightly
MOT Ingestion of infected crustaceans flattened, operculum largely visible at the
large end)
IS Metacercariae
Adult (Large, robust, ovoid flukes,
DS Unembryonated eggs hermaphroditic, possess oral and ventral
suckers; cuticle possess spines)
DX Stool examination
Effusion fluid or biopsy material
Concentration techniques
Biopsy (adult or developing fluke recovery)
Serologic tests (antibody detection)

IV. LIVER TREMATODES

Fasciola hepatica Clonorchis sinensis

CN Sheep Liver Fluke Chinese Liver Fluke

IH Snail 1ST: Snail

2ND: Freshwater fish

DH Man, Sheep Man

HAB Bile ducts Biliary ducts

MOT Ingestion of infected aquatic plants Ingestion of infected raw or uncooked fish

IS Metacercariae

DS Unembryonated eggs Embryonated eggs

DX Stool sample Stool examination

- Direct fecal smear
Enterotest; ELISA; Gel Diffusion - Kato-katz method
- FECT
Serological methods
DNA-based methods

Imaging: CT, MRI, THI

DZ Fascioliasis: Sheep liver rot Clonorchiasis

PATH Light INF: Asymptomatic Light INF: asymptomatic

Heavy INF: Death
Fascioliasis: Fever, Eosinophilia, Jaundice, Liver
tenderness, Anemia, Diarrhea, Digestive discomfort,
Biliary obstruction, tissue damage and irritation of the liver
and bile ducts
Heavy INF: fever, abdominal pain, eosinophilia, diarrhea,
anorexia, epigastric discomfort, enlargement or tenderness of
the liver, leukocytosis, liver dysfunction, pancreatitis, bile duct
stones, Cholangitis, hepatic complications,
Cholangiocarcinoma
Clonorchiasis: Fatigue, Inappetence, Nausea, Bellyache,
Jaundice, Hepatosplenomegaly

TX/PR Dichlorophenol (Bithionol) Praziquantel

Albendazole
Proper fecal disposal Control snail population
Sanitation practices Avoid eating uncooked fish
Food and safety practices
Increase knowledge and awareness
Improve medical personnels
Sanitation practices

QUIZON 3
 MEDICAL PARASITOLOGY

*No commercially produced/effective vaccine is available

MORPH Egg (oblong-shaped, underdeveloped miracidium with Egg (oval, distinct convex operculum, opposite small knob or
distinct operculum) hook-like protrusion; miracidium is visible)

Adult (comparable size; equipped with “shoulders”); Adult (end is narrower than the midportion of the body)
Cone-shaped

V. BLOOD TREMATODES

Schistosoma mansoni Schistosoma japonicum Schistosoma haematobium

CN Manson’s Blood Fluke Oriental Blood Fluke Bladder Fluke

IH Snail

DH Man

HAB Inferior mesenteric veins draining the Superior mesenteric veins draining Vesicular and Pelvic venous plexus of the
large intestine the small intestine bladder; also in the rectal venules

MOT Skin penetration

IS Cercariae

DS Eggs

DX Eggs in stool specimen Eggs in stool specimen Urine

Rectal biopsy Rectal biopsy Travel history, ELISA

Travel history, ELISA Travel history, ELISA Serologic test
CCA (Circulating Cathodic Antigen) test Kato-Katz technique Kato-Katz technique
Kato-Katz technique

DZ Schistosomiasis
Bilharziasis
Swamp fever
Katayama syndrome (acute schistosomiasis)

PATH Heavy INF: typhoid fever-like symptoms, cough, myalgias, malaise, hepatosplenomegaly, cirrhosis of the liver, bloody
diarrhea, bowel obstruction, hypertension and toxic reactions; collateral circulation, eosinophilia if hepatic involvement is
severe
More Chronic Cases: Asymptomatic in endemic areas
Nephrotic syndrome may occur in S. mansoni and S. haematobium

Katayama syndrome: sudden onset fever, malaise, myalgia, headache, eosinophilia, fatigue, abdominal pain for 2-10 weeks
Chronic intestinal form: nonspecific intermittent abdominal pain, diarrhea, and rectal bleeding, pulmonary hypertension
caused by granulomatous pulmonary arteritis can occur in patients with advanced hepatic fibrosis disease
Urogenital schistosomiasis: Hematuria, urinary frequency, burning micturition, suprapubic discomfort, squamous-cell
carcinoma of the bladder
Female genital schistosomiasis (S. hematobium): inflammatory lesions in the ovaries, fallopian tubes, cervix, vagina and
vulva, pain , stress incontinence, infertility, and increased risk of abortion, lesions can increase transmission of HIV
Male urogenital schistosomiasis: hematospermia, orchitis, prostatitis, dyspareunia, and oligospermia (can be resolved
readily after anti-schistosomal treatment than female genital schistosomiasis)
Cerebral schistosomiasis (common in S. japonicum): meningoencephalitis with pyrexia, headache, vomiting, blurred vision,
and altered sensorium or Jacksonian epilepsy; Spinal cord involvement can present acute transverse or subacute
myeloradiculopathy leading to paralysis or lumbar and leg pain with muscle weakness, sensory loss, and bladder
incontinence

TX/PR Praziquantel (acts against adult schistosome worms)

Artemisinin derivatives (antimalarial drugs; kills immature larval forms of developing schistosomes)

Preventive chemotherapy
Snail control
Behavioral modification
Water and Sanitation improvements
Prophylactic or Transmission-blocking vaccine (eventually)

QUIZON 4
 MEDICAL PARASITOLOGY

MORPH Eggs (oblong; prominent lateral spine)
Adult (Dioecious; rounder appearance;
female is longer than male; male
surrounds the female completely
facilitating copulation)
Eggs (roundish, small inconspicuous
lateral spine)
Adult (Dioecious; rounder
appearance; female is longer than
male; male surrounds the female
completely facilitating copulation)
Eggs (oblong, prominent terminal spine)
Adult (Dioecious; rounder appearance;
female is longer than male; male
surrounds the female completely
facilitating copulation)

Legend:
CN (Common Name)
IH (Intermediate host)
DH (Definitive Host)
HAB (Habitat)
MOT (Mode of Transmission)
IS (Infective stage)
DS (Diagnostic stage)
DX (Lab Diagnosis)
DZ (Disease)
PATH (Pathology)
TX/PR (Treatment and Prevention)
MORPH (Morphology)

QUIZON 5
 MEDICAL PARASITOLOGY

VI. REVIEW QUESTIONS

1. Which schistosome has a large terminal spine 2. Hematuria is a typical sign of human infection
a. S. haematobium caused by
b. S. japonicum a. Fasciolopsis buski
c. S. mansoni b. Fasciola hepatica
d. S. mekongi c. Schistosoma haematobium
d. Schistosoma japonicum

3. Number these items from 1 to 7 to describe the chronological sequence of life cycle of an intestinal trematode

____ Metacercariae a. 1,6,4,3,7,2,5

____ Egg b. 6,1,2,4,7,3,5
____ Miracidium c. 6,2,3,5,7,4,1
____ Redia d. None of the above
____ Adult
____ Sporocyst
____ Cercaria

4. Humans can be infected with the larval stage of 9. The fluke acquired by eating contaminated
all except one of the following parasites. Which of vegetation is:
these Digenea cannot develop as a viable larva in a. Clonorchis sinensis
the tissues of humans b. Fasciolopsis buski
a. Hydatid tapeworm c. Heterophyes heterophyes
b. Bird schistosomes d. Paragonimus westermani
c. Manson’s blood fluke
d. Sheep liver fluke 10. Fish carrying metacercariae may transmit:
a. Clonorchis sinensis
5. Which of the Platyhelminthes infects humans by b. Fasciolopsis buski
skin penetration and has an association with c. Paragonimus westermani
bladder cancer? d. None of these
a. S. mansoni
b. S. haematobium 11. Paragonimus westermani infection is acquired by:
c. Clonorchis sinensis a. Drinking contaminated water
d. S. japonicum b. Eating infected crustacea
c. Eating infected fish
6. Eggs of all the following flukes are d. Eating infected water chestnuts
underdeveloped when passed in feces EXCEPT:
a. Fasciola hepatica 12. Schistosoma cercariae enter the human body:
b. Fasciola buski a. In flesh of infected fish
c. Clonorchis sinensis b. By skin penetration
d. Paragonimus westermani c. In contaminated drinking water
d. Either b or c
7. The preferred specimen for the diagnosis of
paragonimiasis is: 13. The Digenea infection for which bloody urine is
a. Bile drainage often a symptom is:
b. Duodenal aspirate a. S. haematobium
c. Rectal biopsy b. S. japnicum
d. Sputum c. S. mansoni
d. B or C only
8. The three species of human blood flukes have as
intermediate host: 14. The fluke most commonly found in the United
a. A cyclops States is:
b. An aquatic snail a. Fasciola hepatica
c. An insect b. Fasciolopsis buski
d. A freshwater fish c. Heterophyes heterophyes
d. None of these

QUIZON 6