CESTODES
individual segments equipped with
 Phylum Platyhelminthes
 Common name – TAPE WORMS
 Multicellular worms
 Has a flat and ribbon-like appearance
 Hermaphroditic (self-fertilizing)
 Require at least 1 intermediate host
for their life cycle.
 Possess reproductive system
 Lack mouth, GI tract & internal means
of excretion
Morphologic Forms
a. EGGS
 Hexacanth embryo (oncosphere)
 Motile
b. LARVAL STAGES
 Not seen in human specimen
 6 small hooks (hooklets) arranged
in pairs
c. ADULT WORMS
 Ribbon appearance
 Length several mm up to 15-20
meters
 Absorbs nutrients and excrete
waste through an outer surface
called – tegument
 SCOLEX – anterior end (head)
contain suckers (4 cup-shaped
structures) that enables
worm to attach to intestinal
mucosa. It has a rostellum
(crown) a fleshy extension of the
scolex.
 NECK – unsegmented region of
growth.
 PROGLOTTIDS (STROBILA) –
male and female reproductive
organs.
1. Taenia solium (Pork tapeworm) &
Taenia saginata (Beef tapeworm)
Morphology
 EGGS
 28-40 µm by 18-30 µm
 Roundish eggs – 33 by 23 µm
 Has oncosphere with 3 pairs of
hooklets
 Embryo is surrounded by a yellow-
brown embryophore with distinct
radial striations.
 Embryonated or nonembryonated
 SCOLICES
 1 to 2 mm in diameter.
 Equipped with 4 suckers.
 T. solium has a fleshy rostellum
and 2 rows of well-defined hooks
 T. saginata lacks these structures
 PROGLOTTIDS
 T. saginata – 1048 segments
 T. solium – 898 segments
 Differs in internal proglottid
structure, appearance and number
of uterine branches on each side
the of the uterus.
 T. saginata - rectangular, 17.5 by
5.5 mm; 15 to 30 uterine branches
usually present on each side of the
uterus.
  T. solium is square in appearance
and only contains 7 to 15 uterine
branches on each side of the
uterus.
Laboratory Diagnosis
 Recovery of eggs & gravid proglottids
in stool.
 Scolex may be present only after the
patient has been treated with
antiparasitic medication.
 Specimens collected around the
perianal area using the cellophane
tape method result in a very high
recovery rate of Taenia eggs.
Life Cycle
 Infection with Taenia spp. occurs
following the ingestion of raw or
undercooked beef (T. saginata) or
pork (T. solium) contaminated with a
cysticercus larva, a type of larva that
consists of a scolex surrounded by a
bladder-like, thin-walled cyst that is
filled with fluid.
 Scolex attachment to the intestinal
mucosa occurs after the larva
emerges in the small intestine, in
which maturation into an adult worm
occurs.
 The resulting adult multiplies,
producing numerous eggs, some of
which may be passed into the feces.
 These eggs are then consumed by the
proper animal species (cow or pig) in
which the oncosphere hatches then
migrates via the blood to the animal
tissue and converts into the infective
cysticercus larval stage.
 A new cycle is initiated on human
ingestion of the infected animal meat.
Epidemiology
 T. saginata is found in cosmopolitan
areas which the inhabitants do not
practice sanitary conditions and beef
or pork is eaten on a routine basis.
Intermediate host is cow.
 T. solium is found worldwide and pig is
its intermediate host.
Clinical Manifestation
 Taeniasis: Beef or Pork Tapeworm
Infection
 Nondescript symptoms, such as
diarrhea, abdominal pain, change in
appetite, and slight weight loss.
 Dizziness, vomiting, and nausea may
also develop.
 Laboratory tests often reveal the
presence of a moderate eosinophilia
Treatment
 Praziquantel – effective against the
entire adult worms but not used when
there is ocular or CNS involvement.
 Paramomycin
 Quinacrine hydrochloride (Atabrine)
Prevention and Control
 Exercising proper sanitation practices
 Thorough cooking of beef and pork
prior to consumption.
  Prompt treatment of infected Life Cycle
individuals.
 H. diminuta is primarily a parasite of
rats.
2. Hymenolepsis diminuta
 Contaminated droppings from infected
(Rat tapeworm)
rats are the source of parasite
Morphology transmission into an intermediate
host, such as the grain beetle or flea.
 EGGS
 Development of the cysticercoid
 55 by 85 μm.
larva, a larval stage consisting of a
 Hexacanth embryo contains 3 pairs of
scolex surrounded by a bladder-like
hooks.
cyst that contains little or no fluid
 A shell surrounds the embryo that
that emerges from select tapeworm
exhibits distinct polar thickenings and
eggs, occurs in this host.
no polar filaments.
 Consumption by a rat of infected
 Colorless embryophore encloses the
insects, which typically reside in
entire structure
grains or cereal, results in the
 SCOLICES
development of an adult worm.
 Equipped with four suckers.
 Eggs are produced in the infected rat
 A small rostellum bearing no hooks
and are excreted in its droppings,
protrudes from the anterior end
thus setting the stage for a new cycle.
 PROGLOTTIDS
 Human infection with H. diminuta is
 Rectangular, measuring 1 mm by over 2
considered to be an accidental
mm.
parasitic disease that normally infects
 Each mature segment contains one set
animals but can also infect humans,
of female and one set of male
known as a zoonotic occurrence, or
reproductive organs.
zoonosis.
 The gravid proglottid consists of a
 In this case, the human takes the
saclike uterus filled with eggs that
place of the rat in the parasite life
occupy most of the available space.
cycle.
Laboratory Diagnosis
Epidemiology
 Stool specimens with eggs.
 H. diminuta is distributed worldwide.
 Proglottids are typically not found in
 Areas in which foodstuffs such as
stool because they usually
grain or cereal are not protected
disintegrate in the human gut.
from rats and insects are at risk of
 Scolex is rarely seen in these samples.
transmitting the parasite.
 . distinguish it from the egg of H.
Clinical Manifestation
 Hymenolepiasis: Rat Tapeworm
 Disease Persons infected with H.
diminuta usually present with mild
symptoms such as diarrhea, nausea,
abdominal pains, and anorexia.
Treatment
 Praziquantel (Treatment of choice)
 Niclosamide (Effective alternative)
Prevention and Control
 Rodent control - preventing rats from
contaminating foodstuffs such as
grains and cereals.
 Protection of food from both rat
droppings and from intermediate host
insects.
 Inspect all potentially contaminated
foodstuffs before human
consumption.
3. Hymenolepsis nana (dwarf tapeworm)
Morphology
 EGGS
 Roundish to oval egg
 45 by 38 μm in size.
 Centrally located hexacanth embryo is
equipped with the standard 3 pairs of
hooklets.
 A shell complete with polar
thickenings protects the embryo.
 Numerous polar filaments originate
from the polar thickenings, which help
diminuta.
 Colorless embryophore serves as the
outermost egg layer.
 SCOLICES
 Contain four suckers.
 Presence of a short rostellum with one
row of hooks.
 PROGLOTTIDS
 Mature and gravid proglottids of H.
nana resemble those of H. diminuta
both in size and appearance
Laboratory Diagnosis
 Stool examination for egg detection
Life Cycle
 Consumption of an infective egg
initiates human H. nana infection.
 Development of the cysticercoid larva
occurs in the intestine.
 On further maturation, the scolex
emerges and attaches to the
intestinal mucosa.
 The resulting adult worm resides in
the intestine, in which it is capable of
self-reproduction.
 Disintegration of gravid proglottids
releases numerous eggs.
 A resulting egg may take one of two
routes: passed outside the body via
the feces, or initiate autoreinfection.
 An egg released into the outside
environment is in the infective stage.
 No intermediate host is required to
complete the cycle.
  This parasite may exist in a number of  Avoidance of contact with potentially
other animal transport hosts, such as infected rodent feces.
fleas, beetles, rats, and house mice,
and the cysticercoid larval stage may 4. Dipylidium caninum (Dog or cat
develop in these hosts and are tapeworm/ pumpkin seed tapeworm)
infective to both humans and rodents
Morphology
Epidemiology
 EGGS
 H. nana is considered to be the most  Egg packets – contains 5-6 eggs.
common tapeworm recovered in the  Each measure 30-60 µm.
United States, particularly in the  Six-hooked oncosphere
southeastern part of the country.  SCOLICES
 Tropical and subtropical climates  Equipped with four-suckers and a
worldwide are known to harbor this club-shaped armed rostellum.
parasite.  Has 1-6/7 circlets of spines that
 Person residing to close quarters reside on the rostellum.
(institutional setting, children at day  PROGLOTTIDS
care centers) are at a particularly  Resemble pumpkin seeds.
high risk of contracting H. nana.  Each mature segments has 2 sets of
 Stool from contaminated rodents may both male and female reproductive
also serve as a source of infection. organs.
 The resulting eggs are enclosed in
Clinical manifestation
embryonic membrane.
 Hymenolepiasis: Dwarf Tapeworm
Laboratory diagnosis
Disease - Persons with heavy H. nana
infections often develop  Recovery of the egg packets or gravid
gastrointestinal symptoms, such as proglottids in stool sample.
abdominal pain, anorexia, diarrhea,
Life Cycle
dizziness, and headache.
 D. caninum is a parasite of dogs and
Treatment
cats but humans can be infected
 Praziquantel (Treatment of choice) following the ingestion of infected
 Niclosamide (Effective alternative) fleas which can be transmitted
through the lick of the cat or dog to
Prevention and Control
humans or by hand-to-mouth
 Controlling transport host populations transmission.
  Infection begins after the ingestion  Dogs and cats should be treated and
of the infective larval stage. The larva protected against flea infestation
matures into adult worms once inside regularly.
the intestine and these adult worms  Children should be taught not to let
undergo self-fertilization. the dogs and cats lick them in or near
 The egg packets and gravid their mouths.
proglottids are passed in stools.
Ingestion by cat or dog’s fleas of the 5. Diphyllobothrium latum (broad fish
stool initiate new life cycle. tapeworm)

Epidemiology Morphology

 D. caninum can be found worldwide,  EGGS

however children are known to be the  Has no hexacanth embryo.
most at risk in contracting the  Equipped with a ciliated larva
tapeworm. (coracidium) with a smooth yellow to
brown shell.
Clinical Manifestation
 Oblong in shape and measures 55-75
 Dipylidiasis: Dog or Cat Tapeworm µm by 40-55 µm.
Disease is caused by D. caninum which  Average size is 65 by 48 µm
exhibit appetite loss, diarrhea,  The one end of the eeg has a lid
abdominal discomfort and indigestion. structure known as operculum.
It also includes anal pruritis due to  Has a small but distinct terminal knob
the migration of gravid proglottid out (abopercular knob) that extends to
of the anus the opposite end.
 SCOLICES
Treatment
 Has four cuplike suckers
 Praziquantel  Almond shape with two long prominent
 Niclosamide sucking grooves.
 Paromomycin  PROGLOTTIDS

Prevention  Wide and long.

 Gravid proglottids has a centrally
 Dogs and cats should be examined by located uterine structure that
a veterinarian regularly. frequently assumes a rosette
 Deworming infected animals and formation.
periodic administration of
prophylactic anti-helminth Laboratory Diagnosis

medications.
  Eggs and frequently proglottids in Epidemiology
stool specimens.
 D. latum are found worldwide. Alaska
 To ensure the that the treatment was
and Great Lake in USA are known to
successful the finding should consist
harbor the tapeworm. Other endemic
of the passage of the scolex and
areas include, South America, Asia,
absence of new proglottids.
Central Africa, Baltic region and
Life Cycle Finland. These areas routinely
consume freshwater fish. Some
 D. latum has a complex life cycle and
animals that eat infected freshwater
basically needs 2 intermediate hosts
fish may also become infected and are
to complete its life cycle.
known as definitive host. The
 Infection in human begins after the
diagnostic stage are the eggs and the
consumption of raw or undercooked
infective stage are the plerocercoids.
freshwater fish contaminated with
the infective plerocercoid (precursor Clinical Symptoms
larval stage).
 Diphyllobothriaisis: Fish Tapeworm
 Inside the small intestine a scolex
Infection or Broad Fish tapeworm
emerges and attached to the
infection
intestinal mucosa.
 Characterized by consistent digestive
 The resulting adult worm undergo
discomfort, overall weakness, weight
self-fertilization and the undeveloped
loss, and abdominal pain. Patient might
eggs are excreted through
also have vitamin B12 deficiency
defecation.
(which mimics the pernicious anemia)
 A coracidium which is a free-swimming
if the adult worm of D. latum reside
larva hatches if the eggs in stool
on the proximal part of jejunum.
comes in contact with the fresh
water. Treatment
 The coracidium will be ingested by the
 Praziquantel and Niclosamide
Cyclops species copepod, the first
intermediate host. Prevention
 Once inside the copepod he  Proper human fecal disposal.
coracidium develops into a procercoid.  Avoidance of eating raw or
This infected copeod is then ingested undercooked fish.
by the freshwater fish and ingestion  Thorough cooking of all fish before
of the infected freshwater fish by ingestion.
humans initiates new life cycle.
  Not seen in humans but found in
canines (definitive host)

Laboratory Diagnosis

 Hydatid cyst fluid examined via biopsy

for presence of scolices, daughter
6. Echinococcus granulosus (dog cysts, brood capsules, or hydatid sand.
tapeworm or hydatid tapeworm)  Patient might suffer anaphylaxis if
fluid escapes.
Morphology
 ELISA, indirect hemagglutination and
 EGGS Western blot are also available.
 Identical and similar to Taenia spp.  Hydatid cyst may be detected using
 Hydatid cysts – is the larval stage and radiography, computed tomography or
found in human tissue. ultrasound.
 Within the cysts miniatures of
Life Cycle
hydatid cysts are present and are
known as daughter cysts.  Humans are known to be accidental
 Surrounded by a protective cyst wall intermediate hosts and sheep are the
and laminated layers of germinal typical intermediate host.
tissue.  Human infection begins after the
 Brood capsules has no protective wall ingestion of infective eggs that are
which are form from the inner acquired through contact with
germinal layer. Scolices are found contaminated dog feces.
within these structures.  A larva the emerges from the eggs
 Hydatid sands are components found penetrate the intestine and travel to
in the fluid of the older E. granulosus different tissue sites, in particular
cysts which includes, daughter cysts, the lungs and liver via the
free scolices, and miscellaneous bloodstream.
nondescript material may evolve.  E. granulosus life cycle stops on the
 ADULT tissue site since humans are a dead-
 Small which measure only for about end host.
4.5 mm in length.  On the sheep, the life cycle is
 Has a scolex, small neck, and 3 completed. A hydatid cyst is form on
proglottids (immature, mature, gravid) the viscera of the sheep.
 The scolex has 4 suckers with 36  Dogs and wild canines which are the
hooks. definitive host become infected once
 they ingest the infected sheep  E. granulosis may also result to lung
viscera. infection wherein the infection causes
 Inside the definitive host the scolex chest pain, coughing and shortness of
matures into adult worms and produce breath. Other organs that can be
eggs which can be passed on the involve is the liver that may cause
feces. obstructive jaundice.
 Ingestion the infective eggs on the
Treatment
feces initiate new life cycle.
 Surgical removal of hydatid cyst
 Anti-parasitic medication if needed,
 Mebendazole, albendazole and
praziquantel
Epidemiology
Prevention
 E. granulosus are distributed in areas
where sheep and other herbivores are  Appropriate hygiene practices.
fostered and in contact with dogs and  Promptly treating canines and human
canines as well as humans. who are infected.
 These regions include Great Britain,  Education programs on high-risk
South America, Africa, Australia, areas.
Asia, China and some parts of the
Middle East.

Clinical Manifestation TREMATODES

 E. granulosus may cause infection  Phylum Platyhelminthes
known as Echinococcus: Hydatid Cyst  Also known as Digenea or Flukes
or Hydatid disease or Hydatidosis.  Can be divided into 2 groups:
 Symptoms may develop 1 year after - Hermaphroditic or self-fertilizing
the initial ingestion of Echinococcus flukes – infect organs and are
eggs. For a year, the egg continues to foodborne
mature which results to the necrosis - Schistosomes or blood flukes –
of infected tissue. Other than that, infect via direct penetration. Also,
the patient may also experience a dioecious, a parasite that
anaphylactic shock, eosinophilia, and reproduce through a separate
allergy reaction. Death may also occur. sexes.
The fluid within the cyst may be  Intermediate host is a mollusk (snail).
spread into other tissue as it raptures
Morphology
and cause new cyst.
  Has 3 morphologic forms;
 Eggs - primary morphologic
recovered in human specimens.
 Eggs vary in appearance; some has a
lid-like structure which opens under
some conditions to release its content
for further development.
 Others vary on the presence and
location of their spines that can be
seen in Schistosoma spp.
 Multiple larval stages
 Usually occur on the
environment or outside the human
host.
 Adult worm - adult flukes can be seen
rarely.
 Thin and unsegmented
resembles the shape and thickness of
a leaves
 Measures 1 to 5 cm in length
 Equipped with a 2 muscular, cup-
shaped suckers, one oral and the
other located ventrally.
 Also contain a simple digestive system
and genital tract.
 Uses its body surface to absorb and
release essential nutrients and waste
products
General Life Cycle
 Has 2 life cycle categories; Organ-
dwelling (intestine, bile duct, or lung)
and Blood-dwelling (blood
around the intestine and bladder)
 Organ-dwelling
 Human infection begins when a human
form host ingest water plants, fish, crab, or
cray-fish that is contaminated with
“metacercaria”, the encysted form of
trematode.
 Once inside the human body, the
metacercaria excysts in the entrance
of the intestinal tract.
 After that it will migrate to the
intestine, bile duct or lung where they
complete their development into adult
stage.
external  Once they are done with self-
fertilization, the resulting eggs exit
the human host through the feces or
sputum.
 On the external environment if this
which egg comes in contact with a fresh
water, the contents of the egg which
is known as “miracidium” emerges.
 Miracidium will then penetrate the
mollusk where they develop into a
sporocyst (larva equipped with saclike
structure).
 Numerous “rediae” (larval stage that
forms in the sporocyst) will produce
many “cercariae” the final stage of
larvae.
 The cercariae emerge from the
mollusk and encyst on the water plants
or enter a fish, crab and crayfish
(second intermediate host). Ingestion
of these second intermediate host will
vessels initiate new life cycle.
 Blood-dwelling
  Schistosoma spp. Are known as blood- Egg Undeveloped miracidium
dwelling flukes. Human infection contents
begins when a cercariae that emerge Other Distinct operculum
from the mollusk penetrate into the features
skin which usually happens when the
susceptible host swim or wade  ADULTS
contaminated water.  F. buski – 5 by 1.5 cm in size.
 Following the human penetration, the  F. hepatica – 3 by 1 cm and has a so-
schistosomula a morphologic form that called shoulder
emerges from the cercariae will Laboratory Diagnosis
reside in the blood vessel around the
liver, intestinal tract, or urinary  Recovery of eggs in stools.

bladder where they mature into adult.  Travel history is necessary to

 Male and female adult worm are diagnose.

needed to complete the copulation and  Speciation – recovery of the adult

the resulting eggs will exit the human Fasciolopsis worm.

body through urinating or defecating  Fasciola – enterotest, ELISA and gel

depending on the species. diffusion.

Laboratory Diagnosis Life Cycle

 Feces, duodenal drainage, rectal  Similar life cycle only differs on

biopsy, sputum, and urine. where the adult worm resides.

 Eggs are primarily seen in specimens.  Human infection begins when a human

 ELISA for Schistosoma spp. host ingest water plants contaminated

with infective metacercaria.

1. Fasciolopsis buski (large intestinal  Once inside the human body, the

fluke) and Fasciola hepatica (sheep metacercaria excysts in the entrance

liver fluke) of the intestinal tract.

 After that it will migrate and reside
Morphology to the small intestine (F. buski) and
 EGGS bile ducts (F. hepatica), where they
complete their development into adult
Size F. buski – 128-140 µm by
stage.
78-85 µm
 After they are done with self-
F. hepatica – 128-150 µm
fertilization, the resulting eggs exit
by 60-90 µm
the human host through the feces.
Shape Oblong
  Once outside the human body, if this syndrome that is typically seen in
egg comes in contact with a fresh patients with giardiasis can be
water, the miracidium emerges and experience by patients with
penetrate the mollusk where they fasciolopiasis. In additional, intestinal
develop into a sporocyst. obstruction and death may also result
 A rediae (larval stage that forms in but it is rare.
the sporocyst) will produce cercariae  Fasciola hepatica
that emerge from the mollusk and  Fascioliasis: Sheep liver rot is
encyst on the water plants. Ingestion characterized by symptoms that can
of infected water plants initiate new be experience because of the adult
life cycle. worm attachment to biliary tract.
Headache, fever and chills, pains in
the area of the liver due to tissue
damage which may extend to the
shoulders and back are experienced
Epidemiology
by patients with fascioliasis.
 F. buski is typically found in Far East Additional symptom includes
area like China, Thailand, Taiwan, eosinophilia, jaundice, liver
Vietnam, and regions of India and tenderness, anemia, diarrhea, and
Indonesia. Rabbits, dogs, pigs may be digestive discomfort. It may also
a reservoir host. result to biliary obstruction.
 F. hepatica on the other hand is
Treatment
found worldwide especially in areas
where sheep and cattle are raised.  H. buski - Praziquantel
 H. hepatica – dichlorophenol
Clinical Manifestation
(bithionol)
 Fasciolopsis buski  Triclabendazole is also effective but
 Fasciolopsiasis is characterized by bot yet available in US.
abdominal discomfort due to the
Prevention
irritation on the site of small intestine
where the worm attaches. Abdominal  Exercising proper human fecal
discomfort is typically associated with disposal
inflammation and bleeding of the  Exercising sanitation practices
affected area, jaundice, diarrhea,  Controlling snail population
gastric discomfort and edema.  Avoidance of consuming raw water
Fasciolopiasis symptoms mimics those plants, contaminated water.
of the duodenal ulcer. Malabsorption
 Epidemiology

2. Clonorchis sinensis (Chinese liver  C. sinensis is endemic in areas like

fluke) China, Vietnam, Korea, and Japan.
Fish-eating animals, dogs and cats are
Morphology
known to be the reservoir host.
 Eggs - average size: 30 by 15 m Transmission is through ingestion of
 Egg contents: Developed miracidium contaminated fish infected with
 Operculum: Present metacercaria.
 Other Features: Presence of distinct
shoulders and presence of small knob
opposite operculum
 Adults - average adult C. sinensis
Clinical Manifestation
measures 2 by 0.5 cm.
 Other features: Each end of the adult  Chlonorchiasis may result to fever,
worm is narrower than the midportion abdominal pain, eosinophilia, diarrhea,
of the body. anorexia, epigastric discomfort and
occasional jaundice. Other than that,
Laboratory Diagnosis
tenderness and enlargement of the
 Recovery of eggs in stool specimen or liver and leukocytosis may be seen.
duodenal aspirates. Person severely infected with C.
 Enterotest is also available. sinensis for a long time may develop
 Adult worms are seen during surgery liver dysfunction
or autopsy procedure.
Treatment
Life Cycle
 Praziquantel
 Human infection caused by C. sinensis  Albendazole
begins after consuming raw or
Prevention
undercooked fish that is contaminated
with the infective metacercaria.  Practice proper sanitation procedures.
 The metacercaria will then travel into  Proper fecal disposal of human and
the liver where it matures into adult reservoir host (dogs and cats)
worms.  Avoid ingestion of raw, undercooked
 The adult worm migrates in the bile or freshly pickled freshwater fish and
duct where it resides and produce shrimp.
numerous eggs that are excreted
through the feces.
 3. Heterophyes heterophyes and Life Cycle
Metagonimus yokogawai
 H. heterophyes and M. yokogawai has
Morphology a very similar life cycle. They are
transmitted to human after the
 Somewhat similar to C. sinensis the
ingestion of raw or undercooked fish
only difference, 1st C. sinensis has
that is contaminated with infective
more distinct shoulders. 2nd is
metacercaria.
Metagonimus and Heterophyes has no
 The resulting adult worms of each
terminal knob
trematode resides in the small
Size 30 by 15 µm intestine where they produce
Egg contents Developing
numerous eggs exits human body
miracidium
during defecation.
Operculum Present
Shoulders Present but Epidemiology
discrete
Small knob May be absent  H. heterophyes is found primarily in
Shell thickness Heterophyes – parts of Africa, Taiwan, Philippines,
thick Korea, Japan, Israel and Egypt. Fish-
Metagonimus – thin
eating mammals are known to harbor
the H. heterophyes.
 Adult - Heterophyes worm is small,
 While the M. yokogawai is found in
measuring just over 1.0 by 0.5 mm in
Japan, Siberia, China, Philippines,
size.
Spain, Greece, and Balkans. Dogs,
 The pyriform organism is grayish in
cats, hogs and fish-eating birds like
color and is protected by an outer
pelicans are known to harbor this
layer of fine spines that are scaly in
trematode.
appearance.
 Adult Metagonimus is similar in size, Clinical Manifestation
measuring 1.5 by 0.5 mm.
 Heterophyiasis and Metagonimiasis
 Worm is pyriform in shape with
has similar symptoms which include
tapering and a tiny layer of scaly
abdominal pain, abdominal discomfort,
spines at the anterior end and
chronic mucous diarrhea and
rounding at the posterior end.
eosinophilia. Granuloma is also
Laboratory Diagnosis detected that happens when the eggs
migrate into the different parts of
 Recovery of eggs in the stool.
the body like heart and brain.
 Careful microscopic examination.
Treatment
  Praziquantel the immature fluke is released and
migrate in the intestinal wall,
Prevention
diaphragm and finally in the lung
 Avoid consuming undercooked fish. tissue where it matures and lay eggs.
 Proper fecal disposal. The eggs are excreted through
sputum or stool if the sputum is
4. Paragonimus westermani (Oriental swallowed back.
lung fluke)
Epidemiology
Morphology
 P. westermani is distributed in
 Eggs – 78 to 120 µm by 45 to 60 µm. portions of Asia, India, and South
 Oval shape with undeveloped America. The reservoir hosts are pigs
miracidium protected by a thin smooth and monkeys along with other animals
shell. that consume crayfish or crabs.
 Opercular rim (shoulders) covers the Unembryonated eggs of this parasite
prominent operculum that as a are the diagnostic stage.
terminal shell thickening.
Clinical Manifestation
 Adults – somewhat oval and has a red
to brown color that measures 1 by 0.7  Paragonimiasis or Pulmonary
cm long. Distomiasis is characterized by
 The cuticle has spines. symptoms associated to pulmonary
discomfort like cough, fever, chest
Laboratory Diagnosis
pain, and increased production of
 Recovery of eggs in sputum specimens. blood-tinged sputum. Symptoms of
 Eggs are usually found in bloody tuberculosis is also similar to
samples. paragonimiasis like chronic bronchitis,
 Sometimes eggs are seen in stools eosinophilia and production of fibrous
specimen when sputum are swallowed. tissue.
 Serologic tests.  Moreover, the migration of immature
P. westermani to the brain leads to
Life Cycle
cerebral paragonimiasis wherein
 Human infection occurs following the patients might develop serious
ingestion undercooked crayfish or neurologic condition. The person
crabs contaminated with the suffers from seizures, visual
metacercaria. difficulties and decreased precision
 Once inside the body, the of motor skills.
metacercaria excyst in the duodenum,
Treatment t miracidiu miracidiu miracidium
m m
 Praziquantel Spine Large; Small; Large;
 Bithionol lateral lateral terminal

Prevention
 Adults – has separate sexes.
 Avoid human ingestion of undercooked  Round in appearance measuring 2 cm in
crayfish and crabs. length (female) and 1.5 cm (male).
 Exercise proper fecal disposal.  The male surrounds the female almost
completely for copulation.

Laboratory Diagnosis

 S, mansoni and S. japonicum –

recovery of eggs in in stool and rectal
biopsy specimens.
 S. haematobium – eggs in
concentrated urine specimen.
 Immunodiagnostics techniques;
ELISA.

5. Schistosoma spp.
 S. mansoni (Manson’s blood
fluke)
 S. japonicum (blood fluke) Life Cycle
 S. haematobium (Bladder fluke)  Schistosoma spp. are known as blood-
Morphology dwelling flukes. Human infection
begins when an infective cercariae
 Eggs that emerge from the mollusk
S. S. S. penetrate into the skin which usually
manosoni japonicum haematobiu happens when the susceptible host
m swim or wade contaminated water.
Size 112-182 50-85 µm 110-170 µm  Following the human penetration, the
µm by 40- by 38-60 by 38-70 µm
schistosomula, a morphologic form
75 µm µm
that emerges from the cercariae
Shape Oblong Somewhat Somewhat
roundish oblong travel into the bloodstream to
Conten Developed Developed Developed complete the maturation.
  S. mansoni and S. japonicum reside in cercaria and the diagnostic stage are
the veins that surround the intestinal the eggs.
tract, while the S. haematobium is in
Clinical Manifestation
the veins surrounding the urinary
bladder.  Schistosomiasis is also known as
 Male and female adult worm are Bilharziasis or Swamp fever. Person
needed to complete the copulation and infected with Schistosoma first
the resulting eggs will exit the human experience inflammation on the site
body through urinating (S. where the cercaria penetrates. Acute
haematobium) or defecating (S. infection results to abdominal pain,
mansoni and S. japonicum). fever, chill, weight loss, cough, bloody
 Once outside the environment, the diarrhea and eosinophilia. Person
eggs must come in contact with a infected with S. haematobium
freshwater so the miracidium is experience painful urination and
released which will penetrate into the hematuria. On the site of the
snail and develop into cercaria. penetration, lesion, necrosis and
granulomas may develop. Secondary
Epidemiology
bacterial infection, obstruction of
 Schistosoma mansoni is prevalent in ureters or bowel, CNS and other
some parts of Africa, other endemic tissue involvement may also result.
countries include Puerto Rico, West  Other disease cause by Schistosoma
Indies and some parts of South and spp. is the Katayama fever, a systemic
Central America. hypersensitivity reaction which is
 Schistosoma japonicum is distributed resulted from the migration of the
in China, Indonesia, and Philippines. schistosomulae through tissue.
Japan was previously an endemic Katayama fever is characterized by
country but today they are no longer rapid onset of fever, nausea, malaise,
part of the endemic countries. fatigue, myalgia, cough, diarrhea and
 Schistosoma haematobium is found in eosinophilia after 1 to 2 months of
Africa, South Arabia. Middle, East, exposure. It typically affects tourists
Iran and Iraq. Monkeys, cattle, other and travelers in endemic areas.
livestock, rodents, dogs and cats are
Treatment
the reservoir host of Schistosoma
spp. Transmission is via skin  Praziquantel is the drug of choice.
penetration of the infective stage  Oxamniquine – S. mansoni
 Antimalarial, artemisinins,
artemether, artesunate is proven
 effective but not in areas endemic for
malaria.
 Surgery for patients with obstruction.

Prevention

 Proper human waste disposal

 Control snail population
 Prompt diagnosis
 Treatment of infected person
 Avoid in contact with contaminated
water
 Educational programs in endemic
areas.