TREMATODES

PREPARED BY: BRENDALYN O. RAMOS, RMT

CHARACTERISTICS
1. All FLUKES appear FLAT and leaf-like except for ____________
2. All are HERMAPHRODITIC except for ___________.
3. All eggs are OPERCULATED except for ____________
4. Life Cycle of Trematodes:

Egg —> _______ —-> ________

Larva: _______ —> _______ —-> ________ —-> ______ —-> _______

** EXCEPT FOR ____________ : NO _______________

CHARACTERISTICS
5. INFECTIVE STAGE TO THE FINAL HOST: ______________

6. MODE OF TRANSMISSION: Ingestion except for ______________

CHARACTERISTICS
7. Require 2 INTERMEDIATE HOST except ____________
Species Common Name 1st Intermediate Host 2nd Intermediate Host Reservoir Host
Paragonimus Oriental Lung Fluke Crab, crayfish Cats, dogs, rats
westermani
Fasciola hepatica Sheep Liver Fluke Freshwater vegetation Ruminants
plants
Clonorchis sinensis Oriental lung fluke/
Oriental Chinese Fluke
Opisthorchis spp O. viverrini: Sea liver Freshwater fishes Fish eating mammal

Fasciolopsis buski
fluke
O. fileneus:
Cat liver fluke
Giant intestinal Fluke
Snail Freshwater vegetation Pig
Echinostoma ilocanum Garrison’s fluke Snail Rats, Birds
Heterophyes Dwarf fluke or Von Fishes Fish eating mammals
heterophyes siebold Fluke
Metagonimus Yokogawa’s Fluke Fishes Fish eating mammals
yokogawai
CHARACTERISTICS
8. ADULTS attach themselves to the host by means of 2
suckers:

a. ORAL SUCKER
b. VENTRAL SUCKER/ACETABULUM

** EXCEPT for _____________ :

3 suckers: __________

** No body cavity, circulatory and respiratory organs.

CHARACTERISTICS
9. EGG

a. Mature when laid

- Schistosoma
- Heterophyes
- Opisthorchis
- Clonorchis
b. Immature when laid
- Fasciola
- Fasciolopsis
- Paragonimus
- Echinostoma
CHARACTERISTICS
10. Possess ALIMENTARY CANAL without
___________

11. Possess COMPLEX reproductive

structures: Testis, Ovary, Uterus

12. TREATMENT: Praziquantel

LIVER FLUKES
1. Fasciola hepatica
→ COMMON NAME: Sheep liver fluke

→ Sheep liver fluke causing “liver rot”

→ Prevalent in sheep raising countries

→ HABITAT: Biliary duct/Passages of Liver

1. Fasciola hepatica
→ FINAL HOST: Sheep

→ FIRST INTERMEDIATE HOST: Snail (Lymnaea and Succinea)

→ SECOND INTERMEDIATE HOST: Plant/Vegetation

→ Kangkong (Ipomea obscura)

→ Watercress (Nasturtium officinale)

→ MOT: Ingestion of ______ host

→ INFECTIVE STAGE: Metacercaria

Fasciola hepatica
Morphology of Eggs
✔ Large
✔ Yellowish Brown in color
✔ Small operculum
✔ Thin Shell
✔ Immature Eggs
 Fasciola hepatica

Morphology of F. hepatica Adult:

✔ With Cephalic cone or conical projection
of shoulders
✔ Well developed-shoulder
2. Fasciola gigantica
→ COMMON NAME: Giant liver fluke

→ Infects cattles in the Philippines

→ Dominant species affecting cattle and water buffaloes

in the Philippines

→ HABITAT: Biliary Passages of liver

2. Fasciola gigantica
→ FINAL HOST: Cattle
→ FIRST INTERMEDIATE HOST: Snail

→ SECOND INTERMEDIATE HOST: Plant/Vegetation

→ MOT: Ingestion of ______ host
→ INFECTIVE STAGE: Metacercaria
 Fasciola gigantica

EGG: Fasciola egg - resembling Hen’s egg shape

ADULT: Longer cephalic cone, less developed
shoulder
** ALMOST THE SAME with F. hepatica but is
BIGGER
Fascioliasis
→ causes PARENCHYMAL INJURY

→ In acute phase during the migration of the larva, patients present with fever,
right upper quadrant pain, eosinophilia, and tender hepatomegaly.

→ In chronic phase, patients may develop biliary obstruction, biliary cirrhosis,

obstructive jaundice, cholelithiasis, and anemia.
3. Clonorchis sinensis
→ COMMON NAME: Chinese liver
fluke/Oriental Liver fluke

→ Most IMPORTANT liver fluke of man

→ HABITAT: Bile duct/ Gallbladder

3. Clonorchis sinensis
→ FINAL HOST: Man
→ FIRST INTERMEDIATE HOST: Snail (Parafossarulus, Bulimus, Alocinma)

→ SECOND INTERMEDIATE HOST: Fish

→ MOT: Ingestion of ______ host
→ INFECTIVE STAGE: Metacercaria

3. Clonorchis sinensis
Morphology of Eggs
✔ Broadly ovoidal
✔ Vase Shaped
✔ “old fashioned electric bulb”
Morphology of Adult:
✔ pointed anteriorly
✔ Rounded posteriorly
✔ Dendritic testes in tandem
✔ Granular vitellaria on the
middle third
3. Clonorchis sinensis
– PATHOGENICITY –
→ may cause CHOLANGITIS.
→ Patients in the early stage have fever, epigastric
pain, diarrhea, and tender hepatomegaly. This is
followed by biliary colic, jaundice, and progressive
liver enlargement.

** can be prevented by proper cooking of fish,

proper disposal of feces, control of snails.
4. Opisthorchis felineus
→ COMMON NAME: Cat liver fluke/Siberia
Liver fluke
→ HABITAT: Liver, Bile passages of the liver
→ ADDITIONAL:
Opisthorchis viverrini - Southeast Asian liver
fluke
3. Opisthorchis felineus // Opisthorchis viverrini
→ FINAL HOST: Cats
→ FIRST INTERMEDIATE HOST: Snail (Bithynia)

→ SECOND INTERMEDIATE HOST: Fish

→ Accidental host: Man
→ MOT: Ingestion of ______ host
→ INFECTIVE STAGE: Metacercaria
 Opisthorchis spp. Morphology of Adult:
✔ Lancet shaped
Morphology of Eggs
✔ Lobed testes
✔ Eggs are the same with Clonorchis sinensis but
elongated ovoidal ✔ Transverse vitellaria
 INTESTINAL FLUKES
(SMALL INTESTINES)
1. Fasciolopsis buski
→ COMMON NAME: Giant intestinal fluke

→ LARGEST FLUKE parasitizing man

→ HABITAT: Small Intestine

1. Fasciolopsis buski
→ FINAL HOST: Man
→ RESERVOIR HOST: Pigs, Dogs, Rabbits
→ 1st Intermediate host: Snail (Segmentina or Hippeutis)
→ 2nd Intermediate host: Plants/Vegetation (Chestnuts(Eleocharis tuberosa),
Caltrop (Trapa bicornis), Morning glory/Kangkong (Ipomea obscura), Lotus
(Nymphaea lotus).
→ INFECTIVE STAGE: Ingestion of _______ host
→ causes FASCIOLOPSIASIS
 Fasciolopsis buski Morphology of Adult:
✔ Same as F. hepatica but larger

Morphology of Eggs
✔ Intestinal caeca not branched
✔ Large ✔ No cephalic cone/ shoulder
✔ Yellow Brown in color
✔ Small operculum
✔ Thin Shell
✔ Immature Eggs
2. Echinostoma ilocanum
→ COMMON NAME: Garrison’s fluke
→ HABITAT: Small Intestine
→ 1st IH: Snail (Gyraulus convexiusculus, and Hippeutis umbilicalis)
→ 2nd IH: Kuhol (Pila luzonica) and Susong pampang (Vivipara
angularis)

→ Infective stage: Metacercaria

→ MOT: Ingestion of ______ IH
 Echinostoma ilocanum Morphology of Adult:
✔ Long
✔ Reddish gray in color
✔ With circumoral disk of 49-51
spikes

Morphology of Eggs
✔ Large
✔ Straw in color
✔ Small operculum
✔ Thin Shell
✔ Immature Eggs
3. Heterophyes heterophyes
→ COMMON NAME: Von Siebold’s fluke/ Heterophyid fluke

→ Teardrop-shaped fluke

→ SMALLEST fluke of man

→ HABITAT: Small Intestine

3. Heterophyes heterophyes
→ FINAL HOST: Man
→ 1st IH: Snail (Melania juncea, and Thiara riquetti)
→ 2nd IH: Fish
→ INFECTIVE STAGE: Metacercaria
→ MOT: Ingestion of ______ IH
 Heterophyes heterophyes

Morphology of Adult:

Morphology of Eggs
✔ Covered with scale like spines
✔ Eggs are the same with Clonorchis sinensis but ✔ With 3rd genital sucker/gonotyle
smaller knob
LUNG FLUKES
1. Paragonimus westermani
→ COMMON NAME: Oriental Lung Fluke

→ Causing ENDEMIC Hemoptysis

→ Common in Sorsogon

→ HABITAT: Lungs
1. Paragonimus westermani
→ FINAL HOST: Man

→ 1st IH: Snail (Antemelania asperata and Antemalania dactylus)

→ 2nd IH: Crab (Sundathelphusa philippina) , Crayfish

→ INFECTIVE STAGE: Metacercaria

→ MOT: Ingestion of 2nd IH with Metacercaria

 Paragonimus westermani
Morphology of Eggs Morphology of Adults
→ resembles COFFEE BEAN
→ Operculated with shoulders
→ Immature/Unembryonated
→ Opposite the operculum is an
abopercular thickening
** SIMILAR to Diphyllobothrium latum
egg
Paragonimus westermani
Morphology of Eggs Morphology of Adults
1. Paragonimus westermani
LABORATORY

→ Specimen for diagnosis - Sputum/ Stool

● Charcot-Leyden crystals may be observed in sputum

or lung tissue specimens
** Paragonimus mexicanus
→ Found in areas of Mexico and South America

→ Formation of subcutaneous or lower

abdominal nodules

→ Egg: Operculated with shoulders, thick

shelled, brownish-yellow, unembryonated egg
BLOOD FLUKES
Schistosomes

→ DIOECIOUS → leads to Schistosomiasis (Bilharziasis)

→ Adult stages are in the blood vessels

→ “PERPETUAL COPULATION”

→ The male worm is broader than the female and its lateral
borders are rolled ventrally into a cylindrical shape,
producing a long groove or trough called GYNECOPHORIC
CANAL in which FEMALE is heald.

→ The male is split LONGITUDINALLY to produce this canal

1. Schistosoma japonicum
→ COMMON NAME: Oriental Blood fluke
→ Causes Oriental-Schistosomiasis or
Katayama disease or Schistosomiasis japonica.
→ HABITAT: Superior Mesenteric Vein in the
small intestine
1. Schistosoma japonicum
→ FINAL HOST: Man

→ Reservoir host: Dogs, Cats, Carabaos, other mammals

→ Intermediate host: Snail (Oncomelania hupensis quadrasi)

→ Infective stage: Cercaria (Fork tail cercaria)

→ MOT: Skin penetration → Allergic reaction - Swimmer’s

itch
2. Schistosoma mansoni
→ COMMON NAME:Manson's Blood Fluke

→ Smallest Adult blood fluke

→ Causes Intestinal Bilharziasis

→ Habitat: Inferior Mesenteric vein of the colon and rectum

2. Schistosoma mansoni
→ FINAL HOST: Man

→ Reservoir Host: Nonhuman primates

→ Intermediate host: Snail (Biomphalaria)

→ Infective stage: Cercaria

→ MOT: Skin penetration

3. Schistosoma haematobium
→ COMMON NAME: Vesical Blood Fluke

→ Causes Urinary Bilharziasis, Urinary Schistosomiasis

(Bloody Urine), Egyptian Hematuria

→ HABITAT: Vesical Uterine plexus near the urinary bladder

3. Schistosoma haematobium
→ FINAL HOST: Man
→ Reservoir Host: None
→ Intermediate host: Snail (Bulinus)
→ Infective stage: Cercaria

→ MOT: Skin penetration

 Differentiation of Schistosoma spp.
Species Schistosoma japonicum Schistosoma mansoni Schistosoma haematobium

Common Name Oriental Blood Fluke Manson’s blood fluke Vesical/bladder blood fluke

Intermediate Host Oncomelania quadrasi snail
Habitat superior mesenteric veins in
the small intestine
Eggs Small lateral spine,
unoperculated, emrbyronated
Biomphalaria, Planorbis, bullinus and physopsis spp.
Tropicorbis spp.
inferior mesenteric veins Vesical/Uterine plexus near
of the colon and rectum the urinary bladder
Large lateral spine, Pointed terminal spine,
unoperculated, embryonated unoperculated, embryonated
 Differentiation of Schistosoma spp.
Species Schistosoma japonicum Schistosoma mansoni Schistosoma haematobium
Common Name Oriental Blood Fluke Manson’s blood fluke Vesical/bladder blood fluke
Adult (Skin pigment) Smooth, non-tuberculated coarsely tuberculated slightly tuberculated
Testes 6-8 8-9 4-5
Ovary median anterior cephalic Posterior
Uterus long well developed short uterus Long
Number of Eggs in uterus 50-100 1-4 20-30
 Pathology and Laboratory Diagnosis

Species General manifestation Specific Manifestation Diagnosis

Schistosoma japonicum Oriental Bilharziasis

Rectal biopsy and stool
Schistosoma mansoni • Cercarial Intestinal Bilharziasis examination of eggs
Dermatitis
Schistosoma • Swimmer’s itch Urinary Bilharziasis
haematobium Urine examination of eggs,
bladder biopsy
**ADDITIONAL**
1. Schistosoma intercalatum

→ Egg: resembles egg of S. haematobium, but acid-fast POSITIVE

→ ADULT: Located in the venules of colon (Large Intestine)

2. Schistosoma mekongi

→ Egg: resembles egg of S. mansoni, but much smaller

→ Adult: located in the venules of small intestine

LABORATORY TESTS FOR Schistosoma
→ DFS, Kato-Katz, FECT: Stool exam for eggs of Schistosoma japonicum and Schistosoma
mansoni.

→ Urine Analysis using 24-hour unpreserved urine (centrifugation) for Schistosoma

haematobium

→ Circumoval Precipitin Test (COPT): Confirmatory test for Schistosomiasis (+)

→ RESULT: Bleb formation

→ Reagent: Lyophilized Schistosoma japonicum eggs from a Rabbit (Reservoir Host)

→ Specimen: Serum

→ Principle: Detection of Antibodies that reacts with the eggs

TREATMENT
→ PRAZIQUANTEL → 2 or 3 doses in a single day.

→ Infection with S. mansoni: may require large dose.

→ Metrifonate (Bilarcil): Alternative treatment for S. haematobium infections

→ given once every other week in a total of three doses