INTESTINAL FLUKES

Fasciolopsis buski
Disease: Fasciolopsiasis
Adult fluke
 Largest parasitic trematode infecting humans
 Thick, fleshy, ovate, flesh-colored worm, 2-7.5 cm x 0.8 -2 cm
 Covered with spines
 no cephalic cone
 unbranched intestinal caeca which reach up to the posterior end
EGG
 Ellipsoidal
 130-140 µm x 80-85 µm
 Yellowish with a clear, thin shell and operculum at one end
 Underdeveloped when passed in the feces
LIFE CYCLE
HOST: Humans, hogs, and dogs
HABITAT: small intestine, particularly the duodenum and jejunum, but sometimes
can be found in the stomach or large intestine
PRIMARY INTERNMEDIATE HOSTS: planorbid snails of the genera segmentina,
Hippuetis, and Gyrualus wherein miracidium metamorphoses into a mother
sporocyst, ripens, rupture, and liberate mother rediae, which in turn prodice
daughter rediae
CERCARIAE: liberated in the water from the snail in 4-7 weeks after infection; show
selective specificity and encyst on the surface of all sorts of aquatic plants
Vegetation in stagnant water
SECONDARY INTERMEDIATE HOSTS: water caltrop, water hyacinth, water chestnut,
water bamboo, water morning glory, and lotus
METACERCARIAE: cercariae casting off the tail and secreting an outer, friable cyst
wall, and a firm inner wall that is soluble in the digestive juices; resistant to cold but
susceptible to desiccation at summer temperature; when swallowed, the wall is
dissolved in the duodenum, and activated larval worm attaches itself to the mucosa
of the upper intestine and becomes and adult worm in 25-30days

PATHOGENESIS AND CLINICAL MANIFESTATION

Pathological changes caused are:
 Traumatic - inflammation and ulceration
 Obstructive - intestinal obstruction due to heavy infection
 Toxic - due to absorption of worm metabolites by the host
 Epigastric pain, nausea, and diarrhea of varying severity occur
 In heavy infections: edema, ascites, and anasarca manifest
 There is slight anemia, often leukocytosis, sometimes leukopenia or
lymphocytosis, and eosinophilia is also common

DIAGNOSIS
 Detection of parasite eggs in stool
 Adult flukes are sometime vomited or passed in the feces
 Final diagnosis is based on finding the eggs in the feces

TREATMENT
 Praziquantel
 Other good drugs include are mebendazole. Thiabendazole, and pyrantel
pamoate

EPIDEMIOLOGY
 Found in Central and South China as far north as the Yangtze valley, Taiwan,
Thailand, Laos, Vietnam Cambodia, India, Korea, and Indonesia
 Chief endemic are is in the Kwangtung and Chekiang province of China
 Endemicity in the Philippines has not been demonstrated yet
 Fasciolopsiasis in Filipinos are probably imported cases
PREVENTION AND CONTROL
 Infected hogs should be restrained from contaminating areas where snails and
water plants are growing
 Education of the public and fundamental changes in eating habits such as
through cooking or steeping of plants in boiling water before eating should
afford protection

Echinostoma ilocanum
Disease: Echinostomiasis
ADULT FLUKE
 Reddish-gray measuring 2.5-6.6 mm x 1-1.35 mm
 Tapered at the posterior end has 49-52 collar spines around their oral suckers
 Oral sucker lies in the center of the circumoral disk and the ventral sucker is
situated at the anterior 5th of the body
 Simple intestinal ceca
 2 testes deeply bilobed, arranged in tandem at the 3rd quarter of the body
 Ovary Located just in front o the anterior testis
 Follicular vitellaria located in the posterior half of the body an uterine coils are
found between the ovary and ventral sucker
EGG
 Straw-color
 Operculated
 ovoid measuring 83-116 µm x 58 -69 µm

LIFE CYCLE
HOST: Humans, aquatic birds, dogs, cats, rats, and pigs
HABITAT: small intestine
PRIMARY INTERMEDIATE HOST: in the philippines, snail species Gyraulus
convexiusculus and Hippeutis umbilicalis wherein miracidium metamorphoses into a
mother sporocyst, mother rediae, which in turn produce daughter rediae, and
cercariae after 42-50 days
SECONDARY INTERMEDIATE HOST: snail species (kuhol and susong pampang)
PATHOGENESIS AND CLINICAL MANIFESTATION
 In heavy infections, inflammation develops at the site of attachment of the adult
worm to the intestinal wall
 Ulceration and consequently, diarrhea (sometimes bloody) and abdominal pain
may also develop
 Absorbtion of metabolites of the worms may result in general intoxication

DIAGNOSIS
 Detection of characteristic eggs in stool
 Echinostoma infection can be diagnosed by observing the parasite eggs in the
faeces of an infected individual, under a microscope
 The eggs typically have a yellow-brown appearance, and are ellipsoid in shape.

TREATMENT
 Praziquantel
 No alcohol; no fats must be taken 24 hours before and after treatment
 Only water must be taken within 3 hours of medication

EPIDEMIOLOGY
 Reported in Southeast and East Asian countries
 Endemic in Northern Luzon, Leyte, Samar, and the provinces of Mindanao

PREVENTION AND CONTROL

 The protection of fish ponds and aquaculture systems from contamination with
feces from people and other definitive hosts
 The treatment or sterilization of feces
 The control of snail host populations
 The implementation of education campaigns

Artyfechinostomum malayanum
ADULT FLUKE
 5-12 mm long x 2-3 mm wide
 Rounded posterior end with 43-45 collar spines around their oral suckers
 2 large testes with 6-9 lobe each
 Ovary is round and small located anterior to the testes
EGG
 Larger than E. ilocanum
 Golden brown
 Operculated measuring 120-130 µm x 80-90 µm

LIFE CYCLE
HOST: Humans, aquatic birds, dogs, cats, rats, and pigs
HABITAT: small intestine
PRIMARY INTERMEDIATE HOST: not known
SECONDARY INTERMEDIATE HOST: snail species
PATHOGENESIS AND CILNICAL MANIFESTATION
 In heavy infections, inflammation develops at the site of attachment of the adult
worm to the intestinal wall
 Ulceration and consequently, diarrhea (sometimes bloody) and abdominal pain
may also develop
 Absorbtion of metabolites of the worms may result in general intoxication

DIAGNOSIS
 Final diagnosis is based on finding the eggs in the feces

TREATMENT
 Praziquantel

EPIDEMIOLOGY
 Reported in Southeast and East Asian countries
 Infection were reported in Northern Luzon and Central Luzon

PREVENTION AND CONTROL

 Education of the public and fundamental changes in eating habits such as
through cooking or steeping of plants in boiling water before eating should
afford protection

Heterophyid Flukes
*Many species live in the intestine of fish-eating hosts:
*4 major species
 Heterophyes heterophyes
 Von Siebold's Fluke
 smallest yet the deadliest fluke of man
 causes heterophysiasis
 Haplorchis taichui
 Haplorchis yokogawai
 Metagonimus yokogawai
*Mode of transmission is by ingestion of metacercariae encysted in fish
*Metacercariae in the abdomen excysts, liberation a larva that attaches to the
intestinal wall

HETEROPHYES HETEROPHYES ADULT

 Elongated, oval, or pyriform
 Measures less that 2 mm in length
 Integuments has fine scale-like spines
 Some species have gonotyle or genital sucker
ADULT FLUKE
 Small measuring 1.3 x 0.5mm
 Pyriform, grayish
 Cuticle is covered with fine scalelike spines
 Large central sucker is located in the anterior middle third of the body
 2 ovoid testes side by side in the posterior fifth of the body
EGG
* HETEROPHYES HETEROPHYES OVA
 Light brown, thick-shelled, operculated
 29 x 16 µm
 The egg contains the embryo (miracidium).
 Shell has a slight shoulder at the rim of the operculum and sometimes a knob at
the posterior pole

DISEASE: Heterophyiasis
LIFE CYCLE
HOST: Humans, domesticated and wild fish-eating mammals
HABITAT: middle part of the small intestine
PRIMARY INTERMEDIATE HOST: brackish water snail of the genera pirenela in Egypt
and Japan
CERCARIAE: encyst as metacercariae om the scales, fins, tail, or less frequently int he
muscles od susceptible fish
SECONDARY INTERMEDIATE HOST: in the Philippines 30 species of the fish
harboring metacercariae are known

PATHOGENESIS AND CLINICAL MANIFESTATION

 In heavy infections, irritation of the intestinal mucosa my result in a chronic
intermittent mucous diarrhea with colicky pains and abdominal discomfort and
tenderness
 There is eosinophilia but no anemia
 Eggs and adults have been observed in autopsied brain and heart of Filipinos
who died of heart failure and intracerebral hemmorhage

DIAGNOSIS
 Final diagnosis is based on finding the eggs in the feces but require
differentation from those of Clonorchis, Opisthrochis, and other heterophyid
flukes

TREATMENT
 Praziquantel

EPIDEMIOLOGY
 Found in Egypt, particularly the lower Nile valley, Greece, Israel, Central and
South China, Japan, Taiwan, Korea, and Philippines
 Chief endemic area is the Kwangtung and Chekiang provinces of China

PREVENTION AND CONTROL

 Curtail the practice of eating raw, imperfectly cooked fish in endemic areas