TREMATODES (FLUKES)

BY GROUP THREE
General Characteristics
• Trematodes • Cercariae
• Flat worms or flukes • Miracidia infected snails go through a
process to produce cercariae
• Have two or more hosts
• Cercariae are released by snails into
• Fresh Water Snails are first intermediate hosts fresh water
• They swim until they find the next
• Eggs host
• Some are embryonated • They may excyst to form metacercaria
• Some contain miracidium
• Operculated except schistosomes.
• Other Characteristics
• Hermaphrodites except Schistosomes
• Miracidium • Treated with praziquantel
• Embryonated part which
• infect snails
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The trematodes
• Intestinal Flukes • Lung Flukes
• Fasciolopsis buski
• Paragonimus westermani

• Liver Flukes • Blood Flukes

• Fasciola hepatica (Sheep liver fluke) • Schistosoma mansoni
• Clonorchis sinensis (Chinese liver fluke) • Schistosoma haematobium
• Opisthorchis felineus (Cat liver fluke) • Schistosoma japonicum
• Dicrocoelium dendriticum (Lancet liver fluke) • Schistosoma intercalatum

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 LIVER TREMATODES

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Fasciola hepatica (Sheep Liver Fluke)
• Fasciola hepatica causes a disease known as fascioliasis

• It is distributed worldwide and is common in sheep rearing areas of the world

• Man is infected accidentally or become an accidental definitive host by eating fresh

water plants (e.g. watercress ) that are infected with the Fasciola hepatica
metacercariae

• Intermediate hosts of F. hepatica are air-breathing freshwater snails from the family
Lymnaeidae. Galba truncatula is the main snail host in Europe, partly in Asia, Africa
and South America

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Morphology
• Adults Fasciola hepatica are flattened, leaf-shaped and brown coloured, having a
cone-shaped anterior protrusion and rounded posterior end

• The fluke measures 2.5 cm to 3 cm in length and 1.5 cm in breadth

• They have an anterior and a ventral suckers

• The adult worms are smaller in sizes than Fasciolopsis buski

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Contd….
• Egg: The eggs are large, ovoid and bile-stained and have a small, but distinct
operculum

• They measure 130-150 µm by 63-90 µm

• These are unembryonated when freshly passed

• The eggs are excreted in the bile into the duodenum, from where they are
excreted out in the faeces

• Further development of the eggs take place only in water

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 Egg Adult

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 LIFE CYCLE OF FASCIOLA

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Clinical Manifestation
• Human Fasciola hepatica infection is manifested by headache, chills, fever
and right upper quadrant pain
• Hepatomegaly, jaundice, diarrhoea and anemia may occur in severe infections
• Hepatic, biliary cirrhosis is a late complication

Diagnosis
• Stool R/E
• Wet preparation
• Concentration technique

Treatment Prevention
• Praziquantel • Can be prevented by not eating
• Wild aquatic vegetables (watercress)
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• Raw sheep 10
Clonorchis sinensis (Chinese or oriental liver fluke)
• It infects fish-eating mammals including humans

• In humans, it infects the common bile duct and gall bladder, feeding on bile

• The fluke passes its life cycle in three different hosts: freshwater snail
(Paraforssarulus manchouricus) as first intermediate host, freshwater fish as
second intermediate host, and mammals as definitive host

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Morphology
• Eggs
• Clonorchis sinensis eggs are small, ranging in size from 27 to 35 µm by 11 to 20
µm.
• The eggs are oval shaped with a convex operculum that rests on visible
“shoulders” at the smaller end of the egg.
• At the opposite (abopercular) end, a small knob or hook-like protrusion is often
visible.
• The miracidium is visible inside the egg. Eggs of C. sinensis are highly
morphologically similar to Opisthorchis spp.

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Contd….
• Adult
• Clonorchis sinensis adults are flattened, lance shaped, and measure
approximately 10 to 25 mm long by 3 to 5 mm wide.

• The oral and ventral suckers (acetabulum) are relatively small.

• The two testes are located posterior to the ovary, and are highly branched–a
feature which separates it from the related Opisthorchis spp. (rounded
testes).

• Reside in the biliary passages of the liver of the definitive host.

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 Adult Egg

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 LIFE CYCLE OF CLONORCHIS

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Clinical Manifestation
• Mostly asymptomatic
• Pathological manifestations result from inflammation and intermittent obstruction of
the biliary ducts
• The acute phase consist of abdominal pain, nausea and diarrhoea
• Chronic phase consist of fatigue, abdominal discomfort, anorexia, weight loss,
diarrhoea and jaundice
• The pathology of long-standing infections consist of bile stasis, obstruction, bacterial
infections, inflammation, periductal fibrosis and hyperplasia
• Development of cholangiocarcinoma is progressive

Diagnosis Prevention
• Stool R/E • Adequate cooking of fish
• Proper disposal of human
Treatment waste
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Praziquantel 16
 LUNG TREMATODES

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Paragonimus westermani
• Paragonimus westermani and other Paragonimus species are lung flukes causing
paragonimiasis.

• Human infections are most common in West Africa, the Far East and certain
regions of Central and South America

• Less frequent, but more serious cases of paragonimiasis occur when the parasite
travels to the central nervous system.

• Humans become infected following ingestion of raw or poorly cooked fresh water
crab – meat or cray – fish, the flesh of which contains the encysted metacercariae
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Morphology
• Egg is ovoid, relative thick-shell golden brown in colour and has a flattened
operculum at the large end and the opposite (abopercular) end is thickened
• Adult worm – reddish brown in colour live in the cavities in the lungs

Egg Adult

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 LIFE CYCLE OF PARAGONIMUS

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Clinical Manifestation
• P. westermani infection of the lungs causes cough, blood-stained sputum, chest
pain and night sweats. These symptoms (and the chest X-ray) may mimic
tuberculosis
• Adult worms of P. westermani occasionally invade sites outside the lung, e.g.
lymph glands, subcutaneous tissue, eyes, testes and brain causing severe disease

Diagnosis
• Wet mount preparation of sputum and stool observed under the microscope

Treatment
• Praziquantel

Prevention
• Adequate cooking of crab
• Proper disposal of human waste
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SUMMARY
Fasciola hepatica
• Disease • Habitat
• Fasciolosis /Fascioliasis • Liver (bile tract)
• Mode of transmission:
• Ingestion of aquatic plants (e.g. water cress) • Infective stage
or raw sheep liver infected with metacercariae • Metacercariae
• Intermediate hosts
• fresh water snail of genus Lymnae • Diagnostic stage
• Aquatic vegetations and water cress • Unembryonated
• Reservoir eggs
• Sheep, cattle, rabbits
• Features of egg • Specimen for
• Large, ovoid with a small but distinct operculum
laboratory diagnosis
• Sputum, urine and
• Features of adult faeces
• Flattened and leaf-like, having a cone shaped anterior protrusion.
• Life cycle:
• Egg Miracidia Sporocyst Rediae Cercariae Metacercariae Adult fluke
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SUMMARY CONTINUED.
Clonorchis sinensis
• Disease • Habitat
• Clonorchiasis • Distal biliary
• Mode of transmission: passages and
• Via feco-oral route pancreatic duct
• By eating raw or undercooked infected fish • Infective stage
• Intermediate hosts • Metacercariae
• Freshwater snail (Paraforssarulus manchouricus) • Diagnostic stage
• freshwater fish
• Embryonated eggs
• Features of egg
• Specimen for
• Oval shaped with a convex operculum (Ant. end)
• Abopercular end, a small knob or hook-like protrusion (Post. end)
laboratory diagnosis
• Features of adult • Sputum, urine and
faeces
• Narrow and flattened dorsal-ventrally
• Tapered at the anterior end and rounded at the posterior end
• Life cycle:
• Egg Miracidia Sporocyst Rediae Cercariae Metacercariae Adult fluke
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SUMMARY CONTINUED.
Paragonimus westermani
• Disease • Habitat
• Paragonimiasis • Parenchyma of the lungs
• Mode of transmission:
• Via feco-oral route • Infective stage
• By eating raw or undercooked crab meat or crayfish
• Metacercariae
• Intermediate hosts
• Freshwater snail as first intermediate host
• Freshwater crustacean as second intermediate host
• Diagnostic stage
• Unembryonated eggs
• Features of egg
• Ovoid, relative thick-shell golden brown in colour
• Flattened operculum at the large end • Specimen for laboratory
• Opposite (abopercular) end is thickened diagnosis
• Features of adult • Sputum, faeces
• Reddish brown in colour
• Similar in size and appearance to a coffee bean
• Life cycle:
• Egg Miracidia Sporocyst Rediae Cercariae Metacercariae Adult fluke
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 THANK
YOU

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