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TREMATODES

(FLUKES)
 Hermaphroditic (both male and female
reproductive organs in single body)
 Exception- schistosomes
 1st intermediate host-mollusks (snails and
clams)
 Eggs have operculum-allows larval worm to
find the host (exception-schistosomes)
Types
 Fasciolopsis buski
 Fasciola hepatica
 Opisthorchis sinensis
 Paragonimus westermani
 Schistosomes
 S.mansoni
 S.japonicum
 S.haematobium
FASCIOLA BUSKI
 Giant intestinal fluke
 Largest, most prevalent
fluke
 Intermediate host-snail
 Reservoir host-
pigs,dogs,rabbits,humans
 Biologic vector-water
plants
Life cycle
 Infective stage- metacercaria
 Diagnostic stage- eggs in feces
 Free swimming larval stage-miracidium
Clinical features
 Abdominal discomfort,diarrhoea
 Marked eosinophilia
 Worm takes up residents in the bile ducts,ther
mechanical irritation and toxic secretions cause
hepatitis,biliary obstruction etc
 Lab diagnosis
 Stool microscopy-large, golden,bile stained eggs with
an operculum on the top
 DOC-praziquantel
 Proper sanitation measures
FASCIOLA HEPATICA
 Sheep liver fluke
 Intermediate host-snail
 Biological vector-water
plants
 Reservoir host-sheep,
cattle, humans
Life cycle
 Lab diagnosis and treatement same as that of
buski
OPISTHORCHIS SINENSIS
 Also called clonorchis sinensis/CHINEESE
LIVER FLUKE
 Intermediate host-snail and fresh water fish
 Biologic vector-uncooked fish
 Reservoir host-dogs,cats, humans
Life cycle
Clinical features
 Pain in the right upper quadrant over the
liver,chills,fever, marked eosinophilia.
 Hepatitis ,portal cirrhosis, invades the bile duct
Lab diagnosis & treatment
 Stool examination- unembryonated eggs
 Eggs are present in the bile also, unlike f.buski
which is limited to small intestine
 Bithionol or benzimadazole compound
triclabendazole are the drugs used
 Avoid uncooked acquatic vegetation
PARAGONIMUS
WESTERMANI
 Lung fluke
 Intermediate host-snail, fresh water crabs,
Cray fish
 Biologic vectors-uncooked crabs, Cray fish
 Reservoir host-pigs, monkeys and humans
Life cycle
 Infective stage-metacercariae in the fresh
water crabs
 Larva hatches in the stomach and migrate
 Adult worm resides in the lungs
 Eggs from it released in sputum or feces
Clinical features
 Onset coincides with larval migration-fever,
chills and high eosinophilia
 When it reaches the lung-fever. cough and
increased sputum-blood stained and dark with
eggs(RUSTY sputum),chest pain
 c/c infections lead to fibrosis of lung
 May invade brain and spinal cord-cerebral
paragonimiasis
 Also invades subcutaneous tissue, abdominal
cavity and liver
Lab diagnosis
 Examination of sputum and feces-golden
brown operculated eggs
 Chest xray-pleural effusions,cyst,infiltrates
 Eosinophilia
Treatment
 DOC-praziquantel
 Avoid consumption of uncooked fresh water
crabs
 Proper sanitation
SCHISTOSOMES(blood flukes)
 S.MANSONI
 S.JAPONICUM
 S.HAEMATOBIUM
 Causes-schistosomiasis/bilhariasis/snail fever
 Separate male and female flukes
 Intermediate host-snail
 Reservoir host-rodents, domestic pets, live
stock, humans
 Eggs do not have operculum.
 Infective stage- cercariae
 S.mansoni and japonicum- mesenteric veins
and produce intestinal amoebiasis
 S.hematobium – veins around the urinary
bladder and causes vesicular schistosmiasis.
Life cycle
Clinical features
 Earliest symptoms- penetration of cercaria
though the skin- pruritic rash
 Onset of oviposition-katayama syndrome-
fever,chills,cough,urticaria,arthralgia,lymphad
enopathy,splenomegaly,abdominal pain
 cases- granulomas and fibrosis
S.MANSONI
 EGGS-
o Oval and have a sharp lateral spine.
 Dermatitis with allergic
reaction,pruritis,edema
 In lungs-cough
 Liver-hepatitis
 Intestinal-abdominal pain,diarrhoea,tenderness
of liver
 c/c cases-hepatosplenomegaly with large
accumulations of ascitic fluid in pleural cavity
 Gross examination-liver-pseudotubercles
(white granulomas)
 Clay pipe stem fibrosis- fibrous tissue
reacting to the eggs in liver surrounds the
portal vein in a thick and grossly visible layer
Lab diagnosis
 Demonstration of eggs
 DOC-praziquantel
 Schistosomal dermatitis and katayama
syndrome –treated with administration of
antihistamines and steroids
 Improved sanitation
S.JAPONICUM
 EGGS- spherical, tiny spine
 Clinical features same as mansoni
 Frequently involves the CNS-
granulomas,lethargy,speech impairment,
visual defects, seizures
 DOC-praziquantel
S.HAEMATOBIUM
 Mainly in the Nile valley
 Develops in the liver and migrates to
vesical,prostatic,uterine plexus of venous
circulation
 Eggs-sharp with a terminal spine
 Eggs may be seen in urine
 Reservoir hosts-monkeys,baboons,chimpanzees
 Initial features are similar to others
 But also has hematuria,dysuria,urinary
frequency
 Develops obstructive uropathy in the end stage
 May show squamous cell carcinoma of bladder
 DOC- praziquantel
Cercarial dermatitis
 Swimmers itch-non human cercaria produce
dermatitis, but they cannot develop in the
human host
 Can lead to secondary bacterial infection
 Treatment-oral trimeperazine, topical
antihistamines