Trematodes

 Belongs to the species of Digena

 Complicated life cycle involving
alteration of generations and host
 Sexual reproduction in adult is followed
by asexual reproduction in the larval
stages in snails
 Most flukes which parasitized man are
also animal parasites and their non-
human vertebrae host, serves as
reservoir host for human infection
 General features
 Flat, leaf like, elongated and non segmented
 Varies in sizes 1 mm to several cm
 Covered by non cellular integument with or
without spines or tubercles
 Integuments plays an important role in the
absorption of carbohydrates and for secretion of
excess metabolites in the body.
 Oral sucker is situated at the anterior end of the
worm and in most species a larger ventral sucker
or acetabulum is located on the ventral surface
posterior to the oral sucker.
 Digestive system is incomplete
 Mouth with no anus
 Muscular globular pharynx extends
from the mouth in the oral sucker to
a short narrow esophagus
 Intestine maybe branched, dendritic
or simple
 Excretory system includes diffusely
scattered flame cells or solenocytes,
capillaries, collecting tubules,
bladder and excretory pore.
 The terminal flame cell is a hollow
cell with tuft of cilia.
 Primitive nervous system includes
two lateral ganglia in the region of
pharynx connected by dorsal
commisures.
 From each ganglia, arise anterior and
posterior longitudinal nerve trunks
connected by numerous commisures.
 Parasitic trematodes are hermaphroditic except
blood flukes
 Male reproductive organ includes conspicuous
testes usually two except in blood flukes.
 Testes are located in the posterior half of the body
and may vary in shape depending on the specie.
 Female reproductive organ includes a single ovary
which may vary in shape and is usually smaller
than the testes, oviduct, seminal receptacle and
vitelline ducts and glands.
 Ova maybe mature or immature
 Consist of vitelline cells, vitelline
membrane and a shell.
 Appearance and shape are
reasonably constant and diagnostic
for each specie
 Most operculated except blood
flukes.
 Life cycle
 All trematodes requires two intermediate host
to complete its life cycle except blood flukes
 Definitive host is usually a vertebrae and the
intermediate host maybe mollusk, fish, water
plants.
 Life cycle includes
 Egg stage
 Larval stages( miracidium, sporocyst, redia,
cercariae, metacercariae )
 adult
 The definitive host, generally man harbors the adult
worm and the first intermediate host usually a fresh
water snail or mollusk harbors the larval stage.
 The second intermediate host which maybe a fish,
another snail, crab or vegetables is required for
encystment and harbors the infective larval stage.
 In order to invade the definitive host, the
metacercariae in the secondary intermediate host
present in fish, crustaceans, and plants must be
ingested or the cercaria must penetrate the skin of
man.
 Variations in the pattern of life cycle
includes the following:
 More than one generation of sporocyst
or rediae
 Deletion of either sporocyst or radial
generations.
 Absence of metacercarial stage.
 Ova
 Fully embryonated or nearly at the time
they are discharged from the body
( schistosomes, clonorchis, opistorchis, and
heteropyids )
 May hatch soon upon contact with water
(schistosomes )
 May hatch upon ingestion by intermediate
host (opistorchis, clonorchis, heteropyids)
 May require a period of embryonation after
deposition in water ( fasciola, fasciolopsis,
paragonimus, echinostoma )
Life cycle of monoecious
fluke
 Adult( liver, intestine, lungs )
 Eggs released in the environment( mature or
immature )
 Miracidium
 Enters snail 1st intermediate host
 Sporocyst
 Rediae
 Cercariae
 Enters 2nd intermediate host
 Encyst as metacercariae
 Ingested by final host
 Encyst in in the duodenum
Life cycle of blood flukes
 Adult ( mesenteric vein )
 Mature eggs pass out in feces or urine into
the water
 Miracidium
 Enters the 1st intermediate host
 Sporocyst 1
 Sporocyst 2
 Cercaria
 Cercaria
 Skin penetration
 Blood circulation
Classification of
Trematodes
 According to habitat
 Portal vein
 Schistosoma japonicum- oriental blood fluke
 Schistosoma haematobium- vesical blood fluke

 Schistosoma mansoni- Manson’s blood fluke

 Lungs
 Paragonimus westermani- oriental lung fluke
 Liver and bile passage
 Fasciola hepatica- giant or sheep liver
fluke
 Clonorchis sinensis- chinese or oriental
liver fluke
 Opistorchis felineus- cat liver fluke
 Intestine
 Fasciolopsis buski- giant intestinal fluke
 Echinostoma ilocanum- garrison’s fluke

 Heterophyds
 Heterrophyes heterophyes
 Metagonimus yukogawai
According to the types of
eggs
 Mature
 Schistosomes
 Clonorchis
 Opistorchis
 Heterophyds
 Immature
 Paragonimus
 Fasciola
 Fasciolopsis
 echinostoma
 Fasciola hepatica
 Giant liver fluke/ sheep liver fluke
 Largest fluke infecting man
 Large leaf-like 20-50mm length and 6-
12mm in width
 With cephalic cone and a characteristic
shouldered appearance
 Two small suckers with equal size
 Intestinal ceca are highly branched or
dendritic
 Fasciola gigantica a elated specie infects
cattle water buffalo and carabao is more
larger and more lanceolate. Shorter
cephalic cone, less developed shoulders,
and a larger ventral sucker with more
branched intestinal ceca.
 Ova is large, operculated, yellowish brown
and a well rounded posterior end. Hen-
egg shaped.
 Life cycle
 Adult in the biliary tract
 Immature eggs passed out in the feces
 Eggs mature in the water 9-15 days
 Miracidium hatch in water
 Enters the 1st intermediate host ( lymnae
philippinensis, lymnae swinhoe, and
lymnae truncatula )
 Sporocyst
 Rediae 1
 Rediae 2
 cercariae
 Free living cercariae leaves the snail
 Cercariae encyst on the surface of the 2nd
intermediate host ( water cress, ipomea
obscura, ipomea reptans
 Man ingest plants with metacercariae
 Metacercariae encyst in the duodenum,
migrate into the intestinal wall, peritoneal
cavity, and liver capsule
 Adult in the biliary tract.
 Lymnae

 Water cress
 Pathology and diagnois
 1. acute or invasive phase
 Dyspepsia
 Anorexia
 Sweating
 Violent headache
 Nausea, vomitting, and urticaria
 Onset high fever
 Enlargement of liver
 Marked eosinophillia
 Latent or invasive phase
 Obstruction of bile ducts
 Adults cause obstruction in the bile
ducts causing inflammation stimulating
pipestem fibrosis
 Halzoun or pharyngeal fasciolopsis
results to ingestion of raw sheep, goat
liver containing the adult that results to
suffocation
 Diagnosis
 Recovery of eggs in the stool
 Bithionol is the drug of choice
 Clonorchis sinensis
 Chinese liver fluke/ oriental liver fluke
 Parasite of fish eating mammals and man
 Flat , elongated and transparent gray worm
 8-25mm by 1.6-6mm
 Ventral sucker is smaller than the oral sucker
 Long intestinal ceca, considered as simple and
extending to the posterior end
 Two deeply branched testis
 Single ovary located anterior to the testis
 Light yellowish brown egg
 The convex operculum rest in a rim with
distinc shoulder
 At the thicker posterior end or
aboperculum is a small protuberance.
 Egg is similar to an old fashioned electric
bulb
 Reported about 4,000 eggs are released
per day
 Life cycle
 Adult in biliary tract
 Mature egg passed out with the feces
 Enters the 1st intermediate host
( parafossarulus manchoricus, fresh water
snails )
 Miracidium hatch
 Sporocyst
 Rediae
 Cercaria
 Free swimming cercaria
 Enters 2nd intermediate host
( ctnopharyngodon idellus, caridina
nilotica gracilipes )
 Metacercaria
 Ingestion of insufficiently cooked
infected fish
 Fresh water snail

 Cardina nilotica
 pathology
 Eggs are associated in the formation of gall
stones
 Fatigue, weakness, weight loss, abdominal
distress, and altered appetite. Fever
enlargement and tenderness of liver and
eosinophilia are symptoms of acute
infections.
 In heavy infection- liver enlargement, slight
jaundice, edema and diarrhea develops.
Diagnosis and treatment
 Eggs in the feces
 Immunologic test and liver scan is
useful
 Praziquantel is the drug of choice
proven to be most effective
 Opistochis felineus
 Cat liver fluke
 Lives in the biliary passage and infects
several species of fish eating mammals.
 Reddish-yellow about 7-12mm by 1.5-
3mm lancet shaped
 Simple intestinal ceca
 Testes are lobate and arranged obliquely
 Single lobed ovary
 Smaller oral sucker than ventral
 Eggs is yellowish brown
 Operculum that sits on a thickend
rim and a minute aboperculum is
also present
 Life cycle
 Adults in biliary passage
 Egg containing miracidium passed out in
the feces
 Ingested by 1st intermediate host
( bithynia leachl )
 Releases miracidium
 Sporocyst
 Rediae
 Cercariae
 Penetrate to the 2nd intermediate host
( idus melanotus, tinca tinca,
cyprinus carpio, barbus barbus )
 Develops into metacercariae
 Ingested by definitive host
 Duodenum and into the bile passage
 Bithynia leach

 Cyprinus carpio
 pathology
 Enlargement of the liver
 Massive congestion of the spleen
with icterus and eosinophilia
 In heavy infection worms can be
found in the pancreas and gall ladder
 Digestive disorder
 Bile stones
 Carcinoma of the bile ducts
Diagnosis and treatment
 Detection of eggs in the stool
 Praziquantel is the drug of choice
Paragonimus westrmani
 Oriental lung fluke
 Reddish brown with spinous cuticle
 7-12 by 4-6 mm with equal oral and
ventral suckers
 Simple intestinal ceca
 2 lobed testes and 6 unbranched
lobes
 Ova are immature golden brown
 Life cycle
 Adults in the lungs
 Eggs passes in the stool /feces
 Eggs mature in water, miracidium hatch
 Miracidium penetrates the 1at I.H.
( antemelania asperata/brotia aspirata and
antemelania dactivius )
 Sporocyst
 Rediae 1
 Rediae 2
 cercariae
 Leaves I.H. /free living
 Penetrate the 2nd I.H. ( Sundathelpusa
philippina/ parathelpusa gnapsoides )
 Ingestion of the 2nd I.H.
 Encyst in S.I. migrate in the
abdominal cavity
 lungs
Pathology and diagnosis
 Development of fibrous capsule with
eggs
 Bloodstained rusty brown sputum
 Hemoptysis
 Fever, sweating, chest pain
 Sputum analysis, bronchial washing
 Praziquantel, emetine HCl, bithionol
 Fasciolopsis buski
 Giant intestinal fluke
 20-70 by 8-20 mm
 Elongated and ova in shape
 Resembles F. hepatica but it does not
have cephalic cone.
 Simple intestinal ceca
 2 testes 1 ovary both branched
 Ova is yellowish and ellisiodal with both
ends operculated
 Life cycle
 Small intestine
 Undeveloped ova pass out in the feces
develop in 4-7 weeks
 Miracidium released penetrate the 1st
intermediate host ( segmentina trocholdeus or
hippeutis umbilicalis )
 Sporocyst
 Rediae1
 Rediae 2
 cercariae
 Cercariae leaves the 1st I.H and
encyst on the 2nd I.H. ( trapa bicornis
( water caltrop ) ellocharis tuberosa (
water chestnut ) ipomea aquatica
( water morning glory ) ) and encyst
as metacercariae
 Ingestion of man
 Parasite in the small intestine
 Ipomea aquatica
Pathology and diagnosis
 Traumatic- inflammation and ulceration at the
site of attachment resulting to increase mucus
secretion and minimal bleeding. Epigastric
pain, nausea, and diarrhea may occur
especially in the morning.
 Obstructive- leads to edema and partial
intestinal obstruction due to large worm
 Toxic- due to the absorption of the metabolite
of the worm and other excretory products
resulting to generalized toxic and allergic
reactions
 Diagnosis is through stool analysis
 Praziquantel, niclosamide,
tetrachloroethylene, hexylresorcinol
and dichlorophen are the drugs of
choice.
 Echinostoma ilocanum
 Medium sized flukes
 Unique due to the presence of collar or spines
around the oral sucker
 Reddish gray 2.5-6.6 by 1-1.5 mm
 The anterior end is provided with a horseshoe
shaped collar of spines with 49-51 spine in two
rows
 Oral suckers lies at the center of the disk
 Testes are bilobe in tandem formation while ovary
is globular and located anterior to the testes
 Life cycle
 Adult in the small intestine
 Immature eggs pass out in the feces
 Eggs matures in 6-15 days
 Miracidium hatch
 Penetrate the 1st I.H. ( gyraulus convexlusculus or
hippeutis umbilicalis )
 Rediae 1
 Rediae 2
 Cercariae ( free swimming )
 Penetrates the 2nd I.H. pila luzonica
 metacercarie
 Ingested by man
 hippeutis
umbilicalis
 Pathology, diagnosis and
treatment
 Inflammation on the site of attachment
 Heavy infection manifest diarrhea and
bloody stools and abdominal pain
 Recovery of eggs in the stool is
diagnostic
 Praziquantel and hexylresorcinol are
the drugs of choice
 Heterophydiae family
 Heterophyes heterophyes- Von
Siebold’s fluke
 Metagonimus yukogawai
 Haplorchis taichu
 Heterophyes heterophyes
 Grayish and smallest fluke in man 1.3-
0.5 mm
 Oral sucker is very small and large
ventral sucker
 Two testes are ovoid side by side in the
posterior fifth of the body.
 Subglobuse ovary is anterior to the
testes.
 Metagonimus yokogawai
 1.4-0.6mm
 Large ventral sucker situated to the right of
the midline.
 Two unequal oval testes arranged obliquely
side by side and situated in the posterior
third of the body
 Globuse ovary is situated at the junction of
the middle and lower third of the body.
 Haplorchis taichu
 Provided with a large ventral sucker,
aglobuse ovary and only one testes.
 Eggs
 Light yellow brown in color
 Ovoidal, opeculated and minute
 Shell has a slight shoulder at the rim of the operculum
and sometimes a knob at the posterior pole maybe
observed
 Fully developed miracidium is already present within the
egg when it is deposited by the adult worm. Sporocyst
 Rediae 1
 Rediae 2
 Cercariae ( free living in water )
 Life cycle
 Adults in the small intestine
 I.H.
 H. heteophyes- pironela conica
 M. yukogawai- thiara and hua

 H. taichu- thiara riquetti

 thiara
 2nd intermediate host where it will
become metacercarie
 H. heterophyes- mugil, acanthogobius
 M. yukogawai- salmo, richarsonlum,
odontoburis
 H. taichu- ambassis burensis, claris
batrachus, gerris kapas, therapon
plumbeus
 Mugil

 salmon
 Ingestion of the 2nd I.H.
 Parasites in the intestine
 Pathology, diagnosis and
treatment
 Inflammation at the site of attachment
 Abdominal pain and mucoidal diarrhea
 Eggs filtered in the heart muscle may leads to
cardiac failure that resembles beri-beri
 Eggs in the brain may result in fatal cerebral
hemorrhage
 Eggs in the spinal chord results to loss or motor and
sensory functions at the level where the lesions are
located.
 Diagnosis is by recovery of eggs in
the stool
 Praziquantel and tetrachloroethylene
are the drugs of choice.
 Schistosomes
 Schistosoma japonicum
 Oriental blood fluke
 Inhabit superior mesenteric veins of the small intestine
 Intestinal and hepatic schistosomiasis, schistosomiasis
japonicum or Katayama disease
 Provided with smooth tuberculation
 Male has 6-9 testes
 The ovary lies somewhat behind the mid plane of the body
and the uterus can have 50 eggs at one time
 Ova with lateral knob
 Schistosoma mansoni
 Manson’s blood fluke
 Mesenteric vein of the large intestine

 With coarse tubersulation

 Males has 6-8 testes

 Ovary is situated on the anterior half of

the body
 Short uterus with 20-40 eggs.

 Eggs with prominent lateral spine

 Schistosoma haematobium
 Vesical blood fluke
 Portal vein of the urinary bladder
 Provided with fine tuberculation
 Ventral sucker is larger than the oral sucker
 4-5 testes and the ovary is posterior located for
the female
 20-100 eggs in the uterus
 Elongated, non opeculated light yellowish
brown with distinct terminal spine
 Life cycle
 Adult in their respective habitat
 Pass out in the urine or feces
 Immediate release of miracidium upon contact in
water
 1st I.H. S. Japonicum- onchomelania quadrasi, S.
haematobium- biomphalaria, tropicorbis and
bullinus, biomphalaria and physopsis for S.
haematobium
 Sporocyst 1
 Sporocyst 2
 cercariae
 Oncomelania
quadrasi

 bulinus
 Cercariae penetrates the skin of the
definitive host
 Parasites goes to their respective
habitat.
 Pathology
 S.japonicum and S. mansoni
 Pruritus and rashes at the site of entry
 Pneumonitis ( pulmonary
schistosomiasis )
 Eggs in the tissues may cause irritation
and formation of ulcers in the mucosa
 Ulceration is responsible for diarrhea or
dysentery seen in acute infections
 Granuloma of affected tissue
 S. haematobium
 Lesions in the urinary bladder, genitalia
( seminal vesicle, vulva, cervix and
vaginal wall )
 Uric acid, oxalate crystals, phosphate
deposits, eggs, blood clots, mucus and
pus maybe present in the urine.
 Hematuria

 Painful micturation
 Diagnosis
 S. japonicum and S. mansoni
 Direct fecal smear
 Kato-katz or concentration technique

 COPT and ELISA

 S. haematobium
 Recovery of drugs in the urine
 Treatment
 Praziquantel and niridazole are the
drug of choice