General characteristics

• collectively called the FLATWORMS

• They are usually leaf shaped, oval, elongated
• dorsoventrally flattened, bilaterally symmetrical
• Size ranges from nearly microscopic to over 60 meters in
length.
• They are covered by a membrane called tegument
(microvilli that absorbs food from the host’s intestine)
• Body is covered by 3 layers of tissue with organs and
organelles
• Head is provided with sensory organs
• Body contains no internal cavity
• They do not have circulatory, respiratory, skeletal
system, digestive system is incomplete while
absent in others , lacks an anus. (flame cell-
protonephridium)
• They are hermaphrodite(sexes are combined in a
single organism), except for Schistosoma species
• Because of their elaborate nervous system, they
are found in a wide variety of habitat. ( lakes,
streams, ponds, ocean sediments from pole to
pole, moist terrestrial environments.)
Cross sectional diagram of flatworms
Cross sectional diagram of flatworms
Class Cestoda
• Adult worm inhabit the small intestines of
vertebrates while the larvae parasitize different
classes of vertebrates and invertebrates
• Digestive system absent, food is acquired through
absorption from the host’s intestine.
• Ribbon like or tape like segmented parasites
varying in size from a few mm. to several meters
• Body consist of 3 distinct regions :
 HEAD or SCOLEX= organ of attachment provided with
suckers (bothrium or acetabulum), rostellum (armed
w/ hooklets or unarmed)
  NECK= which is the region of growth (immature
proglottids)
 STROBILA or BODY= which consists of series of
segments (PROGLOTTIDS) . These are complete
reproductive unit. Composed of 3 regions: Immature,
Mature, Gravid.
• Most require Intermediate host to complete their life
cycle
• Life cycle includes: Egg stage- Hexacanth embryo(
Oncosphere), The Larval stage(Coracidium,
Procercoid, Plerocercoid, Cysticercoid, Cysticercus
larva) and the Adult stage
3 types of proglottid:
• immature – undeveloped sexual organ,
nearest to the neck
• mature – fully mature sexual organ
• gravid – contains fertilized egg, undergoes
apolysis
• Apolysis- normal process of detachment of the
gravid proglottid from the adult worm
Adult worm Egg
General structure of Tapeworms
General anatomy of tapeworms
Order Pseudophyllidea-scolex
spatulate with bothria
• Diphyllobothrium latum
• Scolex segments-
Genital pore + uterine pore
Order Cyclophyllidea-scolex globular
with 4 cup like suckers
• Scolex segments- no
uterine pore undergo apolysis
 Ova
Pseudophyllidea Cyclophyllidea
EGGS EGGS
Operculated, Immature, requires aquatic Passed out readily with hexacanth embryo
vegetation to develop
 Class Cestoda
• Species which require vertebrate I.H.
– Taenia solium
– Taenia saginata
• Species which require Invertebrate I.H.
– Hymenolepis diminuta
– Dipylidium caninum
• Species which may or may not require I.H.
– Hymenolepis nana
• Species which infect man and their larval stage
– Echinococcus granulosus
– Taenia solium
– Diphyllobothrium latum
Diphyllobothrium latum
• “ Broad or Fish tapeworm”
• World wide in distribution, occurring in Northern
temperate areas of the world where pickled or
insufficiently cooked fresh-water fish are
prominent in the diet.
• High prevalence rate in humans is seen in
Scandinavia, Finland, Alaska, Canada, Japan
• Fish-eating mammals such as wild and domestic
members of the dog and cat families, bears,
minks, pigs, walruses and seals.
Life cycle
• Infective stage- Plerocercoid Larva
• Definitive host- Man, dog, cat and other fish
eating mammals
• 1st Intermediate host- copepod
• 2nd Intermediate host- Fresh-water fish
• Stage in man- Adult worm
• habitat in host- Small Intestine
 Morphology
Adult worm
• Long, Tape-like, grayish yellow
• 3-10 m in length
• SCOLEX- elongated, spoon shaped
(spatulate), with 2 longitudinal grooves
(bothria). With 2 suckers
• PROGLOTTIDS- 3000-4000. mature are
broader than long. Uterus is centrally
located and rosette shaped. Genital pore is
located in the middle.
Ova
• 70 x 50um in diameter
• has thin double contoured shell with a lid(
operculum) at one end which may or may
not be open.
• yellowish brown in color
• Ripe eggs escape through the uterine
pore and are discharge into the intestine.
D. latum
D. latum
 Pathology
Disease Clinical features- S&S Dx test T/P/C
Diphyllobothriasis • Majority asymptomatic • DFS – • Niclosamide
• vague abdominal demonstration of • Praziquantel
discomfort, diarrhea, eggs + proglottids
Ingestion of nausea, weakness • Serologic test- ELISA • cooked fish
larvae in fresh- • proximal portion of the • CT/ MRI- cerebral properly, brine
water fish jejunum- tapeworm • Biopsy cured or frozen at
pernicious anemia due neg.10° C for 24-
to Vit. B12 deficiency ( 48 hrs.
absorbed by the worm) • cooked animal
• SPARGANOSIS- meat properly
drinking water • use of potentially
containing copepods infected animals
(procercoids). Larva for medicinal
penetrates the intestine purpose must be
and find its way into the discourage
muscle or subcutaneous • avoid drinking
tissue to grow into a contaminated
SPARGANUM larva- water
Pathology of spraganosis

• Sparganum larva- is a wrinkled, whitish, ribbon-shaped

organism, a few mm wide and up to several cm. long
• Early migratory stage are asymptomatic but when it
reached its final site and begins to grow, its presence
elicit a painful inflammatory reaction in the
surrounding tissue
• Eyes-ocular sparganosis; intense pain w/ periorbital
edema
• CNS-cerebral sparganosis; seizures, paresthesias,
hemiparesis
• Surgical removal of the larva- for Dx purposes
Dipylidium caninum
• “Dog and Cat flea tapeworm”
• Common parasite of domestic dogs and cats all
over the world
• Occasionally found in humans, particularly small
children
• Larva is known as cysticercoids
• The cysticercoid develops when the eggs/ova is
ingested by the cat/dog flea larva and retained
until it becomes an adult flea
D. caninum
• Infection takes place due to accidental ingestion
of fleas who kiss or are licked by their infected
pets.
• The gravid proglottid migrates to the anus and
remain on the exterior to contract and expand
releasing the packets of eggs in the anal area.
• larval fleas will then ingest the ova’s
• Definitive host= dogs, cats, man
• Intermediate host= Fleas
Life cycle
 Morphology
Adult worm Ova
• pale, reddish tape-like worm • spherical, thin hyaline shell
• 20-40 cm in length (ave. 15 cm) • 23-40 um in diameter
• SCOLEX- small 250- 500 um in diameter, • hexacanth embryo
bears 4 suckers with retractile rostellum,
armed with 3-4 rows of hooks shaped like
a rose thorns. Neck is short and thin
• PROGLOTTIDS- mature are longer than
they are wide- vase-like or pumpkin seed
shaped containing 2 sets of reproductive
organs. Gravid are shaped like the mature
segment (barrel like) and are filled with
polygonal uterine blocks- egg packets
containing 8-15 eggs enclosed in an
embryonic capsule/membrane.
Adult worm Ova
Adult worm I.H.
 Pathology
Disease Clinical features (S&S) DX test T/P/C

Dipylidium • Asymptomatic • DFS- • Niclosamide

infection • abdominal pain, diarrhea
• Anal pruritus- proglottids
Zoonoses are motile when freshly
Ingestion of pass and might be mistaken
infected Dog or for maggots or fly larva.
Cat flea. • animals will scrape their
anal region in grass or
Ctenocephalides carpet to relieve itchiness.
canis / felis
demonstration of • Praziquantel
egg packets or
proglottids in
stool • Periodic deworming
of dogs and cats
• maintenance of dog
and cat hygiene.
Hymenolepis spp.
Hymenolepis nana Hymenolepis diminuta
• “dwarf tapeworm”- small • “Rat tapeworm”- Thread
thread like like flatworms
• Common parasites of house
mouse • Commonly parasites of rats
• World wide infection • World wide infection
• Infection is seen most • Requires an arthropod I.H.
frequently in children but can to complete its life cycle
occur in adults as well
• May not require I.H. to
complete its life cycle.
 Morphology
Characteristics H.nana H. diminuta

Adult worm • 1-4 cm-L x 1mm in width • 10-60 cm-L X 4mm in width
 Morphology
Characteristics H. nana H. diminuta

Scolex • globular with 4 suckers-0.3 mm • globular with 4 suckers- 0.2-

in diameter 0.4mm in diameter
• provided with retractile • provide with unarmed rostellum
rostellum armed with single row
of 20-30 hooklets
 Morphology
Characteristics H. nana H. diminuta

Proglottids • up to 200 •800-1000

• MATURE • Broader than long, 3 testes • Broader than long, 3 testes
• UTERUS • Irregular sac-like • Irregular sac-like
• GENITAL PORE • Lateral, on same side • Lateral, on same side
 Morphology
Characteristics H.nana
Ovum • broadly ovoid, covered with a
(Oncosphere) thin, hyaline smooth outer shell.
• Inner thick membrane with polar
thickenings or knobs from which
project 4-8 long, thin polar
filaments. (differential features
from H. diminuta)
• The embryophores contain 6
hooklets arranged in fan shaped
pattern (3 pairs)- Hexacanth
• Eggs are release as the gravid
segments disintegrate, which
measure 30-45 um in diameter
H. diminuta
• Has a thick yellow outer and
colorless (fine concentric
straitions) inner membrane with
a granular intermediate layer.
• Has no polar filaments
• Embryophore contain 6
hooklets arranged in fan shaped
pattern (3 pairs)- Hexacanth
• Eggs are larger, which measure
60-79 x 72-86 um in diameter.
Life cycle- H.nana
Life cycle – H. diminuta
Ova (Oncosphere)
• H. nana
Ova(Oncosphere)
• H. diminuta
Cysticercoid larva
H. nana
• Infective stage=
Oncosphere/Cystecercoid
larva
• Definitive host= Rats, mice,
and man
• Intermediate host= (can be
optional)Flea , grain or flour
beetle, cockroaches.
• Stage in man= Adult or Larva
• Habitat= Small Intestine
H. diminuta
• Infective stage=
Cystecercoid larva
• Definitive host= Rats, mice,
man , and dogs
• Intermediate host= Flea,
grain or flour beetle,
cockroaches.
• Stage in man= Adult
• Habitat= Small Intestine
 Pathology
Disease Clinical features S&S Dx test T/P/C

Hymenolepiasis • Asymptomatic • DFS- demonstration • Praziquantel

• Enteritis of embryonated eggs • Niclosamide
Ingestion of IH • abdominal pain, in stool (oncosphere) • Nitazoxanide
(diminuta) or headache,diarrhea,
oncosphere (nana) anorexia • maintenance of
personal hygiene
Oriental rat flea- • Environmental
Xenopsylla cheopis sanitation. (pest and
Dog flea- insect control)
Ctenocephalides canis • Proper storage of
Human flea- Pulex grain and cereals,
irritans especially those
Flour beetle- Tenebrio consumed w/ out
or Tribolium cooking
Sawtoothed grain • proper disposal of
beetle- Ahasverus feces
advena
Intermediate host
• Rat flea/ Human • Flour beetle/ Grain
flea(2.5 mm) beetle(3-4mm)
Taenia spp.
Taenia solium
• “Pork tapeworm”
• Occurs when people eat cured
or undercooked pork
• Prevalent in Mexico, Latin
America, Slavic countries,
Africa, SE Asia, China
• I.Host= Pig, Man, dogs, bears
• D. Host= Man
• Stage in Man= Adult or larva
• Habitat= Small Intestine
• Infective stage= Cysticercus
cellulosae
Taenia saginata
• “Beef tapeworm”
• Worldwide distribution
• Acquired through ingestion of
raw or undercooked beef
• Frequent infections occur in the
US
• Life cycle similar to T. solium
• I. Host= Cow
• D. Host= Man
• Stage in Man= Adult
• Habitat= Small Intestine
• Infective stage= Cysticercus bovis
 Morphology
Characteristics T. solium T. saginata

Adult worm • whitish or creamy white, tape- • White and semi-transparent

like worm • 5-10 m but can reach up to 25 m
• 2-5 m but can reach up to 10 m
 Morphology
Characteristics T. solium T. saginata

Scolex • globular with 4 cup-like suckers • Quadrate with 4 cup-like suckers

• 1mm in diameter • 1-2 mm in diameter
• rostellum armed with 25-30 • no rostellum
hooklets
Cysticercoid
• Eggs ingested penetrate IW and enter blood
stream( hooklets) lodge in any tissue-
voluntary muscles ( CNS-brain, eyes)
• Complete its development in about 2 months
• semitransparent, opalescent white, and
elongate in shape, measures 8-10mm x 5mm
in diameter
• Scolex bears suckers and hooklets
Cysticercus cellulosae-Bladder worm
C. cellulosae in different parts of the
body
Orbit(eyes)
Subarachnoid Brain
 Morphology
Characteristics T. solium T. saginata

Proglottid • 800-1000 • 1000-2000

• MATURE • Longer than broad, 12 mm x 6 • Longer than broad
• GRAVID mm • 15-30 lateral uterine branches
• GENITAL • 7-13 lateral uterine branches • Lateral alternate sides ,irregular
PORE • Lateral alternate sides ,irregular • Apolysis- singly ( 80K eggs )
• Apolysis- in chains (30-50 K eggs)
 Morphology
Characteristics T. solium T. saginata

Ovum • spherical, yellow to brown in • resembles T. solium ova

color with a thick radially straited • Indistinguishable from each other
embryonic shell
• oncosphere with 3 pairs of
hooklets (Hexacanth)
• 31-43 um in diameter
Life cycle- Taenia spp.
Life cycle- Taenia spp.
 Pathology
Disease Clinical features S&S Dx test T/P/C
Taeniasis • Asymptomatic • DFS- demonstration • Albendazole w/
• Vague abdominal of embryonated eggs Dexamethasone
Ingestion encysted discomfort- in stool (oncosphere) increase the
larva in muscle tissue abdominal pain, or proglottids effectivity in
of pork/beef hunger pangs, chronic subarachnoid
indigestion cysta(brain)
Criteria for successful • anorexia, nausea •X-ray, CT scan, MRI • Praziquantel-
TX= recovery of •Reverse peristalsis- parenchymal cyst
scolex+ negative stool carry egg in the upper • surgical removal
sample 3 months after portion of duodenum
Tx. • proper cooking of
• Bladder worm- meat
Cysticercosis encystment of the • freezing -5°C for 4
Ingestion of eggs larva in the muscles, days, -15°C for 3 days
CNS-brain, eyes, or -24°C for 1 day kills
only for T. solium subcutaneous tissue the larvae
•Siezures,Hydrocephal • proper disposal of
us, visual problems feces to prevent
contamination of
Taeniasis
Taenia asiatica (Asian Taenia)
• First reported in Taiwan in 1980. Korea, China,
Philippines, Thailand , Malaysia, and Indonesia
• Raw or undercooked pork
• Does not produce cysticercosis in humans.
• Morphologically and genetically similar to T. saginata
• Cysticerci develop in the liver and other viscera of pigs
and not in the muscle
• Infects a range of I.H.= goats, monkey, wild boar, swine,
cattle
• D.H= Man
Scolex Proglottid
Echinococcus granulosus
• “Hydatid worm”
• Smallest tapeworm- scolex, a short neck and 3
proglottids
• causes Hydatid cyst that develops in the different
organs and tissues of the host
• 2 different life cycles- PASTORAL and SYLVATIC
• a serious infection in sheep-raising areas of
Australia, New Zealand, North and South
America, Europe, Asia, and Africa
• Goats, camels, reindeer, and pigs, together with
dogs maintain the cycle in various parts of the
world.
• Humans are infected when they accidentally
ingest the eggs, usually as a result of fondling
dogs.
• D.Host= dogs, wolves or other carnivores
• I.Host= man, sheep, horses, goats, cattle, pigs
• Stage in man= Larva
• Location in man= Various organs
 Morphology
Adult worm
• small tapeworm measuring 3-
6 mm in length
• It has 3 segments
• SCOLEX- globular- 0.6 mm in
width with 4 cup like suckers.
Rostellum bears a double crown
of 28-40 hooklets
• PROGLOTTID-
• immature- longer than broad
with immature reproductive
organs
• mature- longer than broad.
Consist of 43-65 pyriform testes
with irregular ovaries at the
posterior portion
• Gravid- 2-3 mm in L X 0.6mm
in width- biggest segment.
Median uterus w/ 12-15 lateral
pouches filled w/ ova
Hydatid cyst Ova
• INFECTIVE LARVA • similar to Taenia spp. ova
• embryo develops slowly into
a cyst reaching a diameter of
1cm in 5 mos. Reach 20 cmin
diameter
• spherical in shape- external
laminated cuticle (ectocyst).
Inner germinal layer
(endocyst) –masses of cells
grow into the cavity of the
cyst. Become vacoulated-
Brood capsules containing
Protoscolices bud from the
inner wall. Daughter cyst
appear w/in the hydatid.
• HYDATID SAND- found in
older cyst that contains
granular materials of free
protoscolices, daughter cyst
Adult worm
Scolex
Hydatid cyst
Ova Hydatid cyst
Life cycle
 Pathology
Disease Clinical features S&S Dx Test T/P/C

Echinococcosis • Effects may not • X-ray, Ct scan, MRI • Albendazole

( Hydatid disease) become apparent for • Serologic test- • Praziquantel
many years after ELISA & IHA • Ivermectin
Ingestion of Eggs infection bec. of its • surgical removal
usual slow growth. • aspiration of
(20 yrs.) hydatid fluid
• primarily affects
the liver, lungs, brain, • maintenance of
bones, and other personal hygiene
organs • avoid close contact
with dogs
• proper disposal of
dog feces
E. granulosus
Radiographic slides
END of Cestodes
Class Trematoda- Flukes
• Digenetic flukes- are among the most
common and abundant of parasitic worms
• Second only to nematodes in their distribution
• They are parasites of all classes of
vertebrates, especially marine fishes, and
nearly every organ of the vertebrate body can
be parasitized by some kind of trematode, as
adult or juvenile
• Flat, unsegmented worms
• Leaf-like organisms
• Incomplete digestive tract
• Oral sucker (nourishment)
• Ventral sucker or acetabulum (for attachment)
• Most are hermaphrodite,except Schistosoma
• Oviparous worms-operculated that requires aquatic
environment for embryonation. except Schistosoma
• require 2 Intermediate host, except Schistosoma
• Infective stage- Metacercaria. except Schistosoma
General Morphology
• Life cycle includes:
– Egg stage
– Larval stage- miracidium, sporocyst, redia,
cercaria, metacercaria
– Adult stage
• Definitive Host- Man
• 1st Intermediate Host- fresh water mollusc
• 2nd Intermediate Host- fish, crustacean, snail,
plants may be required for encystment
General Life cycle- pg. 167
Classification according to habitat in
Man
A. Species which inhabit the portal
bloodstream of vertebrates (Blood Flukes)
1. Schistosoma japonicum
- skin penetration of cercaria
- Schistosomiasis japonicum or
Oriental schistosomiasis
2. Schistosoma mansoni
3. Schistosoma haematobium
A. Species which inhabit the liver of the
vertebrates (Liver Flukes)
1. Fasciola hepatica (Sheep-Liver Fluke)
- ingestion of metacercaria on waterplants
(Fascioliasis)
2. Clonorchis sinensis (Chinese-Liver Fluke)
- ingestion of metacercaria in fish
(Clonorchiasis)
A. Species which inhabit the liver of the
vertebrates (Liver Flukes)
3. Opisthorchis felineus (Cat liver Fluke)
- ingestion of metacercaria in fish
(Opisthorchiasis)
A. Species which inhabit the small intestine of
vertebrates (Intestinal Fluke)

1. Fasciolopsis buski (Giant Intestinal Fluke)

- ingestion of metacercaria on waterplants
(Fasciolopsiasis)
A. Species which inhabit the small intestine of
vertebrates (Intestinal Fluke)

2. Echinostoma ilocanum
- ingestion of metacercaria from snails
(Echinostomiasis)
A. Species which inhabit the small intestine of
vertebrates (Intestinal Fluke)
3. Heterophyid Group
- ingestion of metacercaria from fishes
(Heterophyidiasis)
• H. heterophyes
• M. yokogawai
• H. yokogawai
• H. taichu
A. Species which inhabit Lungs of vertebrates
(Lung Flukes)
1. Paragonimus westermani (Oriental Lung
Fluke)
- ingestion of metacercaria from crabs
(Paragonimiasis)
 Classification of Ova
• Mature • Immature
Schistosoma Paragonimus
Opithorchis Fasciola
Clonorchis Fasciolopsis
Heterophyids Echinostoma
Schistosoma spp.- pg. 181
• Japonicum- “oriental blood fluke”
• mansoni- “ Intestinal blood fluke”
• heamatobium- “Urinary blood fluke”
• intercalatum- “African blood fluke”
• mekongi-”Mekong river blood fluke”
• They are diecious(separate sexes) with two sexes
are dissimilar in appearance
• The females worms leave temporarily the males
to deposit the eggs in small venules close to the
lumen of the intestine or bladder
 General Characteristics
japonicum mansoni haematobium mekongi intercalatum

• confined to the • Africa, Arabian • occurs in the • occurs in The • occurs in

Far East- China, peninsula and African Mekong river Western and
Taiwan, Japan, Malagasy, Brazil, continent basin in Central africa
Philippines, and Surinam, • it is endemic in southern Laos • resembles
Indonesia Venezuela, the Nile river and Cambodia haematobium
• found in all Puerto Rico, and banks and • resembles
mammals parts of delta, Jordan japonicum
exposed to Caribbean. • Asia minor,
infected water • Has spread in Cyprus,
the Western Southern
Hemisphere due Portugal
to African Slave
trade
Morphology
Adult worm- MALE
Japonicum mansoni haematobium

• elongate, cylindrical in • 6-14 mm x 1.1 mm • 19-15 mm x 0.8-1 mm in

shape, • Integument- grossly tuber diameter
measuring 12-20mm x 0.5- culate • Integument- Fine
0.55 mm in diameter • Intestine long tuberculate
• integument is • Testes- 8-9 and in zigzag • Intestine long
nontuberculate arrangement. • Testes- groups of 4-5 in
• gynecophoric canal is numbers, just behind the
present ventral suckers
• oral and ventral suckers lie
close to each other
• alimentary system consist of
the mouth sorrounded by
oral suckers, esophagus,
intestine that bifurcates in
front of the ventral suckers
and joins again in the last
Morphology
Adult worm- FEMALE
Japonicum
• slender,delicate , and
smooth measuring 26 mm x
0.3 mm
• ovary is in the middle of the
body, with genital pore
behind the ventral suckers
• Uterus- 50-100 eggs at a
time
• Lodge in the gynecophoral
canal of the male worm
• Location- Mesenteric veins
mansoni
• slender,delicate , and
smooth measuring 14 mm x
0.25 mm
• ovary is in anterior half of
the body
• Uterus- 1-3 eggs at a time
• Lodge in the gynecophoral
canal of the male worm
• Location- Mesenteric veins
haematobium
• slender,delicate , and
smooth measuring 20 mm x
0.25 mm
• ovary is in posterior half of
the body
• Uterus- 20-30 eggs at a time
• Lodge in the gynecophoral
canal of the male worm
• Location-Pelvic veins
Male worm
Female worm
Schistosoma worm
 OVUM
Japonicum
• ovoidal to round in shape
measuring 70-100 um x 50-
65 um
• thin shelled and frequently
has a rough beaded outer
surface due to cellular debris
attach to it
• Lateral, short, sometimes
curved spinose knoblike
process
• embryonated when laid
• LOCATION- Veins of
Intestine and rectum
• exit from the host=FECES
mansoni
• Elongate, oval measuring
155um x 60 um
• yellowish brown,
transparent shell
• Lateral long spine
• embryonated when laid
• LOCATION- Veins of colon,
rectum, mesenteric lymph
glands, occasionally bladder
• exit form the host= FECES
rarely URINE
haematobium
• Elongate, oval/ spindle
(rounded ant., Conical pos.)
measuring 112-170 um x 50
um
• light yellowish brown
transparent shell
• Terminal, delicate spine
• Partly mature when laid
with miracidium
•LOCATION- Veins of bladder,
occassionaly rectum, pelvic,
lymph glands
• exit from host= URINE,
rarely FECES
OVUM
Cercaria- infective stage
skin penetration
• Elongate pear shape body
with rounded end and a
long tail that is bifid
• 175-240um x 55-100um
in diameter
• body and tail is covered
with cuticle and minute
spines.
• released into the water
25-30 days after the snail
has been infected
Life cycle
Life cycle
parasite Definitive Host Intermediate
Host

S.haematobium Man, monkey Bulinus spp.

S. mansoni Man, monkey Biomphalaria

spp.

S. japonicum Man,dog, cat, Oncomelania

cattle, horses & spp.
hogs
 Pathology
Disease Clinical features- S&S Dx test T/P/C

Schistosomiasis • skin penetration- • DFS- recovery of • Praziquantel

- (bilharziasis) dermatitis, erythema, ova in stool • Oxamniquine
pruritus, papules and • Urinalysis- S.
become intense w/in 48- haematobium • Proper disposal of
Penetration of 72 hrs. (exposure to • sputum exam- S. urine & feces
skin by larva contaminated waters) haematobium • wearing of protective
(cercaria) in • malaise • CSF exam gears in potentially
water • fever snail-infested waters
• hives • eradication of I.Host
• abdominal pain
• Katayama fever- S.
japonicum
• Hepatosplenomegaly
• Intestinal- confined to LI.
Leading to bloody diarrhea
with intestinal polyposis-
marked weight loss and
anemia . S. japonicum &
Disease Clinical features- S&S Dx test T/P/C

Schistosomiasis- • Pulmonary involvement-

(bilharziasis) common in all forms but most
common in S.haemotobium.
Cough-hemoptysis, exertional
Penetration of dyspnea with enlargement of
skin by larva the heart
(cercaria) in • Urinary involvement-
water urinary frequency, dysuria,
hematuria, Bladder cancer
• CNS-common in all forms of
Schistosoma. Brain- S.
japonicum. Spinal cord-
transverse myelitis in the
lumbar area- flaccid paralysis
of the lower limbs. S. mansoni
& haematobium
Skin penetration-dermatitis
Hepato-splenomegaly
S. haematobium- formation of
bladder cancer
Fasciola hepatica
• “sheep liver fluke” – “liver rot”
• Common parasite of herbivores and cosmopolitan in
distribution
• Human infection occurs in sheep-raising countries-
South America, Bolivia, Uraguay, Argentina, Peru, Cuba,
Southern France, Algeria
• D.H- Man, sheep, cattle
• 1st I.H- snails
• 2nd I.H - Aquatic/water plants (ex. Watercress)
• MOT- ingestion of infected aquatic plants
• Worms can live as long as 11 years.
1st I.Host- Lymnaea truncatula
2nd I.Host
• Watercress (Nasturtium officinale), is
a fast-growing, aquatic or semi-
aquatic, perennial plant native to
Europe and Asia, and one of the
oldest known leaf
vegetables consumed by humans. It
is a member of
the family Brassicaceae, botanically
related to garden
cress, mustard and radish — all
noteworthy for a peppery, tangy
flavour.
• The hollow stems of watercress are
floating, and the leaves are pinnately
compound. Small, white and
green flowers are produced in
clusters.
Morphology- Adult worm, pg. 178
• Large, Flat, brownish,
leaf-shaped flukes
• 3cm x 1.5 cm
• has 2 suckers
• Anterior end with
cepahlic cone (shouldered
appearance)
• Integument is covered
with scales
• Alimentary system has an
inverted “Y “appearance
• hermaphrodites
OVUM
• Large, operculated,
ovoid in shape
• 140-150um x 65-90um
• Light yellow in color
• Transparent shell w/
thin double walls
• Contains large mass of
lecithin granules when
freshly voided
Life cycle, pg. 180
Anatomic structure of the Biliary
system
 Pathology
Disease Clinical features-S&S Dx test T/P/C

Fascioliasis • fever, chills •DFS- recovery of ova • Bithionol

• cholangitis- bile in stool (large • Triclabendazole-
ducts operculate eggs) veterinary use
Ingestion of larvae • Rt. Upper quadrant
encysted pain that radiates • serologic test • wash and cooked
(metacercaria) on thru the scapula aquatic plants
aquatic plants • Hepatomegaly properly
• eosinophilia • proper disposal of
• jaundice animal / human
• portal cirrhosis feces
• avoid eating
• HALZOUN- improperly cooked
Ingestion of raw pharyngeal dse. Pain, liver
animal liver infected bleeding, edema that • eradication of the
w/ adult worm sometimes interfere 1st I.Host
w/ respiration
Fascioliasis
Fasciola gigantica- pg.181
• “Giant liver fluke”
• Longer and more slender but otherwise very
similar to F. hepatica.
• May attain a length of 7.4 cm.
• A parasite of herbivores particularly camels,
cattle and water buffalo.
• Found in Africa, Asia, Hawaii
• Morphology, biology, and Pathology is similar to
F. hepatica
• Ova is large , measuring 150-190 um x 70-90
um
Adult worm- a. F.gigantica ; b. F.
hepatica
Clonorchis sinensis-pg. 174
• “Chinese liver fluke”
• Was first discovered in the bile passages of a Chinese
carpenter in Calcutta in 1875.
• Widely distributed in Japan, Korea, China, Taiwan,
Vietnam.
• Adult worms live and localize in the bile ducts and
occupy the bile passages in massive infections
• they can also invade the gallbladder and pancreatic
duct
• Worms can live as long as 30 years. Can lay 2400
eggs/day/worm
• Infection is acquired from consumption of fresh-
water fish containing the encysted larva
• Fish may be eaten raw, pickled, smoked, or dried
• Disease have been reported in Hawaii as a result
of consumption of infected fish imported from
the Orient.
• D.H- Man, (dog, cat, hogs)- R
• 1st I.H- snails
• 2nd I.H- fresh-water fish
 I.Host
2nd- Grass carp-
1st- Parafossarulus manchouricus Ctenopahryngodon idellus
Morphology- Adult worm, pg. 174
• Narrow, oblong, flat,
tapering anteriorly and
rounded posteriorly-
leaf-like
• 10-25mm x 2-3mm
• Oral sucker is larger
than the ventral sucker
• large testes which are
branched in tandem
near the posterior end
OVUM
• Flask shape, yellowish
brown, operculated
• 35um x 20 um
• There is a small knob or
curved spine on the
terminal end.
• fully embryonated
when laid
Life cycle
Anatomic structure of the Biliary
system
 Pathology
Disease Clinical features-S&S Dx test T/P/C

Clonorchiasis • fever •DFS- recovery of ova • Praziquantel

• abdominal pain in stool (large • Albendazole
• diarrhea operculate eggs)
Ingestion of larvae • cholangitis- bile • Duodenal aspirate • cooked fresh-water
encysted (cercaria) ducts • Entero test fish properly
in fresh-water fish • cholecystitis- gall • serologic test/ • proper disposal of
bladder/cholelithiasi compliment fixation animal / human
s test feces
• Hepatomegaly • intradermal test • eradication of the
• eosinophilia 1st I.Host
• jaundice
• carcinoma of biliary
tract-
cholangiocarcinoma
Opisthorchis viverrini-pg. 177
• Family Opisthorchiidae- Clonorchis &
Opisthorchis spp.
• “Southeast Asian liver fluke”
• a major health problem in Northern Thailand
and Laos and about 7 million are infected in
Thailand
• prevalence is 80-90% among rural people,
and 55% in urban dwellers increasing with age
up to 10 years old
• Pathology and epidemiology is similar to C.
sinensis and O. felineus
• MOT= consumption of uncooked fresh-water fish
• D.Host= Man, (cats, dogs)-R
• 1st I.Host-snail
• 2nd I.Host-fresh-water fish
• Life cycle similar to C.sinensis
• infection is highly correlated with incidence of
cholangiocarcinoma-Opisthorchiasis
Adult worm
• Flat ,elongated,
tapering anteriorly and
rounded posteriorly
• 5-10 mm x 1mm
• Testes are lobate
located in the posterior
part of the body
Anatomic structure of the Biliary
system
Ovum
• Relatively short and
broad, operculated
• 28 um x 16 um
• may not posses
terminal tubercle-like
knob
• Fully embryonated
when laid
Opisthorchis felineus-pg. 176
• “cat liver fluke”
• prevalent in the liver of both cats and dogs
• 1884 in the liver of cats by Sebastiano Rivolta of
Italy
• 1891 a Russian scientist K.N. Vinogradov found it
in humans.
• Occurs in Europe, Siberia, Asia- Philippines,
Korea, Japan North Vietnam and India
• 1.5 million infection in Russia
• Pathology and Epidemiology similar to C. sinensis and
Opistorchis spp.
• MOT- consumption of uncooked or raw, slightly
salted, frozen fish
• D.Host- cats,dogs, Man
• 1st I.Host- snails
• 2nd I.Host- fresh-water fish
• Life cycle similar to C. sinensis
• Infection can lead to Liver cancer(cirrhosis) but,
maybe asymptomatic in children, severe anaemia.
Anatomic structure of the Biliary
system
Adult worm
• Almost the same with
the other opisthorchiids
• More similar to C.
sinensis
Ovum
• Ova is narrower,
operculated
• 30um x 11-12um
• Otherwise
indistinguishable from
C. sinensis
Dicroceolium dendriticum- pg. 177
• “lancet liver fluke”- bladelike shape
• A common parasite of the biliary tree of
herbivores (sheep, cattle, goats, pigs,etc.)
• It is common throughout most of Europe and
Asia. Discovered in 1819 by Rudolphi
• They are morphologically similar to C.sinensis
with slight differences.
• Human infection is uncommon
• “brainworms”- they alter ant’s behaviour
increasing it’s probability of ingestion by the D.H
• MOT- ingestion of ants. (Drabick et al. 1988,
case report)
• D.Host- sheep, cattle, hogs, goats,
Man(accidental host) etc.
• 1st I.Host- snail
• 2nd I. Host- ants
• Numerous human infections were false infxn.
Eggs detected in stool are actually part of the
liver eaten awhile ago.
Adult worm
• Bladelike shape
• 6-10mm x 1.5-2.5mm
• Both ends are pointed
• Lobate testes that lie in
the anterior third of the
body
Ovum
• Eggs passed in feces are
dark brown in color
• Thick shelled and with a
large operculum
• 38-45 um x 22-30 um
Life cycle
2nd I.Host
• Arthropod- common
brown ant
• Formica fusca
 Pathology
Disease Clinical features-S&S Dx test T/P/C

dicroceoliasis • Asymptomatic • DFS- demonstration • Praziquantel

• biliary dysfunction of ova in stool
with digestive • inspect food before
Ingestion of larvae disturbances consuming
encysted • enlargement of bile • proper disposal of
(metacercaria) in ducts-cholangitis animal / human
ants. • fibrosis feces
• cirrhosis • eradication of the
1st I.Host
Infected liver
Fasciolopsis buski-pg.168
• Family Fasciolidae
• “Giant intestinal fluke”
• Found in China, Taiwan, Vietnam, Thailand,
Indonesia, Malaysia, India.
• It was first described by George Busk, in London
in 1843
• Adults can lay 25,000 eggs/day
• In heavy infection they are found throughout the
intestinal tract attached to intestinal wall (SI)
• Life span of worm is 6 months and an estimated
10 million infection occur annually
• MOT- ingestion of raw or peeled aquatic plants or
vegetation containing the metacercariae
• D.Host- Man, (pigs, dogs, rabbits)-R
• 1st I.Host- snail- Segmentina and Hippeutis
• 2nd I.Host- water chestnuts, water caltrops, lotus,
bamboo shots, and other edible plants
• Life cycle similar to F. hepatica
Adult worm
• Adult worms are seen
after purgation
• Fleshy worms , elongated
and oval, ant. End
narrower than post. End.
Acetabulum is larger than
the oral suckers
• 2-7.5 cm x 0.8-2 cm
• Resembles F. hepatica but
does not possess cephalic
cone
Ovum
• Yellowish brown,
ellipsoidal
• 130-140um x 80-85um
• Has a clear thick shell
w/ a small operculum
• Similar to F. hepatica
• Unembryonated when
laid-(7wks to mature
and hatch at 27°c-32°c.)
Life cycle
 Pathology
Disease Clinical features-S&S Dx test T/P/C

Fasciolopsiasis • Abdominal pain- • DFS- demonstration • Praziquantel

ulcers w/ of ova in stool
hemorrhages • cooked aquatic
Ingestion of larvae • diarrhea plants before
encysted • edema &ascites- consuming
(metacercaria) in worm toxins • proper disposal of
aquatic plants • Intestinal animal / human
obstruction feces
• eosinophilia • eradication of the
1st I.Host
• stool become
profuse, light w/
much undigested
food –malabsorptive
process
Intermediate Host- snail
Intermediate Host- aquatic plants
Water chestnut lotus
Echinostoma ilocanum -pg. 169
• A common medium-size intestinal fluke that
occurs in the Philippines
• First seen in the stool of a prisoner in Manila
in 1907
• Life cycle involves 2 snail intermediate host
• MOT- ingestion of raw snails
• D.Host- Man, aquatic birds
Adult worm
• Adult worms are seen
after purgation
• Circumoral spine arrange
like a crown numbering
49-51
• 0.25-0.65cm x 0.1-0.13
cm
• Integument is covered
with plaque-like scales
• testes are deeply lobate
Ovum
• Ovoid in shape, straw
colored, operculated
• 83-116um x 58-69um
• Unembryonated when
laid
• Similar to Fasciolopsis
Life cycle
 Pathology
Disease Clinical features-S&S Dx test T/P/C

Echinostomiasis • Asymptomatic • DFS- demonstration • Praziquantel

•Abdominal pain- of ova in stool •Tetrachloroethylene
ulcers w/
Ingestion of larvae inflammation • avoid consuming
encysted • diarrhea raw snails
(metacercaria) in • proper disposal of
snail animal / human
feces
• eradication of the
1st I.Host
The Heterophyids- minute flukes-
pg.172
• Tiny, teardrop-shaped flukes, usually maturing in the
small intestine of fish-eating birds and mammals
• Heterophyes heterophyes
• Metagonimus yokogawai
• Occur in Japan, Korea, China, Taiwan, Philippines, and
Western India
• Heterophyes- Egypt (Cairo-1851), and Israel
• Metagonimus- Balkans, Spain, Israel, Russia, Indonesia
• MOT- ingestion of raw or pickled fresh-water fish
• D.Host- Mammals, fish-eating birds
Adult worm- seen after purgation
H.heterophyes
• Elongate, pyriform, grayish
fluke
• 1-1.7 mm x 0.3-0.4 mm
• The entire body is covered
w/ slender scales
• 2 oval testes lie side by side
near posterior end
• Contains a genital sucker
• Ovaries are small
M.yokogawai
• Small, pyriform in shape with
rounded posterior and
tapering anterior end
• 1-2.5 mm x 0.4-0.75 mm
• Ventral suckers is deflected to
the right of the midline
• 2 oval testes are located at the
posterior third of the body
• Ovary is found at the junction
of the middle and lower third
of the body
Adult worm
H.heterophyes M.yokogawai
Ovum- closely resembles ova of
Clonorchis and Opisthorchis
H. heterophyes M.yokogawai
• Minute, operculate, ovoidal, • Minute, ovoidal,operculate
light brown in color • Slight shoulder at the rim
• 28-30um x 15-17um • 26-28um x 15-17um
• The shell has a slight • Fully embryonated when
shoulder at the rim of the laid
operculum and sometimes
a knob at the posterior end
• Fully embryonated when
laid
H.heterophyes M.yokogawai
Life cycle
 1st Intermediate Host- snail
H.heterophyes- Pironella conica( M. yokogawai- Semisulcospira
Egypt), Cerithidia cingula (Japan) spp.
 Pathology
Disease Clinical features-S&S Dx test T/P/C

Heterophyiasis • Asymptomatic • DFS- demonstration • Praziquantel

• abdominal pain of ova in stool •Tetrachloroethylene
• diarrhea
Ingestion of larvae • nausea • cooked fresh
encysted (cercaria) • Occasionally worms water- fish properly
in fresh-water fish invade the mucosa • proper disposal of
and deposits eggs in animal / human
tissue- gain access to feces
circulation and • eradication of the
invades the brain, 1st I.Host
spinal cord- seizures
neurologic deficits
• heart- cardiac
insufficiency
Haplorchis taichui- pg. 202
• Heterophyid trematode- Intestinal fluke
• reported in Mindanao Island, Southern
Philippines (Belizario et al., 2004)
• Cases have been reported in Thailand and
Philippines
• MOT- ingestion of raw or pickled fresh-water fish
• D.Host- Man, dogs, cats, and hogs
• Life cycle similar to Heterophyes
Morphology
Adult worm Ova
 Pathology
Disease Clinical features-S&S Dx test T/P/C

Haplorchiasis • abdominal pain • DFS- demonstration • Praziquantel

• diarrhea of ova in stool
• nausea
Ingestion of larvae • borborygmi • cooked fresh
encysted (cercaria) water- fish properly
in fresh-water fish • proper disposal of
animal / human
feces
• eradication of the
1st I.Host
Paragonimus westermani- pg. 197
• “Oriental lung fluke”
• First described from 2 Bengal tigers that died in
the zoos in Europe in 1878.
• Most widely prevalent species. It was discovered
in humans 2 years after in Formosa (Taiwan). It
was quickly found in the lungs, brain, and viscera
of humans in Japan, Korea, and the Philippines.
• There at least 8 species known to infect man
under genus Paragonimus. (28 spp. that are
worldwide distributed)
• They are primarily a parasite of wild felines- tigers,
lions, wolves, leopards, dogs, etc..
• Mammals like wild pigs, badgers, mongoose, racoons,
minks and others that eat fresh-water crabs and
crayfish
• Human are accidental host
• MOT- ingestion of raw or insufficiently cooked infected
crustacean
• D.Host- carnivores, Man
• 1st I.Host- snail
• 2nd I.Host- crustacean
Adult worm
• Thick, fleshy and egg-shaped,
reddish brown
• 0.8- 1.2 cm x 0.4-0.6 cm
• tegument is densely covered
with scale like spines
• Testes is irregularly lobed,
placed oblique to each other
in the posterior third of the
body
• Ovary is lobed located anterior
to the testes
• Excretory bladder is large and
at the center dividing the body
into 2 equal parts
Ovum
• Oval shape, golden
brown
• With a flattened
operculum and has a
thick shell
• 80- 120 um x 48-60um
• Unembryonated when
laid
Histological examination of a human
lung
Life cycle
2nd Intermediate Host
 Pathology
Disease Clinical features- S&S

Paragonimiasis • clinical picture resembles that of P. tuberculosis (Chronic)

• productive cough, fever, haemoptysis, eosinophilia
• Chest pain, dyspnea, chronic bronchitis, pleural effusion
Ingestion of larvae • typically the worm are encapsulated in cystic structures
encysted fresh- adjacent to the bronchi. (granuloma)
water crabs or • the eggs are discharge into the bronchi or bronchioles; they
crayfish may be expectorated or if swallowed , appear in the feces.
• Chest film may show patchy infiltrate with nodular cystic
Accidental Host shadows or calcification.
• worms can enter other parts of the body
• Brain- cerebral migration- fever, headache, nausea, vomiting,
convulsive seizures
• Spinal cord- motor and sensory disturbances
• Liver- fibrosis-cirrhosis
 Pathology
DX test T/P/C

•DFS- demonstration of ova in stool • Praziquantel

• Sputum analysis- demonstration of ova
in sputum- is frequently blood tinge and
may contain numerous dark brown eggs
and Charcot-Leyden crystals.
• Pleural fluid aspirate
• Serologic test- ELISA/ EIA
• Bithionol
• cooked fresh-water crabs and crayfish
properly
• washed hands and utensils properly
• eradication of the 1st I.Host
Charcot Leyden crystals- 50um;
enzyme-lysophospholipase. (trichrome
stain)
THE END