Platyhelminths

By Tegegne Eshetu (MSc)

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 Brain storming questions

 What is medically important parasites?

 List classification criteria’s of medically important parasites

Define the term diagnostic stage, infective stage, pathogenic stage.

 Define Host and types of host.

 Define and lists types of vector.

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Outlines
General characteristics of platyhelminths

 Classification of platyhelminths

 General classification of flukes/trematodes

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 Objectives

At the end of this chapter you will expected to:

Describe the general characteristics of platyhelminths

Describe classification of platyhelminths

Describe the general characteristics of trematodes

 Morphology
 general life cycle
 Classification

List common medically important trematodes/flukes

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Characteristics of Platyhelminthes

Platyhelminthes have the following important characteristics:

• Dorso-ventrally flattened

• Bilaterally symmetrical 
•  Have no body cavity other than the gut & lack an anus

• Gut is often highly branched in order to transport food to all

parts of the body
• Same pharyngeal opening both takes in food & expels waste

•   The lack of a cavity also constrains flatworms to be flat

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• They must respire by diffusion & no cell can be too far from
the outside, making a flattened shape necessary

•   Hermaphroditic

•  4 classes: 

•  Tubellaria & Monogenea, not medically important 

•  Cestoda & Trematoda, which are medically important

 The life cycle is complicated with one or more larval stages.

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 Class Trematodes/flukes
 Trematode parasites of man belong to Order Digenea

 inhabit the alimentary canal of vertebrates and many of the

associated organs, such as the liver, bile duct, gall bladder,

lungs, bladder and ureter.
Characters:
 leaf shaped with an outer cover called tegument
(excp. Schistosomes – cylinderical)

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Trema…
 Flattened dorsoventrally
 Bilaterally symmetrical
 Unsegmented
 Hermaphroditic (except blood flukes (Bisexual)) & most of
the body consists of reproductive organs & their associated
structures.
 Has no body cavity
 Organs of fixation in the form of suckers:

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The parasites are so named because of their conspicuous
suckers, the organs of attachment (trematos means "pierced
with holes")
1. Oral sucker – at anterior end surrounding the mouth
2. Ventral sucker (acetabulum)– blind on the ventral surface
posterior to the oral sucker
3. Genital sucker – present in some species

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Hermaphroditic (A) and Bisexual (B) flukes

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 General life cycle
Are digenetic (Require at least two hosts)

 involving one or more intermediate hosts

1. Definitive host: harbour the sexual(adult) stage of the parasite
 Man (DH)
 Other animals (RH)
2. Intermediate host: harbour the asexual stages of the parasite, Snail (molluscan
host)
 Trematode eggs have a smooth hard shell
 the majority of them are operculated (except schistosomes).
 the majority have 4 or 5 larval stages:
 the miracidium, sporocyst, redia, cercaria, and the metacercaria
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General Life Cycle
Infect Secondary Definitive host
Host, develop into
Sexually mature Adult in DF host
Metacercaria
which are later,
Consumed by Infect Definitive Eggs in Feces
Definitive host Host Directly

Intermediate host Miracidium

Released
in H2O
Cercaria
Released Miracidium
in H2O Infects Snail
Sporocyst-rediae-cercaria
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Ova or egg: Contains miracidium inside shell

Miracidium: Free living, ciliated larva seeks the intermediate host

Sporocyst: Loses larval characteristics, grows in the blood of molluscs

and produces germ balls

Redia: Sporocyct develops into active, feeding larval stage with the

germballs

Cercaria: Free swimming larva that leaves the mollusc and enters the

definitive host where it develops into an adult

Metacercaria: Encycted (waiting) stage in second intermediate host

until it is eaten by the definitive host, where it develops into an adult

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 Classification

• Flukes are classified based on the body site where they resides on

the hosts (except schistosomes):

 Liver flukes – in the liver and biliary duct

Includes: Clonorchis sinensis,  Opistorchis spp., Fasciola spp. (F.

hepatica, F. gigantica)
 Intestinal flukes – in the intestine
Includes: Fasciolopsis buski, Heterophyes heterophyes
 Lung flukes – in the lung
Includes: Paragonimus westermani
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Classification...

 Blood flukes (exceptions): found in the portal venous system

Includes: S.mansoni, S. hematobium, S. japonicum, S.
intercalatum, S. mekongi.
• The trematodes that infect liver, lung, and intestine are all food-
borne.
• Freshwater fish, crustaceans, and aquatic vegetation are the
sources of human infection.

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Blood Flukes (Schistosomes)

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Blood flukes (Schistosomes)
It cuases schistosomiasis or Bilharzia (in honor of Theodor Bilharz)
General feature of schistosomes
 Develop in the portal venous system

 The adult live in the veins that drain

the intestine or the urinary bladder (species dependent)

 Sexes are separate (Dioecious - bisexual)

 Cylinderical

 No redia and metacercaria stages

 Males broader & females filiform and larger than male

 Male has gynaecophoric canal where the female resides after mating

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Cont…
 Freshwater snails serve as IHs, no 2 0 IH

 Human the most significant DHs,

 cercaria is the infective stage

 The immature stage that migrates in the body after infection by

cercaria is called schistosomulae

 Eggs with spine (Other flukes – operculated)

 Egg is the main pathogenic stage

 Adult worms reside in venous system

 Reproduction takes in the sporocyst stage in the snail

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Epidemiology of Schistosomes
Wide spread species

 Schistosoma mansoni: by Biomphalaria snails

 causes intestinal and hepatic Schistosomiasis S. mansoni

 Africa (>50 countries), Arabian peninsula, South America

•Schistosoma haematobium: by bulinus snails

 causing urinary Schistosomiasis

 Africa (54 countries), Arabian peninsula

•Schistosoma japonicum by Oncomelania

 Zoonotic - cattle, dogs, pigs and rodents
S. japonicum

 causing intestinal and hepatosplenic schistosomiasis

 China, the Philipines and Indonesia

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Cont...
Less wide spread species
Schistosoma mekongi cause intestinal schistosomiasis and are
prevalent in 7 African countries and the Pacific region
Schistosoma intercalatum is found in ten African countries

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 Distribution of blood flukes

21

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 Transmission and life cycle of schistosomes

Transmitted by skin penetrating Cercariea

Bathing, washing clothes, agricultural activities, fishing and

recreation in contaminated fresh water predispose to infection

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Life cycle of Schistosoma species

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Life cycle of Schistosoma species
The eggs escape from the body by penetrating the walls of the

veins and small intestine or urinary bladder (where adults reside),

and they are passed in the feces or urine.
Example of a Schistosoma mansoni egg

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Life Cycle of Schistosoma spp.

• The eggs, if and when they reach fresh water, will quickly
hatch.
• The miracidium swims ceaselessly until finds a snail host
(die in 3-6 hours).

Miracidium Swimming towards Snail Intermediate Host

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Life cycle in Snail

After miracidium enters, the parasite goes through two asexual

developmental stages: mother and daughter sporocysts.

 Mother sporocysts contain the daughters, which are then

released and found in the snail’s digestive and reproductive

organs.
 The daughter sporocysts hold the cercaiae,

Continues producing sporocystes for up to seven weeks within

snail

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 Intermediate Hosts of Schistosoma spp.

S. mansoni only infect snails of the genus Biomphalaria.

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Intermediate Hosts of Schistosoma spp.

S. japonicum are found in Oncomelania snails

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Intermediate Hosts of Schistosoma spp.

S. haematobium persist in species of Bulinus.

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 Life cycle of Schistosoma spp.: Cercariae

Cercaiae start to emerge

four weeks after penetration

by miracidium
There is NO second
intermediate host

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Life cycle of Schistosoma spp.: Cercariae
Cercariae swim up and down in the water column until finding
host; without host die after three days.
Move around and then enter and can disappear below surface in
10 to 30 seconds, and into circulation system within 24 hours.

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• 5 Minutes after penetration of the human skin by cercaria, the
newly transformed schistosomule has penetrated the outer layer of
the epidermis, and is positioned just beneath the skin.

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• 20 minutes after penetration of
the skin. Here the
schistosomule is migrating
through the dermis. This it will
do until it locates a blood
vessel. The schistosomule will
then break through into the
blood vessel, to be transported
in the circulatory system to the
heart and then the lungs.

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Life cycle of Schistosoma spp.: In
Human
Various ways of migrating through

circulatory system (heart, liver).

End up in veins draining liver where
they develop for three weeks
Pair up in these veins and migrate to

walls of guts or bladder, depending

on species to produce eggs.

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Adults can live 20
to 30 years!!

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Life cycle of Schistosoma spp.: In Human

Species differences in Site Preferences of Adults (male and

female in copula)
S. mansoni –veins of Large Intestine

S. haematobium – veins of bladder

S. japonicum – veins of small intestine

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The infective inhabitation of

Schistosoma in mesenteric vein

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Pathogenesis and clinical features
 Schistosomiasis is mainly caused due to immunological reaction to

schistosoma egg trapped in tissue

 Antigens released from the egg stimulate granulomatous reaction

 Eggs induce intense inflammatory reaction involving T-cell,

macrophages, eosinophils results clinical diseases ,leading to granuloma
formation.
Granuloma consists of egg at center surrounded by eosinophils ,

macrophages and lymphocytes.

Larvae inside the egg produce enzymes that aid in tissue destruction and

allow the eggs to pass through the mucosa and in to lumen of bowel and
bladder
Clinical features

 Schistosomiasis or snail fever is often divided into three phases:

The migratory phase:

o Encompasses the time from cercarial penetration until maturity and

egg production;
o It is often symptomless.

o Penetration of cercariae may produce dermatitis(swimmers'

itch) if a patient’s immune system has been sensitized by earlier

experiences of cercarial penetration.
Cont…

The acute phase/sometimes called Katayama fever

o Occurs when the schistosomes begin producing eggs about 4 to 10 weeks

after initial infection.

o By this time a host has had considerable exposure to various schistosome

antigens, sufficient to mount a humoral response, but the advent of egg

production substantially increases the amount of antigen release.
o The change in Ag-Ab ratio leads to formation of large immune complexes

that must be cleared by cells of the RE.

o The syndrome is marked by chills and fever, fatigue, headache, malaise,

muscle aches, lymphadenopathy, and GI discomfort. There is a high

eosinophilia, and
Cont…
Chronic phase

Symptoms depend on the Schistosoma species that causes the infection, the
duration and severity of the infection, and the immune response of the host to
the egg antigens.
oPatients indigenous to endemic areas are commonly asymptomatic, or, with
Intestinal schistosomiasis, they may show mild, chronic, bloody diarrhea with
mild abdominal pain and lethargy.
Urinary schistosomiasis, there may be pain on urination and blood in the urine.
oAffected people usually accept these conditions as normal and only seek
medical assistance with heavy infections or when more serious complications
develop
Cont…

o Chronic granulomas are dominated by macrophages, lymphocytes,

fibroblasts, and multinucleated giant cells.

These become small fibrous granulomas, or pseudotubercles,

because of their resemblance to the localized nodules of tissue

reaction (tubercles) in tuberculosis.
o Many eggs are carried by the hepatic portal circulation back up into

the liver, where they stimulate granuloma formation, and some may
be carried to the lungs or other tissues
Cont…
In less than 10% of cases, granulomas

can cause blockage of blood flow in

liver causing enlargement of the spleen
and fluid retention in abdomen.

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 abdomen distention looks like
a big drum, Ascites,
emaciation, varicosity, and
splenomegaly
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 abdomen distention looks like a big drum,
emaciation looks like a fire wood.
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 A patient of
schistosomiasis

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 Schistosomes egg excretion process

Excreted through the granulomatous inflammatory response

The excretion process classified in to four stage

I. Egg release into the bloodstream and attachment to the

endothelium
II. Immune-dependent granuloma formation

III. Transition between endothelium and epithelium

IV. Release into the intestinal lumen

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Laboratory diagnosis

 Intestinal schistosomiasis
 Finding the eggs in faeces by direct examination or more
commonly by using concentration ;
 Mucus and blood are often present in the faecal specimen
1. Formol-ether conc. Tech
2. Koto-katz technique

 Examining a rectal biopsy for eggs when they cannot be found

in faeces.
 occasionally eggs may also be found in urine often following
faecal contamination
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Egg:S.mansoni

Size : 114-17µm 45-68µm

Shape: Oval, with one well rounded pole

and one more conical pole

Colour: pale yellow-brown

Spine: large, triangular lateral spine near

the rounded end

Shell: smooth, very thin

Content: fully embryonated (developed

miracidium) when discharged

with the faeces
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Egg: S japonicum
Size: 70-80m

Shape: oval, almost round

Colour: transparent or pale-yellow

Spine: very small hook- like spine laterally

Contain a fully developed miracidium

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Ab-detection

Immuno-diagnosis using ELISA, RIA, Latex `agglutination are

helpful particularly in prevalent period, and in chronic and

ectopic cases in which eggs are difficult to be demonstrated in
the faeces.
Ag-detection.

EIA- detect circulating schistosoma antigens

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Urinary schistosomiasis
Finding eggs or occasionally the hatched miracidia in urine.

Quantitative report is required, no of eggs/10ml urine

 Urine contains blood and appears red or red-brown and cloudy.

 Hematuria

 Protienuria

 Eosinphil

 Eggs may not be present in the urine all the time; it is neccessary to examine urine

collected over several days.

Less frequently detecting eggs in faeces, rectal biopsy or bladder mucosal biopsy when

an infection is light.
Immuno-diagnosis: a variety of sero-diagnostic methods are currently available. These

include: RIA, ELISA , IHA.

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 Egg: S. hematobium

Size : 120 - 170 µm by 40-70µm

Shape: oval, with one well rounded pole

Spine : Terminal spine at one pole

Shell: Smooth, very thin except minute

terminal spines
Colour: pale yellow-brown

Contain fully developed miracidium when

laid

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Prevention and control
1. Avoid contact with water known to contain cercariae by:-
 Providing safe water supplies in villages
 Construction footbridges across infested rivers and streams

 Providing safe recreational bathing sites

2. Preventing water from becoming contaminated with eggs

3. Minimizing the risk of infection from new water conservation and
irrigation schemes by:-
Lining canals with cement and keeping them from silt and vegetation in

which snails can breed

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Cont…
Varying the water levels in the system

Using molluscicides

4. Destroying snail intermediate hosts by:

Using molluscicides

Introducing fish and other predators of snails

Removing vegetation

5. Treating water supplies by

Using a chlorine disinfectant

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Treatment

The drug of choice is now praziquantel,

which is effective against all species of schistosomes

In humans Praziquantel is less effective against schistosomules,

but
Arthemesin and its derivatives are effective against
schistosomules.

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Cercarial dermatitis - “swimmer’s itch”

Two images showing one of the types of cercaria ,which can cause
cercarial dermatitis. 
Diagnostic characteristics include the following:
• Forked-tail
• Presence of "eye-spots"

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Cercarial dermatitis - “swimmer’s itch”
o Is a patchy red pinpoint skin rash associated with itching on the parts of the

body that have been in the water.

o Usually not severe. After the initial transient itching it will disappear without

treatment. (Rarely, it can be severe if a large proportion of the body is affected).

o The itching occurs within 48 hours and may last up to 7 days.

The major, although not the only, causes are trematode parasites of

aquatic/migrating birds.

The life cycles of these parasites involve snails as the IH & aquatic birds
or some mammals as the final host.

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Cercarial dermatitis - “swimmer’s itch”
o Typically, hosts of avian schistosomes are migratory water birds,

including shorebirds, ducks, Swans and geese. 

o Adult worms are found in the blood vessels and produce eggs that

are passed in the feces . 

o On exposure to water, the eggs hatch and liberate a ciliated

miracidium that infects a suitable mollu scan intermediate host

o The larval parasite called a "cercaria" is released by aquatic or

amphibious snails and penetrate the skin of the birds (its rightful
host, usually duck)

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Cercarial dermatitis

It causes dermatitis when it mistakenly penetrates a person's skin

Humans are inadvertent and inappropriate hosts;

Cercariae may penetrate the skin but do not develop further.

Swimmer's itch occurs in both freshwater and in the marine

coastal environments.
A number of species of dermatitis-producing cercariae have been

described from both freshwater & saltwater envt’s, & exposure

to either type of cercariae will sensitize persons to both.

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Cont…
Species Egg Infectious Clinical Symptoms Areas of the
Morphology Location World

S. mansoni Lateral Inferior Hepatic Fibrosis

spine mesenteric Portal Hypertension South America, the
veins Katayama Fever Caribbean, Africa,
CNS damage due to and the Middle East
deposition of eggs in spinal
column

S. haematobium Terminal Bladder Calcified bladder Africa, Middle east

spine venous Squamous cell epithelioma
plexus UTIs, Hematuria in males
Hydronephrosis

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Reading assign.
Schistosoma intercalatum and schistosoma mekongi
 Epidemiology, Morphology, Transmission and life cycle,

clinical features, laboratory diagnosis

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 Other flukes/hermaphroditic/food born flukes

At the end of this content the students will be able to:

Explain the common feature of hermaphroditic /liver, intestinal, lung/ flukes

Explain the general morphology of medical important intestinal liver, and

lung flukes
 Adult, larvae and ova

Explain the geographical distribution, differential characteristics, life Cycles

of each species
Describe the pathogenesis and clinical manifestation of each spps.

Apply the necessary laboratory procedures for detection and identification

of trematode parasites

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 Liver /Biliary/ fluke
Clonorchis sinensis
 Opisthorchis viverrine Opisthorchiidae
Opisthorchis felineus

 Fasciola hepatica Fasciolidae

Fasciola gigantica

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 Liver flukes

Food born trematodiasis is an emerging public health

problems SE Asian and Western Pacific Region

Human liver flukes are members of two families,

 Opisthorchiidae and

 Fasciolidae,

The two family distinguished by differences in life cycle and

pathogenesis.

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 Cont…

In human Opisthorchiidae there are three major species:

Clonorchis sinensis in East Asia,

Opisthorchis viverrini in Southeast Asia, and

Opisthorchis felineus in countries of the former Soviet Union

In the Fasciolidae the species are:

Fasciola hepatica, which has a worldwide distribution, and

Fasciola gigantica in South Asia, Southeast Asia, and Africa.

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Cont…
Opisthorchiidae:

The three major Opisthorchiidae species have similar life

cycles and pathogenic processes.

Differentiation among species is usually based on adult

fluke morphology or geographic distribution, as differences

in egg morphologies are small.

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 Clonorchis sinensis

Is a liver fluke that can infect the liver, gallbladder, and bile duct.

 Found across part of in Asia, it is also known as the Chinese/oriental

liver fluke . 
Endemic in Asia including China, Korea, Taiwan & Vietnam.

The primary intermediate host is a snail and

 The secondary intermediate host is a crap (a fish).

Dogs and cats are reservoirs.

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Clonorchis sinensis

Morphology:
Adult:

boat shaped

 Oral sucker larger than ventral sucker

Simple un-branched caeca

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 Clonorchis sinensi
Eggs:

Small operculated  

Size 27 to 35 µm by 11 to 20 µm. 

The operculum, at the smaller end of the egg, is convex

and rests on a visible "shoulder." 

At the opposite (larger) end, a small knob or hook-like

protrusion is often visible. 

The miracidium is visible inside the egg.
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 Epidemiology and risk factors

Clonorchis and opisthorchis spps are estimated to infect over 30

million people world wide

Acquired by eating raw or undercooked freshwater fish containing

the larvae
These worms are endemic in China and Southeast Asia, including

China, Chorea, Japan, Taiwan, Vietnam

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Life Cycle of C.sinensi, O. felinus/viverni

77
 Pathology of C. sinensis/ O. felinus/viverni

The pathologic changes seen in the liver & biliary system in

clonorchiasis & opisthorchiasis are believed to be:

 Due to mechanical injury by the suckers of the flukes and

 host interactions/inflammatory reaction with their secreted

metabolic products.

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Pathogenesis and clinical manifestation

The worm causes irritation of the bile ducts which become dilated.

The liver may enlarge, become necrotic and tender and its function

may be impaired.
Most causes are asymptomatic and self healing

Modest infections results in indigestion, epigastric discomfort,

weakness and loss of weight.

Untreated, infection may persist up to 30 years, and causes heavier

infections produce anemia, liver enlargement, slight jaundice,

edema, ascites and diarrhea.  
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Pathogenesis and clinical manifestation

Untreated liver fluke infections, the inflammation of the gallbladder

and ducts caused by the parasite has been associated with liver and
bile duct cancers
Cholangitis, periductal fibrosis, gallstones, and cholangiocarcinoma

(CCA), a fatal bile duct cancer

Laboratory Diagnosis
Eggs in feces

Eggs in aspirates of duodenal fluid 

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 Prevention and control
Avoid eating raw or improperly cooked fish

Sanitary disposal of feces

Destroy the snails

Inspection of fish

Treating infected individuals and giving health education 

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 The FDA recommends the following for fish preparation or storage to kill

parasites.
• Cooking

• Cook fish adequately (to an internal temperature of at least 145° F

[~63° C]).
• Freezing

• At -4°F (-20°C) or below for at least 7 days (total time); or

• At -31°F (-35°C) or below until solid, and storing at -31°F (-35°C) or

below for a least 15 hours; or

• At -31°F (-35°C) or below until solid and storing at -4°F (-20°C) or

below for at least 24 hours.

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Fasciollidae

Among the Fasciolidae there are two human flukes:

Fasciola hepatica, the most common & widely distributed, and

Fasciola gigantica, a fluke of much more focal distribution.

Both have similar life cycles & produce similar human disease, but

F. gigantica can be recognized by its larger adult and egg sizes.

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Fasciola hepatica

It is also called sheep liver fluke(liver rot)

Distribution : cosmopolitan (esp. in cattle and sheep raising

countries, including the highlands of Ethiopia)

Morphology:

Adult: fleshy, flat, leaflike

Cone shaped prominent two ”shoulders”

Genital pore anterior to the ventral sucker

Highly branched testes, branched and fan-shaped ovary

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 Fasciola hepatica

Eggs: 

Oval with rounded poles

Have a small, barely distinct operculum. 

The operculum can be opened, for example when a slight

pressure is applied to the cover-slip. 

Have a thin shell which is slightly thicker at the abopercular

end. 
Passed unembryonated. 

Size range: 120 to 150 µm by 63 to 90 µm.

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 Fasciola hepatica

Egg with distinct Egg with an open

operculum operculum

B C
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Life cycle of Fasciola hepatica/gigantica

87
 Pathogencity

Pathological findings include focal haemorhage & inflammation in

the deuodenium
When the flukes enter the liver, they digest hepatic tissue and

cause inflammation, hemorrhage, dialated interahepatic bile ducts

and formation of surface liver nodules.
Inflammation can result in fibrosis, thickening and dilatation of the

extrahepatic bile ducts and gall bladder

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 Clinical features
Light infections are usually asymptomatic

In heavy infection:

Local irritaion during migration of the young worms to the liver

Fever, sweating and abdominal pain

Obstructive jaundice

Acute epigastric pain and abdominal tenderness

Persistent diarrhoea

Inflammation of the bile duct

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 Laboratory diagnosis

Eggs in the feces in chronic infection

Eggs in aspirates and in bile if eggs are absent in feces

Serological diagnosis by testing serum for antibodies

Especially, In the early stages of infection when the immature

flukes are migrating through the liver and causing serious

symptoms but before egg production.

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 Laboratory diagnosis

False fascioliasis: due to ingestion of animal liver containing

Fasciola egg, with the passage of eggs in stool.

This may be ruled out by keeping the patient on a liver free diet

for three days or more.

If eggs continue to be passed in Fasciolopsis-free areas, the

infection is probably genuine (True fascioliasis).

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 Prevention and control

Avoid eating uncooked water plants

Treating infected animals

Destroying snail hosts

Sanitary disposal of feces

Treating infected individuals and giving health education

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 Fasciola gigantica

Also called the giant liver fluke

Similar to F.hepatica in many respects, including its life cycle,

clinical features
Morphology similar to F. hepatica, but is larger with a length up to

7.5cm
Has larger eggs

Has a more limited geographic distribution in Africa, Hawaii and

the Western pacific.

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Liver fluke summary

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 Intestinal fluke
 Fasciolopsis buski
Heterophyes heterophyes

Metagonimus yokogawai

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Intestinal flukes

Different species of intestinal flukes

Little variation in life cycles and hosts, but

 similar clinical features, diagnosis and therapeutic options

Identification of these species can be made by microscopy of the

stool, but ova of most looks alike

Accurate identification depends on collection of the adult worm

Fasciolopsis buski, Heterophyes heterophyes & Metagonimus

yokogawi are medicaly important.

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 Fasciolopsis buski

Also called the giant intestinal fluke

Belongs to the family Fasciolidae, which also contains the

hepatobiliary flukes: F.hepatica and F.gigantica.

Distribution: Thailand, Taiwan, Vietnam, Indonesia

Morphology:

Adult: large, fleshy flat worm

Oral sucker is smaller than the ventral sucker

Testes highly branched

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 Fasciolopsis buski

Adult fluke of Fasciolopsis buski:

 range in size: 20 to 75 mm by 8 to 20 mm.

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 Fasciolopsis buski

Eggs: 

Practically indistinguishable from those of F. hepatica.  

The eggs are ellipsoidal, with a thin shell, and usually small,

indistinct operculum. 
The operculum is open. 

Eggs range in size: 130 to 159 mm by 80 to 85 mm.

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 Fasciolopsis buski

Epidemiology 
Found in China and South East Asia

in areas where animal feces (mainly pigs) contaminate water

sources that contain aquatic vegetation that is consumed by

humans.

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Life cycle of Fasciolopsis buski

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 Pathology

 Mechanical injury, abdominal pain and intestinal disorder

 Covering the wall of intestine to affect absorption
 Allergy caused by secretions and excrement
 Intestinal obstruction by mass of the worms

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 Clinical features
Majority of infections are mild or asymptomatic

Diarrhea, abdominal pain

Ulceration and inflammation of the intestine

Malabsorption and even death have been attributed to infection with

heavy worm burdens

Laboratory Diagnosis
Eggs in feces

Adult worms in the feces (occasional)

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 Prevention and control

Avoid eating uncooked water plants

Latrine construction

Avoid use of human feces as fertilizers

Destroy snails and their habitat

Treating infected individuals and giving health education

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 Heterophyes heterophyes
H. heterophyes is a minute trematode

Adult worm measures 1-1.7mm X 0.3-0.4mm in width

The adult flukes reside in the intestine

They secret eggs that are passed in human feces.

Eggs: operculated, ovoid, light brown

Measure about 28-30X15-17µm

Mammalian and avian hosts acquire by ingesting raw or

undercooked fish
Reservoir of infection are dogs, cats, foxes and some birds
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 Epidemiology

 Geographic distribution: Egypt, Korea, China, Taiwan, Africa,

Japan, Philipines and middle east

 Common in areas where;

Fish and sea food is the main dish

Fish eating mammals are present

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Life cycle of Heterophyes heterophyes

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 Het…
Pathogenesis
Heterophyid flukes cause a mild inflammatory reaction with some

necrosis
The lesions contained lymphocytes, plasma cells and eosinophils

with erosions, goblet cell depletion and edema

The worms are capable of invading the submucosa and eggs may

gain access to the bloodstream and cause disseminated disease

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 Het…

Clinical Features
The majority of infections are mild and asymptomatic

Heavier infections possibly causing chronic diarrhea,

abdominal discomfort, nausea and malaise
Occasionally appendicitis

 disseminated eggs (Eggs can be found in the heart , brain,

spinal cord, liver, lungs and spleen);

Lesion in the myocardium led to heart failure

Brain involvement
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 Het…

Laboratory Diagnosis
Stool microscopy remains the cornerstone of diagnosis

It is difficult to distinguish the small, operculated ova of the

different heterophyid from each other and

also from Clonorchis sinensis and Opistorchis spp.

Treatment
Praziquantel is the first-line drug for heterophyid infections
Other drugs, niclosamide and piperazine

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 Het..

Prevention and Control

Avoid ingestion of raw/improperly cooked fish

Sanitary disposal of feces

Destroy snail intermediate hosts

Inspection of fish meat

Treating infected individuals and giving health education 

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 Metagonimus yokogawai
Adult fluke: 

These minute intestinal flukes (1 mm to 2.5 mm by 0.4 mm to 0.75

mm) resemble Heterophyes heterophyes.  

An important distinctive feature is the position of the ventral sucker,

which is to the side of the midline with its axis in a diagonal line.

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Life cycle of Metagonumus yokogawai

113
Adult and egg morphology

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 Lung fluke
 Paragonimus westermani

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 Lung flukes

Paragonimus westermani:

It is endemic to the Far East, but other species of Paragonimus are

found elsewhere.
P. heterotremus, P. miyazakii, P. uterobilateralis, P. mexicanus.

The first IH is a snail, and the

second IH is a crab.
Domestic and wild animals

are reservoirs for P. westermani.

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 Morphology

 Adult:

 reddish brown and resembles one half of a pea,

 Integument covered with toothed spines

 Measures about 10x5mm

 Resides in the mammalian lungs

Eggs:

 The average size is 85 µm by 53 µm (range: 68 to 118 µm by 39 to 67

µm). 
 Yellow-brown, ovoidal or elongate, with a thick shell, and often

asymmetrical with one end slightly flattened. 

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 Paragonimus westermani

 At the large end, the

operculum is clearly visible. 
 The opposite (abopercular)
end is thickened. 
 The eggs of P. westermani
are excreted unembryonated.

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 Paragonimus westermani

 Epidemiology

Geographic distribution: Asia: China, Taiwan, Japan and

Thailand.

Africa: Nigeria and Cameroon.

South America: Peru and Equador.

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 Mode of transmission

Mode of infection:
Ingestion of crab, crayfish

or shrimps infected with

encysted metacercariae
of P.westermani.
 Ingestion of infected

paratenic host.

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Life cycle of Paragonimus westermani

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 Pathology
Causes paragonimiasis or endemic haemoptysis

the migration of worms cause mechanical lesions

Lung lesions:

The worms provoke granulomatous reactions that lead to fibrotic

encapsulation around them.

Ectopic lesions:

Due to aberrant migration, larvae may lodge in ectopic sites (brain,

abdomen, skin or heart).

Penetrate diaphragms into pleural cavity to cause lung cyst

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 Clinical futures
Acute phase due to invasion & migration marked by diarrhea,

abdominal pain, fever, cough, urticaria, hepatosplenomegaly,

pulmonary abnormalities & eosinophilia 
Chronic phase, pulmonary manifestations include cough,
expectoration of discolored sputum, hemoptysis, & chest
radiographic abnormalities
Extrapulmonary locations of the adult worms result in more

severe manifestations, esp. when brain is involved

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 Laboratory diagnosis
Eggs in sputum

The sputum is usually bloody, mucoid and rusty brown

Eggs in aspirates of pleural fluid and occasionally in feces

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Prevention and control

Avoid eating raw or uncooked crabs and crayfish

Avoid contamination of water with sputum or feces

Destroy snails and their habitat

Inspecting crabs and crayfish for metacercaria

Treating infected individuals and giving health education

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Basic information on digenea biology

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