CHAPTER-3 HELIMINTOLOGY

• Helminths are generally macroscopic, and the adult worms vary

tremendously in size from barely visible to 10 meters in length.
• The life cycles of helminths may be quite complex and include both
direct and indirect cycles.
• The clinical sign and symptoms of helminthic infections depend on the
location of the organisms and may be caused by adults, larva, or eggs.
• The heliminthic parasites are multicellular, bilaterally symmetrical
animals having three germ layers.
• The helminthes of importance to human beings are divided into three
main groups with the peculiarities of the different categories

1
 Cont..
• The host response to the presence of parasite may be prominent
and often includes eosinophilia, especially in the early stages of
infections when the parasites are in tissue.
• The final diagnosis is usually dependant on detection and
identification of a mature or developmental (larva, embryo, egg)
stage of the parasite.
 1. CLASS TREMATODES (FLUKES)  
Trematodes belong to the phylum platyhelminthes. They are found in a
widerange of habitats.
The great majority inhabit the alimentary canal, liver, bile duct, ureter
and bladder of vertebrate animals.
According to the sites they inhabit, there are four groups of flukes which
are the most significant trematodes from a clinical point of view :
1.Blood flukes,
– Schistosoma mansoni,
– S. japonicum and
– S. hematobium.
2.Intestinal fluke,
– Fasciolopsis buski,
3.Liver fluke,
– Clonorchis sinensis and
4.Lung fluke,
– Paragonimus westermani.
 General characterstics
1. Dorso-venterally flattened (leaf or tape-like) and bilaterially symmetrical.
2. They are provided with a nervous system and an elaborate excretory
apparatus.
3. Digestive system may be absent, or when present it is rudimentary
and without anus.
4. No espiratory, circulatory system and body cavity.
5. Tape worms are hermaphrodites and have well developed reproductive system.
6. Each unit of chain (segements) is known proglottides. The entire chain of
proglottids is called strobila
7. The body is divided into three main body regions; this are
Head (scolex): attachment organ and may have grooves, suckers, and rostellum
armed with hooklets; this varies with species.
Neck: growth region, proglottids proliferate from this region.
Strobila: varies in number, shape, size, and maturity. It is divided into three regions:
 Immature and fully mature sex organ ,and
gravid : reduced or atrophied primary genital organs, uterus is filled with eggs
 BLOOD FLUKES
 These are flukes that reside mainly in the blood vessels of various
organs and the schistosomes are the prototype and the commonest
flukes in our country.
Schistosomiasis (Bilharziasis)
• Epidemology
• Approximately 250 million people are infected with schistosomes
and 600 million are at risk
• Wide spread species:-
– Schistosoma mansoni causes intestinal schistosomiasis and is
prevalent in 52 countries and territories of Africa, Caribbean, the
Eastern Mediterranean and South America
– Schistosoma haematobium causes urinary schistosomiasis and
affects 54 countries in Africa and the Eastern Mediterranean
– Schistosoma japonicum cause intestinal schistosomiasis and are
Common in parts of Japan, China, Taiwan, Philippines,
Thailand, and other parts of Southeast Asia
5
 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
• The first two schistosomes (S. mansoni and S. haematobium) are
prevalent in Ethiopia.
Morphology:-
• Adult worms are 10 to 20 mm long; the male has an unusual lamelliform
shape with marginal folds forming a canal in which the slender female
worm resides.
• Unlike other trematodes, schistosomes have separate sexes.
• The female worm lies in the gynecophoral canal of the male. This
condition is important for transportation.
Adults can live 20 to 30
years!!

7
 INTESTINAL SCHISTOSOMIASIS
Etiology :Schistosoma mansoni
Habitat - This species lives in the veins of large intestine.
Geographical distribution: It is found in Africa, South America, Middle
East (some Arab countries) etc. Stream and lake-based transmission is
common.
The snail hosts that harbor S. mansoni are the genera: Biomphalaria
(B.glabrata)
Morphology
Male: The male ranges in size from 1-1.4 cm in length and the body is
covered by coarse tubercles. It has 6-9 testes
Female:The female is 1.5-2.0 cm in length. The ovary is present in the
anterior third and Vitelline glands occupy the posterior two-thirds. It lays
about 100-300 eggs daily. The uterus is short containing few ova.
Distribution: In Ethiopia, S. haematobium is found in the Lower Awash
Valley in the east and in Benshangul-Gumuz (Assossa) regional state in the
west in low altitudes below 1000 meters above sea level.
 URINARY SCISTOSOMIASIS
Etiology - Schistosoma haematobium
Habitat - The worm lives in the veins of the bladder of humans.
•The peak prevalence is the 10-14 year age group.
•The snail hosts that harbor S.haematobium are the genera Bulinus
(Bulinus africanus, B. truncatus).
Male: The male ranges in size from 1-1.5 cm in length. The body is
covered by fine tubercles. It has 4-5 testes.
Female:The female ranges in size from 2-2.5 cm in length.
 The ovary is presentin the posterior third. Vitelline glands occupy the
posterior thirds.
Uterus is long containing many ova. It lays about 20-200 eggs daily.
 SCHISTOSOMA JAPONICUM
Habitat - This species lives in the veins of small intestine.
•The female adult worm lays about 500-3500 eggs daily. The eggs are
ovoid,bearing only a minute lateral spine or a small knob postero-
laterally.
•It is found in Japan, China, and Philippines, etc.
 LIFE CYCLE OF SCHISTOSOMES
 Unusual in that eggs are the damaging stage which promotes growth of
granuloma
 Adult worms reside in pairs: the female lying in the gynecophoral canal
of the
male.
 After fertilization, eggs are passed into the venules. A larval form – the
miracidium - develops within the egg.
Its lytic enzymes and the contraction of the venule rupture the wall of the
venule liberating the egg into the perivascular tissues of the intestine (S.
mansoni) or urinary bladder (S. haematobium).
The eggs pass into the lumens and organs and are evacuated in the feces
(S.mansoni) or the urine (S. haematobium).
On contact with fresh water the miracidia hatch from the eggs and swim
about until they find the appropriate snail, which they penetrate.
 Cont..
 After two generations of sporocyst development and multiplication
within the snail, the fork-tailed cercariae emerge.
 Infection to man takes place during bathing or swimming. The
cercariae penetrate the skin, are carried into the systemic circulation and
pass through to the portal vessels.
• Within the intrahepatic portion of the portal system, the worms feed and
grow to maturity.
Figure 1. Life cycle of schistosomes
 Symptoms and complications
• Patients infected with S. haematobium suffer from terminal haematuria and
painful micturition.
• There is inflammation of the urinary bladder (cystitis), and enlargement of
spleen and liver.
• Patients infected with S. mansoni suffer from cercarial dermatitis (swimmers
itch) and dysentery (mucus and blood in stool with tenesmus) as well as
enlargements of the spleen and liver.
• S. haematobium causes squamous cell carcinoma in the bladder.
Laboratory Diagnosis
S. mansoni
♦ Microscopic examination of the stool for eggs after concentration by
sedimentation method. The egg has characteristic lateral spine.
♦ Rectal snip
S. haematobium:
♦ Examination of the urine after allowing it to sediment in a conical urinalysis
glass. A drop from the sediment is taken and examined for eggs. Egg has
terminal spine and biopsy from bladder
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

15
 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

16
 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

17
 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

18
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
spines on the sucker
• Shell is not acid fast in Ziehl-Neelsen
staining, but the egg shell of other
terminally spined Schistosoma species
is acid fast
• Colour: pale yellow-brown
• Contain fully developed miracidium
when laid

19
 Treatment and Prevention
Treatment: Praziquantel: single oral dose of 40 mg/kg divided into two
doses.
Prevention:
1. Health education:
A. On use of clean latrines and safe water supply
B. Avoid urination and defecation in canals, avoid contact with canal
water
2. Snail control:
A. Physical methods:
i. Periodic clearance of canals from vegetations.
ii. Manual removal of snails and their destruction.
B. Biological methods: Use of natural enemies to the snails such as
Marisa.
C. Chemical methods: Molluscides are applied in the canals to kill the
snails. e.g. Endod
 Liver Flukes

 Include
 Fasciola hepatica
 Clonorchis(opisthorchis) sinensis
General Features
 Adults are large and live in the liver or biliary duct
  Eggs are large and contain undeveloped ovum when passed in the
faeces 
 They are hermaphrodite
 Fasciola hepatica
Common name: sheep liver fluke
Geographical Distribution
Cosmopolitan; prevalent in most sheep and cattle raising countries
In Ethiopia
 does not play an important role in human health in Ethiopia
 only as few reported cases of the disease; as result of finding eggs
in the stools of people who had consumed infected liver of sheep
or cattle
 Causes serious economic loss throughout the highlands in Ethiopia
by infecting cattle and sheep
 Cont….
Habitat
Adult: In the bile duct of sheep, goat , cattle & man
Egg: In faeces
All larva stages: Fresh water snail
Metacercaria: on water vegetation's
Morphology
 Adult
Size: 30 mm by 12 mm
Shape: fleshy , flat, leaf-like
Colour: grey brown
Cone shaped prominent two “ shoulders”
 Egg
Size: 130-150m by 60-90m
Shape: oval with rounded poles
Shell: smooth with a double line &
marked operculum at one pole
Colour: bile-stained or yellow to dark brown
Fasciola hepatica adult stage
 Cont….

Eggs
 Life cycle
 Immature eggs are discharged in the stool
 Eggs become embryonated in water , eggs release miracidia
 miracidia invade snail intermediate host : genus Lymnae  :
miracidia - sporocysts –rediae- cercariae
 Cercariae are released from the snail and encyst as metacercariae on
aquatic vegetation
 Mammals acquire the infection by eating vegetation containing
metacercariae
 After ingestion, the metacercariae excyst in the duodenum
  migrate through the intestinal wall in to peritoneal cavity
 Then, they penetrate liver capsule and reach to biliary ducts, where
they develop into adults
 In humans, maturation from metacercariae into adult flukes takes
about 3 to 4 months
Life cycle of F.hepatica
 Clinical feature and pathology
 Light infections are usually asymptomatic
 In heavy infection
 Local irritation during migration of the young worms to the liver
Fever, Sweating, abdominal pain
 In chronic infection: obstructive jaundice
Persistent diarrhea, anemia
 1. Finding Eggs in the faces in chronic infection
 Several specimen may also needed to detect the egg
 Concentration techniques ( fomol ether ); because the eggs usually few
 Eggs can also be found in duodenal aspirates & in bile
 If eggs are found in human faces it must be confirmed that they are present due
to a Fascial infection & not
 False Fascioliasis - due to ingestion of animal liver containing Fasciola egg
& detected in faeces
Confirmation - keep the patient on liver free diet for three days. If egg is
found in repeated examination the infection is true
2. Serological diagnosis
 by testing serum for antibodies
 valuable in the early stages of infection when the immature flukes are
migrating through the liver and causing serious symptoms but not yet
producing eggs
Treatment
 Bithinol or Triclabendazole

2
Prevention and Control

.
1.Avoid eating uncooked water plants
2.Treating infected animals & fencing grazing land known to be infected
with metacercariae
3. Identifying & destroying snail hosts & snail habitat
4.Sanitary disposal of faeces
5.Treating infected individuals & giving health education
 Clonorchis sinensis
 Common name: Chinese Liver fluke
Geographical Distribution
 Far east- China, Japan, Korea, Taiwan
 Habitat
Adult: bile duct of man and fish eating
animals including cat , dog, pig
Eggs: In the faeces
Metacercariae: under the scale of fresh water fish
 Cont…
Morphology:
Adult- Size: 10-25 mm by 3-5 mm; Boat shaped
 Cont…

Egg: Size: 25-30m;shape like electric bulb

Colour: shell; yellowish brown; contents pale yellow
Operculum: At the narrow end of the egg,
 Cont…..
Life cycle
 Embryonated eggs are discharged in the biliary ducts and in the stool.
 Eggs are ingested by a suitable snail intermediate host
miracidia - sporocysts - rediae - cercariae
 The cercariae are released from the snail.
   Then, they come in contact and penetrate the flesh of freshwater fish,
where they encyst as metacercariae.
  humans acquire infection by ingestion of undercooked, salted, or
smoked freshwater fish.
 After ingestion, the metacercariae excyst in the duodenum and ascend
the biliary tract
Life cycle of C.sinesis
 Cont…

Clinical feature and pathology

 Major symptoms are diarrhea, jaundice, cirrhosis, biliary
obstruction, hepatomegally
Laboratory Diagnosis
1.Finding the eggs in the faeces
2. Finding the eggs in aspirates of duodenal fluids
3. Serological diagnosis
Antibody or antigen detection

Treatment : praziquantel
 Intestinal Flukes
General Characteristics
 Adults live in the intestine
 Eggs are large and contain undeveloped ovum when passed in
the faeces
 They are hermaphrodite
 Include
Fasciolopsis buski
Heterophyes heterophyes
 They are found in Asian countries. Neither are found in Ethiopia.
 Fasciolopsis buski

 Common name: Giant intestinal fluke

 These giant intestinal flukes (2-7.5 cm in length) are found in
some Asian countries.
Geographical Distribution :China, Taiwan, Thailand, Vietnam,
Indonesia
Habitat
Adults: small intestine of man , pig, dog,
Eggs: In the faeces of man, Pig, dog,
Larval forms: Fresh water snails
Metacercariae: encysted on certain aquatic
vegetation
 Morphology
Adult
Size: 20-75mm by 8-20mm

Large, fleshy, flat worm

Has no cephalic cone &

shoulder

Egg
Size: 130-140m by 80-85m
Colur : Pale yellow-brown
Shape: oval
Small operculum
Unembroynated
cont……

Egg
 Life cycle
 Immature eggs are discharged into the intestine and stool
 Eggs become embryonated in water , eggs release miracidia , which
invade a suitable snail intermediate host
sporocysts rediae cercariae
 The cercariae are released from the snail and encyst as metacercariae on
aquatic plants
 The mammalian hosts become infected by ingesting metacercariae on
the aquatic plants
 after ingestion, the metacercariae excyst in the duodenum and attach to
the intestinal wall
 There they develop into adult flukes  
Life cycle of Fasciolopsis buski
 Clinical feature and Pathology
 Epigastric pain, nausea and diarrhea
 In heavier infections, generalized edema and ascites occur
 The fluke attaches itself to the intestinal mucosa where inflammation,
ulceration and abscesses occur
Laboratory Diagnosis
1.Finding eggs in the faeces
2. Finding adult worms in the faeces occasionally
Treatment :Praziquantel
Prevention and Control
1.Avoid eating uncooked water plants which may be infected
2.Construction of latrine
3. Avoid use of human faces as a fertilizer
4. Destroy snails and their habitat
5. Treating infected individuals and giving health education
 Heterophyes heterophyes
 Minute flukes acquired by ingestion of raw fresh water fish.
Geographical Distribution: China, Japan, Egypt, Korea, Taiwan
Habitat
Adult: In small intestine of man, cat, dog, fox
Egg : In the faeces
Larval forms: In fresh water snails
Metacercariae: fresh water fish
Morphology
Adult: Size: 1-2mm;has three suckers :oral, ventral & genital suckers
Egg: Similar to the egg of Clonorchis sinensis
Shell: Slightly thicker than Clonorchis
sinensis
 Life Cycle
Embryonated eggs ,each with a fully-developed miracidium, are passed
faeces
 After ingestion by a suitable snail , the eggs hatch and release miracidia
which penetrate the snail’s intestine (Genera Cerithidia & Pironella  
 sporocysts rediae cercariae  
 The cercariae are released from the snail &encyst as metacercariae in the
tissues of a fresh water fish
 The definitive host becomes infected by ingesting undercooked or salted
fish containing metacercariae
 After ingestion, the metacercariae excyst, attach to the mucosa of the
small intestine & mature into adults
Life cycle of H.hetrophyes
Clinical features
Light infection and pathology
usually asymptomatic
 Heavy infection may cause diarrhea, abdominal pain and eosinophilia
Laboratory Diagnosis
 Finding of eggs in the faeces
Treatment
 Praziquantel

Prevention and Control

 Similar as Clonorchis sinensis
 Lung Fluke (Paragonimus westermani)
Common name: Oriental lung fluke
Geographical Distribution:Extensively distributed in the Far East & West African countries :
Zaire, Nigeria, Cameroon & South America Habitat
Adults: In the lung of man
Eggs: In the sputum of man
Larval forms: Fresh water snails
Metacercariae: Fresh water crabs & crayfish
 Animals such as pigs, dogs, and a variety of feline species can also harbor P. westermani.
Morphology
Adult: Size: 7.5mm-12mm by 4-6mm
Egg
Size: 70-100m by 50-65m
Colour: Yellow-brown or brown
Shape: oval but asymmetrical and has flattened operculum
Paragonimus westermani egg
 Life cycle
 eggs are excreted un embryonated in the sputum, or alternately they are
swallowed & passed with stool
 In the external environment, the eggs become embryonated & miracidia hatch
& penetrate its soft tissues snail
sporocysts rediae cercariae
 The cercariae invade a crustacean such as a crab or crayfish, where they encyst
& become metacercariae
 Human infection with P. westermani occurs by eating inadequately cooked crab
or crayfish that harbor metacercariae
 The metacercariae excyst in the duodenum , penetrate through the intestinal wall
into the peritoneal cavity
 then through the abdominal wall & diaphragm into the lungs, where they become
encapsulated & develop into adults
 The worms can also reach other organs and tissues, such as the brain and
striated muscles
 when this takes place completion of the life cycles is not achieved,
because the eggs laid cannot exit these sites
Life cycle of P.westermani
Clinical feature and pathology
 Light to moderate infection are asymptomatic
 Symptoms sever pulmonary paragonimiasis: chest pain , cough, night
sweets, pleural effusion, & coughing up blood
 Worms may migrate to the brain where they lay eggs and cause a
granulomatous abscess resulting in symptoms similar to epilepsy
Laboratory Diagnosis
1. Finding of eggs in the sputum
 sputum is usually bloody, mucoid &rusty brown
2. Finding of eggs in aspirates of pleural fluid & occasionally in faeces
Treatment :Praziquantel
Prevention and Control
1.Avoid eating raw or uncooked crabs & crayfish
2.Avoid contamination of water with sputum or faeces
3.Destroy snails & their habitat
4.Inspecting crabs & crayfish for metacercariae
5.Treating infected individuals & giving health education
1.Write the site of infection or habitat for the following
blood fluke.
A. Schistosoma mansoni
B. Schistosoma haematobium
C. Schistosoma japonicum
2.State the general characterstics of Trematodes
3.How human got infection of lung fluke
4. List the 3 main body region of Trematodes