TREMATODES GENERAL: Parasitic existence. Hermaphrodites except schistosomes.

covered with spines,

MORPHOLOGY: Leaf-like, tegument: non-cellular,

tubercles or ridges-absorption of carbohydrates. Oral and ventral suckers. Primitive nervous, excretory and digestive systems. Reproductive system-classification (?). Ova operculate, (except schisto) shape, appearance and size is characteristic. Schistosomes unique! Sexes, Intermediate host PHYSIOLOGY: Nutrition-from tissues, secretions or intestinal contents. Respiration anaerobic. Larva aerobic. Ova, Pathology Transmission

LIFE CYCLE: Egg,

Miracidium,

Snail (first intermediate host), Rediae, Cercariae; adult.

Sporocyst: (Mother and daughter-multiply),

Infect (eg. Schisto) or metacercariae on 2nd IH (eg. Crab, fish), ingested,

PATHOLOGY: Lesions depend on location in host, numbers, toxic effects of products. Intestinal: Irritative and toxic. Lung: cystic lesions, Schisto: Adults: blockage (?); Ectopic flukes: CNS, skin etc. Liver: irritative, partial biliary tract obstruction. ova in cavities. Ova-trapped in tissues-granuloma. Disease in schisto-immunopathology.

Schistosomule: Coat of host proteins-evade immune response. Glomerulonephritis immune complexes. Chronic schisto-obstructive uropathy and hydronephrosis. Tissue response predispose to malignant change eg. squamous cell Ca.

SYMPTOMS: Prepatent/Incubation

Acute

Chronic

Resistance and Immunity: Host-specificity of snails. Skin-test reactivity. Eosinophils-damage obstructive uropathy. Calicification of bladder. Ectopic ova. Late

effects (eg. Ca of bladder), SNAIL HOST: Bulinus sp.

S.MANSONI: Pseudopolyposis of colon, liver-pipe stem fibrosis (liver/spleen enlarged). SNAIL HOST: Biomphalaria sp. S. JAPONICUM: Like S. mansoni more severe because more ova. Snail host: Oncomelania sp. (amphibious) GENERAL: Ectopic worms, Salmonella, antigenic disguise, kidney in schisto. CMI to ova,

IMMUNITY: Concomitant immunity, Natural history.

DIAGNOSIS: Urine (Nuclepore), TREATMENT: Praziquantel,

stool,

rectal biopsy,

immunodiagnosis. oxamniquine

metrifonate,

PREVENTION AND CONTROL: Reduce water contamination, chemotherapy, snail control, reduce water contact.

schistosomula by ADCMI. Partial functional immunity-concomitant immunity. SCHISTOSOMA Sp. Species: S. HAEMATOBIUM, S. MANSONI, S. JAPONICUM. Others.

GEOGRAPHICAL DISTRIBUTION: IMPORTANCE: 75 countries, 500-600 million exposed, 200 million infected, Mortality 1%. MORPHOLOGY: Separate sexes, gynaecophoric canal, tegument (smooth or tuberculated), characteristic of species. intestine, number of testes, length of uterus, ova

LIFE CYCLE: Ova in urine and faeces, miracidia,

snail host,

bifurcated

cercariae, penetrate unbroken skin, schistosomulae, circulation, R heart, Lungs, pulmonary capillaries, systemic circulation-portal circulation-into liver/feed and grow. Migrate to pelvic

and vesical veins (S. haematobium); Inferior mesentric and adjacent to lower colon (S. mansoni), superior mesentric and also inf. mesentric, (S. japonicum). PREPATENT PERIOD: Time between infection and egg passage-3 m. INCUBATION PERIOD: Time between infection and symptoms (1-3 weeks) longer.

PATHOGENICITY: Depends on age, previous exposure, worm burden. Ova in tissue, ectopic ova.

Invasive stage: Cercarial dermatitis Migration: Acute, toxaemia Established: Rentention of ova-chief pathology SPECIFIC FEATURES

S. HAEMATOBIUM: Bladder, terminal haematuria, dysuria,

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