Chapter 57

Blood Trematodes
 Objectives
 List the clinically significant blood trematodes
 Describe the general lifecycle of the blood trematodes
and how human infection occurs
 Explain the diagnostic methods used to identify blood
trematodes
 Differentiate the eggs of the five species of schistosomes
 Describe the pathogenesis of the blood trematodes
 List the drug of choice for the treatment of blood
trematode infections
 Describe where blood trematodes are found and how
infection may be prevented
 General Characteristics (1 of 2)
 Blood flukes
 Differ in morphology and life cycles from other trematodes
 All however require a freshwater snail as an intermediate host
 Eight species, with 5 primarily associated with human
disease
 Schistosoma haematobium
 Schistosoma mekongi
 Schistosoma intercalatum
 Schistosoma japonicum (Oriental blood fluke)
 Schistosoma mansoni
 General Characteristics (2 of 2)
 Adult schistosomes are not flattened
 Oral sucker surrounds the mouth
 Ventral sucker is below the oral sucker
 Adult worms live in veins that supply the
intestines or bladder
 Eggs are passed in feces or urine
 Adult Worms
 Male—1.5 cm in length and wider than the female
 Female—2 cm in length and very thin
 Blood Flukes
Epidemiology (1 of 2)
 Schistosoma haematobium
 Africa and Arabian peninsula
 Schistosoma mekongi
 Lower Mekong River basin (Laos)
 Reservoir hosts—Dogs and pigs
 Schistosoma intercalatum
 Central and western Africa
 Reservoir hosts—Rodents, marsupials, and
nonhuman primates
 Blood Flukes
Epidemiology (2 of 2)
 Schistosoma japonicum
 China, Indonesia, and the Philippines
 Reservoir hosts—Domestic animals
 Schistosoma mansoni
 Africa, Arabian peninsula, and Brazil
 Reservoir hosts—Rodents and marsupials
Blood Flukes Lifecycle
Schistosome Eggs
 Spectrum of Disease (1 of 3)
 Variety of species cause acute toxemic
schistosomiasis resembling serum sickness
 S. japonicum causes significant hepatointestinal
disease resulting in portal hypertension and
splenic and hepatic enlargement
 S. intercalatum is primarily associated with rectal
schistosomiasis
 S. haematobium is the only species that causes
urinary schistosomiasis
 Spectrum of Disease (2 of 3)
 Cercariae cause localized swelling and itching
 Larval migration may cause fever and malaise
 Severe tissue damage may occur when eggs
penetrate tissue to reach the intestine or bladder
 Urinary schistosomiasis may give rise to calcifications
in the bladder and renal failure
 Eggs are primarily deposited in the colon, resulting in
blood and mucus in the stool
 Spectrum of Disease (3 of 3)
 Blood flukes that commonly infect other
mammals may cause “swimmer’s itch” in
humans
 cercariae of these species are not able to complete
their life cycle by entering the human bloodstream
and are destroyed by the host immune system
 Laboratory Diagnosis
 Eggs are detected in feces or biopsy
 Rectal biopsy (all schistosomes)
 Urine or bladder biopsy (S. haematobium)
 Wet mounts with or without iodine can be used
 Optimal time for recovery of S. haematobium in
urine is between noon and 2 pm
 Antigen Detection
 Antigen Detection
 anodic and cathodic antigens, can be detected in the
urine
 used widely in Africa and Brazil but is not FDA
approved in U.S.
 Serologic Testing
 Serologic Testing
 Schistosomal IgG antibody EIA, ELISA and
Immunoblot
 Cannot distinguish between current and previous
infections
 Lack sensitivity and specificity, during the early stages
of disease
 Nucleic Acid Detection
 High sensitivity and specificity using genomic or
mitochondrial sequences
 Real-Time PCR
 Cannot distinguish between the species of
Schistosoma
 Monoplex or multiplex in fecal, serum and urine
 Repetitive sequences utilizing nested PCR to identify
genes
• SjR2 for S. japonicum
• SM1-7 for S. mansoni
• Dra I for S. haematobium
 Treatment and Prevention
 Therapy
 Praziquantel given 2 to 3 times in one day
 Prevention
 Educational programs in endemic areas
 Sanitary conditions and safe water supply