Trematodes
DR.MEHRU NISHA
[email protected]
Trematodes or Flukes
INTRODUCTION
Trematodes belong to the phylum platyhelminthes.
Trematodes are leaf-like unsegmented flat worms
The great majority inhabit the alimentary canal, liver,
bile duct, ureter and bladder of vertebrate animals.
Blood flukes, Intestinal flukes, Liver flukes, and Lung
flukes
Body is non-segmented, flattened
dorsal-ventrally, and covered with a
cuticle which may be smooth or
spiny.
Attachment organs are two cup-
shaped suckers, oral and ventral.
Tegument is metabolically active.
Oral cavity leads to muscular
esophagus; intestine branches into
2 caeca, which end blindly near the
posterior end of the worm.
Simple digestive system, no anus -
waste products are regurgitated
General life cycle
Trematodes are parasites of vertebrates. They have complex life cycles
requiring one or more intermediate hosts. Most are hermaphroditic and
capable of self-fertilization.
Eggs shed by the adult worm pass outside to the environment, and a larva
(called a miracidium) hatches and swims away to infect the intermediate
host.
Each species requires a certain species of mollusk (snail, clam, etc) as an
intermediate host. A series of generations occurs in the mollusk, resulting in
the liberation of larvae known as cercariae.
Penetrate directly through skin and develop into adults.
Enter a second intermediate host, and wait to be ingested (they are now
called metacercariae).
Attach to vegetation, secrete a resistant cyst wall, and wait to be eaten (now
called metacercariae).
1
The flukes
Blood
• Schistosoma mansoni
• Schistosoma haematobium
• Schistosoma japonicum
Intestinal:
• Fasciolopsis buski
• Heterophyes heterophyes
• Metagonimus yokogawai
Liver / Lung
• Fasciola hepatica
• Clonorchis sinensis
• Paragonimus westermani
BLOOD FLUKES
SCHISTOSOMIASIS (BILHARZIASIS)
It is estimated that about 600 million people in 79 countries suffer from
schistosomiasis (Bilharziasis).
Schistosome is the only fluke with separate sexes.
The female worm lies in the gynecophoral canal of the male. This condition is
important for transportation.
Causes hematuria, abdominal pain, fibrosis of urethera
https://www.youtube.com/watch?v=leeeWD59D9Q
https://www.youtube.com/watch?v=5NMNAkBLaqA
SCHISTOSOMIASIS (BILHARZIASIS)
• There are five medically important species:
1. Schistosoma mansoni: causes intestinal schistosomiasis.
2. Schistosoma haematobium: causes vesical (urinary)
schistosomiasis.
3. Schistosoma japonicum: causes intestinal schistosomiasis and
prevalent in Malaysia.
4. Schistosoma intercalatum: causes intestinal schistosomiasis.
5. Schistosoma mekongi: causes intestinal schistosomiasis. This
seems to cause milder disease in man. It causes disease in
other vertebrate hosts.
Finding from Malaysian patient
Schistosoma species
(blood fluke)
Disease
• Schistosomiasis
– Schistosoma mansoni, Schistosoma japonicum &
Schistosoma intercalatum : lives in the veins of the
intestine
– Schistosoma haematobium: lives in the veins of human’s
bladder.
Important properties
• Adult exists as separate sexes but.
• Female resides in a groove in a male,
live attached to each other and continuously fertilized
• her eggs.
(1) Schistosoma mansoni
• Habitat
This species lives in the veins of the intestine.
• Geographical distribution
o It is found in Africa, South America, Middle East (some Arab
countries) etc.
o Stream and lake-based transmission is common.
o The snail hosts that harbor S. mansoni are the genera:
Biomphalaria (B. glabrata) and Trobicorbis.
These have oval shells.
Eggs discharge in faeces
Schistosoma mansoni
• Male: The male ranges in size from
1-1.4 cm in length.
• 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 (eggs development)
occupy the posterior two-thirds.
• It lays about 100-300 eggs daily.
• The uterus is short containing few ova.
F
M
(2) Schistosoma japonicum
• The female adult worm lays about 500-3500 eggs daily.
• The eggs are ovoid, bearing a lateral spine or a small knob
post-laterally.
• It is found in Malaysia, Japan, China, and Philippines, etc.
(3) Schistosoma intercalatum
• This is the rarest and least pathogenic schistosome
that matures in man.
• It is found in Western and Central Africa.
• The daily egg output is about 300.
• The eggs have a terminal spine.
(4) 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 - Bulinus (Bulinus africanus, B. truncatus) and
Physopsis.
Distribution
• Middle-east & throughout Africa
• Not endemic
Schistosoma haematobium
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 present in the posterior third.
• Vitelline glands occupy the posterior thirds.
• Uterus is long containing many ova.
• It lays about 20-200 eggs daily.
Schistosoma species
(blood fluke)
Important properties
• Eggs
– S. mansoni: prominent lateral spine
– S. japonicum: small lateral spine
– S. haematobium: terminal spine
• Location in human body
– S. mansoni and S. japonicum: Lives in the mesenteric veins
(veins from large intestine)
– S. haematobium: Lives in veins draining the urinary
bladder
Schistosoma species
(blood fluke)
Symptoms
• Penetration of cercariae causes transient dermatitis
(swimmers' itch).
• The symptoms due to a reaction against the eggs:
splenomegaly, lymphadenopathy and diarrhea.
• In the bladder, they produce granulomatous lesions,
hematuria (blood in urine) and sometimes urethral
occlusion.
• Most bladder cancers in endemic areas are associated
with chronic infection.
• In the intestine, they cause polyp formation which, in
severe cases, may result in life threatening dysentery.
Schistosoma species
(blood fluke)
Symptoms
• In the liver, the eggs cause periportal fibrosis and portal
hypertension: hepatomegaly, splenomegaly and ascites
(accumulation of fluid in abdominal area).
• A gross enlargement of the esophageal and rupture of gastric
veins.
• Eggs carried to the heart produce arteriolitis and fibrosis
resulting in enlargement and failure of the right ventricle
• S. japonicum eggs are sometimes carried to the central
nervous system and cause headache, disorientation, amnesia
and coma.
Schistosoma species
(blood fluke)
Symptoms (cont.)
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.
S. haematobium causes squamous cell carcinoma in the
bladder.
Patients infected with S. mansoni suffer from cercarial
dermatitis (swimmers itch due to S. mansoni ) and dysentery
(mucus and blood in stool as well as enlargements of the
spleen and liver.
Swimmer’s itch
Schistosoma species
(blood fluke)
Diagnosis
• History of residence in an endemic area, swimmers' itch and
other symptoms.
• Microscopic examination of the stool for eggs.
– S. hematobium eggs in urine (55 to 65 by 110 to 170
micrometers) has terminal spine.
– S. mansoni eggs in feces (45 to 70 by 115-175 micrometers)
have a spine on the side (lateral).
– S. japonicum eggs (55 to 65 by 70 to 100 micrometers) are
more round with a vague spine on the side.
• Rectal spp - S. mansoni
• Biopsy from bladder - S. hematobium
Schistosoma species
(blood fluke)
Treatment
• Praziquantel is effective against all species (option: Metrifonater).
Prevention
• Health education
-On use of clean latrines and safe water supply
-Avoid urination and defecation in canals
• Snail control
Physical methods:
i. Periodic clearance of canals from vegetations.
ii. Manual removal of snails and their destruction.
Biological methods: Use of natural enemies to the snails such as Marisa.
Chemical methods: Molluscides are applied in the canals to kill the snails.
e.g. Endod
• No vaccine is available.
GIANT INTESTINAL
FLUKE
Fasciolopsis buski
(Giant intestinal fluke)
Epidemiology
•Asia and the Indian subcontinent, especially
in areas where humans raise pigs and
consume freshwater plants.
Morphology
•The elongate oval fluke is 2 to 7 cm long
•Lives in the small intestine of man
Fasciolopsis buski
(Giant intestinal fluke)
Life cycle
Ingesting water chestnuts contaminated with metacercaria small
intestine attach themselves to the mucosa and mature in 25 to 30
days The fluke eggs are passed in the feces hatch in fresh
water producing miracidia must penetrate a suitable snail within
hours Miracidia in the snail develop into cercaria enter fresh
water where they attach themselves to water plants (water
chestnut) encyst to become metacercaria.
Fasciolopsis buski
(Giant intestinal fluke)
Symptoms
•Epigastric pain, nausea and diarrhea are experienced, especially in
the morning.
•Heavier infections: generalized edema and ascites occur.
Pathology
The fluke attaches itself to the intestinal mucosa inflammation,
ulceration and abscesses.
Fasciolopsis buski
(Giant intestinal fluke)
Diagnosis
•Eggs in feces (75 to 100 by 130 to 150 micrometers) provide the final
diagnosis.
Treatment and control
•Praziquantel
•Water chestnuts from contaminated waters should be avoided.
•Sewage should be treated before disposal.
LIVER FLUKES
(1) Fasciola hepatica (liver flukes)
Epidemiology
•Distributed worldwide
•Parasite of grazing animals (sheep and cattle) and man.
Morphology
•Leaf shaped and measures approximately 1 x 3 cm.
•The eggs measure 80 x 150 µm
Fasciola hepatica
Life cycle
Immature Fasciola eggs are discharged in the biliary ducts and in the stool .
Eggs become embryonated in water , eggs release miracidia , which invade a suitable snail
intermediate host, including the genera Galba, Fossaria and Pseudosuccinea.
In the snail the parasites undergo several developmental stages (sporocysts , rediae , and
cercariae ).
The cercariae are released from the snail and encyst as metacercariae on aquatic vegetation or
other surfaces.
Mammals acquire the infection by eating vegetation containing metacercariae. Humans can
become infected by ingesting metacercariae-containing freshwater plants, especially watercress .
After ingestion, the metacercariae excyst in the duodenum and migrate through the intestinal
wall, the peritoneal cavity, and the liver parenchyma into the biliary ducts, where they develop into
adult flukes .
In humans, maturation from metacercariae into adult flukes takes approximately 3 to 4 months.
The adult flukes (Fasciola hepatica: up to 30 mm by 13 mm; F. gigantica: up to 75 mm) reside in the
large biliary ducts of the mammalian host. Fasciola hepatica infect various animal species, mostly
herbivores (plant-eating animals).
Fasciola hepatica
Symptoms
Larva through the liver produces tenderness and hepatomegaly.
The infection results in upper quadrant pain, chills and fever
accompanied with eosinophilia.
The toxic secretions cause hepatitis.
The presence of the worm in the bile duct causes irritation resulting in
hyperplasia of the epithelium and bile obstruction.
Adult worms may invade the liver and cause necrotic foci (liver rot).
Fasciola hepatica
Diagnosis
•Diagnosis is based on symptoms and history
•The eggs in the stool are indistinguishable from those of F. buski.
Treatment
•NOT RESPONSIVE to praziquantel.
•Triclabendazole is effective.
(2) Paragonimus westermani
Paragonimus westermani
(Lung Fluke)
Epidemiology
Known as Japanese lung fluke
•Commonly encountered in parts of Asia, Africa and South America.
Morphology
•Plump reddish brown oval worm measuring 10 by 4 mm.
•The ovum measures 85 by 55 micrometers
Paragonimus westermani
(Lung Fluke)
Symptoms
oDevelopment of a fibrous tissue capsule with bloody purulent material containing eggs.
oInflammatory infiltrate around the capsule.
oDry cough, followed by production of blood stained rusty brown sputum.
oPulmonary pain and pleurisy (lung inflammation) may develop.
oWorms may migrate to the brain where they lay eggs and cause a granulomatous abscess
resulting in symptoms similar to epilepsy.
Paragonimus westermani
(Lung Fluke)
Diagnosis
•Based on history and symptoms.
•Eggs are found in rust colored sputum, often being examined for tuberculosis.
Treatment and control
•Praziquantel taken orally is quite effective.
•Adequate cooking of crustaceans is a preventive measure.
•Improved sanitary conditions have lowered the infection rate in endemic areas.
Trematodes eggs
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