Lifecycle

- Egg → snail (1st intermediate host) → release

Outline of Discussion
as larvae (cercariae) → eaten by fish (2nd
1. Clonorchis sinensis – Asian liver fluke intermediate host) → eaten by man as raw
2. Fasciola hepatica – liver fluke
3. Paragonimus westermani – lung fluke ● Endemic in China, Japan, Korea, and Indochina
4. Fasciolopsis buski – intestinal fluke
5. Schistosoma – blood fluke Disease – Clonorchiasis
- Most are asymptomatic
TREMATODES
Signs & Symptoms
- Other names: Flukes / Flatworms
a. Abdominal pain
b. Anorexia
Morphology
c. Hepatomegaly
- Leaflet-shaped worms
d. Eosinophilia
- Flat & fleshy
e. Cancer of bile duct: Cholangiocarcinoma,
- From phylum Platyhelminthes
cholelithiasis
Characteristics
Mode of Transmission
1. 2 muscular suckers
- Undercooked or raw freshwater fish
a. Oral type: beginning of incomplete digestive
containing larvae
system
b. Ventral sucker: serves as attachment
Prevention & Control
2. Has digestive tract
- Thorough cooking of fish
- Education of population re-eating habits
Reproductive Organs
- Stopping the seeding of fish culture ponds
1. Most flukes are hermaphroditic
- Proper waste disposal to avoid contamination
- Capable of self-fertilization
of water
2. Schistosoma: separate sexes
- Gynecophoric canal
Fasciola Hepatica (Sheep Liver Fluke)
Adult Worm – Schistosomes Mode of Transmission
- Separate sex (male & female worm) - Ingestion of metacercariae encysted on edible
- Male: has a gynecophoric canal in which it aquatic plants like kangkong and watercress
carries the female during the life cycle
- 10~20 mm long Lifecycle
- Egg → snail → release as cercariae → encyst
Digenitic requires 2 Hosts to complete lifecycle in water plant → develop as metacercariae
1. 1st intermediate host – mollusks (snail, (infective stage) → eaten by man
clam): asexual reproduction takes places
2. 2nd intermediate host – varies ● Snail: Galba truncatula

Transmission Prevention
- By penetration of skin of larvae (cercariae) - Thorough washing and cooking of vegetables
- By ingestion of cysts from undercooked or - Boiling of water in areas where the infection is
raw freshwater fish (2nd intermediate hosts) endemic

Clonorchis Sinensis (Asian Liver Fluke) Control Measures

- Elimination of the intermediate host
Mode of Transmission
- Chemotherapy
- Ingestion of undercooked or raw freshwater
fish containing encysted larvae
(metacercariae)
Disease – Fascioliasis
Fasciolopsis Buski (Intestinal Fluke)
- Migration of the larval worm through the liver
can produce irritation of the organ manifesting Mode of Transmission
tenderness and hepatomegaly - Ingestion

Signs & Symptoms Lifecycle

a. RUQ pain, worms may necrosis foci in liver - Egg → snail → released as cercariae →
called “liver rot” water plant → eaten by man / pig (hosts)
b. Suffocation (Halzoun: allergic pharyngitis)
caused by temporary lodgement of adult worm ● Intestinal parasite of humans and pigs
in pharynx ● Endemic in Southeast Asia, China, Korea, and
India
Diagnosis
- + egg in the stool Disease – Fasciolopsiasis
- Same appearance with F. buski
Signs & Symptoms
Treatment a. Abscess formation
- Bithionol or triclabendazole b. Ulceration and hemorrhage
c. Allergic reaction: edema of the face, abdominal
Mode of Transmission wall & lower limbs
- Ingestion of raw liver of infected sheep or goat d. Profound intoxication may lead to death

Treatment
Paragonimus Westermani (Lung Fluke) - Praziquantel
Mode of Transmission
- Ingestion of undercooked or raw crab meat
Schistosoma Spp. (Blood Fluke)
(crayfish) that contains the encysted larva
(metacercariae) - Also known as Bilharzia
- Not hermaphroditic
Lifecycle - Obligate intravascular parasites
- Egg → snail → release as cercariae → crab - Infective stage is the skin penetrating cercaria
→ eaten as raw by man → lungs
3 Types
Laboratory Diagnosis 1. Schistosoma mansoni
- + egg in the sputum or feces 2. Schistosoma japonicum (oriental blood fluke)
- Chest X-ray: ring shadowed opacity with 3. Schistosoma haematobium
cavitation that gives appearance to bunch of
grapes Mode of Transmission
- Skin penetration
Disease – Paragonimiasis
- Other names: parasitic hemoptysis, Lifecycle
pulmonary distomiasis, endemic hemoptysis - Egg → develop as miracidium (embryo) →
snail → released as cercariae → penetrate
Signs & Symptoms skin of man
a. Chronic cough produces bloody sputum with a
foul fishy odor most pronounced in the morning Snails
b. Chest pain and dyspnea - After larvae hatch from eggs, the larvae infect
c. Resembles TB a very specific type of freshwater snail
a. S. haematobium: Bulinus snail
b. S. mansoni: Biomphalaria snail
c. S. japonicum: Oncomelania quadrasi
snail
Disease – Schistosomiasis / Bilharziasis - Control of disease
- Most are asymptomatic - Provision of sanitary facilities and water
- Chronic infection: pruritic papules supply
–swimmer’s itch or clam digger’s itch (site of - Prevent swimming in areas of endemic
entry) infection should be avoided
- After 2~3 weeks: fever, chills, diarrhea,
lymphadenopathy

Pathogenesis
1. S. Mansoni Eggs
- Damage the wall of the distal colon
- Endemic in Africa and Latin America

2. S. Japnicum
- Damage the walls of both small and large
intestine
- The only one for domestic animals like water
buffalo and pigs act as important reservoir

3. S. Haematobium
- Damage the wall of the bladder induce
granuloma and fibrosis
- Africa and Middle East

S. Japonicum Infection / Katayama Disease

- Endemic in China, Philippines, & Indonesia

Signs & Symptoms

a. Hepatosplenomegaly, splenomegaly
b. Portal hypertension
c. Gastrointestinal hemorrhage
d. Risk of liver cancer
e. Common cause of death: ruptured esophageal
varices

Dermatitis
- First potential reaction
- An itchy, papular rash

Schistosoma Haematobium Infection

- Vesical bilharziasis

Signs & Symptoms

a. Hematuria
b. UTI
c. Risk of developing urinary bladder carcinoma

Treatment
- Praziquantel

Control Measures
- Snail control