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Parasitology
Lec 5

Trematodes: Flukes
Trematodes are unsegmented helminths, which are flat and broad, resembling the
leaf of a tree or a flatfish (hence the name Fluke, from the Anglo-saxon word 'floc'
meaning 'flatfish'). The name Trematode comes from their having large prominent
suckers with a hole in the middle (Greek trema: hole, eidos: appearance).

Flukes: General Characteristics

They vary in size from the species just visible to the naked eye, like Heterophyes to
the large fleshy flukes, like Fasciola and Fasciolopsis.
-shaped
suckers (hence called distomata)— the oral sucker surrounding the mouth at the
anterior end and the ventral sucker or acetabulum in the middle, ventrally

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The body is covered by an integument which often bears spines, papillae, or

tubercles.
cavity, circulatory and respiratory organs.

muscular pharynx and the esophagus, which bifurcates anterior to the acetabulum to
form 2 blind caeca, that reunite in some species. The alimentary canal, therefore
appears like an inverted Y. The anus is absent
lead to a
median bladder opening posteriorly
paired ganglion cells.
-developed. Flukes are hermaphroditic
(monoecious) except for schistosomes, in which the sexes are separate (dioecious).

selffertilization takes place, though in many species cross-fertilization also occurs.

In the schistosomes, the sexes are separate, but the male and female live in close
apposition (in copula), the female fitting snugly into the folded ventral surface of
the male, which forms the gynecophoric canal.
operculated, except in the case
of schistosomes.

Classification Based on Habitat

Based on habitat, trematodes can be classified as
i.Blood flukes
ii.Liver flukes
iii.Intestinal flukes
iv.Lung flukes

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Classification based on Habitat

Habitat Trematodes
Blood (Blood fluke) Schistosoma haematobium (In the
vesical and pelvic venous plexuses)
Schistosoma mansoni (In the inferior
mesenteric vein)
Schistosoma japonicum (In the superior
mesenteric vein)
Biliary tract (Liver fluke) Clonorchis sinensis
Fasciola hepatica
Opisthorchis spp.
Gastrointestinal tract (Intestinal fluke)
Small intestine Fasciolopsis buski
Heterophyes heterophyes
Metagonimus yokogawai
Watsonius watsoni

Large intestine Gastrodiscoides hominis

Respiratory tract (Lung fluke) Paragonimus westermani

Zoological Classification of Trematodes

Superfamily Family Genus Species

Schistosomatoidea Schistosomatidae Schistosoma S. haematobium
S. mansoni
S. japonicum
S. mekongi
S. intercalatum
Paramphistomatoidea Zygocotylidae Gastrodis coides G. hominis
Watsonius W. watsoni
Echinostomatoidea Fasciolidae Fasciola F. hepatica
Fasciolopsis F. buski
Opisthorchioidea Opisthorchiidae Opisthorchis O. felineus
O. viverrini

Heterophyidae Clonorchis C. sinensis

Heterophyes H. heterophyes
Metagonimus M. yokogawai
Plagiorchioidea Paragonimidae Paragonimus P. westermani

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Life Cycle

Medically important members of the class Trematoda belong to the subclass

Digenea, as they are digenetic, i.e. require 2 hosts to complete their life cycle

BLOOD FLUKES

Schistosomes

Schistosomes are dioecious, (sexes are separate) trematodes, which lead to

Schistosomiasis (bilharziasis).

Schistosomiasis is a water-borne disease constituting an important public health

problem and affecting millions of persons in Africa, Asia, and Latin America.

It is estimated that over 100 milion people are infected with S. haematobium, S.
mansoni, and S. japonicum each. Two other species of Schistosoma parasitizing
humans are S. mekongi and S. intercalatum.

The male worm is broader than the female and its lateral borders are rolled
ventrally into a cylindrical shape, producing a long groove or trough called
the gynecophoric canal, in which the female is held. It appears as though the body of
the male is split longitudinally to produce this canal; hence the name schistosome
(Greek schisto: split and soma: body)

Schistosomes were formerly called Bilharzia after Theodor Bilharz who in

1851, first observed the worm in the mesenteric veins of an Egyptian in Cairo.

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Features distinguishing schistosomes from other trematodes

Schistosomes differ from the hermaphroditic trematodes in many aspects.

• They are unisexual (diecious).
• They lack a muscular pharynx.
• Their intestinal caeca reunite after bifurcation to form a single canal.
• They produce non-operculated eggs.
• They have no redia stage in larval development.
• The cercariae have forked tails and infect by penetrating the unbroken skin of
definitive hosts.

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Schistosoma Haematobium

Habitat
The adult worms live in the vesical and pelvic plexuses of veins

Morphology

Adult worm
The male is 10–15 mm long by 1 mm thick and covered by a finely tuberculated
cuticle.
It has 2 muscular suckers, the oral sucker being small and the ventral sucker
large and prominent. Beginning immediately behind the ventral sucker and
extending to the caudal end is the gynecophoric canal, in which the female
worm is held
The adult female is long and slender, 20 mm by 0.25 mm with the cuticular
tubercles confined to the two ends.
The gravid worm contains 20–30 eggs in its uterus at one time and may pass
up to 300 eggs a day.

Egg
The eggs are ovoid, about 150 μm by 50 μm, nonoperculated, with a brownish yellow
transparent shell carrying a terminal spine at one pole; the terminal spine being

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Life Cycle

S. heamatobium passes its life cycle in 2 hosts.

Definitive host: Humans are the only natural definitive hosts. No animal reservoir is
known.
Intermediate host: Fresh water snails.
Infective form: Cercaria larva
The eggs that are passed in urine are embryonated and hatch in water under
suitable conditions to release the free living ciliated miracidia.
Miracidia swim about in water and on encountering a suitable intermediate host,
penetrate into its tissues and reach its liver The intermediate hosts are
snails of Bulinus species in Africa. In India, the intermediate host is the limpet,
Ferrisia tenuis.

Development in Snail
Inside the snail, the miracidia lose their cilia and in about 4–8 weeks, successively
pass through the stages of the first and second generation sporocysts

Large number of cercariae are produced by asexual reproduction within the

second generation sporocyst
The cercaria has an elongated ovoid body and forked tail (furcocercous
cercaria) (
The cercariae escape from the snail.
Swarms of cercariae swim about in water for 1–3 days. If during that period they
come into contact with persons bathing or wading
in the water, they penetrate through their unbroken skin.

Skin penetration is facilitated by lytic substances

secreted by penetration glands present in the cercaria.

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Development in Man
On entering the skin, the cercariae shed their tails and become schistosomulae
which enter the peripheral venules
They then start a long migration, through the vena cava into the right side of the
heart, the pulmonary circulation, the left side of the heart, and the systemic circulation,
ultimately reaching the liver.
In the intrahepatic portal veins, the schistosomulae grow and become sexually
differentiated adolescents about 20 days after skin penetration.
They then start migrating against the blood stream into the inferior mesenteric
veins, ultimately reaching the vesical and pelvic venous plexuses, where they mature,
mate, and begin laying eggs.
Eggs start appearing in urine usually 10–12 weeks after cercarial penetration.
The adult worms may live for 20–30 years.

Pathogenicity and Clinical Features

Clinical illness caused by schistosomes can be classified depending on the stages
in the evolution of the infection, as follows:
Skin penetration and incubation period
Egg deposition and extrusion
Tissue proliferation and repair.
The clinical features during the incubation period may be local cercarial dermatitis
or general anaphylactic or toxic symptoms.
Cercarial dermatitis consists of transient itching and petechial lesions at the site
of entry of the cercariae (swimmer‟s itch).
This is seen more often in visitors to endemic areas than in locals who may be
immune due to repeated contacts.
It is particularly severe when infection occurs with cercariae of nonhuman
schistosomes.
Anaphylactic or toxic symptoms include fever, headache, malaise, and urticaria.
This is accompanied by leucocytosis, eosinophilia, enlarged tender liver, and a
palpable spleen. This condition is more common in infection with S. japonicum
(Katayama fever).

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Laboratory diagnosis of Schistosoma haematobium

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Treatment
Praziquantel is the drug of choice (40mg/kg for 1 day). Metriphonate is the
alternative drug of choice in schisto- somiasis due to S. haematobium. (7.5 mg/kg.
weekly for 3 weeks).

Schistosoma Schistosoma Schistosoma

haematobium mansoni japonicum
Habitat Veins of the vesical Inferior mesenteric Superior mesenteric
and pelvic plexuses, vein and its branches vein and its branches
less commonly in
portal vein and its
mesenteric
branches
Morphology
Size:
Male 1.5 cm × 1mm 1 cm × 1 mm 1.2–2 cm × 0.5 mm
Female 2 cm× 0.22 mm 1.4 cm × 0.25 mm 2.6 cm × 0.3 mm

Integument Finely tuberculated Grossly tuberculated Non-tubercular

Number of testes 4–5 in groups 8–9 in a zigzag row 6–7 in a single file

Ovary In the posterior one- In the anterior half of In the middle of the
third of the body the body body

Uterus Contains 20-30 eggs 1–3 eggs 50 or more eggs

Egg Elongated with Elongated with Round with small
terminal spine lateral spine lateral knob
Cephalic glands in 2 pairs oxyphilic and 2 pairs oxyphilic and 5 pairs oxyphilic, no
Cercariae 3 pairs basophilic 4 pairs basophilic basophilic
Distribution Africa, Near East, Africa and south China, Japan, far east
Middle East, India America (oriental)
Definitive host Man Man Man (mainly)
domestic animals &
rodents (which act as
reservoir of infection
Intermediate host Snail of Genus Snail of Genus Amphibian snail of
Bulinus Biomphalaria Genus Oncomelania

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