PHYLUM PLATYHELMINTHES

-flatworms can be parasitic and free living

Flatworms
-bilaterally symmetrical, compressed dorso-ventrally, definite anteroposterior axis
-have bilaterally symmetrical excretory system, collecting tubules, capillaries which terminate in
flame cells (cells sa kilid)
-lack circulatory system
-sexual organs are highly elaborated and complicated
-some sexes are combined in a single organism (hermaphrodite or monoecious) while in some
groups sexes are found as separate organisms (diecious)
-life cycle requires single obligatory host (tapeworm Hymenolepis nana) or two or more
consecutive hosts (trematode Paragonimus westermani)
-two Platyhelminthes classes of utmost importance - class Cestoidea class Trematoda(?)
Cestodes/tapeworms
-inhabit vertebrates intestinal tract, larva parasitizes tissues of vertebrates and invertebrates
-adult cestodes - ribbon or tapelike segmented parasites, size mm to m
-body 3 distinct regions: 1. Head or scolex or holdfast organs, 2. Neck, the region of growth, 3.
Strobili or body, consist series of segments or proglottids
-each proglottid is a complete reproductive unit with male and female sex organs
-life cycle includes 1. Egg with a hexacanth embryo of oncosphere, 2. Larval stage (cysticercus,
cysticercoid larva, or coracidium, procercoid, and plerocercoid larva, 3. Adult stage
-all cestodes need intermediate host; in some, definitive host can be intermediate host
Trematodes/digenetic flukes
-life cycle: involves alteration of generations and hosts
-usual primary hosts are snails
-most flukes are man parasites; also animal parasites; non-human vertebrate host reservoir for
human infection
-circulatory system - blood flukes
-intestines - Echinostoma ilocanum
-liver - Fasciola hepatica
-lungs - Paragonimus westermani
-size from 1mm to several cm length
-suckers - organs of attachment (oral or ventral suckers)
-most species are hermaphroditic
-alimentary canal is present but incomplete anus is absent
-esophagus bifurcates in front of ventral sucker into a pair of intestinal caeca that are simple or
branched or may reunite to form a single cecum --<>--reproductive system - highly developed and complete
-oviparous; eggs are operculated (except for schistosomes) and can develop in water
-life cycle includes 1. Egg stage (ovum) 2. Larval stage (miracidium, sporocyst, redia, cercaria,
metacercaria) 3. Adult stage [msrcm]
-definitive host - human who harbors the adult worm; intermediate host - freshwater snail or
mollusk which harbor larval stage; sometimes a secondary intermediate host (fish, crab, or
another snail) is required for encystment
Definitions:

Definitive host where parasite reaches adult or sexually mature stage

-final host where infectious agent undergoes adult and sexual stage of its reproduction
Intermediate host where parasite undergoes the asexual stages
-where larval or developmental stages occur
Class Trematoda/flukes
-blood stream vertebrates
-Schistosoma - japonicum mansoni haematobium
-liver vertebrates
-Fasciola hepatica Clonorchis sinensis Opistorchis felineus
-small intestine vertebrates
-Fasciolopsis buski, Echinostoma ilocanum, Heterophyid group
-lungs vertebrates
-Paragonimus westermani

Schistosoma japonicum oriental blood fluke, causes schistosomiasis japonica or

oriental schistosomiasis
-digenetic trematodes inhabiting the veins of verteb host
-snail intermediate host
-10 species; only 3 are medical and public health importance:
1. japonicum
2. mansoni parasitizes branches of portal vein; hepato-intestinal schistosomiasis
3. haematobium inhabits veins of bladder; urinary schistosomiasis
-haematobium Middle East, Africa, southern tip of Europe
-mansoni parts of Africa, South American countries, West Indies, Puerto Rico
-japonicum Philippines, China, Sulawesi in Indonesia, japan, Taiwan
Morphology
-adult flukes in Trematodes, only schistosomes have separate sexes
-male is shorter and more sturdy individual; 1.2-1.75cm length by 0.05mm breadth
-has both oral and ventral suckers
-behind ventral sucker and extending to posterior end is a groove called gynecophoral canal,
where the female is held by the male most of their life
-female is longer and more slender than male measuring 2 to 3cm by 0.3mm, oral and ventral
suckers are also seen
-ovum 70 to 90u by 50 to 65u; have small knob like projection or spine on one side
-depending on developmental stage at the time passed out with feces, one may find them
from multicellular stage to full embryonation with a developed miracidium within the shell
-miracidium ciliated, pyriform with primitive gut, a pair of penetration glands, two pairs of flame
cells and germ balls at its posterior end
-intramolluscan stages miracidium becomes first generation or mother sporocyst after
penetrating snail
-sac-like organism with germ balls
-daughter sporocyst contain cercariae
-cercariae when discharged from snail, its forked, with body and tail of equal length from 100150u, breadth of tail 1/3 of body

-fork of tail is situated posterior third of tail

-oral and ventral suckers
Life cycle
-female deposits eggs in terminal venules in intestinal wall
-female empties uterus 10 to 12 times a day to deposit eggs in tissues of intestine
-maturation of egg with formation of miracidium require 10-12 days
-egg reaches intestinal lumen through ulcerations in intestinal wall
-mature eggs passed out with feces reach waters with Oncomelania quadrasi
-egg hatches, miracidium exits egg shell and enters snail
-miracidium develop into mother sporocyst which give rise to daughter or second generation
sporocyst where cercaria develop
-cercaria will leave snail to live in water until mammal host is exposed
-skin penetration
-cercaria becomes schistosomules after skin penetration
-migrates through circulation to reach portal circulation where it matures
-japonicum becomes sexually mature 24 days after penetration
Pathology
-dependent on host reaction to deposition of eggs in tissues; lesion and clinical manifestations
due to skin penetration of cercariae and due to migrating schistosomules
-dermatitis and hypersensitivity reactions at site of cercarial penetration
-these reactions are rarely seen among natives of endemic areas. Pasagdan ra kay na anad na
-pneumonitis associated with schistosomule migration to pulmonary circulation
-when eggs are deposited, it will accumulate in mucosa and submucosa of intestines
-endothelial irritation; lytic and irritant secretions of egg occlusion of terminal venules and
hypermotility of parasitized part of intestine lead to escape of eggs from blood vessels and
production of ulcers in mucosa
-ulcer cause diarrhea and dysentery seen in early schistosomiasis
-majority of eggs deposit IN intestine and in branches of portal vein where it cant cause
ulceration and reach lumen
-some eggs remain where they are deposited while others are carried with portal circulation to be
filtered in intrahepatic branches
-granuloma are formed around eggs and this is both protective and harmful
-enlargement of granuloma cause tissue damage and its resolution with sequestration of ova
lead to fibrosis
-fibrosis in intrahepatic portal vessels lead to portal hypertension that includes congestion and
enlargement of spleen, ascites and abdominal enlargement
-most cases die of hemorrhages due to ruptured esophageal varices
-many infections eggs are deposited in areas not drained by portal system including lungs and
brain
-essential pathology granuloma formation in brain; granuloma give rise to sensory and motor
disturbances. In lungs, obstruction to pulmonary circulation lead to cor pulmonale (right side of
heart thing)
-schistisomiasis depending on major sites of egg deposition may be hepato-intestinal, hepatosplenic, pulmonary or cerebro-spinal
-many infections are actually asymptomatic
Diagnosis

-demonstration of ova from stools by direct fecal exam or conc. technique

-ova from rectal or liver biopsies
-immunodiagnostic tests to demonstrate antibodies; circumoval-precipitin test
Treatment
-praziquantel single dose of 40-50mg/kg(body weight), 25mg/kg two doses or 3 doses 20mg/kg
every 4 hours
-after treatment - regression of hepatosplenic disease manifestation
Epidemio, prevention, control
-distribution of Schistosoma japonicum in the Philippines due to snail intermediate host
Oncomelania quadrasi
-snail is found Sorsogon, Oriental Mindoro, Samar, Leyte, Bohol, all of Mindanao except oriental
misamis
-those areas have rainfall throughout the year which favors breeding of snail
-prevalence rate 10-60% in areas with population of 650,000
-in those areas, most mammals both domestic and wild are infected and become reservoirs of
human infection
-transmission require contact of man and other mammalian host with waste waters of breeding
sites for the snail host
-in endemic areas, the water supporting snail population are also utilized for occupational,
domestic, and recreational needs therefore the ruling is that amount of water contact dictated by
activities of the populace determines prevalence
-prevention avoid skin contact to snail-infected waters (impractical to farmers)
-proper disposal of feces and domestic animal control
-snail control by using molluscicides and ecological methods to change environment. Effective
but expensive

Paragonimus westermani oriental

distomiasis, endemic hemoptysis

lung

fluke,

paragonimiasis,

pulmonary

Intro morpho
-adult worm reddish brown 12mm length 4-6mm width 3.5-5mm thickness
-rounded anteriorly and tapering posteriorly
-integument covered with single spaced spines
-testes are deeply lobed and situated opposite each other midway between ventral sucker
and posterior part of body
-ovary is located posterior to ventral sucker, has 6 long unbranched lobes
-vitellariae are branched
-egg golden brown oval, flattened prominent operculum
-opposite the operculum is a thickened abopercular(?) portion
-measures 80-188 by 48-60u; immature when released from adult
-microcercous cercaria ellipsoidal body, small spherical tail, both are covered with spines, stylet
is present at dorsal side of oral sucker
-metacercaria round and measures on average 381-457u diameter
Life cycle
-adult worm in lungs cause granulomatous reaction around it, which becomes cyst encapsulation

-adult worm in pairs of threes in these capsules, have openings to allow eggs to escape
[incomplete]
-arrive at pharynx; coughed up or swallowed back into alimentary canal; passed out with feces
-immature eggs embryonate in water, moist soil, or leached feces
-miracidium develop in 2-7 weeks which pushes the operculum and swims freely to look for snail
-In Philippines Brotia asperata snail
-Inside snail, miracidium passes through one sporocyst and two redial stages of development
-first intermediate host Antemelania asperata, Antemelania dactylus
-second intermediate host Mountain crab Sundathelphusa philippina
-cercaria emerges from snail and look for second intermediate host
-cercariae penetrate through soft parts of crustacean and encyst as metacercaria in gills, legs,
body muscles, or viscera
-crab can also be infected by eating snails; definitive host by eating raw or undercooked crabs
-metacercaria excyst in duodenum, the juvenile parasite traverse through intestinal wall into
peritoneal cavity where it wonders and embeds itself in abdominal wall for several days
-parasite returns to colon, migrates through diaphragm to pleural cavity where it penetrate lungs
and develop into adult
-parasites persist for 20 years or more
-reservoir hosts (snail eaters) dog, cat, field rat, other rodents
-symptoms:
-hemoptysis result from destruction of blood vessels in lung cavities that enclose worm
-fever, sweating, chest and back pains, cough misdiagnosed as TB
-during migration to lungs, young parasite may settle down
-abscess surrounding worm found in extrapulmonary sites like abdominal wall, muscular tissues,
liver, lymph nodes
Diagnosis
-detect eggs in stool or sputum
-sputum treatment with 10-30% HCl followed by sedimentation and washing
-repitition is necessary to detect eggs in TB by X-ray
Epidemiology
-found in countries of East and Southeast Asia
-known endemic foci in Camarines, Sorsogon, Mindoro, Samar, Leyte, Mindanao provinces
-transmission by eating infected crabs and eating meat of paratenic hosts
Treatment, prevention and control
-emetine hydrochloride, bithionol, praziquantel for paragonimiasis
-cook thoroughly
-take care not to contaminate kitchen utensils
-health education change diet
Fasciola hepatica sheep liver fluke cause sheep liver rot and fascioliasis hepatica
Intro morpho
-infect herbivorous mammals especially ruminants important in livestock-raising countries
-adult worm large, broad, flat body 20-50mm length, 6-12mm width
-cephalic cone located anteriorly forming conical projection which together with shoulders, the
marked widening at the back of the cone serves as distinguishing feature

-posterior end is broadly pointed, has two relatively small suckers

-eggs large, ovoid, operculated and brownish yellow
-140-180 by 90-100u
-released from adult worm still immature, has large unsegmented mass of yolk cells
-miracidium 130 by 28u forms within egg shell
-gymnocephalus cercaria 280-350u length, tail 700u
-possesses large cystogenous glands, the secretion of which allow cercaria to encyst and
develop into metacercaria which the infective stage to the definitive host
-related species Fasciola gigantica, larger and more lanceolate
-shorter cephalic cone, less developed shoulders, larger ventral sucker, intestinal ceca are
more branched at midline of body
-larger eggs
Life cycle
-hermaphroditic adult worm inhabits biliary passage in liver
-immature eggs carried by bile into intestine to be mixed and voided with feces
-eggs mature in water
-miracidium develop within 9 to 15 days, colder environment retards its development
-miracidium escapes through operculum of shell to look for pulmonate snails in family
Lymnaeidae, serve as first intermediate host (Lymnaea philippinensis and Lymnaea swinhoei)
-inside snail, parasite develops into sporocysts, one or two generations of rediae and cercariae
are finally formed
-cercariae leave snail and attach using oral suckers on surface of aquatic vegetation (watercress)
where they encyst into metacercaria
-watercress/aquatic vegetation secondary intermediate hosts
-Ipomea obscura kangkong
-cercaria can also encyst in water
-definitive host infected by ingesting raw or undercooked plants, drinking water containing
metacercaria
-upon ingestion, metacercarians excyst in duodenum, freeing juvenile fluke, penetrate intestinal
wall into peritoneal cavity
-wonder in peritoneal cavity until reaches liver capsule
-burrows in liver parenchyma, feed and grow until enters bile ducts where it becomes sexually
mature 3-4 months
-adult worms survive 11 years
Pathology
-Fascioliasis two phases: 1. Acute 2. Invasive phase, this corresponds to period during which
parasite migrated from intestine to liver and the latent or chronic phase which corresponds to
period when parasite settled in bile duct
-acute phase patient experiences dyspepsia, occasional symptoms: prostration, anorexia,
sweating, myalgias, join, bone pains, violent headaches, nausea, vomiting, urticarial
-sudden onset of fever, enlargement of liver, marked increased eosinophilia triad of symptoms
[important]
-damage caused by larvae on intestinal wall during migration from duodenum to liver, serious
traumatic and necrotic lesions
-healing and regeneration occur after the parasite has reached bile duct
-few symptoms seen in chronic phase, usually obstructive or inflammatory in nature (jaundice)

-adult worm causes obstruction and cause inflammation on epithelium of bile duct, becomes
fibrosis
-thickened fibrosis duct causes less bile being passed and leads to back pressure
-heavy infection atrophy of liver parenchyma and concomitant periductal cirrhosis may arise
-walls of bile duct become eroded allowing more worms to reenter the liver parenchyma and
cause large abscess formation
-during migration from intestine to liver, parasite can be carried through circulation (penetrate
blood vessels) to ectopic sites of lungs, subcutaneous tissues, brain, and orbit and leads to
abscesses or fibrotic lesion
-pharyngeal fascioliasis or halzuon (suffocation) in Mediterranean countries from ingestion of raw
liver
-halzuon - attributed to liver fluke Dicrocoelium dendriticum
Diagnosis
-ovum in stool
-eggs are distinguishable from Fasciolopsis buski; you should know the endemicity of parasite in
vicinity where patient lives
-Fasciola eggs can be present in stools from individuals who have eaten liver (false fascioliasis)
-this could be rules out by keeping the patient on a liver-free diet for 3 or more days before
another stool exam
-immunodiagnostic tests involving techniques like complement fixation, precipitin reaction,
immunoelectrophoresis, counterimmunoelectrophoresis
Epidemiology
-worldwide distributed (cosmopolitan)
-infections to cattle, carabaos, sheep, goats; F. gigantica is more prevalent species infecting
cattle and carabaos
-Very few human infection
Treatment
-emetine hydrochloride, bithionol, hexachloroparaxylene, chloroquine fascioliasis
-washing and proper cooking of vegetables and boiling drinking water
-eliminate snail and also reservoir host by chemotherapy
Clonorchis sinensis Chinese liver fluke, oriental liver fluke clonorchiasis
Intro morpho
-adult worm inhabits bile ducts of fish-eating mammals
-flat, transparent, rounded posteriorly and attenuated anteriorly
-8-25mm kength, 1.5-5mm width, oral sucker larger than ventral sucker
-hermophroditic, has two deeply branched testes arranged in tandem (one behind the
other) in posterior third of body
-pretesticular ovary is small, has three lobes
-uterus ascends in tightly packed loops
-intestinal ceca are simple, extending blindly to the posterior end
-egg yellowish brown, 26-30 by 15-17u
-operculum is convex fits into broad rims of the eggshell
-at the abopercular end, there is a small protuberance (breast and nipple)
-inside the egg is a well-developed miracidium that has asymmetrical features

-lophocercous cercaria brownish in color

-250-275u long, dorsoventrally keeled tail 650-750u length
-metacercariae 121-150u
Life cycle
-adult worm attaches to mucosa of bile duct using suckers, embed in sticky mucus without
causing permanent ulceration to epithelium
-also found in pancreatic duct or gallbladder
-ingests tissue fluids, red cell, mucus
-eggs are released from worm in mature state (miracidium); adult worm 4000 eggs/day
-passed out with feces (miracidium)
-miracidium are released only after ingestion by first intermediate host snail
-snail Parafossarulus manchouricus, live in fish culture ponds, lakes, swamps, sluggish part of
river or small streams
-inside snail, miracidium becomes sporocyst in 4 hours
-sporocyst produces rediae in 17 days, each redia produces 5-50 cercaria, released into water
-contact with second intermediate host fish cercaria attach to epithelium using suckers, casts
off tail, bores through skin, encyst to become metacercaria under a scale or in muscle
-fish - Family Cyprinidae
-if fish is eaten by mammalian definitive host, metacercariae excyst in duodenum
-young fluke moves toward ampulla of vater, passes through it going towards liver
-can also migrate from duodenum to bile duct into liver
-after reaching bile passages, worm matures and begins to produce eggs in 1 month
-entire life cycle 3 months, lifespan 15-20 years
-reservoir hosts dog and cat
Pathology
-parasite inhabit bile duct provokes intense proliferation of biliary epithelium
-walls of ducts become thickened and lumen dilated 2-3 times diameter hyperplasia cause
unknown
-periductal fibrosis subsequently ensues as epithelial proliferation subsides
-neoplasia leading to cholangiocarcinoma of liver
-worms can be found in pancreatic duct and gallbladder gallstones by eggs
-patient experience symptoms: fatigue, weakness, weight loss, abdominal distress and altered
appetite; also fever, enlargement and tenderness of liver, eosinophilia
Diagnosis
-Clonorchis egg fecalysis specific diagnosis
-close similarities among eggs Clonorchis, Opistorchis, Heterophyid misdiagnosis
Epidemiology
-Mainland China, Taiwan, Hongkong, Korea, Japan, Vietnam
-Cases in Phil only reported in Chinese immigrants
-liver scan
-transmission: eating infected raw fish, more prevalent among higher and older ager group (3050)
-can also be ingestion of fish that have already been frozen, salted, pickled, dried, or smoked
-metacercariae withstand different food processing techniques

Treatment, prevention, control

-praziquantel
-thorough cooking fish, change eating habits
-stop defecating in fish culture ponds
Opisthorchis felineus cat liver fluke, opisthorchiasis felineus
Intro morpho
-parasite infects fish-eating mammals, lives in biliary and pancreatic passages
-adult worm reddish yellow, 7-12mm length, 1.5-3mm width
-internal organs resemble Clonorchis sinensis
-testes lobate, arranged obliquely in tandem
-two suckers, oral and ventral
-blind digestive system, only opening is mouth, no anus
Egg yellowish brown, ovoid, smaller than C. sinensis
-30 by 11u
-has operculum that sits on the thickened ring of eggshell
-a minute tubercular thickening is found in abopercular end
-fully developed in eggshell when released from adult
Lophocercus cercaria flame cell pattern in cercaria differ from C. sinensis
(Opisthorcis viverrini similar species
-ovary and testes nearer to each other compared from felineus
-both are deeply lobulated
-vittelaria are aggregated into clusters and esophagus is elongated
-fuck the eggs
)
Life cycle
-parallels that of Clonorchis sinensis
-eggs have miracidium ingested by first intermediate host hydrobiid snail Bithynia leachi
-Inside snail, parasite become sporocyst and redial stages
-cercaria emerge from two redia
-cercaria attach and penetrate skin of cyprinoid fish second intermediate host
-metercercaria excyst in duodenum, young fluke migrate through ampulla of vater to distal bile
passage to mature in 3-4 weeks
-entire life cycle 4 months
-Opishtorcis viverrini similar life cycle, genus Bithnyia snail first intermediate host
Pathology
-parasite in bile duct cause proliferative changes in biliary epithelium, result to bile ducts dilation,
later on fibrosis
-moderate infections (100-1000 worms) cause liver enlargement, passive congestion of spleen
with icterus and local eosinophilia in bile duct wall
-heavy infections worms found in pancreas, gall bladder, patient will suffer digestive
disturbance
-harboring O. viverrini high incidence of diarrhea, flatulence after meal, pain over liver area,
bile stones form surrounding eggs
-Opisthorciasis linked to carcinoma of bile duct and liver

Diagnosis
-detect egg in stool
Epidemiology
-Philippines only 1 case O. felineus
-cat infections too
-transmission ingesting raw fish, decomposing fish, water, processed fish
-reservoir host dog, cat, rat, fox, beaver, rabbit, seal, lion
Treatment and control
-praziquantel
-same with Clonorchis
Fasciolopsis buski giant intestinal fluke, fasciolopsiasis
Intro morpho
-large hermaphroditic digenetic fluke, intestinal parasite of humans and pigs
-adult worm no cephalic cone, unbranched intestinal ceca reach close to posterior end
-testes are highly branched, arranged in tandem in bodys posterior half
-eggs ellipsoidal, rounded at both ends
-has thin shell and delicate operculum
-resemble hepatica
-cercaria tail 500u long, longer compared to body
-metacercarial cyst found in surface of plants, large, 3.9-4.1mm (visible)
Life cycle
-adult worm lives in duodenum, attach at intestinal mucosa with suckers
-16,000 eggs/day
-immature egg passed out with feces in water where it develops further
-become miracidium in 3-7 weeks
-miracidium released from egg, MUST infect small planorbid snail in Genus Segmentina or Genus
Hippeutis first intermediate hosts
-inside snail tissue, miracidium become sporocyst, give rise to two rediae generations
-cercaria leave daughter rediae, continue developing in tissue, cercaria emerge from snail
-cercaria swim In water, attach and encyst as metacercaria on surfaces of fruits, bulbs, stems of
aquatic plants
-plants second intermediate hosts
-metacercaria are ingested when plants or fruits are eaten
-human and pigs only definitive hosts
-metacercaria after ingestion excyst in duodenum, attach to intestinal wall, become sexually
mature in 3 months
Pathology
-pathological changes - traumatic, obstructive, toxic
-inflammation and ulceration at site of attachment
-traumatic effect increase mucus secretion and minimal bleeding
-gland abscesses formed in mucosa
-heavy infection partial intestinal obstruction

-intoxication result from absorption of metabolites of worm, patient experience generalized toxic
and allergic symptoms like edema in face abdominal wall lower limbs
-too much intoxication death
Diagnosis
-eggs in stool, eggs of F. buski resembles F. hepatica
Epidemiology
-Southeast Asia
-No evidence in Phil, not even pigs
-pigs are the only significant reservoir host
Treatment prevention control
-hexylresorcinol, tetrachloroethylene, praziquante
-controlling infection stop defecating in swamps or ponds where the plants are found
-metacercaria are very sensitive to dryness, avoid soaking fruits
Echinostoma ilocanum carrisons fluke, echinostomiasis
Intro morpho
-adult worm inhabit small intestine
-reddish gray
-tegument is covered with plaquelike scales
-anterior end has circumoral disk surrounded with crown of 49-51 spines
-oral sucker lies in center of disk
-ventral sucker located in anterior fifth of body
-testes are deeply lobed, arranged in tandem, ovary is located in front of testes
-egg straw colored, operculated, ovoid
-immature when passed out in feces
-similar to Fasciola and Fasciolopsis though its smaller
-cercaria has simple tail, body resembles miniature adult worm
-still has spination in the circumoral disk or head collar
Other Echinostome species Malayanum, E. hortense, E, lindoense, E. Malayanum found in PH
Life cycle
-adult worm in small intestine, produce immature eggs, passed out with feces
-within eggshell larva develops into miracidium in 6-15 days
-miracidium infects two known species of planorbid snail: Gyraulus convexiusculus and Hippeutis
umbilicalis
-develop into mother and daughter rediae in them
-cercaria emerge from snail after 42-50 days, infect second intermediate host snail Pila luzonica
or Kuhol
-cercaria become metacercariae, ingestion of snail, metacercariae excyst in duodenum
-juvenile flukes attach to intestinal wall, become adult worm
Pathology
-inflammation at site of attachment
-heavy infection diarrhea, bloody and abdominal pain
-intoxication - absorption of metabolites from worms

Diagnosis
-egg in stool by fecalysis
Epidemiology
-Northen Luzon Leyte Samar Mindanao
-rats important reservoir host
-eating raw snails
Treatment prevention control
-hexylresorcinol, tetrachloroethylene, praziquentel
-thorough cooking snail
FAMILY HETEROPHYIDAE
-Heterophyes heterophyes
-Metagonimus yokogawai
-Haplorchis taichui
-Haplorchis yokogawai
-elongated, oval, pyriform, small
-less than 2mm length
-tegument covered with fine scale like spines
-some species genital sucker present near ventral sucker
-eggs light brown, ovoid, still operculated
-fully developed miracidium present within egg when deposited
-internal organs of miracidium arranged in bilateral symmetry
Life cycle
-adult worm in small intestine
-eggs produced passed out into environment by way with feces
-snails ingest them
-Philipppines snail IH of H. tauchui and Procerovum calderoni are the opcerulate brackish water
snails Melania juncea and Thiara riquetti
-cercaria merge from snail, fish second IH, encyst as metacercaria under scales, muscle, fins,
tails, gills
-metacercaria mostly found in muscles at base of fins
-DH ingest raw fish
-metacercaria excyst in duodenum freeing young larvae that attaches to intestinal wall
-larva matures into adult fluke, short lifespan
Pathology
-inflammation and damages at site of attachment
-patient experience colicky pains and mucus diarrhea
-worms tend to burrow deep into intestinal wall just to get trapped and die
-eggs spill into blood stream
-eggs can filter in heart muscle, cause cardiac failure resembling cardiac beri-beri
-eggs deposit in brain, cause fatal cerebral hemorrhage
-when in spinal cord, result, cause loss of motor and sensory functions
Diagnosis

-egg in stool
-Heterophyid eggs resemble Clonorchis and Opisthorchis, difficult to differentiate
-Autopsy investigation cardiac heterophydiasis, mistaken for cardiac beri-beri since it resembles
MI like thickening of right side heart muscles
-tissue exam reveal Heterophyid eggs
Epidemiology
-found with snails in fresh water, brackish, salty, temperate tropical and subtropical countries
-Fish eating animals dog, cat, bird reservoir host
Treatment
-tetrachloroethylene, praziquantel
-bithionol and niclosamide decrease egg production, doesnt kill
-sufficient cooking, dont let your pets eat raw stuff