Trematodes

Blood flukes Lung flukes Intestinal flukes Liver flukes

Schistosoma Japonicum Paragonimus Fasciolopsis buski Echinostoma Heterophyes Clonorchis sinensis Fasciola hepatica
westermani ilocanum Heterophyes
Opisthorchis spp Fasciola gigantica (prevalent in
PH)
Known as “oriental blood fluke” “lung flukes” Parasite of human and Fish-eating hosts Parasite of the bile duct and
pig intestine gall bladder
Definitive host Carabaos, cows, cows pigs, dogs,cats, Pigs
rodents, monkeys Humans
Intermediate host Antelemania sp. Snails Segmentina/ Hippeutis Gyralus Fish Cyprinidae Aquatic plants (secondary)
(first) snail (first) convexiusculus/h Ipomea obscura “kangkong”
ippeutis Nasturitium officinale “water
Mountain crab Aquatic plants, lotus, umbilicalis (first) cress”
sundathelphusa kangkong, caltrop,
philipina (second) (secondary) Pila conica
“kuhol”
Vivipara
angularis
“susong
pampang”
(secondary)
Inhabit Parasites of the portal vein duodenum Duodenum Biliary passages of liver

Young fluke move into Excysts in duodenum and

hepatobiliary tree jejunum
MOD/Development Skin penetration with cercaria  Ingestinig raw or Ingestion of encysted Ingestion of Ingestion of Ingestion of metacercaria of Ingested metacercaria encysted
schotosomule  into portal vein uncooked crabs metacercariae on aquatic metacercaria metacercaria parasite in infected fish in edible, aquatic plants,
plants  encyst encysted in encysted in fish drinking infected water 
duodenum attachment snails   burrowed in encysts in duodenum 
attachment to the intestinal juvenile flukes penetrates
intestinal wall  mucosa  intestinal wall  into liver 
inflammation  inflammation bile ducts
metabolites from
worms 
general
intoxication
Infective stage Mature cercaria Metacercaria Fascioliasis (most important
parasitic helminth of cattle)
Paragonimiasis
Maturation About a month after penetration Adult worm persist 20 About 3 months Life span adultworm: 9-13 years
years
Manifestation Dermatitis with pruritus (swimmer’s Often consistent with Ulceration, Colicky pain, Cholangiocarcinoma Necrotic lesions (parasite
itch) – 2 to 12 weeks after PTB diarrhea, mucus diarrhea, burrow liver parenchyma)
penetration abdominal pain heterophyid eggs Gallston formation (by eggs)
Cough and hemoptysis in the heart and High fever, hepatomegaly
Schistosomule migration syndrome – brain Desquamation, hyperplasia,
fatigue, respiratory sx, arthralgias, Granulomatous adenomatous tissue Liver atrophy, periductal
malaise, eosinophilia, fever reacton in the lungs, formation, fibrosis cirrhosis
abdominal pain (snail fever of fibrotic encapsulation
katayama)
Dry cough, rust-
Granulomatous reaction to eggs in colored or blood
liver sained sputum, foul
 fish odor most
Portal hypertension pronounced in the
morning
Dysentery or diarrhea
Chest pain, dyspnea,
hemoptysis, fever,
fatigue, misdiagnosis
fo ptb
Triggered
Diagnosis Stool examination – mature eggs Radiographs aid, xray Stool Stool Stool examination Eosinophilia
(often negative) ring-shadowed opacity examination examination -
eggs Stool examination
Circumoval precipitin test (COPT) –
definite diagnosis
Drugs of choice praziquantel Praziquantel praziquantel Praziquantel praziquantel Bithinol

Triclabendazole (hepatic
sonographic findings small
clustered hypoechoic lesions
with poorly defined contours
and nodular lesions)
Additional info Cercaria can survive in water for 24 Adult worm attaches itself f. hepatica – lymnae sp
hours into the mucosa of the bile amphibious and living on mud
duct and feeds on tissue
Life for 20-30 years fluid, red cells and mucus f. gigantica – aquatic snails live
in slow-moving bodies of water
Mean lifespan is about 3-8 years

Stool examination often negative

Merthiolate iodine concentration

technique (MIFC)

KATO-KATZ TECHNIQUE

Eggs Hatched only in clean nonsaline Light brown, Yellow, brown ovoid,
water with sufficient oxygen ovoid, convex operculum,
operculated thickened rim of eggshells
Oval, rounded, pear shaped with thin
shell. Curve hook or spine

Serious Chronic schistomiasis, splenomegaly, Cerebral involvement

complications portal hypertension, ascites,
collateral circulation, esophageal and
gastric varices

Cor pulmonale

Cerebral schistosomiasis