TREMATODES- Flukes

Leaf-like worms of varying sizes that inhibit small intestine of man Acquired by ingestion of metacercariae from respective second intermediate hosts Diagnosis: finding the ova from stool Monoecious DOC= Praziquantel

This is how you will remember them..

CLASSIFICATIONS

1. According to Taxonomic Classification

Phylum: Platyhelminthes Class: Trematoda Sub-Order: Distomata o Family Fasciolidae Fasciolopsis buski o Family Echinostomatidae Echinostoma ilocanum o Family Heterophyidae Heterophyes heterophyes Metagonimus yokogawai

2. According to Size
Large Fluke (2-8 cm) Fasciolopsis buski

Medium Fluke (1-2 cm) Small Flukes (<1 cm)

Echinostoma ilocanum Heterophyes heterophyes Metagonimus yokogawai Phanerophsolus bonnei Haplorchis spp.

3. According to Second Intermediate Host

Water plant borne ~ kangkong o Faciolopsis buski Snail- borne o Echinostoma ilocanum Fish-borne o Heterophyes heterophyes o Metagonimus yokogawai

4. According to the size of the trematode EGGS

Large, unembryonated (100-160u) Fasciolopsis spp Echinostoma spp Fasciola spp Paragonimus westermani brown color; from lungs Clonorchis and Opisthorchis Heterophyes and Metagonimus

Medium, unembryonated (70-90u) Small or minute, embryonated (23-32u)

Eto pa INCLUSION/EXCLUSION CRITERIA: ( sorry may hang over sa ComMed) ALL trematodes are/ should be. hermaphroditic(monoecious) EXCEPT schistosoma ~ copulatory position dioecious ingestion of metacercariae EXCEPT schistosoma ~cercariae directly penetrates skin Usually with TWO SUCKERS except Heterophyes and Metagonimus (3 suckers) HABITAT: SMALL INTESTINE ~ except gastodiscoides hominis (LI) Lungs= Paragonimus Liver = Fasciola/Chlonorchis/Opistorchis

** note on the the ff table: I included the the liver fluke as well

General Characteristics Helminth Distinguishing Characteristics Fasciolopsis buski ** Oral sucker Giant Intestinal smaller than Fluke ventral Fasciolopsiasis sucker~Anterior part of parasite ABSENCE OF CEPHALIC CONE or PROMINENT SHOULDER **simple intestines Echinostoma 2 SNAIL INT ilocanum HOST!! Garrisons Fluke Anterior end w/ (first infection was CIRCUM ORAL in a prison) DISK Spiny mouth Oral sucker Echinostomiasis located at the center of ORAL DISK **Oral sucker located at the center of the disk is smaller than ventral sucker 3 suckers: Oral Ventral Gonotyl Heterophyes heterophyes Heterophyasis

MOT By ingestion of raw or insufficiently cooked water plants

Life cycle/Habitat Indirect Small intestine

Intermediate Host
1st IH: Planorbid snails Segmentina trochoides, Hippeutis sp., Gyraulus 2nd IH: Water plants Water caltrop (Trapa natans) Water hyacinth (Eichonia) Water morning glory (Ipomea aquatica) found in the Philippines Lotus (Nymphaea lotus)

Definitive Host Man and pigs

Infective stage Metacercariae

Diagnostic Stage Ova in feces

Treatment Specific Praziquantel and Niclosamide Non-specific Symptomatic and supportive

By ingestion of infected freshwater snails

Indirect Small intestine

1st IH: Planorbid snails Hippeutis sp., Gyraulus 2nd IH: Snails and clams Pila luzonica (kuhol) **SNAIL TO SNAIL!! Reservoir Host: wild rats

Man and Dogs

Metacercariae

Ova in feces

Specific Praziquantel Hexylresorcinol Tetrachloroethylene Non-specific Symptomatic and supportive

By ingestion of metacercariae from infected fish

Indirect/ Small intestine

1st IH: Brackish-water snails Pirenella in Egypt, Cerithidia in Japan 2nd IH: Freshwater Fish Acanthogobius, Tilapia, Mugil (mullet)

Man and fisheating mammals

Metacercariae

Ova in feces

Praziquantel 20mg per kg TID for 2 consecutive days

Metagonimus yokogawai Metagonimiasis

Ventral suckers located lateraly

Ingestion of insufficiently cooked infected fish

Indirect/ Small intestine

1st IH: Snails Semisulcospira, Thiara, Hua

Man and fisheating mammals

Metacercariae

Ova in feces

2nd IH: Freshwater Fish

Specific Praziquantel Niclosamide Non-specific Symptomatic and supportive

Salmonoid Fish: Plectoglossus, Salmo Cyprinoid Fish: Richardsonium, Odontobuntis Sheep and other herbivores ** manaccidental host Adult fluke Unembryonated egg in feces Praziquantel

Fasciola hepatica Sheep liver fluke

Prominent CEPHALIC CONE Branched intestinal ceca

By ingestion of raw or insufficiently cooked water plants and contaminated water By ingestion of raw or insufficiently cooked water plants and contaminated water By ingestion of raw or insufficiently cooked fish

Liver ~biliary duct ~biliary passage

Snails->water plants-> herbivores

Fasciola gigantica

Less Prominent CEPHALIC CONE Branched intestinal ceca ( mas madami!!) Simple intestinal ceca *oral sucker greater than the ventral sucker *multilobulated testis *clustered vitellaria *oral sucker same size as the ventral sucker *lobated testis *compressed vitellaria

Liver ~biliary duct ~biliary passage

Snails->water plants-> herbivores

Praziquantel

Chlonorchis sinensis Chlonorchiasis

~biliary duct ~biliary passage

Snails->fish-> humans

Humans Dog Hog Cat

Metacercariae

embryonated egg in feces

Praziquantel

Opistorchis filineus

By ingestion of raw or insufficiently cooked fish

~biliary duct ~biliary passage

Snails->fish-> humans

Humans Other fish eating animals

Metacercariae

embryonated egg in feces

Praziquantel

by: Gen Redoblado; Prov 3:5 Trust in the Lord wit h all your heartand He will direct your path.