TREMATODA (FLUKES)

JDBB 2018
Drug of choice for all flukes:
PRAZIQUANTEL
Alternative drug:
BITHIONOL or NICLOSAMIDE

JDBB 2018
LUNG FLUKES

JDBB 2018
 PARAGONIMUS spp.
Ovum

Common name: Oriental Lung Fluke

Disease: Paragonimiasis, Endemic Hemoptysis,

Pulmonary dismotiasis

Habitat: Parenchyma of the lung

1st IH: Freshwater snails

2nd IH: Crustaceans, crayfish

MOT: Ingestion of raw or undercooked crab meat

containing encysted metacercaria

 Golden brown color

 Broadly ovoidal, thick-shelled with FLATTENED
prominent operculum at the posterior end
 UNEMBRYONATED when laid

Prevention:
 Adeq cooking of crab or crayfish before eating
JDBB 2018  Proper disposal of human waste
 PARAGONIMUS spp.
Redia

Common name: Oriental Lung Fluke

Disease: Paragonimiasis, Endemic Hemoptysis,

Pulmonary dismotiasis

Habitat: Parenchyma of the lung

1st IH: Freshwater snails

2nd IH: Crustaceans, crayfish

MOT: Ingestion of raw or undercooked crab meat

containing encysted metacercaria

Intramolluscan cycle: sporocyst  redia  cercaria

Prevention:
 Adeq cooking of crab or crayfish before eating
 Proper disposal of human waste

JDBB 2018
LIVER FLUKES

JDBB 2018
 CLONORCHIS SINENSIS
Eggs

Common name: Chinese Liver Fluke

Disease: Clonorchiasis

2nd IH: Fish

Reservoir host: man, dog, cat, and other animals

 Thick, broadly ovoidal, operculated with small

protuberance at opposite end
 “OLD-FASHIONED ELECTRIC BULB” appearance
 Embyonated when laid

JDBB 2018
 CLONORCHIS SINENSIS
Adult
Common name: Chinese Liver Fluke

Disease: Clonorchiasis

2nd IH: Fish

Reservoir host: man, dog, cat, and other animals

 Elongate, leaf-shaped
 Anteriorly: attenuated
 Posteriorly: rounded
 Teguments: smooth and transparent
 Size of sucker: ventral < oral
 Testes: 2 highly branched, in tandem at post-half of
the body
 (-) cirrus pouch and prostate gland
 Seminal receptacle: retort-shaped
 Uterus: closely coiled
 Ovary: at middle third of the body
 Intestinal ceca: long, extend down to the posterior
end
JDBB 2018
 OPISTHORCHIS VIVERRINI
Egg

Common name: Southeast Asian Liver Fluke

Disease: Opisthorchiasis

1st IH: Snail – Bithynia leachi / goniomphalus

2nd IH: Ciprinoid fish – Punteus orphoides

 Oval-shaped with operculum resting on the

shoulder
 (+) fully developed miracidium when passed in stool

JDBB 2018
 OPISTHORCHIS VIVERRINI
Adult

Common name: Southeast Asian Liver Fluke

Disease: Opisthorchiasis

1st IH: Snail – Bithynia leachi / goniomphalus

2nd IH: Ciprinoid fish – Punteus orphoides

 Elongate, thin, transparent and aspinous

 Anteriorly: attenuated
 Posteriorly: rounded
 Size of sucker: ventral = oral
 Testes: 2 large, lobed, at post-fourth of the body
 (-) cirrus pouch and prostate gland
 Uterus: coiled
 Ovary: branched, coiled, close proximity with testes
 Excretory bladder: long, sac-like

JDBB 2018
 FASCIOLA HEPATICA
Ovum

Common name: Sheep Liver Fluke

Disease: Fascioliasis Hepatica/Sheep Liver Rot,

Halzouns Disease (Pharyngeal Fascioliasis)

2nd IH: Plants/water vegetation

MOT: Ingestion of metacercaria encysted in aquatic

plants

 Light yellow to brown

 Large, ovoidal, operculated
 Yolk granule clamped around the yolk cell
 UNEMBRYONATED when passed in stool

JDBB 2018
 FASCIOLA HEPATICA
Adult

Common name: Sheep Liver Fluke

Disease: Fascioliasis Hepatica/Sheep Liver Rot,

Halzouns Disease (Pharyngeal Fascioliasis)

MOT: Ingestion of metacercaria encysted in aquatic

plants

 Large, broad with flat body

 (+) conical projection at the anterior end with its
shoulders called CEPHALIC CONE – distinguishing
feature
 Tegument: covered with spines
CONICAL
 Size of sucker: oral < ventral
PROJECTION
 Testes: 2 highly branched, large
 (-) cirrus pouch and prostate gland
 (-) seminal receptacle
 Uterus: short and coiled
 Ovary: dendritic, near the testes
 Intestinal ceca: long, highly branched at the
JDBB 2018 posterior end of the body
 FASCIOLA GIGANTICA
Ovum

Common name: Giant Liver Fluke

Disease: Fascioliasis Hepatica/Sheep Liver Rot,

Halzouns Disease (Pharyngeal Fascioliasis)

2nd IH: Plants/water vegetation

MOT: Ingestion of metacercaria encysted in aquatic

plants

 Ovoid, operculated
 Larger vs. F. hepatica
 UNEMBRYONATED when passed in stool

JDBB 2018
 FASCIOLA GIGANTICA
Adult

Common name: Giant Liver Fluke

Disease: Fascioliasis Hepatica/Sheep Liver Rot,

Halzouns Disease (Pharyngeal Fascioliasis)

2nd IH: Plants/water vegetation

MOT: Ingestion of metacercaria encysted in aquatic

plants
CONICAL
PROJECTION Vs. F. hepatica
 Larger, longer, more lanceolate
 Cephalic cone: shorter, shoulder less developed
 Size of sucker: ventral is larger
 Ovary: larger, highly branched
 Intestinal ceca: more branched, at midline of the
body

JDBB 2018
INTESTINAL FLUKES

JDBB 2018
 FACSCIOLOPSIS BUSKI
Egg

Common name: Giant Intestinal Fluke

Disease: Fasciolopsiasis
- NOT endemic in the Philippines

2nd IH: Plants/water vegetation

MOT: Ingestion of metacercaria encysted on fresh

water vegetation (bamboo shoots/water chestnuts)
which may be consumed raw or peeled with the teeth

 Large, hen’s-egg shape, thin-shelled with

operculum
 Ave. daily egg output: 21 to 28k per fluke
 UNEMBRYONATED when laid

Prevention: Washing or boiling of plants

JDBB 2018
 ECHINOSTOMA spp.
Egg

Common name: Garrison’s Fluke

Disease: Echinostomiasis
- Endemic in the Philippines
- Intestinal parasite of human and rats

1st IH: Freshwater snails

2nd IH: Another snail, bivalves, fish, and tadpoles

 Yellow-brown color
 Ovoidal, operculated, thin shelled
 Immature when passed in feces

Prevention: Avoid eating raw or improperly cooked 2nd

IH

JDBB 2018
 ECHINOSTOMA ILOCANUM
Adult

Common name: Garrison’s Fluke

Disease: Echinostomiasis
- Endemic in the Philippines
- Intestinal parasite of human and rats

 Flat, elongate, reddish-gray colored

 Anterior end: bluntly rounded, horse-shoe shaped
 Provided with circumoral disk surrounded with
collarette of spines (distinguishing char.)
 Posterior end: more attenuated
 Tegument: PLAQUE-LIKE SCALES
 Size of sucker: oral < ventral
 Oral sucker @ middle of cicumoral disk
 Ventral sucker @ anterior 1/5
 Testes: 2 lobed in tandem @ middle of the body
 Ovary: @ front of the testes
 Vitellaria @ lateral side

Prevention: Avoid eating raw or improperly cooked 2nd

JDBB 2018 IH
 HETEROPHYES HETEROPHYES
Egg

Common name: Von Siebold’s Fluke

 Smallest but deadliest among the human flukes

Disease: Heterophysiasis

2nd IH: Fish

 Light brown color

 Ovoid-shaped, operculated
 With broad anterior end
 EMBRYONATED when laid
 Fully developed miracidium present within the egg
when deposited by adult worm

JDBB 2018
 HETEROPHYES HETEROPHYES
Adult

Common name: Von Siebold’s Fluke

 Smallest but deadliest among the human flukes

Disease: Heterophysiasis
2nd IH: Fish

 Elongate, oval or pyriform-shaped

 Anteriorly: attenuated
 Posteriorly: rounded
 Teguments: FINE, SCALE-LIKE SPINES more
numerous near the anterior end
 3 SUCKERS:
1. Oral – smaller, @ anterior
2. Ventral – larger, thick-walled, @ mid-third
3. Genital (gonotyl) - @ near the left posterior
border of ventral sucker, armed with spines
 Fan-shaped vitellaria
 Testes: 2 ovoid-shaped @ posterior end
 (-) cirrus sac
 Seminal receptacle: retort-shaped
JDBB 2018  Ovary: globular, slightly lobe, @ ant. to the testes
 METAGONIMUS YOKOGAWAI
Adult

Common name: Yokogawai Fluke

Disease: Metagonomiasis

2nd IH: Fish

 LARGER THAN H. heterophyes

 Pyriform-shaped
 Anteriorly: attenuated
 Posteriorly: broadly rounded
 Teguments: FINE, SCALE-LIKE SPINES
 Ventral sucker: deflected right of the midline
 Fan-shaped vitellaria
 Testes: 2 oval, unequal size @ post-third of the body
 Ovary: slightly lobe @ submedian to the testes

JDBB 2018
BLOOD FLUKES
SCHISTOSOME

JDBB 2018
BLOOD FLUKES
Prevention:
Avoid wading in places infested with snail IH
Eradication of snail host and egg with chemicals
Proper disposal of human waste and urine
• Instruct farmers to wear rubber gloves and boots during farming

JDBB 2018
BLOOD FLUKES
LAB DIAGNOSIS: Presence of eggs in feces
 S. japonicum and S. mansoni:
a) Direct fecal exam (NSS prep)
b) Stool concentration technique
• Merthiolate-iodine
o Formalin conc method
o Suitable for field survey exam
• Kato-katz technique – most suitable for enumeration of eggs in feces
 S. haematobium:
 Demonstrating eggs from sediments that settle out of urine
 Bladder biopsy
JDBB 2018
BLOOD FLUKES
LAB DIAGNOSIS: Serological test
 COPT (Circummoval precipitation test) – method of choice for
definitive dx of schistosomiasis in the Philippines

JDBB 2018
 SCHISTOSOMA JAPONICUM
Ovum

Common name: Oriental Blood Fluke

Disease: Oriental Schistosomiasis, Snail Fever,

Bilharziasis, Farmer’s Disease

Habitat: Superior mesenteric venule

Host: Oncomelania

 Biconcave/ovoidal/pear-shaped, pale yellow color

 Presence of rudimentary LATERAL KNOB at one side
near the polar end
 Contains fully developed miracidum when passed
out with feces

JDBB 2018
 SCHISTOSOMA JAPONICUM
Miracidium

Common name: Oriental Blood Fluke

Disease: Oriental Schistosomiasis, Snail Fever,

Bilharziasis, Farmer’s Disease

Habitat: Superior mesenteric venule

Host: Oncomelania

Role of miracidium in the general life cycle:

 A free-swimming cilated larva
 Hatched from the egg when the embryonated egg
comes in contact with fresh water
 Swims in water and penetrate appropriate snail
intermediate host

JDBB 2018
 SCHISTOSOMA JAPONICUM
Cercaria

Common name: Oriental Blood Fluke

Disease: Oriental Schistosomiasis, Snail Fever,

Bilharziasis, Farmer’s Disease

Habitat: Superior mesenteric venule

Host: Oncomelania

Role of cercaria in the general life cycle:

 A free-swimming cilated larva
 Leaves the snail  swims in water and penetrate
skin of the definitive host  casts off its tail 
transforms into schistosomula  after skin
penetration, enters the superficial lymphatic vessel
 venous circulation  heart  lung  pleural
cavity  diaphragm  liver  portal vein  where
they feed and grow

JDBB 2018
 SCHISTOSOMA JAPONICUM
Adult worm: Female

Common name: Oriental Blood Fluke

Disease: Oriental Schistosomiasis, Snail Fever,

Bilharziasis, Farmer’s Disease

Habitat: Superior mesenteric venule

Host: Oncomelania

Female
 Tegument: smooth
 Ovary: centrally located
 Uterus: long, extends to middle of body
 Ave. # of eggs: 50-100
 May live for 20-30 years

JDBB 2018
 SCHISTOSOMA JAPONICUM
Adult worm: Male

Common name: Oriental Blood Fluke

Disease: Oriental Schistosomiasis, Snail Fever,

Bilharziasis, Farmer’s Disease

Habitat: Superior mesenteric venule

Host: Oncomelania

Male
 Tegument: smooth
 (+) gynecophoral canal
 Genital pore: behind the ventral sucker
 Ave. # of testes: 6-8 arrange in 1 row above the
ventral sucker
 2 intestinal ceca: unite more posteriorly

JDBB 2018
 SCHISTOSOMA JAPONICUM
Adult worms: In copula

Common name: Oriental Blood Fluke

Disease: Oriental Schistosomiasis, Snail Fever,

Bilharziasis, Farmer’s Disease

Habitat: Superior mesenteric venule (where the adult

worms copulate)

Host: Oncomelania

JDBB 2018
 SCHISTOSOMA MANSONI
Ovum

Common name: Manson’s Blood Fluke

Disease: Intestinal Bilharziasis/Schistosomiasis,

Katayama Fever

Habitat: Inferior mesenteric venule

Host: Biomphalaria

 Large, ovoidal, yellowish brown color transparent

shell
 With large, prominent LATERAL SPINE near the
posterior end and contains fully mature miracidium

JDBB 2018
 SCHISTOSOMA MANSONI
Adult worm

Common name: Manson’s Blood Fluke

Disease: Intestinal Bilharziasis/Schistosomiasis,

Katayama Fever

Habitat: Inferior mesenteric venule

Host: Biomphalaria

Male
 Tegument: Grossly tuberculate; larger than those of
S. haematobium
 Ave. # of testes: 8-9 in ZIGZAG row
 Intestinal ceca: unite early and the united ceca is
long

Female
 Tegument: smooth
 Ovary: at anterior half of body
 Uterus: short, extends to middle of body
JDBB 2018  Ave. # of eggs: 1-4
 SCHISTOSOMA HAEMATOBIUM
Ovum

Common name: Vesical Blood Fluke

Disease: Vesical Schistosomiasis, Schistosomal

Hematuria, Urinary Bilharziasis, Endemic Hematuria

Habitat: Vesical and pelvic venous plexus

Host: Bulinus

 Yellowish brown color

 Elongate, spindle-shaped with distinct TERMINAL
SPINE at one pole

JDBB 2018