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Treatment: Diagnosis:
Praziquantel Stool exam
Species differentiation is difficult due to
3. Heterophyes heterophyes similarities with Clonorchis sinensis and
Common Name: Von Siebold’s Fluke/Heterophid Fluke Metagonimus yokogawai
FH: Man, fish-eating animals and birds (reservoir)
IH 1: Cerithidia, Pironella species Treatment:
IH 2: Tilapia and other fresh/brackish water fish Praziquantel
Habitat: small intestine
Diagnostic Stage: Ova in stool 4. Metagonimus yokogawai
*smallest fluke infecting man Common Name: Heterophid fluke
FH: Humans, fish-eating mammals and birds
Morphology: IH 1: Semisulcospira species
Adult: IH 2: Fresh/brackish water fish
grayish in color Habitat: Small Intestine
protected by an outer layer of fine spines (scaly in Diagnostic Stage: Ova in stool
appearance *smallest human fluke (according to CDC)
Has third sucker: the gonotyl or genital sucker
Paired testes Morphology:
Egg: Adult:
Operculated pyriform in shape
with tapering at the anterior end and rounding at Oxyresveratrol, a stilbenoid found in extracts
the posterior end of Artocarpus lakoocha is effective against H. taichui.
with a tiny layer of scaly spines heavily distributed
over the anterior end
C. BLOOD FLUKES
ventral sucker/genitoacetabulum - to the side of
*no metacercaria and redia stages
the midline and closely associated with the genital
pore
1. Schistosoma japonicum
Egg:
Common Name: Oriental Blood Fluke
thinner shell than Heterophyes heterophyes; no
FH: Man and other vertebrates
species differentiation
IH: Snail (Oncomelania hupensis quadrasi)
Habitat: Superior mesenteric veins of small intestine
Life Cycle Notes:
Diagnostic Stage: Ova in stool
Adults release embryonated eggs passed in the
*Take note of rules for MoT (skin penetration) and IS
feces
(fork-tailed cercaria)
*Host-permissive: can complete cycle in other
Pathology:
vertebrates
diarrhea and colicky abdominal pain
*Reservoir hosts: dogs, cats, carabaos
Same symptoms with Heterophyes heterophyes
*Most number of reservoir hosts among the
Schistosomes
Diagnosis:
*Endemic in the Philippines
Stool exam
Morphology:
Treatment:
Adult:
Praziquantel
MALE: Hollow structure called gynecophoral
canal (receives female during copulation)
5. Gastrodiscoides hominis
Testis: 6 to 7, behind the ventral sucker
(notes only, wala sa book and CDC)
FEMALE: slender, with greatest egg production
- Pear-shaped: globular appearance
When in copulation: described as Schistosoma in
> Discoid posterior
copula (perpetual copulation); most “romantic”
> Conical Anterior
parasites
- “Massive” acetabulum
No integumentary tuberculation; aspinous (no
- Lay immature eggs
spines)
- Habitat: Small intestine
Largest among Schistosoma species in man
- Life cycle: Not well studied
Egg:
- Pathology: Mucoid diarrhea, gastritis
Ovoid/round/pear-shaped with minute lateral
- Egg: similar to heterophids
knob
- Treatment: Carbon Tetrachloride (CCl4)
- Praziquantel is ineffective
Life Cycle Notes:
Eggs are released via feces
6. Haplorchis taichui
Cercaria penetrate human skin and shed their
(wala ako mahanap info tungkol dito!)
forked tail, becoming schistosomule
From wiki:
Females deposit eggs in the small venules of the
Haplorchis taichui is a species of intestinal flukes in the portal and perivesical systems
genus Haplorchis. It is a human parasite found in the
Philippines. Pathology:
Due to Adult:
Katayama Disease - systemic hypersensitivity Diagnostic Stage: Ova in stool
reaction to the schistosomulae migrating through * Take note of rules for MoT (skin penetration) and IS
tissue (fork-tailed cercaria)
Snail Fever *Endemic in Africa and South America
Oriental Schistosomiasis
Due to Larva: Morphology:
Swimmer’s Itch Adult:
Male:
Diagnosis: o Prominent Integumentation
Stool Exam o 8-9 testes, the most number of testes among
o WHO recommendation: Kato-Katz in three Schistosomes
stool samples for 3 consecutive days Female:
Rectal Biopsy, Liver Biopsy o Ovary – at the anterior part of the body
Egg-hatching technique o Uterus – 1-4 eggs
ELISA Egg:
Ritchie Technique – to quantify eggs Diagnostic Stage
Serological Test: Detects three antigens: With lateral spine
o Circulating Cathodal Antigen (CCA)
o Circulating Anodal Antigen (CAA) Life Cycle Notes:
o Soluble Egg Antigen (SEA) Same as S. japonicum; the only difference is the
COPT habitat of the adult
o Sensitive, cannot differentiate present from
previous infections Pathology:
o Confirmatory and definitive test for Intestinal bilharziasis
Schistosomes in the Philippines Diagnosis:
o “Circumoral Precipitin Test” COPT, Stool Exam, Egg Hatching Technique
o Reagent: Antigen – freeze-dried/lyophilized Treatment:
Schistosoma japonicum eggs Praziquantel
o Specimen – Patient Serum
o Positive result: bleb formation 3. Schistosoma haematobium
o Liquefied petrolatum/wax/paraffin – used to Common Name: Vesical Blood Fluke
avoid evaporation and to seal the preparation FH: Man
o Glass beads/nail polish – to elevate the IH 1: Bulinus spp.
preparation Habitat: Vesical, Prostatic, Uterine, Venous Plexuses
o *Incubate at 36oC for 24 hours and examine of Urinary Bladder///Vesical Plexuses of the Venous
under microscope for blebs Circulation
Diagnostic Stage: Ova in urine
Treatment: *Urine is red in heavy Schistosoma haematobium
Praziquantel infection, unlike in heavy filarial infections where urine
is milky/turbid.
2. Schistosoma mansoni *Endemic in Middle East and Africa
Common Name: Manson’s Blood Fluke
FH: Man Morphology:
IH 1: Biomphalaria spp. Adult:
Habitat: Inferior mesenteric veins of the large Male:
intestines, colon, rectum o 4-5 testes
o Fine tuberculations Spines in the integument
Female:
o Ovary is in the posterior end Egg:
o 20-3o eggs in the uterus Ovoid, with flat, WIDE operculum (unlike in
Egg: Heterophid eggs)
With prominent terminal spine With abopercular thickening opposite of
operculum
Life Cycle Notes: Brownish operculum
Same as S. japonicum and S. mansoni, except for
habitat Life Cycle Notes:
Discharged in urine instead of feces Eggs are excreted unembroynated in the feces
and/or sputum
Pathology: Metacercaria excyst in the duodenum
Urinary Bilharziasis, Egyptian Schistosomiasis The worms can also reach other organs and
tissues such as the brain and striated muscles.
Diagnosis: However, when this takes place, completion of
Urine Exam, COPT, egg hatching technique the life cycles is not achieved, because the eggs
Centrifuge urine, and look for eggs in the laid cannot exit these sites.
sediments. Concentration technique known as
Nucleopore Filtration Technique may be used
Pathology:
Treatment:
TB-like symptoms
Praziquantel
Hemoptysis – expectorating/coughing blood
which originated from the lungs (differentiate
D. LUNG FLUKE
with hematemesis, in which blood is from the GI
tract)
Paragonimus westermani
Jacksonial epilepsy
Common Name: Oriental Lung Fluke
Pulmonary Distomiasis
FH: Man
Cerebral Paragonimiasis, when there is migration
IH 1: Antemelania asperata
to the brain
IH 2: Sundathelphusa philippina (crab, one claw is
bigger)
Diagnosis:
Habitat: Lungs (encapsulated in pairs)
Sputum Exam
Diagnostic Stage: Ova in sputum/stool
o 3X in different days, preferably in the morning
*Old name of Antemelania asperata is Broatia asperata
o Use NaOH, 10-30% HCl or NAL-C as mucolytic
*Endemic in Bicol, and one is given a direct sputum
agent (1 part sputum, 9 parts digestant)
smear in addition to Acid Fast staining when there are
o Centrifuge, then look for eggs in the sediment
TB-like symptoms
Stool Exam
*Prawns - paratenic host
o Eggs are present when sputum is swallowed
o Can also confirm P. westermani
Morphology:
Biopsy and Autopsy – the only way to remove or
Adult:
recover adult worms
Reddish, spoon or coffee bean shaped
Rounded anterior, ovoid posterior
Treatment:
Testes – Deeply lobed obliquely in tandem
Praziquantel, Bithionol (will kill the adult worm
Large, broad and flat body
and cause fibrosis)
Wavy intestinal ceca
E. PANCREATIC FLUKE Diagnosis:
Eurytrema pancreaticum Treatment:
(lab notes only, wala sa book and CDC)
Common Name: Pancreatic Fluke
FH: Hogs, cattle (Man is AH)
IH 1: Macrochlamys indica
IH 2: Technomyrmex deterquens (ant) or grasshopper
Habitat: Pancreatic duct, biliary passages, gallbladder
Morphology:
Adult:
Ruffle border
2 notched testes
1 notched ovary
Egg:
Similar to D. dendriticum
Pathology:
Eurytremiasis – destruction of pancreas; diabetes
mellitus
Diagnosis:
Same as previous
Treatment:
Praziquantel
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TEMPLATE (for reviewing)
Common Name:
FH:
IH 1:
IH 2:
Habitat:
Diagnostic Stage:
*
Morphology:
Adult:
Egg:
Life Cycle Notes:
Pathology: