TREMATODES 5.

Cercariae
6. Metacercariae
General Characteristics:
7. Adult
 Flatworms Snail
 With oral and ventral suckers
(acetabulum)  1ST intermediate host
 Hermaphroditic
Egg
 Eggs are operculated
 The typical F. buski egg measures
According to habitat
128 to 140um to 85um, whereas that
 Intestinal flukes of F. hepatica measures 128 to 150
 Liver flukes um by 60 to 90 um
 Lung fluke  The eggs are identical. They
 Blood flukes consists of an oblong
underdeveloped miracidium
Phylum equipped with a distinct operculum
 The eggs of the two species are
 Platyhelminthes
considered to be indistinguishable
Class
MORPHOLOGY
 Trematode (also referred as
 The somewhat oblong freshly adult
digenea)
F. buski (averages 5 by 1.5 cm in
Intestinal species size) the adult F. hepatica
approximately 3 by 1 cm
 Fasciolopsis buski
 Heterophyes heterophyes F. hepatica is equipped with so called
 Metagonimus yokogawai shoulders

Liver species

 Fasciola hepatica
 Clonorchis sinesis
Lung species

 Paragonimus westermani
Blood species

 Schistosoma mansoni
 Schistosoma japoincium
 Schistosoma haematobium Fasciolopsis buski
Fasciola hepatica
Stages
1. Eggs
2. Miracidium
3. Sporocyst
4. Rediae
ADULT from stool specimens or duodenal
aspirates
 Elongated and fluke
 The enterotest may also be
 No cephalic cone performed
 Unbranched intestinal ceca  The rarely encountered adult worms
 Measures 2 – 7.5 cm by 0.8-2 cm by are only seen when removed during
0.5-3cm surgery or autopsy procedure
Basic Techniques

 The specimen choice for recovery of MORPHOLOGY

the eggs of F. buski and F. hepatica
is stool  Metagonimus yokogwai (heterophid
 Speciation may also be fluke)
accomplished by recovery of the  Heterophyes heterophyes
adult fasciolopsis worm (heterophoid fluke) von Siebold
 Other methodologies available for fluke/dwarf fluke
the detection of fasciola include the  Eggs: the eggs of heterophyes
eneterotest, ELISA and gel diffusion heterophyes and metrogonimus
yokogawai are basically
Clonorchis sinensis indistinguishable and may be easily
 Chinese liver fluke confused with those of C.sinesis
(with operculum)
 Transmission is by ingestion of fish
infected with metacercariae that is  These eggs measure approximately
eaten raw or undercooked the same C.sinensis, 30 by 15 um
 Worms feeds on tissue fluids, RBCs  There are only two somewhat
and mucus discrete differences among the eggs
of H. heterophyes and M.yokogawai
Egg versus those of C.sinensis
 Heterophyes and Metagonimus eggs
 the typical clonorchis sinensis egg
have shoulders, they are less
measures 30 by 15 um
distinct than those of clonorchis
 The developed miracidium takes up
 The eggs of heterphyes and
the interior of the egg
metagonimus may lack the small
 The egg is equipped with a distinct terminal knob found on those
operculum opposite a small knob ] Clonorchis
Adult Paragonimus westermani (Oriental lung
 The average C.sinensis measures 2 fluke)
by 0.5 cm  Eggs ranges from 78 to 120 um by
 Each end of the adult worm is 45 to 60 um
narrower than the midportion of the  Oval eggs consists of an
body undeveloped miracidium protected
Laboratory diagnosis by a thin smooth shell
 An opercular rim (Shoulders)
 C.sinensis is accomplished by surrounds the prominent operculum
recovery of the characteristic eggs
 Diphylobothrium latum eggs have
similar morphology to P. westermani
INTERMEDIATE HOSTS
but lack opecular shoulders and are
more rounded in shape 1st intermediate hosts
 D. latum eggs have similar morphology
to P.westermani  Ricefield snail (brotia asperata,
semisculcospira libertine, brostia
 D latum eggs have abopercular knob
costula epicospalia)
lacking in P.westermani
 Sundathelphusa philippina
 size is also helpful in distinguishing
the two eggs in stool specimens  Transmission is mainly attributed to
the preparation of local delicacies
(kinagang in Sorsogon)
 Metecercariae, dislodge during food
preaparation, may contaminate
eating and cooking utensils
 Endemicity of disease is related to
dieatary habits, methods of food
preparation and the presence of
appropriate snail, freshwater
crustaceans and reservoir hosts.

ACUTE PHASE CHRONIC PHASE

Diarrhea Hemoptysis

Expectoration of
Abdominal pain
discolored sputum
Chest radiographic
Fever
abnormalities
Severe manifestations
Cough
if the brain is involved

Urticaria

Hepato-splenomegaly
 eggs from flukes in lungs are passed
out with sputum or swallowed and Pulmonary
passed in feces abnormalities
 snail (semisulcospira libertine) – 1st
intermediate host Eosinophilia
 crustaceans (Crabs) – 2nd
intermediate host (infective)
Pulmonary paragonimiasis

 Similar clinical manifestations with

tuberculosis
 Often misdiagnosed as PTB, not
responding to treatment
Integrate detection of Paragonimus ova
and Acid Fast Bacilli or TB

 Possible co-existence of the two

diseases in documented endemic
sites
 Utilize existing laboratory
framework/method of the national
tuberculosis program to include  Contact with contaminated water
diagnosis of paragonimiasis  Cercariae respond to chemical
signals from the skin
Basic Techniques  Skin penetration is facilitated by
serine proteases in the acetabular
 Microscopic examination for
glands of the cercariae
paragonimus eggs in smear by:
1. 3% NaOH concentration technique Morphology of Schistosoma egg
(sedimentation)
2. Ziehl-neelsen staining technique  Schistosoma egg is compromised of
a developed miracidium. The
Other/specialized techniques presence of lateral or terminal
spines as well as the organisms
 Intradermal test
shape and size, aid in species
 ELISA
identification
Schistosomiasis  Schistosoma mansoni is relatively
large, measuring 112 to 182 um by
 Parasitic infection caused by the 40 to 75 um the organism is
trematode of the genus Schistosoma somewhat oblong and possesses a
 Major ethiologic agents of prominent large lateral spine
schistosomiasis  Schistosoma japonicum is the
1. Schistosoma japornicum smallest of the Schistosoma spp.
(blood fluke) Measuring 50-85 um by 38 to 60
2. Schistosoma mansoni um. The egg is characterized by the
(Manson’s blood fluke) presence of a small lateral spine,
3. Schistosoma haematobium which is often difficult to detect on
(bladder fluke) microscopic examination
 207M infected worldwide  Schistosoma haematobium
 2M infected in the Philippines resembles S.mansoni is size and
 Next to malaria 2nd most important shape. The somewhat oblong egg
parasitic infection in terms of public measures 110 to 170 um by 38 to 70
health globally um the presence of large, prominent,
 terminal spine distinguishes the egg  dracunulus medinensis
from that of other Schistosoma spp.
Morphology of Schistosoma adult

 the adult of Schistosoma are the

only trematodes that have separate
sexes
 the typical female measures 2 cm in
length
 the male measure 1.5 cm, the male
surrounds the female almost
completely facilitating copula

NEMATODES
Phylum

 nemathelminths
Class

 nematoda
Intestinal species

 enterobious vermicularis
 trichuris trichiura
 ascaris lumbricodes
 necator americanus
 ancylostoma duodenale
 strongloides stercoralis
Intestinal-Tissue Species