TREMATODES General Characteristics Flattened dorsally, leaf-like, elongated and unsegmented ovoid, conical or cylindrical depending upon the

state of contraction vary in size from less than 1 mm to several cm covered by non-cellular integument, which maybe covered with spines or tubercles Integument: absorption of carbohydrates and may also serve for secretion of excess metabolites and mucus. most distinguishing characteristic of adult trematodes: oral suckers: attachment to the host. o oral sucker: anterior end o ventral sucker or acetabulum: larger, blind, located at ventral surface; posterior to the oral sucker Digestive system: o Incomplete o with mouth o no anus o muscular, globular pharynx extends from the mouth in the oral sucker to a short narrow esophagus o Below the esophagus, the intestine bifurcates into two o Intestines: branched/dendritic simple Excretory system: o diffusely scattered flame cells or solenocytes o capillaries, collecting tubules, bladder and excretory pore o The terminal flame cell is a hollow cell with tuft of cilia. Primitive Nervous system: o two lateral ganglia in the region of pharynx connected by dorsal commisures. o From each ganglia arise anterior and posterior longitudinal nerve trunks connected by numerous commisures. Hermaphroditic (all trematodes are hermaphroditic except the BLOOD FLUKES) LIFECYCLE: 1) adult fluke lays eggs (passed in stool) 2) eggs in water miracidium (ciliated larva)

3) miracidium ingested by 1 IH (snail) sporocyst 4) sporocyst redia cercaria (leaves snail) encysts as metacercaria nd 5) metacercaria: 2 IH: water plants, fish, crustacean (crab/crayfish) nd 6) metacercaria in 2 IH is consumed by man Classification of Trematodes According to habitat Portal vein (Blood Flukes) Schistosoma japonicum- Oriental blood fluke Schistosoma haematobium - Vesical blood fluke Schistosoma mansoni - Mansons blood fluke Lungs Paragonimus westermani Oriental lung fluke Liver and bile passages Fasciola hepatica Giant or Sheep liver fluke Clonorchis sinensis Chinese or Oriental liver fluke Opistorchis felineus Cat liver fluke Intestine Fasciolopsis buski Giant intestinal fluke Echinostoma ilocanum Garrisons fluke Heterophyds Heterophyes heterophyes Von Siebold fluke Metagonimus yokogawai Haplorchis taichu BLOOD FLUKES: Schistosoma japonicum CN: Oriental Blood Fluke Habitat: superior mesenteric vein of Small Intestines IS: forked tail cercaria MOT: skin penetration Final Hosts: Man Disease caused: Oriental schistosomiasis, Intestinal schistosomiasis, Hepatic schistosomiasis Schistosomiasis japonica Katayamas disease

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Schistosoma mansoni CN: Mansons Blood Fluke Habitat: mesenteric vein of Large Intestines IS: forked tail cercaria MOT: skin penetration Final Hosts: Man Disease caused: Schistosomiasis mansoni Rectal/Intestinal schistosomiasis Schistosomia hematobium CN: Vesical Blood Fluke Habitat: portal vein of the urinary bladder IS: forked tail cercaria MOT: skin penetration Final Hosts: Man Disease caused: Vesical schistosomiasis Bilharziasis Urinary schistosomiasis MORPHOLOGY Schistosoma japonicum adult is provided with smooth tuberculations. The male have 6 9 testes arranged in rows. The ovary of the female lies somewhat behind the mid plane of the body and the uterus can have 50 eggs at one time Schistosoma mansoni is provided with coarse tuberculations. Male has 6 8 testes while the ovary of the female is situated in the anterior half of the body. The uterus is short with 20 40 eggs. Schistosoma haematobium is provided with fine tuberculations, wherein the ventral sucker is larger than the oral sucker. The number of testes in male is 4 5 . The ovary of the female is posteriorly located. The number of eggs in the uterus is 20 100. EGGS: Schistosoma japonicum eggs are ovoidal, non operculated. 70 90 micra by 50 65 micra. A rudimentary or minute lateral spine is present. Schistosoma mansoni eggs are elongated, non operculated.114 175 micra with transparent shell and a prominent lateral spine

Schistosoma haematobium eggs are elongated, non-operculated, light yellowish brown and possess a distinct terminal spine LIFE CYCLE st Eggs miracidia (ciliated larva) sporocyst (1 IH: snail) redia nd cercaria (leaves snail) metacercaria (2 IH: fresh water plant, fish, crustacean) man PATHOGENESIS Symptoms associated with schistosomiasis include weakness, diarrhea, hepatosplenomegaly, and carcinoma of the intestine, liver, uterus and urinary bladder Treatment: Praziquantel & Niridazole Schistosoma japonicum and Schistosoma mansoni Site of entry: Pruritus and rashes = swimmers itch Migration of the adolescent in the lungs: pneumonitis (Pulmonary schistosomiasis.) Deposition of eggs in the tissues: irritation and formation of ulcers in the mucosa leading to the escape of the eggs into the intestinal lumen. Ulceration in mucosa: diarrhea or dysentery seen in acute schistosomiasis Granuloma of affected tissue and organ is also evident: o obstructions to the pulmonary circulation o formation of pseudotubercle in affected organs/tissues maybe observed o Schistosomiasis japonica depending on the major sites of eggs deposition maybe hepato-intestinal, hepato-splenic or [Link] clinical course of infection is divided into three progressive stages: Incubation: corresponding to the period from the cercarial penetration and schistosomular migration to the time the flukes mature period of early egg deposition and extrusion period of tissue proliferation Schistosoma hematobium lives primarily in the pelvic veins: o eggs are primarily deposited in the vessical plexus =

lesions in the urinary bladder, genitalia (seminal vesicle, vulva, cervix and vaginal walls) Uric acid and oxalate crystals, phospate deposits, eggs, blood clots, mucus and pus maybe present in urine ** most characteristic symptom is hematuria (blood in the urine) mucosal surfaces become inflamed = painful micturation/urination and a constant urinary residual. Pain in the suprapubic region and weakness may occur. LUNG FLUKE: Paragonimus westermani CN: Oriental Lung Fluke Habitat: lungs st 1 IH: snail = Antemelania asperata (formerly Brotia asperata), Antemelania dactylus nd 2 IH: crab = Sundathelpusa philippina (formerly Parathelpusa grapsoides) nd Infective Stage: encysted metacercaria within 2 IH nd MOT: ingestion of metacercaria in 2 IH Final Hosts: Man Disease caused: Paragonimiasis Pulmonary distosomiasis Endemic hemoptysis Morphology Adult worm: reddish-brown 7 12 mm length, 4 6 mm in width and 3.5 5 mm in thickness cuticle is spinous oral and ventral suckers are of equal size intestinal ceca are simple two testes are deeply lobed, situated opposite each other ovary has 6 unbranched lobes and is anterior to the testes shape of adult: When Active - Spoon-shaped, with one end contracted and the other elongated When preserved - Oval, flattened, coffee bean shaped Persist in humans for as long as 20 years or more.

Animal reservoir hosts of this parasite include: dogs, cats, field rats and other rodents. LIFE CYCLE cercaria leaves snail in about 13 weeks and penetrate 2 IH: freshwater crab or crayfish = Sundathelphusa philippina (formerly Parathelphusa grapsoides) ** cercaria penetrates through the soft parts of the body of the crab and encysts as metacercaria in the gills, legs, body muscles or the viscera ** definitive host acquires the infection by ingestion of raw or insufficiently cooked infected crabs upon ingestion: excysted metacercaria pass through the duodenal wall into the abdominal cavity adolescent worms: burrows through diaphragm, enter the pleural cavity and in 20 days reach the lungs and become adult in 5 6 weeks in prolonged migration: adolescent worms may o remain for long period in the peritoneum o enter and leave the liver o lodged in organs (rare cases) Pathogenesis : PARAGONIMIASIS Lungs: o o parasite causes development of a fibrous tissue capsule FIBROUS TISSUE CAPSULE: (within this cyst) = blood tinged, purulent material containing eggs Early Infection: dry cough Later part: bloodstained, rusty brown sputum (most pronounced on rising in the morning) Pulmonary pain and hemoptysis occurs ** Along with these symptoms, the patient may experience fever, sweating, chest pains, cough = MIMICS symptoms of PTB
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o o

o o

** hard to distinguish from pulmonary tuberculosis, pneumonia and bronchitis

Cyst formation: o **localize in the abdominal wall, abdominal cavity, mesenteric lymph nodes, omentum, pericardium, and myocardium and in intestinal wall abdominal pain, rigidity and tenderness

In the brain: Jacksonian epilepsy Visual disturbances Worms situated in the subcutaneous tissue cause creeping tumor Identification of eggs in: Sputum Bronchial washing Feces Treatment:Praziquantel, Emetine hydrochloride &Bithionol LIVER FLUKES: Fasciola hepatica CN: Sheeps Liver Fluke, Giant Liver Fluke Habitat: liver, bile ducts st 1 IH: snail = Lymnae philippinensis, Lymnae swinhoe and Lymnae truncatula nd 2 IH: aquatic plants Infective Stage: forked tail cercaria nd MOT: ingestion of metacercaria in 2 IH: aquatic vegatation Final Hosts: Man Disease caused: Sheep Liver Rot Fascioliasis Morphology largest fluke infecting man Adult: large, flat, leaf-like

20 50 mm in length and 6 12 mm in width anterior end: conical projection (cephalic cone) and a characteristic shouldered appearance is also observed **which serve as distinguishing features posterior end: broadly pointed o two relatively small suckers o intestinal ceca are highly branched or dendritic. o two deeply branched or dendritic testes o single dendritic ovary Related species: Fasciola gigantica which commonly infects cattle, water buffaloes and carabaos, is larger, more lanceolate than F. hepatica. 30 70 mm in length and 3 11 mm in width shorter cephalic cone, less developed shoulders, a larger ventral sucker and the intestinal ceca is more branched.

EGGS large, ovoid, operculated, yellowish brown well rounded posterior end characteristically hen-egg shaped 140 180 by 80 100 microns and is unsegmented at oviposition LIFECYCLE eggs are passed out in the feces and mature in water miracidium is formed within 9 15 days. st miracidium escapes through the operculum and invade the 1 intermediate host: snails = o Lymnae philippinensis o Lymnae swinhoe o Lymnae truncatula Inside the snail intermediate host: o sporocyst one or two generations of rediae cercaria. Cercaria: emerge from the snail and attach by way of their oral sucker on the surface of 2ng IH: aquatic vegetation(watercress) where they develop into metacercaria. o Ipomea obscura or kangkong o Ipomea reptans or morning glory Definitive Host: o metacercaria excyst in the duodenum, liberating the juvenile flukes penetrate intestinal wall peritoneal

cavity viscera liver capsule burrows through the liver parenchyma bile ducts where it matures in 3 4 months o The adult worm survives for as long as 11 years in definitive host. This parasite infects herbivorous mammals like sheep, cattle, deer and rabbits while man serve as occasional host. The adult worm inhabits the biliary passages in the liver. On the other hand the first intermediate host of Fasciola gigantica is Lymnae rubiginosa. Pathogenesis: Fascioliasis Latent or chronic phase period when the parasite has already settled in the bile ducts Clinical manifestations: adult causes obstruction of bile ducts inflammation on the epithelium of the bile duct stimulating pipestem fibrosis Pharyngeal Fascioliasis or Halzoun: result from ingestion of raw sheep liver or goat liver containing the adult parasite attachment of the worm in the pharyngeal mucosa may result to asphyxiation (suffocation). Diagnosis: Fascioliasis recovery of the eggs in the patients stool Fasciola eggs maybe present in stool of individual who has earlier consumed infected animal liver (False fascioliasis) ruled out by keeping the patient on a liver free diet for three to 7 days before another stool examination is done. Immunodiagnostic tests: o CFT, precipitin test, immunoelectrophoresis, counter immunoelectrophoresis o FAST (Falcon Assay Screening Test)-EIA alone or in combination with EITB can detect F. hepatica excretorysecretory antigens in serum o EIA with somatic antigen or excretory-secretory antigens from F. gigantica or F. hepatica (especially excretorysecretory products), yield high sensitivity, including

detection of reactive IgM in acute fascioliasis and confirmation by enzyme-linked immunoelectrotransfer blot (EITB). Treatment: Bithionol LIVER FLUKES: Clonorchis sinensis CN: Chinese Liver Fluke, Oriental Liver Fluke Habitat: bile ducts; gall bladder, pancreatic duct (heavy infection) ** NOT FOUND IN DUODENUM because it can only survive the presence of digestive juices for only a few hours st 1 IH: snail = Parafossarulus manchoricus nd 2 IH: = Ctenopharyngodon idellus (fish), Caridina nilotica gracilipes (shrimp) nd Infective Stage: metacercaria in 2 IH Diagnostic Stage: egg/ova in stool nd MOT: ingestion of metacercaria in 2 IH: Final Hosts: Man, dogs, cats, pigs, ducks (rare occasion) ** a parasite of fish-eating mammals Disease caused: Clonorchiasis 1stIH:Parafossarulus manchoricus snails that live in fish culture ponds, lakes, swamps, and sluggish parts of the river or small streams 2ndIH: Ctenopharyngodon idellus = aka Grass Carp: herbivorous freshwater fish Caridina nilotica gracilipes = aka Freshwater shrimp Adult: flat, elongated, aspinous, and transparent gray tapering anteriorly and somewhat rounded posteriorly 8 25 mm in length and 1.5 5 mm in width. ventral sucker is smaller than the oral sucker. intestinal ceca: long, simple extending to the posterior end two deeply branched testes in tandem formation are situated in the posterior part of the body single ovary is relatively small with three lobes and located anterior to the testes The entire life cycle can be completed in three months. The life span of the adult is 15 20 years. LIFE CYCLE:

free-swimming cercaria dies within 24 48 hours unless ingested nd by freshwater fish (2 IH): Ctenopharyngodon idellus, Caridina nilotica gracilipes nd Inside 2 IH: o metacercaria encyst chiefly in the muscles and subcutaneous tissues, less often on the scales, fins and gills of fish. Infected fish is eaten by the mammalian definitive host: o metacercaria excyst in the duodenum o In the human duodenum: outer wall is dissolved by trypsin inner layer is ruptured by the activity of the metacercaria freed larva migrates to: common bile duct distal biliary ducts: maturation in a month

Habitat: biliary passages st 1 IH: snail = Bythinia leachi nd 2 IH fish: = Idus melanotus, Tinca tinca, and Cyprinus carpio, Barbus barbus nd Infective Stage: metacercaria in 2 IH Diagnostic Stage: egg/ova in stool nd MOT: ingestion of metacercaria in 2 IH Final Hosts: Man Disease caused: Opistorchiasis felineus Adult: reddish yellow Lancet shaped 7 12 mm in length and 1.5 3 mm in width intestinal ceca is simple two testes are lobate and arranged obliquely in tandem (in pairs) oral sucker is smaller than the ventral sucker single ovary is lobed A closely related species infecting man: Opistorchis viverrini = differentiated from Opistorchis felineus:- ovary and testes are nearer to each other, both of which are more deeply lobulated - testes are obliquely arranged EGGS yellowish-brown, ovoid and is smaller than Clonorchis sinensis ova With operculum that sits on the thickened rim and a minute aboperculum is also present o LIFE CYCLE: Same as Clonorchis sinensis differs only in the specific species as intermediate hosts o Pathogenesis: Opistochiasis felineus clinical involvement depends largely on worm burden and the duration of the infection. Moderate infections: (about 100-1000 worms) o enlargement of the liver, passive congestion of the spleen, with icterus and local eosinophilia in the wall of the bile ducts In heavier infections:

Pathogenesis: Clonorchiasis Eggs are associated with formation of gallstones Diet affects chronic infections: o Increased intake of dimethylnitrosamines (in fermented fish) usually leads to cholangiocarcinoma (neoplasia of the liver) Symptoms: o fatigue, weakness, weight loss, abdominal distress and altered appetite o fever, enlargement and tenderness of the liver and eosinophilia (acute infection) o anemia, liver enlargement, slight jaundice, edema and diarrhea (heavy infection) Diagnosis: o Identification of characteristic eggs in the feces o Immunodiagnostic test and liver scan Treatment: Praziquantel LIVER FLUKES: Opistorchis felineus CN: Cat Liver Fluke

Worms found in the pancreas and the gall bladder and the patient suffers from digestive disturbances o Bile stones maybe formed around the parasite eggs Opistorchis has been linked to carcinoma of the bile ducts and the liver Diagnosis: identification of egg/ova in the stool Treatment: Praziquantel INTESTINAL FLUKES: Fasciolopsis buski CN: Giant Intestinal Fluke Habitat: duodenum and jejunum st 1 IH: snail = Segmentina trochoideus or Hippeutis umbilicalis nd 2 IH aquatic plants: = Trapa bicornis (water caltrop), Eliocharis tuberosa (water chestnut), Ipomea aquatica (water morning glory) and Nymphae lotus (lotus) nd Infective Stage: metacercaria in 2 IH Diagnostic Stage: egg/ova in stool nd MOT: ingestion of metacercaria in 2 IH Final Hosts: Man Disease caused: Fasciolopsiasis Morphology 20 70 mm in length, 8 20 mm in width elongated and oval in shape oral sucker is about one- fourth the size of the nearby ventral sucker. This fluke resembles Fasciola hepatica: o Differentiation: No cephalic cone shoulder and the intestinal ceca are simple but wavy and unbranched testes are highly dendritic in tandem formation single ovary is branched EGGS yellowish ellipsoidal thin-shelled, rounded at both ends and operculated 80 85 micra

The adult inhabits the small intestine particularly the duodenum and the jejunum. It is either attached to the intestinal mucosa by the ventral sucker or lies buried in the mucous secretions. Each adult produces an average of 16,000 eggs per day. LIFECYCLE: Each adult produces an average of 16,000 eggs per day. egg is undeveloped when passed in the feces In water: eggs miracidium (3 7 weeks) st Miracidium penetrate the 1 IH (snail): Segmentina trochoideus or Hippeutis umbilicalis In the snail intermediate host: o Miracidium sporocyst rediae 1 rediae 2 cercaria st Cercaria will leave the body of the 1 intermediate host (4 7 nd weeks) encyst on the surfaces of the 2 IH (aquatic plants): Trapa bicornis (water caltrop), Eliocharis tuberosa (water chestnut), Ipomea aquatica (water morning glory) and Nymphae lotus (lotus) nd Metacercaria in 2 IH are ingested by man metacercaria excyst in the duodenum and attach themselves to the intestinal wall and becomes an adult worm in about three months. Pathogenesis: Fasciolopsiasis Pathology maybe due to the following: Traumatic inflammation and ulceration at the site of attachment increase mucus secretion and minimal bleeding Epigastric pain, nausea and diarrhea may occur especially in the morning. Obstructive In heavy infections: edema and partial intestinal obstruction due to the large size of the worm Toxic Intoxication occurs: absorption of the worms excess metabolites and excretory by-products which become systematic upon absorption generalized toxic and allergic symptoms profound intoxication may result in death

Treatment: Praziquantel, Niclosamide,Tetrachloroethylene,Hexylresorcinol,Dichlorophen INTESTINAL FLUKES: Echinostoma spp. Echinostoma: medium sized adult worms: unique due to the presence of collar of spines around the oral sucker Many species have been reported in man and are differentiated on the basis of number of spines and number of lobes in testes In the Philippines: Echinostoma ilocanum Echinostoma malayanum Echinostoma ilocanum CN: Garrisons Fluke Habitat: small intestines st 1 IH: snail = Gyraulus convexiusculus or Hippeutis umbilicalis (IN THE PHILIPPINES) nd 2 IH snail = Pila luzonica or kuhol and Vivipara angularis or susong pampang nd Infective Stage: metacercaria in 2 IH Diagnostic Stage: egg/ova in stool nd MOT: ingestion of metacercaria in 2 IH Final Hosts: Man Disease caused: Human Echinostomiasis Echinostoma malayanum Habitat: small intestines st 1 IH: snail = unkown (IN THE PHILIPPINES) nd 2 IH snail = Lymnae cumingiana or birabid (formerly Bullastra cumingiana), Radix quadrasi and Physastra hungerfordiana nd Infective Stage: metacercaria in 2 IH Diagnostic Stage: egg/ova in stool nd MOT: ingestion of metacercaria in 2 IH Final Hosts: Man Disease caused: Human Echinostomiasis Morphology: Echinostoma ilocanum

reddish gray 2.5 6.5 mm in length, 1 1.5 mm in width anterior end: horseshoe-shaped collar of spines (Collarette of spines) = circumoral disk surrounded with 49 51 spines in two rows oral sucker found at center of this disk Testes: bilobed, in tandem formation Ovary: globular, anterior to the testes Morphology: Echinostoma malayanum 5 12 mm in length and 2 3 mm in width Elongated, bluntly rounded ends 43 45 collar of spines multilobulated testes (6 9 lobes) in tandem formation ovary is small, rounded or oval Echinostoma ilocanum ova: 86116 micra by 5869 micra straw-colored, operculated ovoidal and with characteristic germ ball Echinostoma malayanum ova: Larger than Echinostoma ilocanum 120 130 micra by 80 90 micra operculated with characteristic germ ball LIFECYCLE: immature eggs are passed out with the feces st ova mature within 6 15 days miracidium enters the 1 IH: for Echinostoma ilocanum: Gyraulus convexiusculus or Hippeutis umbilicalis for Echinostoma malayanum: unknown Inside the snail intermediate host: miracidium redia 1 redia 2 cercaria nd Cercaria escape from the snail 42 50 days to infect the 2 IH: also a snail: Echinostoma ilocanum: Pila luzonica or kuhol Vivipara angularis or susong pampang Echinostoma malayanum: Lymnae cumingiana

Radix quadrasi Physastra hungerfordiana cercaria metacercaria man ingests metacercaria by eating infected snail metacercaria excyst in the duodenum and the adult fluke attaches itself to the intestinal wall Pathogenesis: Echinostomiasis little damage to the intestinal mucosa: inflammation at the site of attachment In heavy infections: diarrhea, bloody diarrhea abdominal pain General intoxication: absorption of the metabolites of the worms Diagnosis: identification of eggs/ova in stool Treatment: Praziquantel & Hexylresorcinol INTESTINAL FLUKES: Heterophyds Family Heterophydiae: Heterophyes heterophyes Metagonimus yokogawai Haplorchis taichu Adult Heterophyds: elongated, oval or pyriform in shape the smallest yet the deadliest: less than 2 mm in length HABITAT: Small Intestines Morphology: Heterophyes heterophyes CN: Von Siebolds Fluke Adult: Grayish smallest fluke of man: 1.3 by 0.5 mm oral sucker is very small ventral sucker is large, situated in the anterior middle-third of the body conspicuous genital sucker (gonotyle) found in the lateral posterior border of the ventral sucker two testes: ovoid, side by side in the posterior fifth of the body

ovary: subglobuse, anterior to the testes Morphology: Metagonimus yokogawai Adult: 1.4 by 0.6 mm. large ventral sucker is situated to the right of the midline two oval testes: unequal in size, arranged obliquely side by side and situated in the posterior third of the body ovary: globuse, situated at the junction of the middle and lower third of the body Morphology: Haplorchis taichu Adult: large ventral sucker a globuse ovary only one testis EGGS light yellow brown ovoidal, operculated smallest trematode egg: 20 30 by 15 17 micra Shell: o slight shoulder at the rim of the operculum o knob at the posterior pole maybe occasionally observed fully developed miracidium already present within the egg when it is deposited by the adult worm LIFECYCLE: eggs are passed out into the environment with the feces st Eggs ingested by 1 IH: fresh water snail o The first intermediate host of the species of Heterophyds are: H. heteophyes: Pironella conica Cerithidia cingula M. yokogawai : Semisulcospira, Thiara and Hua H. taichu Melania juncea, Thiara riquetti

Inside the 1 IH: eggs sporocyst one or two generations of rediae cercaria nd Cercaria, that emerge from the snails and penetrate 2 IH: a suitable fish species The second intermediate hosts are: H. heterophyes: Mugil, Salmo, Acanthogobius M. yokogawai : Plecoglossus, Salmo, Richarsonium, Odontobutis H. taichu: Ambassis burensis (langaray) Amphacathus jacus (samaral) Anabas testidineus (martiniko) Arius manilensis (kanduli) Claris batrachus (hito) Gerris kapas (malakapas) o Glossogonius giurus (bia) o Hemiramphus georgii (cansusuit or bugning) o Ophiocephalus striatus (dalag) o Pelates quarilineatus (babansi) o Therapon plumbeus (ayungin) Metacercaria: o encyst on or under the scales, in muscles, fins tails or gills of the second intermediate host o Man ingests metacercaria: raw or insufficiently cooked infected fish is ingested by the definitive host metacercaria escapes from the cyst adult worm (1week) and attaches itself to the intestinal wall Pathogenesis: inflammation at the site of attachment causing damage to the intestinal mucosa = mucoid diarrhea colicky pain: severe abdominal pain caused by spasm, obstruction or distention of any hollow viscera (ex. Intestines) adult worm: may burrow deep into the intestinal wall = become trapped and eventually die eggs of the degenerating worms:

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blood stream and lymphatics: carried to the different parts of the body heart muscles: cardiac failure resembling that of cardiac beri-beri brain: fatal cerebral hemorrhage spinal cord: loss of motor and sensory functions at the levels where the lesions are located Diagnosis: identification of eggs/ova in stool Treatment: Praziquantel & Tetrachloroethylene