Schistosoma sp.

A. Classification
Phylum: Plathyhelminthes (flatworms)
Class: Trematoda (flukes)
Family: Schistosomatidae
Schistosoma sp. (schistosomes or blood flukes)

B. Morphology
Schistosoma species are unique trematodes because the sexes are separate. The average adult
form measures approximately 7-20 mm in length. The female worms are generally larger than
the males. The female is held by the gynecophoral canal of the male. Each female may produce
up to several hundred eggs each day. The eggs are considerably large, approximately 114 to
180m, although the S. japonicum eggs are smaller than the other species (68 to 100m by 45 to
80m). .

Abbreviations: gc.
gynecophoral canal,
os. oral sucker, Ov.
ovary, Sp. spermatic
gland, ut, uterus, vs.
ventral sucker, vt.
vitelline gland

Top Left: Female and Schistosoma mansoni

Bottom Left: Female being held to the male in the gynecophoral canal.

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Top Left: Schistosoma mansoni cercariae. Top Right: Adult Schistosoma haematobium.
Bottom Left: Schistosoma mansoni egg. Bottom Right: Schistosoma haematobium egg.

C. Lifecycle and Epidemiology

Schistosoma sp. are not like other trematodes because they reside in the blood vessels of the
definitive host, there is no second intermediate hosts in their life cycles, and they are dioecious
(meaning the sexes are separate). Different animals may serve as reservoir hosts, for example,
dogs, cats, rodents, pigs, horses, and goats, for S. japonicum. Dogs can be reservoir hosts for S.
mekongi. Schistosoma species, specifically, live in the veins of the abdominal cavity of the host.
The adult form can live between 20 and 30 years.
Eggs are first removed with feces or urine, depending on the specific species of Schistosoma.
The Schistosoma eggs hatch and release miracidia. The intermediate host, a snail, is penetrated
with the miracidia. Two generations of sporocysts occur in the snail and the production of
cercariae occurs. The infective cercariae are released from the snail, which swim and penetrate
the human hosts skin. Upon penetration, the cercariae lose their forked tail, becoming
schistosomulae. If the cercariae do not reach the host within 48 hours, it will most likely not
survive. It takes about six weeks until the cercariae reach sexual maturity. The schistosomulae
go through several tissues and stages, and finally reside in the mesenteric venules. Where the
worm specifically resides in the human host depends on the specific type of species. S.
japonicum is usually found in the superior mesenteric veins draining into the small intestine. S.
mansoni is usually found in the superior mesenteric veins draining the large intestine. S.
haematobium is usually found in the venous plexus of bladder or the rectal venules. The eggs
move toward the lumen of the intestine, if S. mansoni or S. japonicum, or toward the bladder and
ureters, if S. haematobium. The eggs are then eliminated with the feces or urine.

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D. Geographic Distribution
There are numerous of different species of the Schistosoma genus that can infect humans. The
most common human infections are caused by Schistosoma mansoni, S. haematobium, and S.
japonicum. S. mansoni can be found in parts of South America and the Caribbean, Africa, and
the Middle East. S. haematobium is usually found in 53 countries of Africa and the Middle East.
S. japonicum is found in the Far East, China, Indonesia, Philippines, and Thailand. There are
also two other types of Schistosoma that can infect humans, S. mekongi and S. intercalatum.
Those two are typically found in Southeast Asia and central West Africa, respectively.

The Schistosomiasis endemic worldwide. Categorized by the type of schistosomiasis.

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E. Pathology and Symptoms
Some early and cronic infections tend to be asymptomatic. After becoming infected, within
days, a rash or itchy skin may develop. The Schistosoma eggs do not directly cause the
symptoms of schistosomiasis; the bodys reaction to the eggs produced by the worms cause the
symptoms. Schistosomiasis is also known as bilharzias. If the infection is acute, then it may be
called Katayamas fever. Symptoms of acute
schistosomiasis, which may develop one to two
months after infection, include: fever, cough,
abdominal pain, diarrhea, hepatospenomegaly
(enlargement of liver or spleen), eosinophilia
(abnormally high amounts of a specific type of white
blood cells in the blood or body tissues), and
occasionally central nervous system lesions.
Chronic symptoms may include portal hypertension
and granulomatous reactions (poorly functioning
phagocytes). There are some specific symptoms for
each species of Schistosoma. For the S. mansoni infection it is common to have bloody diarrhea.
Minor hematemesis (blood in vomit) and splenomegaly (spleen enlargement) may occur in S.
mansoni, and S. japonicum infections. S. haematobium may cause cystitis and ureteritis with
hematuria, which can then lead to bladder cancer, scarring, calcification, squamous cell
carcinoma, and occasional embolic egg granulomas in brain or spinal cord. All the three of these
major types of infections may cause pulmonary hypertension, and glomerulonephritis
(inflammation in the kidney).
Approximately 120 million of the 200 million people
infected are symptomatic and 20 million are thought to
suffer the severe and chronic symptoms of the Schistosoma
infection. It is estimated that one million people die each
year from the infection.

F. Diagnosis
When infection is thought to have occurred, stool or urine
samples should be taken and examined under a microscope
for the eggs. S. mansoni and S. japonicum eggs can be
found in stool samples, while S. haematobium eggs can be
found in urine samples. Repeated examinations are
recommended to confirm the presence of Schistosoma since
the eggs are passed in small amounts. If the stool or urine
examinations are negative, tissue biopsy may reveal eggs.
Rectal biopsy may be used for all species and biopsy of the
bladder may be used for S. haematobium.
Another method of detection if the fecal or urine do not
show eggs, but infection is still suspected, is the use of
antibody detection. A blood test has also been developed to
identify the infection, but this method is only useful six to
eight weeks after ones last exposure to contaminated water.

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 Top Left: Schistosoma mansoni egg. Top Right:
Schistosoma haematobium egg. Bottom Left:.
Schistosoma japonicum egg. (not to scale)

G. Treatment of the Individual

Praziquantel is the recommended drug for treating all Schistosoma species. However, S.
monsoni is becoming resistant to this so oxamniquine is the recommended drug in this case..
After six months of treatment with praziquantel in S. haematobium infections, significant
changes in the urogenital tract can be reversed. Metrifonate is a drug specific for infections of S.
haematobium.
Antibiotic therapy has been successful in reducing morbidity rates, for example, in Brazil, China,
Egypt, and the Philippines. It has also reduced the mortality by 56% between 1979 and 1997 in
Brazil.
Although antibiotic therapy has been very successful in decreasing the morbidity and mortality
rates, it is very hard to implement and it is very expensive; therefore possible vaccines are being
developed. There have been studies that show the existence of a common or host antigen
between Schistosoma mansoni and laboratory hosts.

H. Public Health Issues and Eradication

The reasons the Schistosoma infections are spreading include environmental changes linked to
water resources development, population movements, and population growth. There has been
success in controlling Schistosoma over the last 50 years. In Japan and some islands in the
Lesser Antilles, it has been eradicated. Transmission levels have decreased in Tunisia, Morocco,
the Philippines, Saudi Arabia, and Venezuela. The biggest reason for the success in decreasing
Schistosoma is chemotherapy and economic development.

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Since Schistosoma exists in fresh water in infected areas, recommendations to controlling
infections include avoid swimming, wading, or drinking the fresh water. Treating water with
chlorine, iodine, or heat to 122 F for five minutes will kill the cercariae. It may also be possible
to control the snails by surfacing the shore of a body of water, i.e. a river, with concrete. This
would make it difficult for snails to live on. In poorer countries, it is hard to eradicate.
Educating the population is recommended to prevent the occurrence of Schistosoma.

Works Cited

Acute Glomerulonephritis. Nephrology Channel. Accessed 26 2005.

<[Link]

Clinical Aspects of Schistosomes. Schistosoma japonicum. Accessed 27 January 2005.

<[Link]

Figure 16.17. Accessed 27 January 2005. <[Link]

Hart, J. Splenomegaly. Medline Plus. 20 June 2004. Accessed 27 January 2005.

<[Link]

Initiative for Vaccine Research. World Health Organization. Accessed 21 January 2005.
<[Link]

Karim, M. Eosinophilia. NetDoctor. 29 August 2000. Accessed 27 2005.

<[Link]

Lehrer, J. Vomiting Blood. University of Maryland Medical Center. 21 January 2002.

Accessed 27 January 2005. <[Link]

Parasite Images. Parasites and Parasitological Resources. Accessed 26 January 2005

<[Link]

Schistosoma sp. Parasites and Parasitological Resources. Accessed 21 January 2005.

<[Link]

Schistosomiasis. Centers for Disease Control and Prevention- Laboratory Identification of

Parasites of Public Health Concern. 30 August 2004. Accessed 21 January 2005.
<[Link]

Schistosomiasis. Centers for Disease Control and Prevention. 30 June 2003. Accessed 21
January 2005. <[Link]

Schistosomiasis. Emedicine. 2004. Accessed 27 January 2005.

<[Link]

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Vers- Plathelminthes. Accessed 27 January 2005.
<[Link]

Angela Chung
Drew Dickinson
Carrie Barker
January 31, 2005