TREMATODES

A. SYSTEMATIC CLASSIFICATION OF TREMATODES

PHYLUM PLATYHELMINTHES

CLASS TREMATODA

SUBCLASS DIGENEA

ORDER PROSOSTOMATA
 SUBORDER SUBORDER
STRIGEATA SUBORDER DISTOMATA
PARAMPHISTOMATA
SUPERFAMILY SUPERFAMILY
1. STRIGEOIDEA
➢ Alaria Americana SUPERFAMILY 1. ECHINOSTOMATOIDEA/
FASCIOLOIDEA
PARAMPHISTO-
2. ➢ Echinostomatoidea
MATOIDEA - E. ilocanum
SCHISTOMATOID ➢G. hominis
EA ➢ Fascioloidea
➢W. watsoni - F. hepatica
➢ S. mansoni
➢ S. japonicum - F. gigantica
➢ S. haemalobium - F. buski
2. PLAGIOTRAMATODEA or
TROGLOTREMATOIDEA
-Dicrocelium
dendriticum
- P. westermani
 3. OPISTHORCHIOIDEA
➢ Opisthorchidae
- C. sinensis
- O. felineus
➢ Heterophyidae
- H. heterophyes
- M. yokogawai

B. ACCORDING TO THE HABITAT OF TREMATODES

(FLUKES)

1. INTESTINAL TREMATODES (INTESTINAL FLUKES)

(a.) Small Intestine
- Fasciolopsis buski - Heterophyes heterophyes
- Metagonimus yokogawai - Watsonius watsoni
- Echinostoma ilocanum

(b.) Large Intestine

- Gastrodiscoides hominis
2. HEPATIC TREMATODES (LIVER FLUKES)
- Clonorchis sinensis - Opisthorchis felineus
- Fasciola hepatica - Fasciola gigantica

3. LUNG TREMATODES (LUNG FLUKES)

- Paragonimus westermani

4. BLOOD TREMATODES (BLOOD FLUKES)

(a) In the vesical venous plexus
- Schistosoma haematobium
(b) In the rectal venous plexus and portal venous system
- Schistosoma mansoni
- Schistosoma japonicum
 TREMATODES
- TAKEN FROM THE WORD TREMATOS WHICH
MEANS PIERCED WITH HOLES OR BODY WITH
HOLES

- named on account of their conspicuous

suckers
CHARACTERISTISTICS OF TREMATODES:
1. Leaf shaped, unsegmented flat worms
called flukes.
2. Size varies from 1 mm. to several cm. in
length.
3. Organs of attachment are 2 strong
muscular cup shaped depressions called
suckers or acetabulum.
a.) oral sucker – surrounds the mouth
b.) ventral sucker – found on the ventral
surface of the body
c.) genital sucker or cone – found in
some species of trematodes
4. Sexes are not separate – each worm is a
hermaphrodite or monoecious except
schistosomes which are unisexual or
diecious (sexes are separate).
5. Body cavity is absent
6. Alimentary canal is present but
incomplete.
- anus is absent
- esophagus bifurcates in front of ventral
sucker into a pair of blind intestinal
ceca or crura which maybe simple (in
Clonorchis sinensis) or branched (in
Fasciola hepatica) or may reunite to form
a single cecum (in Schistosomes)
- nutrients are absorbed thro’ the skin
7. The worm is oviparous since eggs are
liberated.
8. Eggs are operculated except in Schistosomes
and can develop in water.
- in majority of cases they are immature when
oviposited
- don’t float in saturated solution of common
salt
9. Excretory and nervous systems are present
- excretory system consist of flame cells and
collecting tubules which open posteriorly
into the excretory pore.
- nervous system is composed of a group of
paired ganglion cells displaced like a saddle
on the dorsum of the pharynx or esophagus
10. Reproductive system is highly developed
and complete.
- the genital organs lie between the two
branches of the intestine.
- MALE REPRODUCTIVE SYSTEM:
A. 2 testis (except in shistosomes with
multiple testis) in the posterior region of
the body
B. 2 vasa efferentia
C. 1 vas deferens
D. vas deferens is dilated as seminal
vesicle followed by a constriction,
ejaculatory duct, before opening into the
genital atrium.
E. the terminal part of the vas
deferens is modified into a muscular
cirrus which serves as the organ of
copulation.
F. prostate gland which surrounds
the constricted portion of the vas
deferens.
G. the seminal vesicle, cirrus organ
and prostate gland are enclosed is a
pouch, the cirrus sac.
FEMALE GENITAL SYSTEM:
A. Single ovary and its ducts
B. 2 vitellaria or yolk glands and their
ducts on either side
C. Laurel’s canal, a vestigial vagina or
rudimentary vagina which may or may
not open on the dorsal surface
D. Seminal receptacle
E. Uterus
F. Ootype which is the fertilizing chamber
G. Mehli’s gland which surrounds the
ootype
Both male & female reproductive organs open
into the common genital atrium.
DIFFERENT LARVAL STAGES:
1. MIRACIDIUM – first larval stage coming out of the
trematode egg in water which is ciliated
2. SPOROCYST
3. REDIA – developed into first generation redia and
second generation redia; in schistosomes there is no
stage or redia formation
4. CERCARIA – final stage of larval development of
trematodes in mollusk possessing a body and tail; it
escapes into the water and may remain either free
or encysted in the second intermediate hosts ( fish,
crab or aquatic plants)
5. METACERCARIA – infective stage to the definitive
host
TYPES OF CERCARIA ACCORDING
TO THE NATURE OF THE TAIL:
1. LOPHOCERCUS CERCARIA - large,
fluted tail; seen in metagonimus,
clonorchis, heterophyes
2. MICROCERCUS CERCARIA – small,
stumpy tail; seen in the
paragonimus
3. FURCOCERCUS CERCARIA – fork
tailed; seen in schistosomes
4. PLEUROLOPHOCERCUS
CERCARIA – long, powerful tail
with pair of fin folds; seen in
opisthorchis
Life Cycle :

These worms pass their life cycle in two

different hosts:
1. Definitive host – man, herbivorous &
domestic animals which harbors the
adult worm
2. Intermediate host – harbors the larval
stage of the parasite
A. First intermediate host – fresh
water snail or mollusk
B. Second intermediate host – fish or
crab or aquatic plants or vegetations
COMMON NAME
DISEASE
GEOGRAPHICAL DISTRIBUTION
RESERVOIR HOSTS
HABITAT
MORPHOLOGY
ADULT WORM
EGG
LIFE CYCLE
PATHOGENECITY(SIGNS AND SYMPTOMS)
LABORATORY DIAGNOSIS
TREATMENT
PREVENTION
INTESTINAL TREMATODES
FASCIOLOPSIS BUSKI
ECHINOSTOMA ILOCANUM
ARTYFECHINOSTOMUM MALAYANUM
HETEROPHYID FLUKES :
> HETEROPHYES HETEROPHYES
> METAGONIMUS YOKOGAWAI
> HAPLORCHIS TAICHUI
> HAPLORCHIS YOKOGAWAI
 FASCIOLOPSIS BUSKI
COMMON NAME: large or giant intestinal fluke
DISEASE: Fasciolopsiasis
GEOGRAPHICAL DISTRIBUTION: Prevalent in Southeast Asia (China,
Thailand, Malaysia, Indonesia, India, Taiwan, Korea, Vietnam, Bangladesh)
Endemicity in the Philippines, has not been demonstrated
RESERVOIR HOSTS: pig, dog, rabbit, man
HABITAT: small intestine, attached to the walls of duodenum and jejunum
MORPHOLOGY:
ADULT WORM: largest trematode parasitizing man, size is 20-75mm in
length by 8-20mm in width, 0.5-3mm in thickness
elongated, oval, anterior end narrower than posterior end,
no cephalic cone, intestinal ceca don’t have lateral branches (differ from F.
hepatica)
ventral sucker is large & lie close to the oral sucker
2 testis, ovary and vitellaria are highly branched
 Genital Formula : O
T
T
Life span of the adult worm is short (6 months – 1 year)
EGG: Identical to that of F. Hepatica; large, size (130-140um x 80-85um),
ovoid,hen’s egg shaped, yellowish brown in color, unembryonated when laid
LIFE CYCLE:
DEFINITIVE HOSTS: pig, man, dog, rabbit
INTERMEDIATE HOSTS: First IH – fresh water snail (genus SEGMENTINA &
HIPPEUTIS)
Second IH – Water caltrop (TRAPA NATANS - China)
- Aquatic plants or vegetable (TRAPA BICORNIS – Thailand)
- Water Chestnut (ELIOCHARIS TUBEROSA)
- Water Morning Glory (IPOMOEA AQUATICA)
- Lotus (NYMPHAEA LOTUS
- Water Bamboo
SIGNS & SYMPTOMS :
- Due to intoxication which results from absorption of worms metabolities
into the system
1. Asthenia
2. Abscess & Ulceration of the intestinal wall
3. Mild Anemia – because of hemorrhage due to erosion of the wall
4. Chronic Diarrhea, abdominal pain, nausea & vomiting, anorexia
5. Edema of face & lower extremities, ascites
6. Partial Intestinal Obstruction
DIAGNOSIS: Finding of eggs in feces or vomitus by microscopic examination
Eggs of F. hepatica and F. buski are indistinguishable, so adult
worm has to be recovered.
TREATMENT:
1. Hexylresorcinol 5.Thiabendazole,mebendazole,levamizole
2. Tetrachlorethylene pyrantel pamoate
3. Dichlorophen
4. Praziquantel – drug of choice Dose- 25 mg/k for 1 day given in 3 doses
 ECHINOSTOMIDS

Two species have been documented in the

Philippines:

1. ECHINOSTOMA ILOCANUM

2. ARTYFECHINOSTOMUM MALAYANUM
ECHINOSTOMA ILOCANUM
COMMON NAME: Garrison’s Fluke
- Garrison first found the eggs of this fluke from a native prisoner in Manila in
1907 & later discovered the adult worm
DISEASE: Echinostomiasis
GEOGRAPHICAL DISTRIBUTION: Far East & Southeast Asian Countries
(Philippines, India, Indonesia, Thailand, China, Japan, Malaysia, Singapore,
Korea); in the Philippines, it is found in Northern Luzon, Samar and Leyte
and Mindanao
RESERVOIR HOSTS: Norway rat, man, domesticated & wild mammals, birds,
ducks, geese, chicken, pigeon, dogs, cats, rats, pigs
HABITAT: Attached to the walls of the small intestine
ADULT WORM: reddish gray in color, size is 2.5- 6.6 mm in length x 1-1.35
mm in width,
- Anterior end is provided with circumoral disk surrounded with a crown of
spines or collar spines of about 49-51 spines, posterior end is attenuated
- 2 suckers : oral & ventral suckers ; ventral sucker is larger than oral sucker
- Integument is covered with plaque like scales
 - Genital Formula : O
T
T
- Deeply lobed testis lie one behind the other; ovary is ovoid just in front or anterior to
the 2 testis
- Vitellaria consist of medium sized follicles in the lateral fields of the body
EGG:
- Ovoid, operculated, straw colored, size is 80-140um x 58-90um
- Immature or unembryonated when laid in feces, mature in water in 6-15 days
- Same as F. Hepatica & F. buski but smaller
LIFE CYCLE:
DEFINITIVE HOSTS: the reservoir host
INTERMEDIATE HOSTS: First IH – planorbid snail, frog (less often)
(GYRAULUS CONVEXIUSCULUS-Phil. , Java)
( HIPPEUTIS UMBILICALIS – Philippines)
Second IH – Fresh water mollusk or snail (kuhol)
(PILA CONICA OR LUZONICA – Philippines), VIVIPARUS
ANGULARIS ( Susong Pampang )
- fish, clams, tadpoles, crustaceans (less often)
PATHOGENESIS, PATHOLOGY & SYMPTOMATOLOGY :
- Development of inflammatory lesion at the site of attachment to the
intestinal wall
1. Intestinal Colic
2. Bloody Diarrhea
3. Nausea & Vomiting
4. Fever
DIAGNOSIS: recovery of eggs from stool
TREATMENT:
1. Hexylresorcinol
2. Tetrachlorethylene – also for hookworm infection
3. Oleoresin of aspidium
4. Praziquantel – dose is 40 mg/k single dose or 25 mg/k/dose for 1 day
5.Albendazole,mebendazole,niclosamide
PREVENTION:
1. Avoid eating raw or inadequately cooked fresh water mollusk (kuhol) in
endemic areas
2. Use of molluscides to eliminate the snail ( First IH )
 ARTYFECHINOSTOMUM
MALAYANUM
 Epidemiology
 1st documented in humans in 1987 and has been
reported in Northern and Central Luzon
 2005, a study in Siargao island, Surigao del Norte,
showed infection in 11.4% of individuals with GI
disturbances with history of eating snails, kuhol
and kiambuay, raw with coconut milk and lime
juice
 Adult Worm
 5-12 mm in length, 2-3 mm in width
 Rounded posterior end. has 43-45 collar spines
 2 testes, large each with 6-9 lobes in tandem
 Ovary, small, oval/rounded anterior to testes
 Egg
 Larger than E. ilocanum, golden brown,
operculated, 120-130 um x 80-90 um,
unembryonated
 Life cycle
 1st IH: has not been yet identified but suspected to
be same as Ilocanun
 2nd IH:
 1) Lymnaea cumingiana (syn: Bullastra birabid)
 2) Ampullarius canaliculatus ( golden apple snail)

 definitive host
 dogs, cats, rats, pigs, man
 WATSONIUS WATSONI
This trematode was found only once in humans when an autopsy was
done in an African who died of severe diarrhea. Worms were
recovered from the small intestine attached to the duodenal & jejunal
wall, others were free in the lumen of the large bowel
GEOGRAPHICAL DISTRIBUTION: Eastern Asia (Singapore) & Africa
RESERVOIR HOSTS: primates (monkey)
MORPHOLOGY:
ADULT WORM:
- pear-shaped body, reddish yellow in color, with transluscent glistening
appearance
- measures 8-10 mm length by 4-5 mm width, 4 mm in thickness
- flattened dorsoventrally, indented shallowly at the posterior end slightly
concave ventrally
- intestinal ceca is simple, not branched
- 2 suckers, oral and ventral suckers; oral sucker is provided with pair of
lateral pouches
 - GENITAL FORMULA: T
T
O
- 2 testis are squarish with notched margins which lie one in front of the
other just anterior to the small ovoidal ovary in the middle third of the body
- Finely granular vitellaria at the lateral sides of the body

EGG:
- ovoidal in shape, operculated, light yellow in color, immature or
unembryonated
- measures 122-130 um x 75-80 um
LIFE CYCLE:
- unknown but infection is probably contracted by ingestion of aquatic
vegetables with encysted metacercaria
SYMPTOMS: severe toxic diarrhea, hemorrhage, anorexia
TREATMENT & PREVENTION: have not been studied
 HETEROPHYID FLUKES

1. HETEROPHYES HETEROPHYES

2. METAGONIMUS YOKOGAWAI

3. HAPLORCHIS TAICHUI

4. HAPLORCHIS YOKOGAWAI
 HETEROPHYES HETEROPHYES
COMMON NAME: Von Siebold’s fluke
DISEASE: Heterophyiasis
GEOGRAPHICAL DISTRIBUTION: Far East Countries (Japan, Korea, China,
Taiwan, Philippines), Egypt, Turkey, India, North Africa
RESERVOIR HOSTS: dog, cat, fox, wolf, birds, man
MORPHOLOGY:
ADULT WORM:
- elongated, pyriform worm flattened dorsoventrally with attenuated anterior
end and rounded posterior end, tear drop shape fluke
- smallest fluke which measures 2 mm length by 0-3 – 0-4 mm width
- oral sucker is smaller than the ventral sucker; genital sucker is present
armed with spines about 60-90 in number
- intestinal ceca is blind and simple
- cuticle is covered with fine, scale like spines
 - GENITAL FORMULA: O
T T
- ovary is round which is anterior to the 2 testis
- 2 testis are also round which lie side by side
- 14 large, polygonal vitelline follicles are present in the lateral fields
- life span of adult worm: 2 months
EGG:
- small, 20-80 um x 15-17 um, ovoid, operculated, light brown in color,,
embryonated or mature when laid
LIFE CYCLE:
1. Definitive host – dog, cat, fox, wolf, man
2. Intermediate host – first IH – freshwater snail (PIRONELLA CONICA) –
Egypt, (CIRITHIDIA CINGULA ALATA) – Japan,
second IH ( mullets ) MUGIL CEPHALUS
PATHOGENESIS, PATHOLOGY, SYMPTOMATOLOGY:
- due to inflammatory reaction produced by the worm at the site where they
are attached to the intestinal mucosa
 1. Colicky abdominal pain
2. Mucoid diarrhea
- in the Philippines, it was found out that eggs of this worm may filter thro’ intestinal
wall to mesentric lymphatics then filter out in cardiac valves and myocardium
causing cardiac failure and myocarditis resembling that of cardiac beri beri or
maybe carried to the brain with production of fatal cerebral hemorrhage; in the
spinal cord it causes loss of motor and sensory functions at the level where lesions
are located.

DIAGNOSIS: recovery of eggs in feces; eggs resemble those of C. sinensis & O.

felineus ; PCR – polymerase chain reaction – sensitive diagnostic tool for low
intensity infection

TREATMENT:
1. Tetrachloroethylene – as for hookworm infection
2. Piperazine – as for ascariasis and enterobiasis
3. Praziquantel – drug of choice; dose: 25 mg/k/day, 3 doses, 1 day
4. Bithionol & niclosamide – decrease egg production

PREVENTION: avoid eating raw or uncooked fish in endemic areas

HAPLORCHIS TAICHUI
 In the Phil. , prevalence was considered low;
less than 1% in 1980’s; in 1998 survey was done
in Monkayo, Compostela Valley; increase to
30% prevalence and the species identified was
Haplorchis taichui; infection were high in
both males and females; and in all age groups
 1st IH (snail hosts) can be freshwater, brackish
or seawater
 In the Phil. snail host of Haplorchis taichui
and Procerovum calderoni are the brackish
water snail hosts: Melania juncea and
Thiara riquetti
 SNAIL HOSTS OF H. TAICHUI

1. MELANIA JUNCEA

2. THIARA RIQUETTI
 Source of infection:
 > consumption of raw or undercooked fresh

water fish with infective metacercaria

 Clinical symptoms :

> upper abdominal discomfort or pain

> borborygmi
 Treatment:

> praziquantel – 75mg/k/day in 3 divided

doses
 PATHOLOGY OF H. TAICHUI INFECTION IN
THE
SMALL INTESTINE OF HUMANS:

 1.mucosal ulceration and hemorrhages

 2. fusion and shortening of villi
 3. chronic inflammation
 4. fibrosis of submucosa
HAPLORCHIS YOKOGAWAI
 Seen in Asia & Mediterranean, Taiwan, China,
 Egypt, Java, Hawaii, India, Australia

 Habitat : small intestine

 Morphology: adult worm is small but wide,

ventral sucker is covered with small number of
very small spines rather than hooks
 Life cycle:

 First intermediate host: snail (Stenomelania

newcombi)
 Second intermediate host: mullets ( fish )
 Humans are infected by ingestion of infected fish

 Prevention: Avoid ingestion of infected fish

 METAGONIMUS YOKOGAWAI
COMMON NAME: Yokogawa’s fluke or Japanese fluke
DISEASE: Metagonimiasis
GEOGRAPHICAL DISTRIBUTION: Far East Countries (Korea, Formosa,
Japan, China, Indonesia, Philippines), Russia, Siberia, Balkans
RESERVOIR HOSTS: dog, cat, pig, pelican, man
HABITAT: small intestine
MORPHOLOGY:
ADULT WORM:
- more or less resembles heterophyes in its size and shape
- minute worm which measures 2 mm length by 0.5 mm in width
- pyriform in shape, narrow anterior end and round posterior end
- intestinal ceca is blind and simple; has 2 suckers, oral & ventral suckers
- distinct feature: ventral sucker or acetabulum is displaced laterally to the
right side of the middle line
 - GENITAL FORMULA: O
T T
- 2 testis are round which lie side by side; ovary is round which is anteriorly
placed to the 2 testis
EGG:
- indistinguishable from that of heterophyes
- size: 26-28 um by 15-17 um
- Ovoid, operculated and embryonated when laid
LIFE CYCLE:
1. Definitive host – pig, dog, cat, pelican, man
2. Intermediate host – first IH: snail (species of MELANIA)
(SEMISULCOSPIRA LIBERTINA)
second IH: freshwater fish – trout (PLECTOGLOSSUS ALTIVELIS)
PATHOGENESIS, PATHOLOGY, SYMPTOMATOLOGY:
- Fluke’s attachment irritate the mucosa producing an excess mucus and
superficial erosion of cells; sometimes they infiltrate the internal capillaries
& lymphatic and carried to the myocardium of the heart, brain, spinal cord,
and other tissues of the body where granulomatous changes maybe
provoked by their presence
- Symptoms: mild diarrhea, colicky abdominal pain, nausea, lethargy
- anorexia, fatigue, body malaise, seizures, neurologic deficit
-

DIAGNOSIS: recovery of eggs in feces; specific diagnosis can only be made if

adult worms are obtained

TREATMENT:
1. Tetrachlorethylene
2. Niclosamide – 100 – 125 mg/k in children
3. Praziquantel – drug of choice – dose: 25 mg/k/dose, 3 doses, 1 day
4. Bithionol
FASCIOLA HEPATICA
FASCIOLA HEPATICA
FASCIOLA HEPATICA
FASCIOLA HEPATICA EGG
FASCIOLA HEPATICA WITH EMERGING
MIRACIDIUM
FASCIOLA GIGANTICA EGG
CLONORCHIS SINENSIS
OPISTHORCHIS FELINEUS
ECHINOSTOMA ILOCANUM
METAGONIMUS YOKOGAWAI
HETEROPHYES HETEROPHYES
SEMISULCOSPIRA LIBERTINA
ARTYFECHINOSTOMUM MALAYANUM