CLINICAL PARASITOLOGY LECTURE
TREMATODE INFECTIONS Definitive hosts: Good and
Schistosoma species (BLOOD FLUKES) dogs, pigs, cats, permissive host:
Schistosoma japonicum carabaos, and S. japonicum
Oriental blood fluke cows, as well as matures and
Schistosomiasis japonica wild animals like oviposits over
Intermediate host: Oncomelania snails rodents and extended periods
Schistosoma japonicum ova monkeys
Non-permissive
host:
schistosomes are
stunted or they
may mature but
eventually, the
Schistosoma mansoni ova infection dies out.
● Manson’s blood fluke
LIFE CYCLE OF Schistosoma spp.
Schistosoma haematobium
● Urinary schistosomiasis
PARASITE BIOLOGY OF Schistosoma spp.
● Primarily the parasites of the
portal veins and its branches.
● Each female fluke deposits 500 to
2000 immature eggs per day in
the branches of the portal veins
STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD
CLINICAL PARASITOLOGY LECTURE
● These eggs require 10-12 days to ● The 1st generation of sporocyst
mature and embryonate. (mother) takes place.
● The 2nd generation of sporocyst
Schistosoma japonicum (daughter) takes place on the 8th
Its eggs come in contact with day.
freshwater, it hatches and liberated a ● Cercariae produces
free-swimming ciliated larva called
miracidium (singular) CERCARIAE
● Miracidia (plural)
infect snail
intermediate host
● Oncomelania
hupensis quadrasi
OVA AND MIRACIDIUM
● Has a body of a forked tail
● Swims on the surface of the
water, making skin contact and
attachment easier.
● Eggs require 8-10 days to ● Penetration is stimulated by skin
embryonate and develop to lipids
miracidium ● Some chemical like dimethylate
● Eggs hatch only on clean water and niclosamide repels cercariae
with sufficient oxygen (2-4 hours) when applied to the skin.
● The miracidium swims actively in
the water and is infectious for SCHISTOSOMULE
snails for 8-12 hours).
INTERMEDIATE HOST (Oncomelania)
Factors which influence the infection of
snails by miracidida:
● Age of snails and
miracidia
● Number of miracidia
per snail.
● Length of contact ● After skin penetration,
time schistosomule develop, resulting
● Water flow in shredding of the tail
● Turbulence ● Can be found in the:
○ Pleural cavity (2nd day of
INTRAMOLLUSCAN DEVELOPMENTAL infection)
STAGES ○ Parenchyma (4th day)
● Ciliated surface ○ Liver parenchyma (6th day)
disappears once ○ Intrahepatic branches of
penetration is the portal vein at later time.
complete.
STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD
CLINICAL PARASITOLOGY LECTURE
ADULT WORM ● Non-reproductive cough during
the period corresponding to larval
or schistosomular migration.
COLONIC SCHISTOSOMIASIS
● Results in dysentery or diarrhea
depending on wormburden
● Chronic stage - asymptomatic;
associated with malignancies
HEPATOSPLENIC DISEASE
● Has separate sexes
● Ingests RBC and possesses an
enzyme protease
(hemoglobinase) that breaks
down globulin and hemoglobin
PATHOGENESIS AND CLINICAL
MANIFESTATION OF Schistosoma spp.
● Due to host granulomatous
reaction to eggs deposited in the
liver
● Most serious consequence of
● Cercarial penetration may or
chronic schistosomiasis
may not result in dermatitis
● Hepatomegaly (enlargement of
● Schistosomule transversing the
the liver) and ascites and
pulmonary microvasculature
collateral circulation.
may cause pneumonitis
● Most serious is the obstruction of
PULMONARY SCHISTOSOMIASIS
the intrahepatic portal branches.
● Occur during the period of larval
migration
CLINICAL ASPECTS
● Cor pulmonale - principal
3 progressive changes:
manifestation
1.) Incubation - period of cercarial
● May develop earlier or before a
penetration and schistosomular
patient dies of portal
migration to the time the flukes
hypertension.
mature.
2.)Period of early egg deposition
CEREBRAL SCHISTOSOMIASIS
and extrusion
● Motor or sensory disturbances
3.)Period of tissue proliferation
● Acute cases: fever, headache,
confusion, lethargy, and coma
EARLY SCHISTOSOMIASIS
● Itching soon after infection
TREATMENT
● Chills
● Praziquantel
● Fever’
STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD
CLINICAL PARASITOLOGY LECTURE
DIAGNOSIS
● Negative stool exam even in OTHER INTESTINAL SCHISTOSOME SPECIES
active infection
● Rectal or liver biopsy - eggs can
be recovered
1.)Stool exam:
● MIFC (Merthiolate-iodine
formalin concentration
technique)
● Kato-katz Paragonimus westermani (LUNG FLUKES)
2.)Immunodiagnosis Common name: Lung fluke / Oriental
a. Intradermal test lung fluke
b. IHA using adult worm and Diseases:
egg antigens ● Lung fluke disease
c. COPT -method of choice in ● Pulmonary distomiasis
the Philippines ● Endemic hemoptysis
d. ELISA ● Parasitic hemoptysis
EPIDEMIOLOGY PARASITE BIOLOGY
● 24 endemic provinces in the
Philippines:
● Sorsogon, Oriental Mindoro,
Samar, Leyte, Bohol, All provinces
of Mindanao except Misamis
Oriental.
Indices of human infection
• Epidemiologic indices ● Adult resembles a coffee bean
1.) Prevalence ● Known to persist in humans for as
2.)Incidence long as 20 years or more.
3.)Intensity or worm burden
• Use of mapping of “hot spots” of CERCARIAE
infection by the use of Geographic
information system (GIS).
• Environmental fecal contamination
• Water contact
PREVENTION
● Chemotherapy
● Health education
● Control of Oncomelania snails
● Chemical control ● Covered with spines and has an
● Environmental sanitation ellipsoidal body and a small tail
● INtegration of schistosomiasis
control in primary health care
● Monitoring and evaluation of
control
STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD
CLINICAL PARASITOLOGY LECTURE
OVA ● Low grade fever, fatigue generally
myalgia lead to frequent
misdiagnosis of tuberculosis.
● Cerebral involvement is a serious
complication.
DIAGNOSIS AND TREATMENT
● Definitive diagnosis: detection of
eggs in the sputum and stool
● Flattened with a permanent ● Equal amount of 3% NaOH is
operculum added to the sputum.
● Intradermal test screening
LIFE CYCLE ● Complement fixation (CF) is the
standard serological test
TREATMENT
● Praziquantel
EPIDEMIOLOGY
● Japan, S. Korea, Thailand, China,
Philippines
● Philippines: Leyte, Sorsogon,
Mindoro, Camarines, Samar,
Davao, Cotabato, Basilan
PREVENTION AND CONTROL
● Eating sufficiently cooked crab
and meat of paratenic hosts like
wild pigs
INTERMEDIATE HOSTS
● Safe food prep
1st I.H.
● Health ed
● Antemelania asperata
● Antemelania dactylus (previously
INTESTINAL FLUKES
known as Brotia aspirata)
Fasciolopsis buski
2nd I.H. (cercariae)
Fasciolopsis buski
● Mountain crab (Sundathelpusa
The intestinal parasite of humans and
philippina PKA Parathelpusa
pigs.
grapsoides)
PARASITE BIOLOGY
PATHOGENESIS AND CLINICAL
MANIFESTATIONS
● Early stages = asymptomatic
● Heavy infection: dry cough that
later produces bloodstained or
rust-colored sputum with a foul
fish odor (most pronounced in
the morning) ● Adult’s habitat: Duodenum
● CHest pain, dyspnea and
hemoptysis
STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD
CLINICAL PARASITOLOGY LECTURE
● Heavy infection, worms can be PATHOGENESIS AND CLINICAL
found throughout the intestinal MANIFESTATIONS
tract. ● Heavy infection: intestinal
OVA obstruction
● Pathological changes caused by
the worms are traumatic,
obstructive and toxic
● Inflammation and ulceration
occur at the site of worm
attachment
● Patient experiences generalized
toxic and allergic symptoms:
○ edema in the face,
● Embryonates in the water and
abdominal wall and lower
gives rise to miracidium in 3-7
limbs.
weeks.
DIAGNOSIS AND TREATMENT
LIFE CYCLE
● Egg in stool
● One should consider the
resemblance between the eggs
of F. buski and Fasciola spp.
Treatment: Praziquantel
INTESTINAL FLUKES
E. ilocanum, and A. malayanum
Echinostoma ilocanum,
Artyfechinostomum malayanum
● Digenetic trematodes
characterized by a collar of
spines around their oral suckers.
PARASITE BIOLOGY
Mode of transmission: ingestion of
metacercariae encysted snail (2nd I.H.)
Habitat: small intestine
Definitive hosts: humans, dogs, cats,
rats and pigs
INTERMEDIATE HOST
2nd I.H.
● Trapa bicornis (water caltrop)
● Eliocharis tuberosa (water
chestnut)
Definitive host: Humans and pigs
E. ilocanum A. malayanum
STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD
CLINICAL PARASITOLOGY LECTURE
OVA INTERMEDIATE HOSTS
1st I.H.
● Gyraulus convesiusculus
● Hippeutis umbilicalis
● Matures in water after 6-15 days
2nd I.H.
LIFE CYCLE ● Pila luzonica (kuhol)
● Vivipara angularis (susong
pampang)
PATHOGENESIS AND CLINICAL
MANIFESTATION
● Heavy infections: inflammation
develops at the site of
attachment
● Ulceration and diarrhea
(sometimes bloody) and
abdominal pain.
DIAGNOSIS AND TREATMENT
● Eggs in stool
● Treatment: Praziquantel
EPIDEMIOLOGY
● Luzon, Leyte, Samar, provinces of
Mindanao
PREVENTION AND CONTROL
● Avoid ingestion of raw or
improperly cooked 2nd I.H.
STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD
CLINICAL PARASITOLOGY LECTURE
INTERMEDIATE HOSTS
INTESTINAL FLUKES ● Freshwater, brackish water or
Heterophyid marine species
● Snail host (Philippines): H. taichui,
Procerovum calderoni
● Melania juncea
● Thiara riquetti
PATHOGENESIS AND CLINICAL
MANIFESTATIONS
● Inflammation at the site
Adult worm of heterophyid
● Consistent peptic ulcer disease
● Intestinal fish fluke (PUD) or acid peptic disease
● Habitat: small intestine (APD)
● Short lifespan of less than a year
DIAGNOSIS AND TREATMENT
OVA ● Bowel disturbance and history of
consumption of raw fish
● Definitive diagnosis: detection of
eggs in stool using Kato katz
method
Treatment: Praziquantel
EPIDEMIOLOGY
● Egypt, Israel, Western India,
Central and S. China, Japan,
● Color: Light brown Korea and the Philippines
● Shape: Ovoid
PREVENTION AND CONTROL
LIFE CYCLE ● Avoid ingestion of raw or
improperly cooked fish
LIVER FLUKES
Fasciola hepatica, Fasciola gigantica
Fasciola hepatica
● Parasite found in the liver and
biliary passages of humans and
herbivore animals
● Mode of transmission: ingestion
of metacercariae encysted on
STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD
CLINICAL PARASITOLOGY LECTURE
edible aquatic plants or by
drinking water with floating
metacercariae.
● Habitat: duodenum or jejunum
● Adults live in the biliary passages
of the liver.
OVA
Eggs mature in water within 9-15 days
forming viable miracidium
INTERMEDIATE HOSTS
1st I.H.
● Lymnaea philippinensis
● L. auricularia rubiginosa
2nd I.H.
● Ipomea obscura (kangkong)
● Nasturtium officinale (water
cress)
PATHOGENESIS AND CLINICAL
MANIFESTATIONS
2 clinical stages:
● Acute stage: larval migration and
worm maturation
● Chronic stage: persistence of
fasciola worms in biliary ducts
DIAGNOSIS AND TREATMENT
● Acute or invasive phase - difficult
to diagnose because of lack, or
overlapping symptoms.
● Identification of eggs in stools,
duodenal contents or bile or the
recovery of adult in surgical
Miracidium of Fasciola hepatica
exploration
● Serological tests - alternative
LIFE CYCLE
method of confirming early and
extrabiliary human fascioliasis
● Radiologic means
Treatment: Bithionol
EPIDEMIOLOGY
● Worldwide
PREVENTION AND CONTROL
● Wash and cook vegetables and
boil water in endemic areas
STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD
CLINICAL PARASITOLOGY LECTURE
● Control measures include LIFE CYCLE
elimination of snail I.H. and killing
the parasite in the reservoir host
by chemotherapy.
LIVER FLUKES
C. sinensis, O. felineus, O. viverrini
Clonorchis sinensis
Opisthorchis felineus
Opisthorchis viverrini
Mode of transmission: Ingestion of
metacercariae of parasite present in
infected fish that is eaten or
undercooked
Habitat: pancreatic duct and
gallbladder
Adult: attaches itself PATHOGENESIS AND CLINICAL
to the mucosa of the MANIFESTATION
bile duct by using its ● Acute stages (less than 1 month
suckers. of infection)
● Chills and fever
● Chronic stage: ranges from
asymptomatic to mild to severe
disease wherein cirrhosis and
Egg: egg is fully portal hypertension are present
matured when it is
released from the DIAGNOSIS AND TREATMENT
worm. ● Egg in stool - distinct melon light
ridges when stained with
INTERMEDIATE HOSTS potassium permanganate
Clonorchis sinensis ● Enzyme-linked immunosorbent
1st I.H. assay (ELISA) with crude extract
● Parafossarulus of adult C. sinensis
● Bulimus ● Enzyme immunoassay (EIA) and
● Semisulcospira conproovoscopy used to define
● Alocinma the spread of clonorchiasis
● Melanoides Treatment: Praziquantel
O. felineus & O. viverrini PREVENTION AND CONTROL
● Bithynia 3 Interrelated Approaches
1.) Stool exam & treatment of
2nd I.H. of both positive cases with praziquantel
● Freshwater fish and freshwater in order to eliminate human host
shrimp reservoir
2.)Health ed
3.)Proper human waste disposal
STEVE CASERES - O2B INSTRUCTOR: MYLENE LAMPANO, RMT, MSMT, PhD
