TREMATODES

TREMATODES
-Belongs to the Platyhelminthes Phylum
-Parasitic flatworms more commonly known as flukes
-Possesses suckers used to cling and feed on their hosts
-Hermaphroditic, meaning that they possess both sexual
organs (Except: Blood flukes, because it has two separate
sexes)
-Most types invade at least two hosts in their lifetime,
primarily molluscs and vertebrates
BLOOD
FLUKES
ASHLY FERRER
REGINA ESCUETA
RIZELE EUNICE ZAMORA
 Schistosoma haematobium
Common name: Bladder fluke
- Schistosoma haematobium is one of the most diagnosed
parasitic infections in humans called schistosomiasis that is also
known as snail fever and bilharzia.

Infective and Diagnostic Stages

• Infective Stage: Cercariae
• Diagnostic Stage: Eggs in feces/urine
Host
• The intermediate hosts are various species of
freshwater snails. Eggs are shed from the
human host in feces or urine. Under optimal
conditions in the environment, the eggs hatch and
release miracidia, which swim and penetrate specific
snail intermediate hosts.
 Morphology
Eggs. Resembles S. mansoni in size and shape. The somewhat oblong egg
measures 110 to 170 µm by 38 to 0 µm. The presence of a large,
prominent, terminal spine distinguishes the egg from that of other
Schistosoma spp.
Adults. Adult males are 10 to 15 mm long. They have deep grooves called
gynecophoral canals in which adult females typically lie. Males have many
small nodules (tubercles) on their dorsal surfaces and many tiny spines on
their suckers and inside their gynecophoral canals. 

Epidemiology
• S. haematobium has been known to occur primarily in the Old
World. Almost all of Africa and portions of the Middle East,
including Iran, Iraq, and Saudi Arabia are considered endemic
regions.
Laboratory Diagnosis/Methods
• The specimen of choice for the recovery of S. haematobium eggs
is a concentrated urine specimen. In addition, a number of
immunodiagnostic techniques, including ELISA, are also available.
Schistosoma Japonica
Common Name: Blood Fluke
- Schistosoma japonicum is an
important parasite and one of the
major infectious agents of
schistosomiasis.
Infective and Diagnostic Stages
•Infective Stage: Cercariae
•Diagnostic Stage: Eggs in feces
Host
•Various animals such as cattle, dogs,
cats, rodents, pigs, horses, and goats,
serve as reservoirs 
 MORPHOLOGY
Eggs .The somewhat roundish Schistosoma japonicum
(Fig. 11-10) is the smallest of the Schistosoma spp.,
measuring 50 to 85 µm by 38 to 60 µm. The egg is
characterized by the presence of a small lateral spine,
which is often difficult to detect on microscopic
examination.
Adults. The worms are yellow or yellow brown in colour.
The male measures 12mm by 0.5mm and female
measures 20mm by 0.4mm. Both sexes have a strong
sucker around the mouth and the tegument of the worms
is coated with tiny spines, ridges and sensory organs.
Epidemiology
•The geographic distribution of S. japonicum is limited to the
Far East. Areas known to harbor the parasite include parts of
China, Indonesia, and the Philippines. There is evidence to
suggest that although portions of Japan were once known
endemic areas, it may no longer be considered as such.
Laboratory Diagnosis/Methods
Laboratory diagnosis of d S. japonicum is accomplished by
recovery of the eggs in stool or rectal biopsy specimens.
Manson’s Blood Fluke
MORPHOLOGY
Size range: 112- 182 um by
40-75 um
Shape: Oblong
Egg Contents: Developed Miracidium
Appearance: Large
Location of Spine: Lateral

EPIDEMIOLOGY
Distributed throughout Africa, South
America, and Carribean
 INFECTIVE
STAGE
Cercariae
DIAGNOSTIC
STAGE
Eggs/Stool shed from
infected human

HOST
Definitive Host: Human

Intermediate Host: Snails

LABORATORY
METHOD
Recovery and Identification
of eggs/stool or rectal biopsy.
Kato-Katz concentration
Schistosoma Mekongi
MORPHOLOGY
EGG
S. mekongi eggs are 30 – 55 μm and have a diminutive spine, and
only 95 per mating pair are produced per day
nearly spherical embyronated eggs produced by the mating worms
are small compared to other schistosoma, with a diminutive spine on
the lateral axis. 
ADULT
• Male worms can grow up to 2.2 cm,
• females grow up to 2.6 cm .
• Adults have both an oral and ventral sucker which
attaches to the venous wall, preventing blood flow from
dislodging the parasite.
• The worms are an off-white color
Epidemiology
Laos and Cambodia
Mekong River, Basin
Infective Stage: Cercariae
Diagnostic Stage: Eggs in urine/stool
Intermediate Host: Snail, Neotricula Aperta
Definitive Host: Man and Dog
Laboratory Diagnosis: Infection is verified
by the presence of eggs in stool samples.
 Schistosoma Intercalatum
Morphology

Epidemiology
Central and West Africa

Infective Stage: Cercariae

• Terminal spine and tend Diagnostic Stage: Eggs in feces
to be moderately larger Definitive Host: Man
than those of S. Intermediate Host: Snail (Bulimus
haematobium forskalii and Bulimus Africanus)
(approximately 130 ×
75 μm).
• eggs are ovoid and have Laboratory Diagnosis: Stool, Rectal
a curved terminal spine. Biopsy
 LUNG
FLUKES
Jason Aldwin Arcolas
PARAGONIMUS
WESTERMANI Morphology: The adult lung fluke is reddish-
brown and measures 7 to 12 mm in length, 4 to
(ORIENTAL LUNG FLUKE) 6 mm in width, 3.5 to 5 mm in thickness, and
resembles a coffee bean.
The cercaria is covered with spines, has an
ellipsoidal body, and a small tail. A stylet is
present at the dorsal side of the oral sucker.
The metacercaria is round and measures from
381 to 457 µm.
The oval, yellowish-brown, thick-shelled egg
measures 80 to 118 µm by 48 to 60 µm, and
has a flattened but prominent operculum.
Intermediate Host: Laboratory Method:
1st Intermediate Host: Snail (Antemelania • Radiographs
asperata Antemelania dactylus ) • Complement fixation (CF)
• Enzyme Immunoassay (EIA)
2nd Intermediate Host: Mountain crab • Immunoblot (IB)
(Sundathelphusa philippina) • Based on the detection of characteristic
eggs in the stool
Definitive Host:
Humans and other mammals  Epidemiology: Paragonimiasis has a focal
distribution in limited parts of Asia, Latin
Diagnostic Stage: Egg in sputum or feces America (Peru and Ecuador), and Africa
(Nigeria and Cameroon). Paragonimiasis
Infective Stage: Encysted Metacercariae has a focal distribution, largely determined
by local patterns of consumption of
inadequately cooked crustaceans and
paratenic hosts.
INTESTINAL
FLUKES
Tria Sarah Talosig
Mark Rosswell Asiao
 Fasciolopsis Buski (Giant Intestinal Fluke)
Morphology
Egg: Oval-shaped, brownish yellow eggs that has a length around
130 to 150 micrometers and has a width around 60 to 90 micrometers.
Operculated (has an operculum where larva exits from)
Adult: Has an elongated-oval shape, ventral and oral suckers, and
unbranched ceca
Length - 20-75mm | Width: up until 20mm
Hermaphroditic: Has both reproductive organ sets (testes and ovaries)

Epidemiology
Fasciolopsis buski is found mainly in Asia and the Indian subcontinent
(mainly Taiwan, Thailand, Laos, Bangladesh, India, and Vietnam) –
Places with humid and warm weather and aquatic freshwater
environments
Fasciolopsis Buski (cont.)
Infective Stage: Encysted Metacercariae
Diagnostic Stage: Unembryonated Eggs in feces

1st Intermediate Host – Snail (either genus Segmentina or Hippeutis)

2nd Intermediate Host – Aquatic Vegetation (such as Trapa bicornis/
Water Caltrop or Eliocharis tuberosa/Water Chestnut)
Definitive Host – Humans / Pigs

Laboratory Methods – Buski eggs can be detected in stool samples

 Echinostoma Ilocanum (Garrisons Fluke)
Morphology
Egg: Oval-shaped with a straw-like color, measuring 83 to 116
micrometers by 58 to 69 micrometers. Also operculated.
Adult: reddish-gray in color, tapered at the posterior end, and has 49
to 51 collar spines around oral suckers.
Length - 2.5 to 6.6 mm | Width: 1 to 1.35 mm
Hermaphroditic: Has both reproductive organ sets (testes and ovaries)

Epidemiology
Southeast Asian and East Asian countries like the Philippines and
Japan – Places with wetlands like rice-fields and where people eat
snails
Echinostoma Ilocanum (cont.)
Infective Stage: Encysted Metacercariae
Diagnostic Stage: Unembryonated Eggs in feces

1st Intermediate Host –Snail (Either genus Gyraulus or Hippeutis)

2nd Intermediate Host - Snail from a different genus (either Pila
Luzonica or Vivipara Angularis)
Definite Host – Fowl/Mammals/Humans

Laboratory Methods - detection of eggs in the stool

 Heterophyes heterophyes (Von Siebod’s fluke)
• Morphology:
Ova: The egg is ovoid, operculate, elongate and light
brown (almost yellow) in colour. The egg contains
the embryo (miracidium). It measures 27 - 30µm by
15 – 17µm.
• Adult: The mature adult measures 1.0 to 1.7mm
by 0.3 to 0.4mm. The body is covered by scales.
The female fluke ovary is located near the end of
the body.
• Epidemiology
H.heterophyes is commonly found in the Middle
East, Philippines, Taiwan, Korea, China and Japan.
 Heterophyes heterophyes (Von Siebod’s fluke) cont.
Infective Stage: Encysted Metacercariae
Diagnostic Stage: Embryonated Eggs in feces
1st Intermediate Host –Snail (Cerithidia sp. and Pironella sp)
2nd Intermediate Host – fresh/brackish water fish

DEFINITIVE HOST: Human

Laboratory Methods – Laboratory diagnosis of Heterophyes
heterophyes is by stool microscopy. The ova of
H.heterophyes are difficult to distinguish from other
heterophyid species and some other flukes but collection of
the adult worm allows accurate identification of the species.
 Metagonimus yokogawai (Small Intestinal Fluke)

Morphology:
Ova: The egg is ovoid, operculate, elongate and
light brown (almost yellow) in colour. The egg
contains the embryo (miracidium). It measures 27 -
30µm by 15 – 17µm.
Adult: The mature adult measures 1.0 to 1.7mm by
0.3 to 0.4mm. The body is covered by scales. The
female fluke ovary is located near the end of the
body.
Epidemiology
Korea, China, Taiwan, Japan, Russia, Indonesia,
Israel, and Spain. This species is found in areas
with sweetfish, and that includes western and
eastern riversides. It is basically found in places
with water
 Metagonimus yokogawai (Small Intestinal Fluke) cont.

Infective Stage: Encysted Metacercariae

Diagnostic Stage: Embryonated Eggs in feces
1st Intermediate Host –Snail (Cerithidia sp. and Pironella
sp)
2nd Intermediate Host – fresh/brackish water fish
DEFINITIVE HOST: Human

Laboratory Methods – Stool microscopy

LIVER FLUKES
Jhom Andrei Apolinar
Jason Aldwin Arcolas
Ronalyn Resma
 FASCIOLA HEPATICA (Sheep Liver Fluke/ Temperate Liver Fluke)

• Morphology:
Egg: The F. hepatica egg is large, ovoidal, operculated and
yellowish to brownish in color. It measures 140 to 180 µm by
63 to 90 µm in size.
Adult: F. hepatica has a large, broad, and flat body which
measures 18 to 51 mm in length and 4 to 13 mm in width,
distinguishing feature is the cephalic cone which has a marked
widening at the base of the cone (“shoulder”). The suckers are
comparatively small It has an anterior elongation where oral
and ventral suckers are located. The ovary is dendritic and
situated. The uterus is coiled and relatively short.
Hermaphroditic: Has both reproductive organ sets (testes and
ovaries)
 FASCIOLA HEPATICA (Sheep Liver Fluke/ Temperate Liver Fluke) cont.

• INTERMEDIATE HOST
1ST: SNAIL- living on mud ( Lymnaea truncatula, EPIDEMIOLOGY:
L. bulmoides, L. tomentosa ) Found in rural areas of temperate and
2ND: Plant vegetation/ aquatic Plant (pomea tropical region. Especially in region with
obscura (morning glory or kangkong) and cattle and sheep herding.
Nasturtium officinale (watercress) It is found in parts of Latin America, the
• DEFINITIVE HOST Caribbean, Europe, the Middle East,
Africa, Asia, and Oceania.
• Sheep
LABORATORY METHOD: identification of
• cattle
eggs in stool, duodenal contents, or bile.
• human (accidental host) -Certain types of blood tests can be
other mammal helpful for diagnosing Fasciola infection,
DIAGNOSTIC STAGE: Unembryonated eggs in including routine blood work and tests
feces. that detect antibodies to the parasite
INFECTIVE STAGE: Encysted Metacercariae such as ELISA and Western blot.
 FASCIOLA GIGANTICA(Giant Liver Fluke/ Tropical Liver Fluke)

• Morphology:
Egg: The F. gigantica egg is large, ovoidal, operculated,
and yellowish to brownish in color. It is slightly larger than
the F. hepatica egg, it measures (160-190 µm by 70-90
µm).
Adult: Compared to F. hepatica, the F.gigantica adult
worm is longer (25-75 mm), with about the same width (3-
12 mm), with less developed shoulders, and a shorter
cephalic cone. The ceca are more branched especially
towards the midline of the body and the branches of the
ovary are longer and more numerous.
Hermaphroditic: Has both reproductive organ sets (testes
and ovaries)
 FASCIOLA GIGANTICA(Giant Liver Fluke/ Tropical Liver Fluke) cont.

• INTERMEDIATE HOST
1ST: SNAIL- ( L. auricularia , L. acuminata, L. EPIDEMIOLOGY:
natalensis) Fasciola gigantica is found in fewer
2ND: Plant vegetation/ aquatic Plant (pomea geographic regions. Human cases have been
obscura (morning glory or kangkong) and reported in the tropics, in parts of Africa and
Nasturtium officinale (watercress) Asia, and also in Hawaii. In the Philippines,
the dominant species affecting cattle and
• DEFINITIVE HOST
water buffaloes is F. gigantica.
• Sheep
LABORATORY METHOD: identification of
• cattle eggs in stool, duodenal contents, or bile.
• human (accidental host) -Certain types of blood tests can be helpful
other mammal for diagnosing Fasciola infection, including
DIAGNOSTIC STAGE: Unembryonated eggs in routine blood work and tests that detect
feces. antibodies to the parasite such as ELISA and
INFECTIVE STAGE: Encysted Metacercariae Western blot.
CLONORCHIASIS Morphology: Adults are flattened,
lance shaped, and measure
SINENSIS approximately 10 to 25 mm long by 3
(CHINESE LIVER FLUKE) to 5 mm wide. The oral and ventral
suckers (acetabulum) are relatively
small. Like other flukes, they are
hermaphroditic.
The eggs are small, ranging in size
from 26 to 30 µm by 15 to 17 µm. The
eggs are oval shaped with a convex
operculum that rests on visible
shoulders at the smaller end of the
egg. 
INTERMEDIATE HOST Laboratory Method:
• Ova and parasite (O&P) stool
1ST INTERMEDIATE HOST: FRESH
WATER SNAIL examinations for liver fluke eggs

2ND INTERMEDIATE HOST: FRESH WATER Epidemiology: C. sinensis is endemic in

FISH China, Korea, Japan, and Vietnam.
DEFINITIVE HOST: CARNIVOROUS
Traditional consumption of improperly
MAMMALS cooked fish, and indiscriminate
defecation habits among rural
DIAGNOSTIC STAGE: MICROSCOPIC inhabitants are significant factors that
IDENTIFICATION OF THE PARASITE'S determine the high prevalence of liver
EGGS IN STOOL SPECIMENS
fluke infection in an area.
INFECTIVE STAGE: ENCYSTED
METACERCARIAE
 Opisthorchis felineus (cat liver fluke)

• Morphology:
Egg: Seed-shaped, brownish yellow eggs that has a length around
19 to 30 micrometers and has a width around 10 to 20 micrometers.
Operculated (has an operculum where larva exits from) and possess
prominent opercular 'shoulders' and and abopercular knob.
• Adult: Adult: Has an elongated-oval shape, similar to, but often
smaller than, Clonorchis sinensis.
Length: 7-12mm | Width: up until 2-3mm
Hermaphroditic: Has both reproductive organ sets (testes and
ovaries)
• Epidemiology - Opisthorchis felineus is found in europe mainly in
Italy, Germany, Belarus, Russia, Kazakhstan, and Ukraine.–
people are usually infected by this parasite due to the
consumption of undercooked fish.
 Opisthorchis felineus (cat liver fluke) cont.

Infective Stage: Encysted Metacercariae

Diagnostic Stage: Unembryonated Eggs in feces

1st Intermediate Host: Snail

2nd Intermediate Host: Fresh Water Fish
Definitive Host: Humans/Cat/Dogs

Laboratory Methods – Opisthorchis felineus eggs can be

detected in stool samples
Treatment: Praziquantel and/or Albendazole
 Opisthorchis viverrini (Southeast Asian liver fluke)

• Morphology:
Egg: Seed-shaped, brownish yellow eggs that has a length around
19 to 30 micrometers and has a width around 10 to 20 micrometers.
Operculated (has an operculum where larva exits from) and possess
prominent opercular 'shoulders' and and abopercular knob.
• Adult: Adult: Has an elongated-oval shape, similar to, but often
smaller than, Clonorchis sinensis.
Length: 5-10mm | Width: up until 1-2mm
Hermaphroditic: Has both reproductive organ sets (testes and
ovaries)
• Epidemiology - Southeast Asian countries like northeast
Thailand, Laos, Cambodia, and central and southern Vietnam. –
Places that usually consume raw or undercooked fish.
 Opisthorchis viverrini (cont.)

Infective Stage: Encysted Metacercariae

Diagnostic Stage: Unembryonated Eggs in feces

1st Intermediate Host: Snail

2nd Intermediate Host: Fresh Water Fish
Definitive Host: Humans
Laboratory Methods – Opisthorchis felineus eggs can be
detected in stool samples
Treatment: Praziquantel and/or Albendazole
THANK YOU!!!