Phylum Platyheminthes

Class of Trematoda
From the word trematoda meaning body with holes
Leaf-like and hermaphroditic (male and female reproductive system in a single worm) except
Schistosomes which are cylindrical and have separation of sexes
Prominent feature is the presence of acetabula (suckers) oral and ventral
Usually the digestive tract of flukes is described as having inverted Y figure (Monoecious)
Life cycle of trematodes:
a. Egg stage
b. Larval stage: Miracidium Sporocyst Redia Cercaria Metacercaria
c. Adult stage
Eggs are operculated except for the Schistosomes (non-operculated)
Infective stage to the final host is the metacercaria (monoecious trematodes) and cercaria
(diecious trematodes Schistosoma)
Requires 2 intermediate hosts except for the Schistosomes (only 1 intermediate host)
o 1st intermediate host is usually a snail
o 2nd intermediate host fish, crab, plant/vegetation, snail
Fish: Heterophyes heterophyes, Clonorchis sinensis, Opistorchis felineus
Crab: Paragonimus westermanni
Plant/ vegetation: Fasciola hepatica, Fasciola gigantic, Fasciolopsis buski
Snail: Echinostoma ilocanum
Sub-divided into:
a. Monoecious
Flattened or leaf-shaped bodies
Hermaphroditic
Need two intermediate hosts
Producing operculate eggs
b. Diecious
Cylindrical bodies
Sexes are separate
Utilizing only one intermediate host
Producing non-operculate, embryonated eggs (containing miracidium)
Flukes may also be classified based on the habitat of the adult worm:
a. Intestinal fluke
Fasciolopsis buski
Echinostoma ilocanum
Heterophyes heterophyes
Haplorchis yokogawai
Metagonimus yokogawai
b. Lung fluke
Paragonimus westermani
c. Liver fluke
Fasciola hepatica
Clonorchis sinensis
Opistorchis felineus
Opistorchis viverrini
 d. Blood fluke
Schistosoma japonicum
Schistosoma mansoni
Schistosoma haematobium
A. Monoecious trematodes
Stages of development:Egg Larva (Miracidium Sporocyst Redia Cercaria
Metacercaria) Adult
1. Eggs of diecious flukes are already embryonated when laid
2. Miracidium - a free-swimming ciliated embryo that exhibit phototaxis, is provided with
penetration glands that aid in entering the body of intermediate host (attracted to the
mucus secreted by the snail)
3. Once the miracidium is inside the snail intermediate host, it develops into sporocyst
(elongated sac-like structure with a small opening that serves as birth pore) that contains
germ cells that will develop into redia or a second generation sporocyst
4. Redia a blind and a non-forked cecum with locomotion organelles are release through the
birth pore of the sporocyst and transform to the next stage of development called cercaria
5. Cercaria a free-swimming, non-feeding larval stage, with penetration glands is attracted to
light (phototaxis)

Types of cercaria:
Simple-tail lophocercus
Keel-tailed lophocercus
Microcercus
Fork-tailed

6. Cercaria leaves the snail host, (which can be due to death of the snail or overpopulation of
the cercaria) finds the second intermediate host and becomes encysted to become
metacercaria
7. Metacercaria (encysted form)
8. Ingested metacercaria undergoes excystation in the upper level of the small intestine
9. Released microorganism migrates to tissues or organs where is going to mature (liver, lungs,
intestine
LIVER FLUKES

Fasciola hepatica
Common name: Sheep liver fluke
Common disease: Fascioliasis, sheep liver rot

Morphology

Egg
measures 128 to 150 m by 60 to 90 m
is large, hens egg shaped, ovoid with broad operculum, light yellowish brown and immature
when laid

Adult
Flat, leaf-like with prominent cephalic cone at anterior end
Highly branched intestinal ceca

Laboratory Diagnosis
The specimen choice for recovery of the eggs
Enterotest
ELISA
Gel diffusion

Clinical Symptoms
Fascioliasis: Sheep Liver Rot
- Persons infected with F. hepatica experience symptoms caused by the presence and attachment of the
adult worm to the biliary tract. These include headache, fever, and chills, and pains in the liver area of
the body (because of tissue damage), some of which may extend to the shoulders and back.
Eosinophilia, jaundice, liver tenderness, anemia, diarrhea, and digestive discomfort are sometimes seen.
Biliary obstruction may also result.

Treatment
- Dichlorophenol (bithionol)

Prevention and Control

Prevention of future potential infections with F. hepatica may be accomplished by exercising proper
human fecal disposal and sanitation practices, particularly in areas in which animal reservoir hosts
reside, controlling the snail population, and avoiding the human consumption of raw water plants or
contaminated water.
Opistorchis felineus
Common name: Cat liver fluke
Most important liver fluke of man
Common Disease: Opistorchiasis or Cat liver fluke

Morphology

Egg
measures 30 by 15 m
The developed miracidium takes up the interior of the egg.
The egg is equipped with a distinct operculum opposite a small knob.
A thick rim is strategically located around the operculum and is referred to as shoulders.
old fashioned electric bulb

Adult
Lancet-shaped with smooth cuticle, attenuate anterior, rounded posterior

Laboratory diagnosis
Demonstration of eggs in direct fecal smear or duodenal aspirates

Clinical Symptoms
Most infections are asymptomatic. In mild cases, manifestations include dyspepsia, abdominal
pain, diarrhea or constipation. With infections of longer duration, the symptoms can be more
severe, and hepatomegaly and malnutrition may be present.
an acute phase resembling Katayama fever (schistosomiasis), with fever, facial edema,
lymphadenopathy, arthralgias, rash, and eosinophilia.

Treatment
Praziquantel and Albendazole
Clonorchis sinensis
Common name: Chinese liver fluke.
Common disease: Clonorchiasis

Morphology

Egg
same as Opistorchis felineus Old fashioned electic
bulb

Adult
The average adult C. sinensis measures 2 by 0.5 cm
Flat spatulatem transparent anterior is attenuated,
slightly rounded posterior

Laboratory Diagnosis
Recovery of the characteristic eggs from stool specimen
Duodenal aspirates
Enterotest
The rarely encountered adult worms are only seen when removed during a surgery or autopsy
procedure.

Clinical symptoms
Light infections typically occur without any obvious symptoms.
Clonorchiasis
- Persons infected with a heavy worm burden often experience symptoms that include fever, abdominal
pain, eosinophilia, diarrhea, anorexia, epigastric discomfort, and occasional jaundice. Enlargement and
tenderness of the liver and leukocytosis may also occur. Liver dysfunction may result in persons severely
infected over a long period of time.

Treatment
Praziquantel and Albendazole

Prevention and control

Include practicing proper sanitation procedures, especially in regard to fecal disposal by the
human and reservoir host (dogs and cats) and avoiding the ingestion of raw, undercooked, or
freshly pickled freshwater fish and shrimp.
 INTESTINAL FLUKES
Fasciolopsis buski
Common name: Large intestinal fluke
Largest fluke parasitizing man
Common disease: Fasciolopsiasis

Morphology

Egg
indistinguishable from that of Fasciola hepaticaHens egg shape

Adult
Large and fleshy, often elongate ovoid without cephalic cone

Laboratory Diagnosis
The specimen choice for recovery of the eggs
Enterotest
ELISA
Gel diffusion

Clinical Symptoms
Fasciolopsiasis
Patients suffering from F. buski infection usually develop abdominal discomfort because of
irritation at the site of worm attachment in the small intestine. This is often accompanied by
inflammation and bleeding of the affected area, jaundice, diarrhea, gastric discomfort, and
edema. These symptoms often mimic those of a person suffering from a duodenal ulcer.
Patients may also suffer from malabsorption syndrome, similar to that seen in patients with
giardiasis. Intestinal obstruction, and even death, although rare, may result.

Treatment
Praziquantel

Prevention and Control

Prevention of future potential infections with F. buski may be accomplished by exercising proper
human fecal disposal and sanitation practices, particularly in areas in which animal reservoir
hosts reside, controlling the snail population, and avoiding the human consumption of raw
water plants or contaminated water.
Echinostoma ilocanum
Common name: Garrisons fluke
Common in bilibid prisoner
Disease: Echinostomiasis

Morphology

Egg
straw colored, immature, with a small operculum and oftentimes with a
prominent germ ball inside

Adult
Reddish-gray when alove, plaque-like scales on cuticle, attenuated posterior, anterior end has a
prominent circumoral disk provided with a collarete of spines (diagnostic feature)

Laboratory Diagnosis
Microscopic identification of eggs in the stool. Because the eggs are large, careful
measurements must be taken to avoid confusion with the eggs
of Fasciola or Fasciolopsis. Species-level identification cannot be done based on egg
morphology and adults are needed for a definitive diagnosis.

Clinical Symptoms
Catarrhal inflammation often occurs due to the penetration of the sharp-spined collar into
the intestinal mucosa. In heavy infections, nausea, vomiting, diarrhea, fever and
abdominal pain may occur.

Treatment
Praziquantel
Heterophyds (small intestinal flukes)

a. Heterophyes heterophyes
Common name: Von Siebolds fluke
Smallest fluke of man but the deadliest
Disease: Superficial necrosis, myocarditis, heart failure, eggs may be filtered into mesenteric cavities,
cardiac valves, myocardium, brain

Morphology:
Egg
same as Clonorchis sinensisOld fashioned light bulb
Adult
Presence of two ovoid testes of equal size

Laboratory Diagnosis
The diagnosis is based on the microscopic
identification of eggs in the stool. However, the eggs
are indistinguishable from those ofMetagonimus
yokogawai and resemble those
of Clonorchis and Opisthorchis.

Clinical Symptoms
The main symptoms are diarrhea and colicky abdominal pain. Migration of the eggs to the heart,
resulting in potentially fatal myocardial and valvular damage, has been reported from the
Philippines.

Treatment
Praziquantel

Prevention and control

The easiest and most logistically possible measure to prevent and control Heterophyes is the
avoidance of consuming undercooked fish

b. Metagonimus yokogawai
Common name: Yokogawas fluke
Disease: Metagonomiasis

Morphology
Egg
Similar to Heterophyes heterophyes, Old-fashioned light bulb
Adult
Presence of two ovoid testes of unequal size
Laboratory Diagnosis
The diagnosis is based on the microscopic identification of eggs in the stool. However, the eggs
are indistinguishable from those of Heterophyes heterophyes and resemble those
of Clonorchis and Opisthorchis. Specific diagnosis is based on identification of the adult fluke
evacuated after antihelminthic therapy, or found at autopsy.

Clinical Symptoms
The main symptoms are diarrhea and colicky abdominal pain. Migration of the eggs to
extraintestinal sites (heart, brain) can occur, with resulting symptoms.

Treatment
Praziquantel

Haplorchis yokogawai
Single, large ovoid testis
Egg: Similar to Heterophyes heterophyes, Old-fashioned electric bulb

LUNG FLUKES
Paragonimus westermani
Common name: Oriental lung fluke
Disease: Oriental distomiasis or paragonomiasis

Morphology
Egg
ovoid with flattened operculum, posterior part
of shell is thick (thickened aboperculum)

Adult
thick plump, ovoid, rounded anterior and tapered posterior (coffee bean)
Vitellaria consist of branching follicles and with zigzag intestinal ceca

Laboratory Diagnosis
The recovery of eggs in sputum specimens. These eggs are commonly
found in bloody samples. Occasionally, the eggs may be seen in stool
samples when sputum is swallowed. Serologic tests have also been
developed.

Clinical Symptoms
 Paragonimiasis: Pulmonary Distomiasis
Associated with pulmonary discomfortcough, fever, chest pain, and increased production of
blood-tinged sputum. Individuals infected with this parasite (the corresponding condition is
known at paragonimiasis and as pulmonary distomiasis) may also experience chronic bronchitis,
eosinophilia, and the production of fibrous tissue. These symptoms often mimic those seen in
persons infected with tuberculosis.

Cerebral Paragonimiasis
Migration of immature P. westermani organisms to the brain may result in the development of a
serious neurologic condition. Patients experience seizures, visual difficulties, and decreased
precision of motor skills.

Treatment
Praziquantel

Prevention and control

the primary prevention and control measures for the eradication of Paragonimus include
avoiding human ingestion of undercooked crayfish and crabs and exercising proper disposal of
human waste products.

B. Diecious trematodes
Stages of development: Egg Larva (Miracidium Mother Sporocyst (S1) Daughter Sporocyst
(S2) fork-tail cercaria) Adult
1. Adults in natural habitat copulate and female produces eggs
2. Eggs accumulate inside the blood vessels
3. Mucus that comes when eggs are laid causes irritation of the intestinal walls or urinary
bladder resulting to hyperperistalsis
4. Eggs are discharge with the feces or urine
5. Eggs deposited on water are hatch and released the embryo
6. Miracidium finds the intermediate host and enters its body (snail)
7. Inside the intermediate host body, miradium develop into mother sporocyst (S1) that
later on produces daughter sporocyst (S2), which develops into fork-tail cercaria
8. Fork-tail cercaria(Infective stage) leaves the intermediate host and comes in contact
with the skin of human(definitive host) and penetrate the skin
9. After penetration it reaches its habitat to become adults and copulate to produce eggs

BLOOD FLUKES
Schistosoma japonicum
Common name: Oriental blood fluke
Habitat: Superior mesenteric vessels
Disease: Schistosomiasis japonica, Katayamas disease

Morphology
Egg
are embryonated when laid
 is characterized by abbreviated lateral spine or a rudimentary knob on one side
Schistosoma mansoni
Common name: Mansons blood fluke
Smallest of blood flukes
Habitat: Inferior mesenteric vessel
Disease: Schistosomiasis mansoni or Masons intestinal schistosomiasis or Bilharziasis

Morphology
Egg
are embryonated when laid
are characterized with the presence of prominent
lateral spine at the inferior lateral side

Schistosoma haematobium
Common name: Vesical blood fluke
Habitat: Vesical plexuses
Disease: Vesical schistosomiasis or Urinary Bilharziasis or Schistosomal hematuria (bloody urine)

Morphology
Egg
are embryonated when laid
are characterized with the presence of prominent
terminal spine

ADULT of Shistosoma spp.

have separate sexes

are rounder in appearance
the typical female measures 2 cm in length and the male measures 1.5 cm,
the male surrounds the female almost completely, facilitating copulation

Laboratory Diagnosis
Demonstration of egg in feces, rectal biopsies, urine
Faust and Meleneys egg hatching technique
Circumoval precipitin test of Oliver and Gonzales

Clinical Symptoms

Schistosomiasis, Bilharziasis, Swamp Fever

The first symptom experienced by most symptomatic persons infected
with Schistosoma is inflammation at the cercaria penetration site.
Symptoms of acute infection include abdominal pain, fever, chills,
weight loss, cough, bloody diarrhea, and eosinophilia. Painful urination
and hematuria may also occur in persons infected with S.
haematobium.
Katayama fever - is a systemic hypersensitivity reaction to the schistosomulae migrating through tissue.
Rapid onset of fever, nausea, myalgia, malaise, fatigue, cough, diarrhea, and eosinophilia occur 1 to 2
months after exposure.

Treatment
Praziquantel
Oxamniquine is only used for S. mansoni

Prevention and Control

Older methods of preventing schistosomiasis included proper human waste disposal and control
of the snail population, primarily their breeding areas; prompt diagnosis and treatment of
infected persons, the avoidance of human contact with potentially contaminated water, and
educational programs for the inhabitants of known endemic areas.