Trematoda

Dr. Mohieddīn Abdul-Fattah

 Trematodes According to Habitat
• Intestinal Trematodes: • Lung trematodes:
1. Heterophyes 1. Paragonimus.

• Liver trematodes:
1. Fasciola. • Blood trematodes:
1. Schistosoma
 Heterophyes heterophyes
I. Biology
• Final host: Man, dogs
and cats
• Habitat : between villi in
small intestine
• Diagnostic stage: mature
egg in stool.
 II. Epidemiology
• Geographical distribution: Egypt around Borollos
and Menzella lakes , Palestine, Europe and Far East.
• Transmission:
1. Intermediate host (I.H.): Pirenella conica is 1st I.H.
and Bolty and Boory fish are 2nd I.H.
2. Reservoir hosts: dogs and cats act as final reservoir
hosts.
3. Infective stage: Encysted metacercaia in fish
muscles
4. Mode of infection: Ingestion of insufficiently cooked
or under salted fish infected with Encysted
metacercaria
 Clinical picture
1. Mild infection is almost asymptomatic
2. Heavy infection induces local intestinal
inflammation and intermittent diarrhea
3. The small eggs may be inoculated into the
blood vesels and migrate to heart and
brain resulting in embolic manifestations.
4. Myocarditis and neurological
complications
 IV. Diagnosis
• Detection of eggs in
stool.
• Egg charcteristics:
1.30 x 15 µm,
2.oval, thick shelled,
3.yellowish brown,
operculated
4.mature (contains
developed larva
[miracidium]).
 V. Treatment
• Praziquantel; 25 mg/kg/8h PO for one day

VI. Control
• Adequate salting and cooking of fish and
snail control.
• Proper disposal of human waste and
eradication of stray dogs.
• Mass examination and treatment of
fishermen and health education
 Fasciola hepatica and F. gigantica
I. BIOLOGY
• Man, sheep and cattle act as
final hosts.
• Habitat in the final host: The
biliary tracts of the liver.
• Diagnostic stage: Immature egg
in stool.
 Lymnaea snail Simple tailed cercaria

Fasciola egg
E. metacercaria
on grass

Fasciola hepatica
 II. Epidemiology
• Geographical distribution: Egypt
and sheep and cattle raising
countries.
• Transmission:
1. Intermediate host (I.H.): Lymnaea
is 1st I.H. and vegetable is 2nd I.H.
2. Reservoir hosts: Sheep and cattle
act as final reservoir hosts
3. Infective stage: Encysted
metacercaria
4. Mode of infection: Ingestion of raw
vegetable contaminated with
encysted metacercaria
 III. Clinical picture

• Acute fasciolitic hepatitis during the

migratory phase in liver. fever, eosinophilia
and allergic features.
• Chronic biliary fascioliasis → jaundice and
haematobilia → anaemia. anaemia Fasciolitic
pharyngitis (Halzoun) caused by the
presence of adult in the pharynx after eating
infected raw sheep liver infectd with adults..
 IV. Diagnosis
• Detection of eggs in
stool. Direct and conc.
• Egg charcteristics:
1. thin walled,
2. 140 x 70 µm,
3. ovoid,
4. yellowish brown,
Operculated,
5. immature (does not
contain developed larva
[miracidium]).
 Indirect diagnosis
 Serodiagnosis
(especially. during
invasive stage)
• IFAT (T.S of adult
worm) or ELISA (ES
antigens).
 Imaging: CT -
sonography
 V. Treatment
• Triclabendazole (10 mg/kg PO for one
dose) or Mirazid.

VI. Control
1. Adequate washing of vegetable.
2. Mass treatment of Reservoirs.
3. Sanitations of slaughter houses.
4. Control of snails.
5. Proper disposal of human waste.
 Paragonimus westermani
I. Biology
 Final host: Humans,
dogs, cats, rodents and
pigs.
 Habitat: Encapsulated
in the bronchioles of the
lung
Adult
 Diagnostic stage:
immature eggs passed
in feces and sputum.

Egg in sputum
 II. Epidemiology
 Distribution: worldwide but more
confined in oriental countries such as
Japan.
 Reservoir hosts: Dogs, cats, rodents
and pigs.
 Intermediate hosts: 1st IH snail;
Semisulcospira or Thiara and 2nd
fresh water cructaceans.
 Infective stage: Encysted
metacercaria in gills and muscles of
crustaceans (crabs).
 Mode of infection: ingestion of
encysted metacercaria in
undercooked crustacean.
 III. Host Parasite Relationship
 Early symptoms cough
with blood tinged
sputum.
 Low grade fever
Difficult to distinguish
from pneumonia and T.S. of lung containing
tuberculosis. encapsulated adult

 Ectopic sites may

include: abdominal
wall, heart, lymph
nodes and nervous
system.
Eggs in m. LN with granulomas
abundant with esosinophils
 IV. Diagnosis
 Clinical picture with
eosinophila in
endemic areas.
 Detection of eggs in
sputum or feces.
 Serology for ectopic
sites DIG or ELISA.
 Imaging: plain x-ray.
 V. Treatment
• Praziquantel; 25mg/kg/8h PO for 2 days
• Bithionol ; 20 mg/kg/12h Po daily for 14 ds.

VI.Control
• Health education.
• proper cooking of crabs and crayfish .
Schistosoma mansoni & S. hematobium
• BIOLOGY
Man only acts as final hosts.
Habitat in the final host:
Inf. mesenteric veins draininnig large
intestines in S. mansoni.
vesical plexus draining urinary bladder in S.
hematobium.
Diagnostic stage: mature egg in stool
(S.mansoni) and in urine (S.
hematobium).
 II. Epidemiology
 Geographical distribution: Africa, south
America, Middle East and Portugal.
 Transmission:
1. Intermediate host (I.H.): The snails;
Biomphalaria is I.H. of S.mansoni and Bulinus
is I.H. of S hematobium.
2. Reservoir hosts: No animal reservoir hosts.
3. Infective stage: Free swimming cecaria in fresh
water
4. Mode of infection: free cercaria penetrates
skin
 •
• Clinical picture
The manifestations in the chronic stage include:
 In S. mansoni:
a) Colonic polyps with bloody diarrhea
b) Periportal fibrosis → portal hypertension with
hematemesis and splenomegaly.
 In S. hematobium:
a) Cystitis (sq cell carcinoma), ureteritis with hematuria.
b) Ureteric stricture induces hydronephrosis
c) CNS disorders and core pulmonale occur earlier in
S.hematobium due to direct passages of eggs from
bladder and ureteral veins into systemic veins than
in S. japonicum and mansoni.
 Pathogenesis

Colonic polyps endoscopy

Periportal fibrosis
B splenomegaly
Periportal fibrosis
Polyposis post mortem

Esophageal
varices
Eggs in C. polyp biopsy
 IV. Diagnosis
 Detection of eggs in stool (S.mansoni) or in urine
(S.hematobium).
 Egg characteristics:
o S. mansoni: Ovoid non-operculated, 140 x 70 µm,
yellowish brown with lateral spine and mature
(contains miracidium).
o S. hematobium: spindle shaped, non-operculated,
140 x 70 µm, yellowish brown with terminal spine and
mature (contains miracidium).
o Serology in prepatent and chronic infection to
detect specific schistosome antigens and antibodies
 V. Treatment
• Praziquantel; 40 mg/kg PO with food
divided into 2 doses separated by 4-6
hours for S. mansoni and hematobium .
VI. Control
1. Avoiding swimming in fresh water.
2. Proper disposal of human waste.
3. Control of snails and health education.
4. Mass treatment