Trematode
Intestinal flukes
Blood flukes
317221, 317242
Dr. Pongsri Tippawangkosol
Cestode (Tapeworm)
Trematode (Fluke)
Helminths
Nematode (Round worm)
Phylum nematoda
Roundworm
Class Phasmidia
- Ascaris lumbricoides
- Enterobius vermicularis
- Gnathostoma spinigerum
- Angiostrongylus cantonensis
- Necator americanus
- Ancylostoma duodenale
- Wuchereria bancrofti
- Brugia malayi
Class Aphasmidia
- Trichinella spiralis
- Trichuris trichiura
- Capillaria phillipinensis
Phylum Platyhelminthes
Trematoda
(flukes)
Lung flukes
- Paragonimus spp.
Liver flukes
- Clonorchis spp.
- Opisthrochis spp.
- Fasciola spp.(ใบไม้ตบั )
- Dicrocoelium spp.
- Eurytrema
Intestinal flukes
- Fasciolopsis buski
- Echinostoma spp.
- Heterophyes spp.
- Haplochis taichui
Blood flukes
- Schistosoma spp.
Cestoda
(tapeworms)
Order Pseudophyllidea
- Dipyllobothrium latum (ตืดปลา)
- Spirometra spp. (ตืดสุ นขั )
Order cyclophyllidea
- Dipylidium caninum (dog tapeworm)
- Hymenolepis nana (dwarf tapeworm)
- Hymenolepis diminuta (rat tapeworm)
- Taenia solium (pork tapeworm)
- Taenia saginata (beef tapeworm)
- Echinococcus spp. (dog tapeworm)
- Multiceps multiceps (dog tapeworm)
Trematode (Fluke)
Lung fluke
Liver fluke
Intestinal fluke
Blood fluke
Complex life cycle
1st intermediate host
2nd intermediate hosts: depend on species
1 st intermediate host
2 nd intermediate host
Lung fluke
- Liver fluke (Fasciola spp.)
- Intestinal fluke (F. buski)
- Liver fluke (O. viverrini)
- Intestinal fluke (H. taichui)
Development
Adult
(human)
(ingestion)
egg
miracidium in water
sporocyst in snail
Blood fluke
(penetration)
1st intermediate host
redia in snail
cercaria in snail
metacercaria in 2nd intermediate host
(crab, shrimp, fish, water plant)
Are there any parasites in these menu ??
Papaya salad
Raw fish
pricked fish
ส
preserved fish
Vegetable (water plant)
H. taichui
Liver flukes
Intestinal fluke
(1 mm.)
Lung fluke
Liver fluke
5-8 cm.
Intestinal fluke
Intestinal flukes
Large size : Fasciolopsis buski
Small size : Haplorchis taichui
Adult worms live in small intestine
Blood flukes :
Schistosoma spp.
Adult worms live in blood vessels in intestine or bladder
Intestinal flukes
Fasciolopsis buski
Haplorchis taichui
Large intestinal fluke, 5-8 cm.
Small intestinal fluke, 1 mm.
Are there any parasites in water plant ??
Water caltrop
Water chestnut
Morning glory
Lotus
Water mimosa
The largest intestinal fluke : Fasciolopsis buski
Disease : Fasciolopsiasis
- Infection 10 million/year
- Thailand, India, China, Loa, Vietnam, Cambodia,
Indonesia, Malaysia, Korea
Larva develop in snail
Eat fresh water plant
Development
Adult (Small intestine)
Eat
Egg passed in feces
Larva developed in snail
Metacercaria in water plant
Adult : size 2-7 cm. long
Unbranched intestine
Uterus
1 Ovary
(branch)
2 Testes (Branch)
Egg : large size 130x80 um
Small operculum
Oval shaped with thin shell
Unembryonated egg
The egg is similar as
liver fluke egg (Fasciola spp.)
Symptoms
Attachment of large worms to the mucosal of small intestine
Mild infection
Inflammation of mucosa
Hemorrhage
Ulcerlation
Symptoms
Heavy infection (100-10,000 worms)
Abdominal pain
Chronic diarrhea
- Decrease absorption of Vit B12
- Intestinal edema (absorption of worm toxin)
- Allergy and can cause death
Diagnosis
Stool examination to find egg
Prevention
- Be careful to eat raw fresh water plants
- Wash vegetable
- Heat can kill flukes
Are there any parasites in fresh water fish ??
“Eat raw fish”
Pla som
Koi pla
Pla ra
Jaew bhong
Minute or small intestinal fluke : Haplorchis taichui
Haplorchiasis
Southeast Asia
Thailand, Loa, Vietnam,
Cambodia, Philippines
Development
Adult live in small intestine
Eat
Egg passed in feces
Larva develop in snail
Metacercaria in fresh water fish
- Small size (1 mm.)
- Flat elongate cover with spines
Haplorchis taichui
ข
1 Ovary
1 testis
Ventral sucker
Surrounded by fan shaped
hooklet (13-16 hooklets)
Egg
operculum
shoulder
- Small size
- Oval shaped
- Embryonated egg
miracidium
(egg contain miracidium inside)
knob
Egg is similar as liver fluke egg (Opisthorchis viverrini)
Symptoms
diarrhea
Abdominal pain
Diagnosis
Prevention
Do not eat raw or uncooked fish
Stool examination to find egg
Are there any parasites in water ??
Contact the water in Africa, south America, India, SEA
How dose Blood fluke enter to human ?
Skin penetration
Cercarial dermatitis
Hepatosplenomegaly
Blood fluke (Schistosome)
Disease : Bilhaziasis or Schistosomiasis
What is the importance of blood fluke ?
Epidemiology
- Infect 200 million people/year throughout the world
- 76 countries (85% in Africa)
- Died 200,000/ year
- No case in Thailand
How many human blood fluke ?
1. Schistosoma mansoni (South America)
2. S. haematobium (Africa, India)
3. S. japonicum (Southeast Asia)
4. S. mekongi (Southeast Asia)
5. S. intercalatum (Africa)
Intestinal schistosomiasis
Adult live in blood
vessels in
large intestine
(S. mansoni)
Adult live in blood
Vessel in
small intestine
S. japonicum
S. makongi
S. intercalatum
Urinary schistosomiasis
Adult live in blood
vessels in bladder
S. haematobium
Adult live in blood vessels in
small intestine, large intestine,
urinary bladder
Fork-tailed cercaria
penetrated the skin
Urinate or defecated
in the water
Egg passed in feces
or urine
Fork-tailed cercaria
Larva developed in snail
Development
Adult (vessels in small intestine, large intestine, bladder)
egg passed in feces or uine
sporocyst larva develop in snail
Penetrate skin
Fork-tailed cercaria in water
Skin
circulation
Lung
Liver
intestine or bladder
Cercaria
(schistosomule) (adult)
Fork-tailed cercaria (infective stage)
Where is blood fluke ?
Adult live in human
Larva live in water
First intermediate host
Bolinus spp. in S. haematobium
Biomphalaria spp. in S. mansoni
Oncomelania spp.
in S. japonicum
Tricula aperta in S. mekongi
Blood flukes (Schistosoma spp.)
 sex separate
 male has gynecophoric canal for female live inside
 infective stage is fork-tailed cercaria
 no larva stage (redia and metacercaria)
 egg without operculum
 egg with miracidium inside (embryonated egg)
 egg with spine or knob
Female (2 cm. x 0.3 mm.)
Testis
- Sex separate
- Male has many testes
- Male carries the female in
the gynecophoric canal
- Has reunion intestine
Male (1 cm. x 1 mm.)
Ovary
Oral sucker
Male
Oral sucker
Ventral sucker
Ventral sucker
Female
Gynecophoric canal
- Oval shaped with spine or knob
- Egg without operculum
- Embryonated egg contains miracidium
How does blood fluke develop symptoms ?
Nudules in liver & brain
Eggs go back into liver & brain
Adult live in blood vessels
in small intestine, large
intestine, urinary bladder
Female lay eggs
Many eggs invade in tissues
Nudules in intestines & bladder
Bloody urine, bloody stool
How does blood fluke cause symptoms ?
1. Penetration of cercaria cause dermatitis
2. Migration of schistosomulae (larva) to lung cause inflammation
3. Egg deposit in intestine or bladder cause trauma & haemorrhage
4. WBC & fibroblast infiltration around eggs
cause small fibrous nodule in the intestine or bladder
5. Many eggs go back into the liver
the process followed No. 4
cause many nodules in liver (Cirrhosis, hepatospleenomegaly)
Bladder
Brain
Eggs cause nodules
in small intestine, large intestine, spleen, bladder, brain
Eggs in brain
Nodules in bladder
Nodule in small intestine
Hepatosplenomegaly caused by many eggs from small intestine
& large intestine go back into portal vein to the liver
What are symptoms caused by blood flukes ?
Itching & rash (swimmer’s itch)
Fever, diarrhea, abdominal pain
Bloody urine (hematuria)
Bloody stool
Cirrhosis, Hepatosplenomegaly
Bladder cancer, colon cancer
Coma (nodules in brain)
Symptoms
Urinary schistosomiasis (S. haematobium)
- Bloody urine (haematuria), RBC in urine
- Obstruction of urinary system
- Kidney failure, bladder cancer
Intestinal schistosomiasis
(S. mansoni, S. japonicum, S. makongi)
- Bloody stool , abdominal pain, nodules in intestine
- Hepatosplenomegaly (egg go back to liver)
- Coma, paralysis (egg go back to the brain)
- Colon cancer
How to diagnose ?
1. Stool or urine examination to find egg
2. Tissue biopsy (rectal or liver) to find egg
3. Blood examination to find antigen or antibody
Egg of S. mansoni by rectal biopsy
How to prevent & control blood fluke ?
Snail control
spraying
Treatment
Single oral dose of praziquantel
Avoid enter to endemic area
Rapid treatment of patient
Hygienic education
feeding
Lung fluke
Liver fluke
Intestinal fluke
Blood fluke
Intestinal flukes
Large size Fasiolopsis buski
Egg 2nd intermediate host
Adult
Small size Haplorchis taichui
Adult
Egg
2nd intermediate host
Blood flukes
Schistosoma spp.
Adult
egg
fork-tailed cercaria
Preserved fish
- liver fluke (O. viverrini)
- small intestinal fluke
(Haplorchis taichui)
Water plant
Pickled water crab
lung fluke
Paragonimus spp.
- large intestinal fluke
(Fasiolopsis buski)
- liver fluke
(Fasciola spp.)
Animal Schistosome
S. spindale (cattle and water buffalo)
S. bovis (cattle, sheep, goats)
Orientobiharzia harinasutai (water buffalo)
S. incognitum (dog, pig, rat)
Trichobiharzia ocellata (duck)
Gigantobiharzia spp. (birds)
Skin penetration
by animal cercaria
Severe rash
Swimmer’s itch
Schistosome cercarial dermatitis
Skin penetration