BLOOD FLUKES Dr.

Cabudoy

Note: Italicized text were taken from the manual

BLOOD FLUKES o Ovary is posterior to the mid portion of

the organism
Superfamily Schistosomatoides Male
Major source of morbidity and mortality for o With oral and ventral suckers
developing countries o Shorter and stouter with a gynecophoral
o Africa canal
o S. America o Cuticle has fine tuberculation
o Carribean o With 4-5 large testes in cluster
o Middle East EGG
o Asia Shape is elongate, ovoidal
Disease caused: Schistosomiasis, Bilharziasis with thin shell and
Medically Important: terminal spine
o Schistosoma haematobium Contains ciliated embryo
o Schistosoma mansoni
o Schistosoma japonicum SCHISTOSOMA MANSONI
1st INTERMEDIATE HOST: Snail
2nd INTERMEDIATE HOST:None
DEFINITIVE HOST: Man
EGG: Mature, Non operculated
SEX: Dioecious
FREE SWIMMING LARVA: Forktailed Cercaria
DEVELOPMENT: S1 S2 -C
INFECTIVE STAGE: Cercaria
DIAGNOSTIC STAGE: Egg
Peculiar Flukes
Mature in blood vascular system in Definitive
Host ADULT
Calcified egg of S. haematobium in Egyptian Female
mummies o Long and slender with oral and ventral
Split body gynecophoral canal of male; spines
where female lodge during copulation o Ovary is anterior to the mid-portion of
S. japonicum lays the most number of eggs the organism
MALE = Shorter, stouter, no pharynx, with strong Male
oral sucker o With oral and ventral suckers
FEMALE = long, slender o Shorter and stouter with a gynecophoral
Romancing parasite once they copulate, tey canal
wont separate anymore o With 6-9 small testes in column or
Adult live in veins group
Previously called BILHARZIA
EGG
Adults live in veins that drain certain organs
shape is elongate ovoidal
paired worms go upstream into smaller veins
with thin shell and lateral
where female deposit eggs eggs traverse wall
spine
of venule eggs traverse intervening tissue
traverse gut/bladder mucosa expelled from contains ciliated embryo
host FECES or URINE

SCHISTOSOMA HAEMATOBIUM SCHISTOSOMA JAPONICUM

ADULT
Female
o Long and slender with oral and ventral
suckers

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Note: Italicized text were taken from the manual
ADULT
Female
o Long, slender, with oral and ventral
suckers
o Ovary is centrally located
Male
o With oral and ventral suckers
o Shorter and stouter with gynecophoral
canal
o Cuticle has no tuberculation
EGG
Shape is ovoidal or subglobular,
with thin shell, rudimentary or
abbreviated lateral spine and
cellular debris attached to the shell
Contains ciliated embryo
EGGS (3 species)
Causes infection/symptoms
Form pseudotubercles microscopically
Marked eosinophilic reaction surrounding eggs
Multinucleated giant cells
Have antigenic properties depend on host
variability cause granuloma
S. japonicum and S.mansonia eggs in the liver and
intestine
o Intestine: fibrosis in mucosa
malabsorption mucoid, bloody
diarrhea
o Liver: fibrosis cirrhosis
LIFE CYCLE
OVA in feces MATURE when laid hatch in water (to
look for Intermediate Host) Release MIRACIDIA
penetrate SNAIL SPOROCYST NO REDIA STAGE
CERCARIA goes out into the water SKIN PENETRATION
BLOOD FLUKES Dr. Cabudoy
(enzyme mediated penetrance to skin)Attracted to AA
ARGININE penetrate skin and disappear in 10-30s
LEAVES TAIL BEHIND SCHISTOSOMULAE (without
tail) enter peripheral circulation migrate to portal
blood in liver and mature into adult paired worm go
upstream into smaller veins where female deposit eggs
eggs traverse wall of venules (aided by spine) traverse
intervening tissue right heart pulmonary left
heart systemic liver and pair up travel in pairs
migrate to wall of urinary bladder and GIT and lay eggs
*Unpaired female dont sexually mature; starving growth,
stimulation for function is the male class
PATHOGENESIS:
Unusual
Due to EGGS, not adult worms
ACUTE SCHISTOSOMIASIS
Katayama Fever
Serum-like sickness that develops several weeks
after exposure
Corresponds to the 1st cycle of egg deposition and
is associated with marked peripheral
eosinophilia and circulating immune complexes
It is most common with S. japonicum and S.
mansoni infection and is most likely to occur in
newly infected individuals after primary
infection
Signs and symptoms usually resolve over several
weeks but can be fatal to very young and very old
Mild maculopapular lesion, high grade fever
CHRONIC SCHISTOMIASIS
More common
Result from egg-induced immune response,
granuloma formation and associated fibrotic
changes
Schistosomal eggs are highly immunogenic and
induce vigorous circulating and local immune
response
EGG RETENTION AND GRANULOMA FORMATION in the
BOWEL WALL (S. mansonia and S. japonicum)
Bloody diarrhea
Cramping
Inflammatory Colonicpolyposis
Increased rate of recurrent Salmonella infection
Heavy infection Hepatic Disease
Severe Fibrosis Pipestem pattern
Periportal Fibrosis portal HPN
Portal HPN sequelae:
o Splenomegaly
o Ascites
o Esophageal varices
o Development of portosystemic
collaterals
EGG RETENTION (S. haematobium)
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 BLOOD FLUKES Dr. Cabudoy

Note: Italicized text were taken from the manual

Hematuria PHYSICAL
Dysuria Vary with stage of illness, worm burden, and end-
Ulcer organ involvement
Bladder polyp
Obstructive uropathies DIAGNOSIS
S. japonicum and S. mansoni
STAGES OF SCHISTOSOMIASIS Stool Exam
Serology
STAGE 1 o ELISA helpful in confirmation of past
Invasion exposure
o Early infection, mild signs and o Schistosomal atigen test to help
symptoms distinguish between active and inactive
o Skin penetration infection
o Papulodermatitis due to fork tailed o Antigen titers from serum and urine
cercaria correlate with degree of infection
o Schistosomial dermatitis Rectal Biopsy
Migration Kato-Katz thick smear clarified with glycerol;
o Fever, cough for identification and quantification of ova in
o Inflammatory reaction to lungs and feces
liver Immunodiagnostic tests
Diagnosis o Circum-oval precipitin test (COPT)
o Cercaria Huellen reaction o Cercaria Huellen Reaction(CHR)
Skin test (+) at stage 1 o Fluorescent Antibody test for cercaria
Non-specific (FAT)
o ELISA
STAGE 2 Ultrasound to detect pipestem fibrosis of the
Maturation liver and patency of the portal, splenic and
o From migration to penetration of egg superior mesenteric vessels
o Katayama fever: early fever in
schistosomial infection S. haematobium
Acute febrile response Urine Examination (+) eggs definitive
diagnosis; 24-hour urine collection may be
STAGE 3 recommended
Stage of Established infection Micropore filtration for the detection of ova in
o Massive egg laying urine
o Early chronic infection, due to Cytoscopy
granuloma formed by egg Immunodiagnostic tests
o Circum-oval precipitin test (COPT)
STAGE 4 o Cercaria Huellen Reaction(CHR)
Late infection and complications o Fluorescent Antibody test for cercaria
Prolonged infection, marked decrease in egg (FAT)
production and extrusion of eggs or no eggs at all o ELISA
Possible development of sequelae such as cor Ultrasound to detect urinary tract lesion
pulmonale, obstructive uropathy and formation
of varices TREATMENT
Progressive fibrosis relative to infection DOC: Praziquantel (Biltricide)
Involves brain in S. japonicum infection Anti inflammatory drugs
Liver fibrosis liver cirrhosis portal
hypertension ascites, splenomegaly (due to SWIMMERS ITCH
direct invasion of eggs, portal hpn, and Schistosoma cercarial dermatitis
granuloma formation
Cachexic patient with big abdomen BIRDS SCHISTOSOME
Cercaria release allergens
SQUAMOUS CELL CA Inflamed pus-filled pimple
Most common cancer in Schistosomiasis Die in subcutaneous tissue cause allergy
severe manifestation abscess
TRANSITIONAL CELL CA
Most common type of cancer in Bladder CA

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 BLOOD FLUKES Dr. Cabudoy

Note: Italicized text were taken from the manual

S. haematobium S. mansoni S. japonicum

Disease Vesical Mansons Oriental blood
caused schistosomiasis intestinal fluke,
schistosomiasis Schistosomiasis
japonica
# of testes 4-5 6-9 7
Uterus Least eggs Few Most eggs
~300
Eggs Short, terminal Sharp, lateral Rudimentary,
spine spine abbrev spine
with cell debris
Habitat Urinary bladder Large intestine, Small intestine,
plexus inferior superior
mesenteric mesenteric
Snail Bullinus, Biomphalaria Oncomelania
Biomphalaria, (Africa, KSA, quadrasi
Physopsis Middle East),
Tropicorbis
centrimetralis
(Brazil)
Infection Least serious Most serious
(most number
of eggs)
Distribution Africa (Egypt) Africa, SA SEA,
Philippines
Excreted in Urine Feces Urine and
Feces
Male Short, stout, Short, stout, Short, stout,
Morphology gynecophoral gynecophoral gynecophoral
canal present, canal present canal present,
cuticle no cuticle
tuberculation tuberculation
Female Ovary post-mid Ovary ant-mid Ovary centrally
Morphology portion position located

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