FLUKES (CLASS TREMATODA) o Includes all flukes except Schistosomes

2) Blood flukes
TREMATODES o Separate sexes (dioecious)
o Includes Schistosomes
• Intestinal
*Larval stages
• Liver
• Miracidium – a ciliated larval stage that
• Pancreatic
emerged from the trematode egg
• Lung
• Sporocyst – a saclike structure that produces
• Blood
secondary larval stages and is the first larval
stage in the developmental cycle in the snail
GENERALITIES: host.
• Phylum: Platyhelminthes (Cestodes & • Redia – a larval stage with an oral sucker that
Trematodes) is produced by sporocyst (Absent in blood
• Class: Trematoda (Trematodes) flukes).
• Subclass/Order: Digenea • Cercaria – a free swimming larva of
• All are flat and leaf like except Schistosomes trematode which escapes from a sporocyst
• All are hermaphrodites (monoecious) except or redia. Infective stage of Schistosomes
Schistosomes (diecious) • Metacercaria – an encysted larva found in
• All have well developed reproductive organs the 2nd IH. Infective stage of hermaphroditic
• All eggs are operculated except flukes.
Schistosomes (has spine like projections)
• All require 2 IH except Schistosomes (1 IH)
• MOT: Oral/Ingestion except Schistosomes
(Skin penetration)
• Infective Stage: Metacercaria except
Schistosomes (cercaria)
• Alimentary canal (Inverted Y shape) is
incomplete (No anus)
• *Adult flukes are covered with a
metabolically active tegument equipped
with spines
• All possess 2 suckers except H. heterophyes
(3 suckers) LIVER FLUKES
1) Oral Sucker Fasciola Hepatica
2) Ventral sucker (Acetabulum)
• CN: Sheep liver fluke / Common liver fluke
3) Gonotyl sucker (only for H.
• Adult worm:
heterophyes)
o Leaf-shaped; Flat, large in sized; brown
*Additional Notes from other ppt
in color; dorsoventrally flattened
*Classifications:
o 2 suckers (Oral & Ventral)
1) Hermaphroditic / Organ dwelling flukes
o Rounded posterior end
o Inhabits host organs
o Anterior end projection / shoulder
o Monoecious
where oral sucker is situated
o found in the intestines, liver, pancreas
• Egg:
and lungs
 o Oval in shape; bile stained; operculated;
non-embryonated
o Very similar to F. buski
o Contains an immature larva called
Miracidium
o Does not float in saturated soln. of
common salt
• Diagnosis
o Stool Microscopy – detects operculated
eggs (Not specific)
o Antibody detection – ELISA, CIEP
(Counterimmunoelectrophoresis),
Western Blot
o Molecular Test – DNA probe, PCR
o USG, CT Scan, MRI – detect lesions in
liver
o Peripheral blood eosinophilia –
increase in IgE, IgG, and eosinophils
Fasciola gigantica
• CN: Tropical liver fluke
• Closely related to F. hepatica; eggs are
morphologically similar but larger in size
• Definitive Host: Man, sheep, goat, cattle
• Intermediate host for both Fasciola spp.:
1) Amphibian (For hepatica) & Aquatic
(For gigantica) Snail: Lymnaea
philippinensis, Lymnaea auricularia
rubiginosa
2) Aquatic plants: Ipomea obscura
(kangkong), Nasturtium officinale (water
cress)
Clonorchis sinensis
• CN: Chinese liver fluke
o Because the first patient who was
identified with the parasite was Chinese
• Adult Worm:
o Lancet-shaped; dorsoventrally
flattened; elongated
o Distinguishing feature: two deeply
lobulated & branched testes
• Egg:
o Distinct operculum & prominent
shoulder
o Posterior tiny-knob
o Flask-shaped appearance
o Contains miracidium
o * Bell-shaped
o * thickened opercular rim
o Does not float in saturated soln. of
common salt
• Definitive Host: Human, dogs & other fish
eating canines can serve as reservoir host
• Intermediate Host:
1) Snail:
Parafossarulus/Bulimus/Aloncima
2) Fish: Ctenopharyngodon idellus
(Cypirinidae fish)
• Diagnosis:
o Stool microscopy – detects flask shaped
operculated eggs (Not specific since egg
is similar to Opistorchis, Metagonimus,
Heterophyes
o Serodiagnosis – CFT, IHA, ELISA for
antibody detection, ELISA for antigen
detection – Positive indicates current
infection
o Molecular methods – Multiple PCR –
Has high specificity and sensitivity
Opistorchis felineus & Opistorchis viverrini
• O. felineus & O. viverrini adult worms are
similar
• Adult worm: Elongated; dorsoventrally
flattened
o Similar to Chlonorchis sinensis but
smaller
Opistorchis felineus
• Eggs: operculated
• Definitive host: Man, cat & dogs
• Intermediate host:
1) Snail: Codiella/Bithynia (Bithynia inflata,
Bithynia leachi, and Bithynia troscheli)
2) Fish: Cyprinidae fish
Opistorchis viverrini
• Eggs: flask-shaped w/ knob & operculum 2) Grasshopper/Tree crickets:
similar to C. sinensis Technomyrmex deterquens
• Definitive host: Man, cat, dogs • Diagnosis:
• Intermediate host o Stool microscopy (nonspecific)
1) Snail: Bithynia (Bithynia funiculate and o Collecting bile & duodenal drainage
Bithynia siamensis)
2) Fish: Cyprinidae fish (Genera INTESTINAL FLUKES
Cyclocheilichthys, Hampala, and Fasciolopsis buski
Puntius) • CN: Giant intestinal fluke
Dicrocoelium dendriticum • Largest and most common fluke in man
• AKA: Fasciola dendriticum or Fasciola • Adult worm: Similar to F. hepatica except
lancelolata for:
• CN: Lanceolate fluke or Lancet fluke Properties F. hepatica F. buski
• Adult worms: Flat & transparent Size Smaller Bigger (2-
• Eggs: (3cm) 7.5cm)
o thick-shelled; Anterior Bears Doesn’t have
o operculated; end/Shoulder cephalic cone cephalic
o golden-brown in color cone
• Definitive host: Humans Oral and Well Lie close to
ventral separated each other
• Intermediate host:
suckers
1) Snail: Cionella lubrica
Intestinal Bear lateral Doesn’t have
▪ Slime balls – accumulated cercaria caeca branches lateral
2) Ants: Formica fusca branches

PANCREATIC FLUKES • Eggs: large, operculated, bile-stained; similar

Eurytrema pancreaticum to F. hepatica
• CN: Pancreatic Fluke o Similar to Echinostoma ilocanum &
• Adult worm: More ovate and broader than Gastrodiscoides
dendriticum o Definite identification is the recovery of
o *Oral sucker is larger than ventral the adult stage
sucker • Definitive host: Man, pig, *dogs
o *Ruffled body margins • Intermediate host:
• Eggs: 1) Amphibian Snail: Segmentina coenosus,
o Similar to dendriticum Hippeutis cantori
o *thick shell, golden brown 2) Aquatic plants: Trapa bicornis (“water
o *distinctly operculated caltrop”), Eliocharis tuberosa (“water
o *similar to eggs of Lancet fluke chestnut”)
• *Habitat: pancreatic duct of hogs, biliary and • Diagnosis:
pancreatic passages of sheep, goat, cattle o Stool microscopy (by wet mount and
and water buffaloes sedimentation concentration
• Intermediate Host: technique) – detects operculated eggs
1) Snail: Macrochlamys indica
Echinostoma ilocanum
• CN: Garrison’s Fluke
• Distinguishing feature:
o Oral sucker is surrounded by crown of
spine
o Reddish-gray color’
• Adult worm:
o *tegument is covered with plaque like
scales
o *anterior end is equipped with
circumoral disk
• Eggs:
o ellipsoidal, operculated;
o similar to F. buski, *straw colored
• Definite identification: getting patient
history & other clinical findings
• Definite host: Man
• Intermediate host:
1) Snail: Gyraulus convexiusculus,
Hippeutis umilicalis
2) Snail: Pila luzonica (“kuhol”), Vivipara
angularis (“susong pampang”)
Heterophyes heterophyes
• CN: Von Siebold’s fluke
• Smallest fluke but deadliest infecting man
• Adult worm: gray color
o Round-broad posterior end
o 3 suckers (3rd gonotyl/genital sucker)
• Eggs:
o Operculated; smaller in adults;
o embryonated
• Definitive host: man & other mammals
• Intermediate host:
1) Snail: Cerithideopsilla cingulata (South
east asia), Pironella conica (Egypt)
2) Brackish water fish: Mugil cephalus, Liza
haematocheila, Acanthogobius
flavimanus, Glossogobiusgiuris, and
Tridentiger obscurus (SEA), Mugil
cephalus (Egypt)
• Diagnosis
o Stool microscopy – eggs are similar to
M. yokogawai and C. sinensis
o Formalin-ethyl acetate sedimentation
concentration – recommended for egg
recovery; used in light to medium
infection
LUNG FLUKE
Paragonimus westermani
• CN: Oriental lung fluke
• Adult worm:
o Fleshy (plump), large,
o reddish-brown in color;
o thick; oval shaped
o Tegument (outer covering) is covered
with spines or scales
• Eggs:
o Golden-brown in color;
o Oval, unembryonated similar to
fasciola
• Definitive host: Man, dogs & cats
• Intermediate host
1) Snail: Antemelania asperata/ Brotia
asperata, Antemelania dactylus
2) Crab, cray fish: Sundathelphusa
philippina / Parathelpusa grapsoides
(mountain crab or “talangka”)
BLOOD FLUKES
• Schistosoma japonicum
• Schistosoma mansoni
• Schistosoma haematobium
• Additional:
o Schistosoma intercalatum
o Schistosoma mekongi
• Dioecious = “in copula”
o Male and female are always together
• Adult worm:
o Cylindrical bodies
o Body is covered with thick tuberculated
syncytial
• Male adult: contains a sexual canal called
gynecophoric canal where female enters
• Female adult: slender, slightly longer than
male
• Eggs:
o Non-operculated w/ spine-like
projections
o Egg is fully embryonated when laid in
urine or stool (miracidium comes out)
• Cercaria: forked-tail w/o a pharynx
• Schistosomula: a cercaria w/o a tail (got
removed when penetrating the skin)
• Definitive host: Humans or other animals
• Intermediate host: Snail
o Harboring ceraria (Infective stage)
• MOT: skin penetration
Schistosoma haematobium
• Diagnosis:
o Urine microscopy - Detects terminal
spined eggs
o Histopathology of bladder mucosal
biopsy – detects terminal spined eggs
o Antibody detection (serum) – HAMA-
FAST-ELISA, HAMA-EITB, IFA, IHA and
cercarial Huller reaction
o Antigen detection (serum and urine) –
CCA (circulating cathodic antigen) and
CAA (circulating anodic antigen)
detection by ELISA or dip stick assay
o Meaning of acronyms
▪ HAMA = S. haematobium microsomal
antigen
▪ EITB = Enzyme-linked
Immunoelectrotransfer blot
▪ IFA = Immunofluorescence assay
▪ IHA = Indirect hemagglutination test
Schistosoma mansoni
• Diagnosis:
o Stool microscopy – detects egg with
lateral spine
▪ Wet mount and stool concentration
technique
▪ Hatching test (Hatching of motile
miracidium)
▪ Kato thick smear technique for egg
counting
o Rectal biopsy specimen – to detect
eggs
▪ Histopathology
▪ Acid fast stain (Ziehl-Neelsen)
o Antigen detection – CCA, CAA, SEA
o Antibody detection – ELISA, EITB
Schistosoma japonicum
• Diagnosis: Similar to S. mansoni