HELMINTHOLOGY

Phylum Nemathelminthes (round worms)

Phylum Platyhelminthes (flatworms)

Classes: Trematoda – Trematodes / Flukes
Cestoda – Cestodes / Tapeworms
TREMATODES
(Flukes)

Figure 4. Tr
3. pharynx,
collection tu
and 12. va
(ejaculation
receptacle, 2
24. yolk glan
Morphology & Structures of Adult worm:

= Leaf-like shaped, flattened dorsoventrally and unsegmented

= Body covered with external non-cellular teguments which
may be smooth or spiny more conspicuous at the
anterior portion of the body
(used for absorption and protection of the body)
= Musculature consist of outer circular, middle oblique and
an inner longitudinal layers just beneath the teguments
(serves to alter the shaped of the worm)
= No body cavity
= Alimentary/Digestive system-present but incomplete and
consist of: mouth surrounded by oral sucker located
at or near the anterior end of the body  pharynx
 esophagus which bifurcate in front of the ventral
sucker to assume an inverted “Y” figure to form 2
blind intestinal ceca. No anus
= 2 suckers - cup-shaped external depression found at the
surface of the body
 oral – anteriorly located surrounding the mouth
- used for ingestion and procurement of food
 ventral - found in the ventral surface of the body
- serve as organ of attachment of the parasite
 some spp. are provided with a third genital sucker or
gonotyl (genus Heterophyes)

Excretory system - bilaterally symmetrical which opens as

excretory pore at the posterior end of the body

Nervous system – bilaterally symmetrical and are composed of

paired lateral ganglia in the region of pharynx which are
directed to nerve trunk

Circulatory system – absent

Reproductive system – highly developed and complex

 generally hermaphroditic (monoecious) - possess both

male and female genitalia in one adult worm,
except Schistosome (dieocious) sexes are found in
separate organism

 cross fertilization and self-insemination are methods of

reproduction

male reproductive system

= consist of paired testes (primary organ)
vas efferens, vas deferens, seminal vesicle,
ejaculatory duct, prostate gland and cirrus organ
(serves as male organ for copulation)
female reproductive system
= consist of a single ovary, oviduct, ootype where
components of egg are synthesized
= vitelline gland symmetrically arranged in the lateral
side of the body
= surrounding the ootype is a cluster of acinus glands
known as the Mehlis gland (shell gland of the parasite )
= seminal receptacle-storage of spermatozoa in female
= uterus – coiled tube arising from ootype and
terminate in the common genital atrium

Ova:
= all trematode are oviparous (liberate egg)
= smooth, hard shelled and operculated, except
Shistosome (non-operculated)
= generally yellow brown or brown colored
 Life Cycle of Liver, Intestinal & Lung Flukes
= requires one or more intermediate host to complete their life cycle
(sexual cycle–occurs in human, asexual cycle–intermediate host)
Adult worm (Sm. intestine of vertebrate host)

lays egg ingested by human
 
excreted in water and hatch metacercaria
 
free swimming miracidium liberated (fishes, water vegetation,
 snails, crabs/shrimps)
Ingested by snail (1st I.H.) encyst in tissue
of 2nd I.H.

(intramolluscan phase) swim in water
development inside snail 
sporocyst redia 1 redia 2 cercaria (emerge from snail)
Larval stages of trematodes:
1. Miracidium
= 1st larval stage that emerge from the egg in fresh water, as the
free-swimming ciliated embryo
= infective to mollusk only
2. Sporocyst
= emerge from the miracidium as sac-like structure containing the
2nd larval stage
= asexual multiplication among Schistosomes occurs in this stage
3. Redia
= 3rd larval stage developed within the sporocyst
= asexual multiplication for all trematodes occurs in this stage except
Schistosomes
4. Cercaria
= 4th larval or final stage of development occurring within the redia
= cercaria of most trematodes have tapered tail except Schistosomes
which have bifid or forked tail
= infective stage of Schistosomes to man
5. Metacercaria
= encysted cercaria occurring in the second intermediate host
= infective stage of all trematodes to man except Schistosomes.
Host of Trematodes:

Definitive host – Man (one that harbors the adult worm)

Intermediate host – 1st intermediate host – fresh water snail/

mollusk for larval development except
schistosomes
2nd intermediate host – required for
encystment of cercaria. Cercaria may
encyst in the following:

Plants /Water vegetation --- F. buski, F. hepatica

Fish ---------------------------- C. senensis, H. heterophyse
M. yokogawai, O. felineus
Crab/Crayfish ----------------- P. westermani
Another snail ----------------- E. ilocanum
Laboratory Diagnosis:
* Intestinal and Liver fluke:
demonstrate characteristic egg in stool
* Lung fluke:
demonstrate characteristic egg in
sputum, pleural fluid and stool

Treatment:
Praziquantel (drug of choice)
Bithionol/Niclosamide (alternate drug)
Classification of Trematodes based on their habitat:
I. Intestinal flukes (Small intestine)
a) Fasciolopsis buski
b) Echinostoma ilocanum
c) Echinostoma malayanum
d) Heterophyse heterophyse
e) Metagonimus yokogawai

II. Liver flukes (Biliary passage & liver)

a) Clonorchis sinensis
b) Opisthorchis felineus
c) Opisthorchis vinerrini
d) Fasciola hepatica
e) Fasciola gigantica

III. Lung fluke (lung)

a) Paragonimus westermani

IV. Blood flukes

a) Schistosoma japonicum portal venous plexus
b) Schistosoma mansoni
c) Schistosoma hematobium - vesical venous plexus
 Intestinal Flukes

Fasciolopsis buski

Common Name: Giant Intestinal Fluke

= common intestinal parasite of human and pigs in the
Orient
= lives in the small intestine of its definitive host rather
than in the liver
= considered to be the largest of the intestinal fluke

Disease: Fasciolopsiasis

Geographical Distribution:
= endemic in Southeast Asia, China, Korea, Taiwan, India
= endemnicity in the Philippines not demonstrated
Morphology:

Adult worm:
= elongate, broadly ovoidal,
large and fleshy,
anterior end narrower
than posterior end
= tegument – spinose
= absence of cephalic cone
= ventral sucker larger than oral sucker
= paired testes, highly branched at the posterior half of the
body arranged in tandem (one on top of other)
= intestinal ceca unbranched and extend up to the
posterior end
= ovary branched and lies midline anterior to the testes
= vitellaria extensive at the lateral margin of the body
= life span seldom exceeds 6 months
Egg = large, hen’s-egg shape, thin-shelled with
small operculum (identical to F. hepatica ova)
= average daily egg output 21,000-28,000
per fluke
= unembryonated when laid

MOT = ingestion of metacercaria encysted on fresh water

vegetation (bamboo shoots / water chestnuts) which
may be consumed raw or peeled with the teeth
 Pathogenesis and Clinical infection:
= pathological changes are traumatic, obstructive and toxic to
the intestinal mucosa
= localized inflammation, ulceration, abscesses formation and
hemorrhage occurs at the sites of worm attachment
producing increase mucus secretion and bleeding
= diarrhea, abdominal pain, anorexia, nausea and vomiting
may occur
= malabsorption syndrome occur in some infected patient
= heavy infection, worm may cause intestinal obstruction
with edema and ascitis
= intoxication may result from absorption of worm metabolite
by the host
Laboratory Diagnosis: = detection of egg in the stool
Prevention and Control:
= washing of plants or boiling kills the parasite
 Echinostoma ilocanum

Common Name: Garrison’s fluke

Disease: Echinostomiasis

Geog. Distribution:
= Confirmed to be endemic in the Philippines
= Prevalent in Northern Luzon, Leyte, Samar and
Mindanao
= endemic in Indonesia, India, China, Thailand,
Japan, Malaysia and Sumatra
= intestinal parasite of human and rats
Morphology:
Adult worm:

= flat, elongate, reddish-gray

colored, bluntly rounded
horse-shoe-shaped anterior end surrounded with
collarette of spines (distinguishing characteristic)
& posterior end attenuated
= oral sucker smaller than ventral sucker and lies
at the anterior fifth of the body
= tegument covered with plaque-like scales
= 2 lobed testes at the middle of the body in tandem
= ovary located in front of the testes
= vitellaria at the lateral side

Egg = ovoidal, operculated, thin-shelled

yellow-brown colored
= immature when passed in feces
 Echinostoma malayanum

= parasite of human and rats

Geographical distribution:
= Malay Peninsula, India, China, Sumatra

Morphology: Adult worm:

= ovoid shaped with attenuated anterior end
and bluntly rounded posterior end
= circumoral disc surrounded with
collarette of spines
= 2 large branched testes – deeply indented at tandem
= excretory system Y-shape appearance
= excretory bladder pouch-like
= ovary small located anterior to the testes
Pathogenesis and Clinical manif:
= little damage is produce as a result of the attachment of
the worm to the intestinal mucosa
= light infection usually asymptomatic
= heavy infection may produce inflammatory reaction and
mild ulceration with abdominal pain and diarrhea
= absorption of worm metabolites may result in general
intoxication

Lab. Diagnosis: Detection of egg in the stool

Treatment: Praziquantel

Prevention: Avoid eating raw or improper cooked 2nd I.H.

 Heterophyes heterophyes

Common Name: Von Siebolds Fluke

= smallest of the human fluke but the deadliest

Disease: Heterophysiasis

Geographical distribution:
= Egypt, Turkey, Far East (Japan, Korea, Central & South)
China, Taiwan & Philippines
Morphology:

Adult worm:
= elongate, oval or pyriform-shaped, attenuated anteriorly,
rounded posterior end
= tegument covered with fine scale-like spines more numerous
near the anterior end
= provided with 3 suckers:
oral – smaller and found anteriorly
ventral – larger and thick-walled found in the middle
third of the body
genital (gonotyl)– located near the left posterior border
of the ventral sucker armed with spines
= 2 ovoid-shaped testes at the posterior end of the body
= seminal receptacle retort-shaped
= vitellaria in the posterior third
= cirrus and cirrus sac absent
= globular slightly lobe ovary located anterior to the testes
Ova = ovoid-shaped, operculated
with broad anterior end
light-brown color
(same Metagonimus)
= embryonated when laid
= fully developed miracidium present within the egg when
deposited by adult worm

Cercaria
= tail keeled arm with spines
= pigmented eyespots

MOT – ingestion of metacercaria encysted under scales / flesh

of fish
Pathogenesis:
= attachment of adult worm to the intestinal wall may
produce no symptoms
= heavy infection may produce mild inflammatory reaction
causing damage to intestinal mucosa
= excessive mucus production and sloughing off of the
superficial layer of intestinal wall may occur
= infected individual may produce chronic intermittent
diarrhea, abdominal pain, anorexia and vomiting
= occasionally worm may invade the tissue and their egg
gain access to the circulation and disseminate to
different parts of the body
= ectopic ova: heart - provokes tissue reaction leading to
cardiac failure
spinal cord - result in loss of motor and
sensory function at the level where
lesions are located
brain – fatal cerebral hemorrhage
 Metagonimus yokogawai
(Yokogawai fluke)

Disease: Metagonimiasis

Geographical distribution:
= Spain, Israel, USSR, Prevalent in the Far East

Morphology: Adult worm:

= pyriform-shape, broadly rounded posteriorly and
attenuated anteriorly
= teguments has fine scale-like spines
= size larger than heterophyes
= ventral sucker deflected right of the midline
= vitellaria in a fan-shaped distribution
= 2 oval unequal size testes at posterior-third of the body
= ovary slightly lobe located submedian to the testes
Egg:
= minute, ovoidal, operculated with
thick-wall
= absence of knob at abopercular end
= fully developed miracidium inside
the egg when passed in stool

Cercaria:
= tail keeled, armed with spines
= pigmented eyespots
Pathology and Clinical Feature:
= causes mild inflammatory reaction in the intestinal
mucosa
= ectopic ova can cause granuloma in other organ
especially in the liver and brain

Lab. Diagnosis:
= detection of egg in stool using Kato-Katz method

Treatment:
= Praziquantel
 Liver Flukes

Fasciola hepatica (Sheep Liver Fluke)

Faciola gigantica (Giant Liver Fluke)

= parasites of the liver and biliary passage of human and

herbivorous animal especially ruminants
= causative agent of fascioliasis in ruminants
= considered to be the most important helminth infection in
cattle in tropical countries
= rare in human but common parasite of herbivores
(sheep, cattle)
= cosmopolitan - distribution

Disease: Fascioliasis Hepatica/Sheep Liver Rot

Halzouns disease (Pharyngeal fascioliasis)

MOT: - ingestion of metacercaria encysted in aquatic plants

Morphology: Fasciola hepatica

Adult worm:
= large, broad with flat body
= presence of conical projection at the
anterior end with its shoulders
called “Cephalic cone” (distinguishing feature)
= tegument’s covered with spines
= oral sucker smaller than ventral sucker
= uterus short and coiled
= seminal receptacle absent
= testes paired, large and highly branched
= ovary dendritic situated near the testes
= intestinal ceca long and highly branched at the posterior
end of the body
Egg:
= large, ovoidal and operculated, light yellow to brown
colored
= yolk granule clamped around the yolk cell
= unembryonated when passed in stool
Morphology: Fasciola gigantica
Adult worm
= larger, longer and more lanceolate than
F. hepatica
= cephalic cone shorter with shoulder less
developed
= ventral sucker larger than that of F. hepatica
= intestinal ceca more branched situated midline
of the body
= ovary longer & highly branched

Egg: = ovoid, operculated and larger than

F. hepatica
= measures 160-190 X 70-90u
= unembryonated when passed with
feces
Pathogenesis and Clinical Infection:

= 2 stages observed in human fascioliasis:

1. Acute / invasive stage

= coincide with larval migration and worm maturation
from the intestine to the liver parenchyma
= damage produced by the worm are traumatic and
necrotic when the worm burrows into the liver
tissue
= patient usually asymptomatic but may experience
high fever, right upper quadrant abdominal pain,
hepatomegaly and marked eosinophila
2. Chronic / Latent stage

= coincide with the persistence of the worm in the

billary duct
= results in hyperplasia of biliary epithelium,
proliferation of connective tissue with partial
or total biliary obstruction
= in heavy infection, atrophy of the liver parenchyma
may cause fibrosis and periductal cirrhosis
= ingestion of raw sheep or goat liver with adult worm
will result in local irritation and pharyngeal
infection “ Halzoun”
 Clonorchis sinensis
Opisthorchis felineus
Opisthorchis viverrini

= parasite of the bile duct and gallbladder of human and

fish eating mammals
= the main similarity between C. sinensis and Opisthorchis
species is the location of the vitellaria which are
found in the middle third of the body at the level
of the uterus
= the main differences of both parasite are in the
morphology and arrangement of the testes
= O. viverrini is differentiated from O. felineus in that the
testes of O. viverrini is close to each other and are
more deeply lobulated
= MOT-ingestion of metacercaria encysted in fresh water
fish that is eaten raw/undercooked (salted, dried/pickled)
 Clonorchis sinensis
Common Name: Chinese liver fluke
Disease: Clonorchiasis
Geog. Distribution: Confined to the Far East
(Korea, Japan, Taiwan, Formosa, Thailand, China)
Reservoir Host: man, dog, cat and other animals
Morphology: Adult worm
= elongate, leaf-shaped, attenuated anteriorly, rounded
posteriorly
= teguments smooth and transparent
= ventral sucker smaller than oral
= 2 highly branched (dendritic) testes in tandem at post-
half of the body
= cirrus pouch and prostate gland absent
= seminal receptacle retort-shaped
= uterus closely coiled
= ovary lobed at middle-3rd of body
= intestinal ceca long and extend down to the post. end
Egg: = thick, broadly ovoidal, operculated w/ small protuberance
at opposite end “OLD-FASHIONED ELECTRIC BULB”
appearance
= embryonated when laid

Cercaria:
= elongated with pigmented eye and keeled tail
Pathogenesis and Clinical Infection:

= light infection generally asymptomatic

= ingestion of large number of metacercaria may produce
symptoms characterized by fever, diarrhea, epigastric
pain, hepatomegally and jaundice
= leukocytosis and eosinophilia present
= heavy infection may result in functional impairment of the
liver secondary to billary obstruction aggravated by
hepatic stone formation, cholangitis and multiple liver
abscesses
= cholecystitis & cholelithiasis of the gallbladder may result
 Opisthorchis felineus

Common Name: Cat liver fluke

Disease: Opisthorchiasis

Geog. Distribution: Central and Eastern Europe, Siberia,

Poland, Korea, Japan, India, North Vietnam
and Philippines

= prevalent in cats, dogs, foxes and hogs

= highly endemic in Poland and areas where human

population eats raw or pickled fish
Morphology: (closely resemble C. sinensis)
Adult worm: = lancet-shape, aspinous, tapering anteriorly
and rounded posteriorly
= measures 7-12um L X 1.5-3um W
(shorter than C. sinensis)
= oral and ventral sucker equal in size
= integument smooth
= testes lobed and are arranged obliquely in
tandem at the posterior fourth of body
= absence of prostate gland and cirrus sac
= uterus coiled and ovary in close proximity with
the testes
Egg: = resemble egg of C. sinensis but narrower with more
tapering ends
= oval-shape, yellowish-brown color and operculated
= may or may not posses terminal tubercle-like knob
= fully embryonated when laid
Pathology:
= parasite in the bile duct initiate proliferative changes
of biliary epithelium resulting in dilatation and
thickening of the duct walls and eventually fibrotic
= worm burden and duration of infection causes
enlargement of the liver with passive congestion
of the spleen
= localized eosinophilia, hepatomegaly, impaired liver
function test may occur
= in rare cases may result to Cholangitis, Cholecystitis
and Cholangiocarcinoma
 Opisthorchis viverrini

Common Name: Southeast Asian liver fluke

Geog. Distribution: Major health problem in Northern Thailand

= infection is acquired through consumption of Koi-pla

(a dish prepared from uncooked fresh-water fish)

= adult parasite differs slightly in structure from

O. felineus
Morphology:
Adult = elongated, thin, transparent and aspinous,
attenuated anterior end rounded posterior end
= oral and ventral sucker are of same size
= 2 large lobed testes at posterior fourth of body
= lack prostate gland and cirrus sac
= uterus coiled
= ovary branched and coiled close proximity with
testes
= excretory bladder long and sac-like
Ova:
= oval-shape with operculum resting on the
shoulder
= presence of fully developed miracidium when
passed in stool
 O. viverrini and O. felineus

1st intermediate host

Snail – Bithynia leachi; Bithynia goniomphalus

2nd intermediate host

Ciprinoid fish - Punteus orphoides

Pathology and Clinical infection:

= inflammation & proliferative changes in the biliary tract
= fibrosis of the distal biliary vessel may also occur
= S/Sx epigastric pain, loss of appetite, flatulence and
fever, enlarged painful liver, jaundice and watery
diarrhea
Lab. Diagnosis:
= Detection of parasite egg in the stool and
duodenale aspirate
= Serological test:
ELISA – sensitive and highly specific
for human opisthorchiasis
= PCR 100% sensitive for detecting of O. viverrini
egg in the stool

Treatment:

= Praziquantel
 Lung Fluke

Paragonimus westermani

Common Name: Oriental Lung fluke

Geographical dist:
= most prevalent specie in the Far East, esp. China,
Japan, Korea, Taiwan and Philippines
(Leyte, Samar, Cotabato, Sorsogon and Camarines)
= endemic in Africa, Mexico, Central America, Peru and
Ecuador

Habitat: Parenchyma of the lung

Morphology:

Adult worm
= thick, fleshy, ovoidal body, reddish-brown
color, anteriorly rounded and tapering
posterior end
= teguments covered with spines
= oral and ventral suckers are equal in size
= 2 deeply lobed testes arranged side by
side at the posterior half of the body
= ovary lobed located posterior to the ventral sucker
= vitellaria extensively branched and covers the entire
length of the body
= cirrus and cirrus pouch absent
= uterus tightly coiled into a rosette formation found near
the ventral sucker
Egg:
= broadly ovoidal, thick-shelled with flattened
prominent operculum at the posterior end,
golden-brown color
= measures 80 X 55u
= unembryonated when laid

Cercaria
= knob-shaped tail with minute oral stylet

2nd Intermediate host

Disease: Paragonimiasis/Endemic Hemoptysis/Pulmonary distomiasis

= acquired through ingestion of raw or undercooked

crab meat containing encysted metacercaria which
provoke a granulomatous reaction in the lung with
development of fibrotic encapsulation formed by the
host tissue

= inflammatory reaction to the worm and the ova

leads to :
1. the formation of peribronchial granulomatous lesion
2. cystic dilatation of the bronchi
3. abscess formation
4. pneumonitis
= early stage of infection patients are usually asymptomatic

= heavy infection, common manifestation are:dry cough,

bloodstained or rusty-colored sputum, chest pain, dyspnea
and hemoptysis.

= migration allows the worm to lodge and mature in

different ectopic location which can leads to
involvement of the brain causing serious complication
like: “Jacksonian epilepsy”, cerebral hemorrhage,
visual disturbance and meningitis

= pulmonary infection is easily mistaken for pulmonary TB

Lab. Diagnosis:
= finding the typical operculated egg in sputum,
pleural fluid and feces
Treatment:
= Praziquantel
Bithionol – alternate drug
Prevention:
= adequate cooking of crab or crayfish should be done
before eating
= proper disposal of human waste
Life Cycle:
1. ingestion of crab/crayfish with metacercaria
2. excyst in duodenum and migrate to the intestinal
wall abdominal cavity diaphragm
pleural cavity lungs where they grow
3. self-fertilization occur and worms lays immature egg
4. passed out as immature ova either:
a.) thru coughing out with sputum
b.) swallowed and passed out with feces
5. eggs mature in water hatch liberating the
miracidium
6. swim in water and penetrate first intermediate host
7. intramolluscan cycle:
sporocyst redia cercaria
8. escape from the snail and encyst in crab and
crayfish
 Blood fluke
Schistosome
Differs from other Trematodes by:
1. separate sexes (dioecious)
2. eggs non-operculated with spines / knob on its shell
3. cercaria (infective stage)
4. absence of metacercarial stage in their life cycle
5. MOT - penetration of cercaria to the skin
6. no second intermediate host required
Specie of Medical Importance:
1. S. japonicum
2. S. mansoni
3. S. haematobium
GENERAL ANATOMY OF SCHISTOSOME
General charac. of Schistosomes:
Male:
= shorter, stouter and more robust than female
= lateral margin of male are folded ventrally to form a
gynecophoral canal where female resides
= both sexes have 2 suckers found at the anterior end
= muscular pharynx absent
= intestinal ceca reunite behind the ventral sucker
to form a single cecum. Length of the reunited
cecum varies in different species
= testes elliptical shape lying in a single column just
behind the ventral sucker
Female:
= long and slender with body almost circular in cross section
= ovary located anterior, posterior or at the middle of the
body
= uterus short or long depending on the specie
= laurer canal absent
Ova: = non-operculated and fully embryonated when laid
= cercaria bifid or forked tail
 Schistosoma japonicum

Common name: Oriental Blood Fluke

Disease: Oriental Shcistosomiasis, Snail fever, Bilharziasis,

Farmers disease

Geog. Distribution:
Common in the Far East: Japan, China, Formosa,
Thailand,
Endemic in Yangtze River Valley of Central China
and Philippines (Mindanao, Mindoro, Luzon,)
Samar, Leyte (Palo) & Bohol
Habitat = Superior mesenteric venule
Morphology: Adult worm
Male = elongate, cylindrical
= tegument’s – smooth
= presence of gynecophoral canal
= genital pore behind the ventral sucker
= ave. # of testes - 6-8 arrange in 1 row
above the ventral sucker
= 2 intestinal ceca unite more posteriorly
Female
= tegument’s smooth
= ovary centrally located
= uterus long and extend to middle of
the body and contains 50-100 eggs
= may live for 20-30 years
Ova
= biconcave/ovoidal/pear-shaped,
pale yellow color
= presence of rudimentary lateral knob
at one side near the polar end
= contain fully develop miracidium when
passed out with feces
Pathogenesis and Pathology:
= Schistosomiasis is a disease which is entirely due to
egg deposited in the liver, spleen and walls of the
GIT or bladder and not to the adult worm
= most of the pathologic findings is primarily due to host
reaction as a result of deposition of the egg charac.
by hepatosplenomegaly, lymphadenopathy,
abdominal pain and bloody diarrhea
3 phases:
1) Phase of invasion and migration
= encompasses the time from penetration of the
worm until maturity and egg production
= penetration of cercaria to the skin causes
dermatitis (swimmers itch), transient
pruritus, urticarial rashes and fever due to
damage of the skin by proteases and other
toxic substances secreted by the worm.
2) Phase of egg deposition and extrusion
= occurs during the acute stage of the disease or the
Katayama fever stage
= charac. by recurrent fever, chill, muscle pain,
lymphadenopathy, hepatosplenomegaly, profuse
diarrhea (stool bloody & mucoid) with marked
eosinophilia due to antigen secreted by the egg

3) Phase of fibrosis
= charac. by period of tissue proliferation and repair
= intestinal wall becomes thickened by fibrosis
= involvement of the liver induces granuloma formation
which leads to fibrosis, hepatosplenomegaly and
portal hypertension resulting in abdominal
distention, dyspnea and dilatation of the
superficial vein of abdomen
= CNS may occur due to deposition of egg in the brain
charac. by severe headache and convulsion
 Schistosoma mansoni

Common Name: Manson’s blood fluke

= smallest of the Schistosomes pathogenic to human

Disease: Intestinal Bilharziasis/Schistosomiasis/Katayama fever

Geog. Distribution: Common throughout tropical Africa,

Nile Valley, Puerto Rico, Brazil, Venezuela and
America

Habitat: = inferior mesenteric venules

Morphology: Adult worm
Male
= tegument’s grossly tuberculate and are
distinctly larger than those of
S. hematobium
= intestinal ceca unite early & the united
ceca is long
= ave. # of testes - 8-9 in zigzag row
Female
= teguments smooth
= uterus short and contains very few ova
1-4 eggs
= ovary located at the anterior half of body
Ova
= large, ovoidal, yellowish brown color
transparent shell w/ large prominent
lateral spine near the posterior end
and contains fully mature miracidium
Lab. Diagnosis:
1.) Specific diagnosis for S. japonicum and S. mansoni is based
on the presence of charac. egg in feces either by:
a.) direct fecal exam (NSS preparation)
b.) stool Concentration technique

Merthiolate-iodine – formalin concentration method

= suitable for field survey examination

Kato Katz technique

= considered to be the most suitable method of
enumeration for egg in feces

S. hematobium diagnosis can be done by demonstrating egg

from sediments that settles out of urine or by bladder biopsy
2.) Serological test
COPT (Circummoval precipitation test)
– regarded as the method of choice for definitive
diagnosis of schistosomiasis in the Philippines
ELISA (Enzyme-linked immunosorbent assay)
CFA (Complement fixation with adult cercarial antigen)
CA (Cercarial agglutination test)

Treatment – Praziquantel

Prevention:
= avoid wading in places infected with snail intermediate
host
= eradication of snail host and egg with chemicals
= educate population for proper disposal of human waste
and urine
= instruct farmer to wear rubber gloves and boots during
farming
 Schistosoma haematobium

Common Name: Vesical Blood Fluke

Disease: Vesical Schistosomiasis

Schistosomal Hematuria
Urinary Bilharziasis
Endemic Hematuria

Geog. Distribution: Prevalent in tropical Africa

= highly endemic in Nile Valley, Yemen, Turkey,
Western Asia and Southern Europe

Habitat: Vesical and Pelvic venous plexus

Morphology: Adult worm
Male
= shorter and stouter
= tegument’s contain small tubercle
= intestinal ceca unite at the middle
body and united ceca short
= testes large 4-5 arrange in group
Female
= long and slender
= ovary located in the posterior half
of the body
= uterus long & contains 20-30 eggs
at one time
Ova
= elongate, spindle-shaped with
distinct terminal spine at one pole
= yellowish brown color
Cercaria

Life Cycle:
(same with other Schistosome except for snail)
intermediate host

Genera: Bulinus
Planorbarius
Physopsis
Pathogenesis, Pathology and Symptomatology:
= primarily lives in the pelvic vessel
= damage occurs in the walls of the urinary bladder
producing granulomatous lesion and urethral occlusion
= infected patient often present hematuria
(most prominent manifestation)
= most bladder cancer in endemic areas are associated
with chronic infection of S. hematobium
= metabolite secreted by the worm provokes allergic reaction
= among male, seminal vesicle most frequently affected
producing ulceration and perivesical abscesses
= 80-90% of bladder infection occurs among female
= S/SX includes: hematuria, frequent and painful urination,
presence of mucus and pus in the urine

Lab. Diagnosis:
Microscopic examination of urine/feces for the presence of
egg with large terminal spine
General Life Cycle:
General Life Cycle:

 adult fluke S. japonicum and S. mansoni in the tributaries of

superior and inferior mesenteric vein
 S. hematobium in the venous flexus of the urinary bladder
 after copulation, female fluke gives off large number of
immature egg (500-2000 per day) and requires 10-12
days to mature/embryonate
 embryonated egg passed through the wall of the intestine or
bladder and out with feces/urine
 when it comes in contact with fresh water, egg hatched
liberating a free-swimming ciliated larva called
miracidium
 swim in water and penetrate appropriate snail intermediate host
 follows by intramolluscan cycle:
(mother sporocyst, daughter sporocyst, cercaria)
 cercaria leave the snail, swim in water and penetrate skin of the
definitive host casts off its tail transformed into
schistosomula after skin penetration enters the
superficial lymphatic vessel venous circulation heart
lung escape from the lung pleural cavity
diaphragm liver portal vein where they feed and grow
 when sexually mature migrate to superior and inferior
mesenteric vein (S. japonicum & S. mansoni) or to the venus
plexus of the urinary bladder (S. haematobium) where male
and female copulate
THE END