2. General Characteristics
• Trematodes
• Flat worms or flukes
• Have two or more hosts
• Fresh Water Snails are first intermediate hosts
• Eggs
• Some are embryonated
• Some contain miracidium
• Operculated except schistosomes.
• Miracidium
• Embryonated part which
• infect snails
• Cercariae
• Miracidia infected snails go through a
process to produce cercariae
• Cercariae are released by snails into
fresh water
• They swim until they find the next
host
• They may excyst to form metacercaria
• Other Characteristics
• Hermaphrodites except Schistosomes
• Treated with praziquantel
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5. Fasciola hepatica (Sheep Liver Fluke)
• Fasciola hepatica causes a disease known as fascioliasis
• It is distributed worldwide and is common in sheep rearing areas of the world
• Man is infected accidentally or become an accidental definitive host by eating fresh
water plants (e.g. watercress ) that are infected with the Fasciola hepatica
metacercariae
• Intermediate hosts of F. hepatica are air-breathing freshwater snails from the family
Lymnaeidae. Galba truncatula is the main snail host in Europe, partly in Asia, Africa
and South America
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6. Morphology
• Adults Fasciola hepatica are flattened, leaf-shaped and brown coloured, having a
cone-shaped anterior protrusion and rounded posterior end
• The fluke measures 2.5 cm to 3 cm in length and 1.5 cm in breadth
• They have an anterior and a ventral suckers
• The adult worms are smaller in sizes than Fasciolopsis buski
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7. Contd….
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• Egg: The eggs are large, ovoid and bile-stained and have a small, but distinct
operculum
• They measure 130-150 µm by 63-90 µm
• These are unembryonated when freshly passed
• The eggs are excreted in the bile into the duodenum, from where they are
excreted out in the faeces
• Further development of the eggs take place only in water
10. Clinical Manifestation
• Human Fasciola hepatica infection is manifested by headache, chills, fever
and right upper quadrant pain
• Hepatomegaly, jaundice, diarrhoea and anemia may occur in severe infections
• Hepatic, biliary cirrhosis is a late complication
Diagnosis
• Stool R/E
• Wet preparation
• Concentration technique
Treatment
• Praziquantel
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Prevention
• Can be prevented by not eating
• Wild aquatic vegetables (watercress)
• Raw sheep
11. Clonorchis sinensis (Chinese or oriental liver fluke)
• It infects fish-eating mammals including humans
• In humans, it infects the common bile duct and gall bladder, feeding on bile
• The fluke passes its life cycle in three different hosts: freshwater snail
(Paraforssarulus manchouricus) as first intermediate host, freshwater fish as
second intermediate host, and mammals as definitive host
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12. Morphology
• Eggs
• Clonorchis sinensis eggs are small, ranging in size from 27 to 35 µm by 11 to 20
µm.
• The eggs are oval shaped with a convex operculum that rests on visible
“shoulders” at the smaller end of the egg.
• At the opposite (abopercular) end, a small knob or hook-like protrusion is often
visible.
• The miracidium is visible inside the egg. Eggs of C. sinensis are highly
morphologically similar to Opisthorchis spp.
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13. Contd….
• Adult
• Clonorchis sinensis adults are flattened, lance shaped, and measure
approximately 10 to 25 mm long by 3 to 5 mm wide.
• The oral and ventral suckers (acetabulum) are relatively small.
• The two testes are located posterior to the ovary, and are highly branched–a
feature which separates it from the related Opisthorchis spp. (rounded
testes).
• Reside in the biliary passages of the liver of the definitive host.
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16. Clinical Manifestation
• Mostly asymptomatic
• Pathological manifestations result from inflammation and intermittent obstruction of
the biliary ducts
• The acute phase consist of abdominal pain, nausea and diarrhoea
• Chronic phase consist of fatigue, abdominal discomfort, anorexia, weight loss,
diarrhoea and jaundice
• The pathology of long-standing infections consist of bile stasis, obstruction, bacterial
infections, inflammation, periductal fibrosis and hyperplasia
• Development of cholangiocarcinoma is progressive
Diagnosis
• Stool R/E
Treatment
• Praziquantel
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Prevention
• Adequate cooking of fish
• Proper disposal of human
waste
18. Paragonimus westermani
• Paragonimus westermani and other Paragonimus species are lung flukes causing
paragonimiasis.
• Human infections are most common in West Africa, the Far East and certain
regions of Central and South America
• Less frequent, but more serious cases of paragonimiasis occur when the parasite
travels to the central nervous system.
• Humans become infected following ingestion of raw or poorly cooked fresh water
crab – meat or cray – fish, the flesh of which contains the encysted metacercariae
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19. Morphology
• Egg is ovoid, relative thick-shell golden brown in colour and has a flattened
operculum at the large end and the opposite (abopercular) end is thickened
• Adult worm – reddish brown in colour live in the cavities in the lungs
Egg Adult
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21. Clinical Manifestation
• P. westermani infection of the lungs causes cough, blood-stained sputum, chest
pain and night sweats. These symptoms (and the chest X-ray) may mimic
tuberculosis
• Adult worms of P. westermani occasionally invade sites outside the lung, e.g.
lymph glands, subcutaneous tissue, eyes, testes and brain causing severe disease
Diagnosis
• Wet mount preparation of sputum and stool observed under the microscope
Treatment
• Praziquantel
Prevention
• Adequate cooking of crab
• Proper disposal of human waste
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22. SUMMARY
Fasciola hepatica
• Disease
• Fasciolosis /Fascioliasis
• Mode of transmission:
• Ingestion of aquatic plants (e.g. water cress)
or raw sheep liver infected with metacercariae
• Intermediate hosts
• fresh water snail of genus Lymnae
• Aquatic vegetations and water cress
• Reservoir
• Sheep, cattle, rabbits
• Features of egg
• Large, ovoid with a small but distinct operculum
• Features of adult
• Flattened and leaf-like, having a cone shaped anterior protrusion.
• Life cycle:
• Egg Miracidia Sporocyst Rediae Cercariae Metacercariae Adult fluke
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• Habitat
• Liver (bile tract)
• Infective stage
• Metacercariae
• Diagnostic stage
• Unembryonated
eggs
• Specimen for
laboratory diagnosis
• Sputum, urine and
faeces
23. SUMMARY CONTINUED.
Clonorchis sinensis
• Disease
• Clonorchiasis
• Mode of transmission:
• Via feco-oral route
• By eating raw or undercooked infected fish
• Intermediate hosts
• Freshwater snail (Paraforssarulus manchouricus)
• freshwater fish
• Features of egg
• Oval shaped with a convex operculum (Ant. end)
• Abopercular end, a small knob or hook-like protrusion (Post. end)
• Features of adult
• Narrow and flattened dorsal-ventrally
• Tapered at the anterior end and rounded at the posterior end
• Life cycle:
• Egg Miracidia Sporocyst Rediae Cercariae Metacercariae Adult fluke
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• Habitat
• Distal biliary
passages and
pancreatic duct
• Infective stage
• Metacercariae
• Diagnostic stage
• Embryonated eggs
• Specimen for
laboratory diagnosis
• Sputum, urine and
faeces
24. SUMMARY CONTINUED.
Paragonimus westermani
• Disease
• Paragonimiasis
• Mode of transmission:
• Via feco-oral route
• By eating raw or undercooked crab meat or crayfish
• Intermediate hosts
• Freshwater snail as first intermediate host
• Freshwater crustacean as second intermediate host
• Features of egg
• Ovoid, relative thick-shell golden brown in colour
• Flattened operculum at the large end
• Opposite (abopercular) end is thickened
• Features of adult
• Reddish brown in colour
• Similar in size and appearance to a coffee bean
• Life cycle:
• Egg Miracidia Sporocyst Rediae Cercariae Metacercariae Adult fluke
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• Habitat
• Parenchyma of the lungs
• Infective stage
• Metacercariae
• Diagnostic stage
• Unembryonated eggs
• Specimen for laboratory
diagnosis
• Sputum, faeces