Blood Flukes Flashcards
Schistosoma
Type of fluke
Blood flukes
Schistosoma
Schistomes that can infect humans:
○ Schistosoma japonicum
○ Schistosoma mansoni
○ Schistosoma haematobium
○ Schistosoma intercalatum
○ Schistosoma mekongi
Schistosoma
Life span
30 years
Schistosoma
Intermediate host
Snails
Schistosoma
Infective stage
Forked tail cercaria
Schistosoma
MOT
Skin penetration
Life Cycle of Schistosoma
Humans are infected through skin penetration, usually
in contact with _____
water
Schistosoma
Final host
Human
Life Cycle of Schistosoma
Infection would usually happen early in the _____ when cercaria are being released into the water
morning
Schistosoma
Habitat
● Blood vessels
● Mesenteric veins (most species)
Schistosoma
supply blood to the intestinal tract
Mesenteric veins
Life Cycle of Schistosoma
Once skin is penetrated, circaria will find its way into the ______
blood vessels
Life Cycle of Schistosoma
Circaria release ______ that allow for
penetration to happen
lytic enzymes
Life Cycle of Schistosoma
The tail is lost during penetration and the circaria without the tail is called the ______ that enters the blood vessel
schistosomule
Life Cycle of Schistosoma
The female releases eggs that will be passed in the ______ or be deposited in to the ______ or ______ causing obstruction
- stool
- liver
- blood vessel
Life Cycle of Schistosoma
Once passed out in the feces, the eggs are
________
embryonated
Life Cycle of Schistosoma
If Schistosoma eggs are recovered in feces
S. mansoni and S. japonicum
Life Cycle of Schistosoma
If Schistosoma eggs are recovered in the urine
S. haematobium
Life Cycle of Schistosoma
Egg will find its way in freshwater, and eggs will hatch releasing _______.
miracid
Life Cycle of Schistosoma
These miracidium will penetrate the ___________.
snail intermediate host
Life Cycle of Schistosoma
Inside the _____, developmental processes are initiated.
snail
Life Cycle of Schistosoma
Schistosomule will migrate to portal blood in the _____ and mature into adults in the _________
- liver
- mesenteric veins
Life Cycle of Schistosoma
Schistosomule becomes a mature male or female worm and be found together ________.
copulating
Life Cycle of Schistosomav
_______ will be released from the snail, ready to infect another susceptible human host.
Cercariae
Life Cycle of Schistosoma
Miracidium will become _________
Sporocysts
Life Cycle of Schistosoma
Sporocysts will become _______
Cercariae
Life Cycle of Schistosoma
In the life cycle of Schistosoma, its unique feature is it has no _____ stage
redia
Schistosoma japonicum
Ovary appearance
Female
pyramidal
Schistosoma japonicum
Longer and slender
Female
Schistosoma japonicum
Ovary location
Female
middle
of the body
Snails Involved in Schistosoma
Snail intermediate host of Schistosoma haematobium
Bulinus
Snails Involved in Schistosoma
Snails Involved in Schistosoma
Biomphalaria
Schistosoma: Important Features of Adult Worms
Among the 3 major species, ________ adult worms are the largest in size
S. japonicum
Snails Involved in Schistosoma
Snail intermediate host of Schistosoma japonicum
Oncomelania
Schistosoma japonicum
Arrangement and number of testis
Male
in a single
file approximately
8-6 testis
Schistosoma japonicum
body covering is
smooth meaning it has no ________
Male
no integumentary
tuberculations
Schistosoma: Important Features of Adult Worms
Among the 3 major species, _________adult
worms are the smallest in size.
Schistosoma mansoni
Schistosoma mansoni
Arrangement and number of testis
Male
zigzag row around 8-9 testis
Schistosoma mansoni
Ovary location
Female
anterior half of the
worm
Schistosoma mansoni
tegument appearance
Male
rough;
prominent integumentary
tuberculations
Schistosoma haematobium
Arangement and number of testis
Male
In groups;
4-5 testis
Schistosoma haematobium
ovary location
Female
posterior half of the
worm
Schistosoma haematobium
Tegument has __________
Male
fine
integumentary
tuberculations
Schistosoma: Diagnostic Stages
Diagnostic stage
eggs
Schistosoma: Diagnostic Stages
First thing to consider with fluke eggs
They are
non-operculated
Schistosoma: Diagnostic Stages
Shape
Schistosoma japonicum
Round to oval
Schistosoma: Diagnostic Stages
Size comparison
Schistosoma japonicum
Smallest egg among 3 species
Schistosoma: Diagnostic Stages
Shape
Schistosoma mansoni
Oval
Schistosoma: Diagnostic Stages
Presence of _______
Schistosoma mansoni
lateral spine
Schistosoma: Diagnostic Stages
Presents of a knob:
Schistosoma japonicum
lateral knob/recurved hook
Schistosoma: Diagnostic Stages
shape
Schistosoma haematobium
Oval
Schistosoma: Diagnostic Stages
Presence of ________
Schistosoma haematobium
terminal spine
Types of schistosomes
Common
Name
S. japonicum
Oriental
Blood Fluke
Types of schistosomes
Habitat
S. japonicum
Superior mesenteric
vein of the small
intestine
Types of schistosomes
Location of
Ovary
S. japonicum
Middle
Types of schistosomes
IH
S. japonicum
Oncomelania hupensis
quadrasi
Types of schistosomes
Egg
Production
S. japonicum
Greatest
(3000 eggs per worm
pair per day)
Types of schistosomes
Integumentary
Tuberculations
S. japonicum
None
Types of schistosomes
Eggs
S. japonicum
Oval with recurved
hook or knob
Smallest
Types of schistosomes
Eggs
S. mansoni
Eliptical with
lateral spine
Types of schistosomes
Egg
Production
S. mansoni
190-200
eggs/day
Types of schistosomes
Integumentary
Tuberculations
S. mansoni
Prominent
Types of schistosomes
Location of
Ovary
S. mansoni
Anterior 1/2
Types of schistosomes
IH
S. mansoni
Biomphalaria
Types of schistosomes
Habitat
S. mansoni
Inferior mesenteric
vein of the colon
Types of schistosomes
Habitat
S. haematobium
Vesical, prostatic,
uterine plexuses of
the venous circulation
Types of schistosomes
Common Name
S. mansoni
Manson’s
Blood Fluke
Types of schistosomes
Common Name
S. haematobium
Vesical Blood Fluke
Types of schistosomes
IH
S. haematobium
Bulinus
Types of schistosomes
Location of
Ovary
S. haematobium
Posterior 1/2
Types of schistosomes
Egg
Production
S. haematobium
30 eggs/day
Types of schistosomes
Integumentary
Tuberculations
S. haematobium
Fine
Types of schistosomes
Eggs
S. haematobium
Eliptical with terminal
spine
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Schistosoma japonicum
Oriental Schistosomiasis; Snail Fever; Oriental blood fluke
Found in Asia
Schistosoma: Disease Manifestation (Schistosoma japonicum)
migrating larval
stages
Signs and symptoms of Oriental Schistosomiasis
Pulmonary Schistosomiasis
Schistosoma: Disease Manifestation (Schistosoma japonicum)
As the schistosomule is migrating towards the superior mesenteric veins that are found in the small intestine, patients
might experience _________
Signs and symptoms of Oriental Schistosomiasis
Pulmonary Schistosomiasis
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Itchiness, edema, hemorrhage at
the site of penetration
Signs and symptoms of Oriental Schistosomiasis
Schistosome Cercarial Dermatitis
Schistosoma: Disease Manifestation (Schistosoma japonicum)
may manifest
through dyspnea, cough, and hemoptysis
Signs and symptoms of Oriental Schistosomiasis
Pulmonary Schistosomiasis
Schistosoma: Disease Manifestation (Schistosoma japonicum)
dyspnea, cough
hemoptysis
Signs and symptoms of Oriental Schistosomiasis
Cor pulmonale
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Abrupt onset of fever, chills, muscle pain, headache, enlargement of liver (hepatomegaly), lymphadenopathy, dysentery/blood diarrhea
Katayama Syndrome/Katayama Fever
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Due to the ______
Katayama Syndrome/Katayama Fever
deposition of the eggs
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Acute phase:
Katayama Syndrome/Katayama Fever
Schistosoma: Disease Manifestation (Schistosoma japonicum)
This will happen ____ after the initial
manifestation
Katayama Syndrome/Katayama Fever
months
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Happens when the parasite is already in the ______ and the female worm is already releasing/producing eggs.
Katayama Syndrome/Katayama Fever
mesenteric veins
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Mucosal inflammation, ulceration, hyperplasia, blood loss, and lower abdominal
pain
Intestinal phase
Schistosoma: Disease Manifestation (Schistosoma japonicum)
The _____ can cause
ulceration of the intestine. As the
eggs are deposited in the
mesenteric veins, they may cause ulceration until it finds it way to the intestine
lateral knob
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Blood loss is possible due to
dysentery and the parasite capacity to digest _______
Intestinal phase
blood cells
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Chronic infection:
Hepatosplenic Schistosomiasis
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Around ______ from the time of infection
Hepatosplenic Schostosomiasis
18 months
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Eggs become trapped up by the ________
Hepatosplenic Schostosomiasis
portal of
blood flow
Schistosoma: Disease Manifestation (Schistosoma japonicum)
The eggs in the liver can trigger an inflammatory reaction that can lead to formation of __________
Hepatosplenic Schostosomiasis
granulomas
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Eggs can also be deposited in the liver that can cause blockage in the portal triad and can lead to:
Hepatosplenic Schostosomiasis
- portal hypertension
- enlargement of the spleen (hepatosplenomegaly)
- liver (hepatomegaly)
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Beacuse of the abundant
production of eggs, these eggs are now blocking the ______
Hepatosplenic Schostosomiasis
blood vessels
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Granulomas can be associated with:
Hepatosplenic Schostosomiasis
- scarring
- fibrosis of the liver
- symmer’s pipe
stem fibrosis
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Because of the blockage/obstructure, it may lead to:
Hepatosplenic Schostosomiasis
- Esophageal Varices
- Massive Ascites
Schistosoma: Disease Manifestation (Schistosoma japonicum)
Due to the pressure, the veins of
the _______ can dilate and can eventually rupture and lead to bleeding which can cause death to the patient
Hepatosplenic Schostosomiasis
esophagus
Schistosoma: Disease Manifestation (Schistosoma japonicum)
The eggs can find their way to the CNS, which can trigger the formation of granulomas in the brain—resulting in _________
Cerebral Schistosomiasis
Schistosoma: Disease Manifestation (Schistosoma japonicum)
In chronic cases of S. japonicum infections
Link to Occurrence to Colon Cancer and Liver
Cancer
Schistosoma: Disease Manifestation (Schistosoma japonicum)
The pathology of Schistosoma is always attributed to the
______
eggs
Schistosoma: Disease Manifestation (Schistosoma mansoni)
Location
Africa and in some parts
of South America
Schistosoma: Disease Manifestation (Schistosoma mansoni)
Intestinal Bilharziasis Signs and Symptoms:
- Schistosome Cercarial Dermatitis
- Acute Schistosomiasis
- Hepatosplenic Schistosomiasis
Schistosoma: Disease Manifestation (Schistosoma mansoni)
similar to japonicum
Intestinal Bilharziasis Signs and Symptoms
Schistosome Cercarial Dermatitis
Schistosoma: Disease Manifestation (Schistosoma mansoni)
Katayama-like fever (similar to
japonicum, but this is usually less
severe)
Intestinal Bilharziasis Signs and Symptoms
Acute Schistosomiasis
Schistosoma: Disease Manifestation (Schistosoma mansoni)
(less severe as compared to
japonicum)
Intestinal Bilharziasis Signs and Symptoms
Hepatosplenic Schistosomiasis
Schistosoma: Disease Manifestation (Schistosoma haematobium)
location
Middle East
Schistosoma: Disease Manifestation (Schistosoma haematobium)
S. haematobium primarily infects the ______, which are blood vessels near the urinary bladder. Hence, the eggs are released in the urine.
vesical plexuses
Schistosoma: Disease Manifestation (Schistosoma haematobium)
Usually asymptomatic; Symptoms
appear in _______
Signs and Symptoms of Urinary Bilharziasis
heavy infections
Schistosoma: Disease Manifestation (Schistosoma haematobium)
Associated with
Urinary Bilharziasis; Egyptian Hematuria
Schistosoma: Disease Manifestation (Schistosoma haematobium)
(difficulty in urination)
Signs and Symptoms of Urinary Bilharziasis
dysuria
Schistosoma: Disease Manifestation (Schistosoma haematobium)
Early signs and symptoms include:
Signs and Symptoms of Urinary Bilharziasis
dysuria and hematuria
Schistosoma: Disease Manifestation (Schistosoma haematobium)
(blood in urine)
Signs and Symptoms of Urinary Bilharziasis
hematuria
Schistosoma: Disease Manifestation (Schistosoma haematobium)
Link with
Signs and Symptoms of Urinary Bilharziasis
Bladder Carcinoma
(Squamous Cell Carcinoma)
Schistosoma: Disease Manifestation (Schistosoma haematobium)
can trigger irritation
or inflammatory reaction in the bladder. This leads to hematuria.
terminal spine
Schistosoma: Disease Manifestation (Schistosoma haematobium)
causes ________ syndrome
Signs and Symptoms of Urinary Bilharziasis
Nephrotic
Diagnosis
Primarily for S. japonicum and S. mansoni
Stool Exam
Diagnosis
Stool exam performed:
- Kato-Katz
- DFS
- FECT
Diagnosis
Technique used in Modified Acid Fast Staining
Modified Ziehl–Neelsen Technique
Diagnosis
Appropriate for S. mansoni
Modified Acid Fast Staining
Diagnosis
(+) result of Modified Ziehl–Neelsen Technique
red coloration of mansoni eggshell
Diagnosis
Time of collection
Detection of Eggs in Urine (in cases of S. haematobium)
12 pm to 3 pm
Diagnosis
But you can also collect ______
Detection of Eggs in Urine (in cases of S. haematobium)
24-hour urine
Diagnosis
For this, you would have to collect the urine samples produced by the patient in 24 hours. Then, you
concentrate or centrifuge the
samples
Detection of Eggs in Urine (in cases of S. haematobium)
24-hour urine
Diagnosis
In 24 hour urine, you examine the
______ to look for eggs.
Detection of Eggs in Urine (in cases of S. haematobium)
sediment
Diagnosis
Concentration Technique used
Detection of Eggs in Urine (in cases of S. haematobium)
Nucleopore Filtration
Technique
Diagnosis
To increase the detection of eggs in the urine sample
Detection of Eggs in Urine (in cases of S. haematobium)
Nucleopore Filtration
Technique
Diagnosis
This test determines the viability of miracidium (In order for us to determine if the larval stage inside the egg is still alive or viable)
Faust-Meleney’s Egg Hatching Technique
Diagnosis
The larva or miracidium is considered to be _____ if
the egg hatches and the miracidium swims.
Faust-Meleney’s Egg Hatching Technique
viable
Diagnosis
It is viable if
the miracidium is ______ near the light source
Faust-Meleney’s Egg Hatching Technique
concentrated
Diagnosis
There is a flask or a beaker filled with water, and it is covered with ___here you put the egg)
Faust-Meleney’s Egg Hatching Technique
foil
Diagnosis
At the end of the flask/beaker, you use
a flashlight to:
Faust-Meleney’s Egg Hatching Technique
- check if the egg will hatch
to release the miracidium - check if the miracidium follows the light
Diagnosis
To look for the eggs in the liver
Rectal or Liver Biopsy
Diagnosis
using adult worm extracts
Immunodiagnosis
Intradermal Tests
Diagnosis
Ab detection
Immunodiagnosis
- Indirect Hemagglutination
- ELISA
Diagnosis
Detection of Ag such as:
Immunodiagnosis
- CCA:Circulating Cathodic Antigen
- CAA:Circulating Anodic Antigen
- SEA: Soluble Egg Antigen
Diagnosis
Confirmatory Test / Definitive Test in the
Philippines
Immunodiagnosis
COPT - Circumoval Precipitin Test
Diagnosis
Patients in chronic cases may no longer excrete eggs in feces, so this serologic test is used to confirm
Immunodiagnosis
COPT - Circumoval Precipitin Test
Diagnosis
The Sample used COPT - Circumoval Precipitin Test
Immunodiagnosis
serum
Diagnosis
(+) Result in COPT - Circumoval Precipitin Test
Immunodiagnosis
Bleb or Septate Precipitates
(contain antibodies)
Diagnosis
Place ________ or ________
Schistosoma eggs on the slide (they would serve as reagents since they have antigen)
COPT - Circumoval Precipitin Test procedure
Immunodiagnosis
lyophilized or freeze-dried
Diagnosis
Mix it then on the 4 corners around the sample, place _________ or __________ then cover it with coverslip. They will be serve as a “tuntungan” because if there’s none, the egg may be crushed.
COPT - Circumoval Precipitin Test procedure
Immunodiagnosis
nail polish or ground glass
Diagnosis
Seal the edges of the coverslip with _________ or _______ (commonly used).
COPT - Circumoval Precipitin Test procedure
Immunodiagnosis
nail polish or melted paraffin wax
Diagnosis
Put it in the incubator for _____ at body temperature, after incubation, exam it under the microscope
COPT - Circumoval Precipitin Test procedure
Immunodiagnosis
2 days
Diagnosis
Skin test
Fairley Test
Treatment
Drug of choice
Praziquantel
Treatment
For S. haematobium
: Alternative drug is
Metrifonate
Epidemiology
S. japonicum
Asia
Epidemiology
S. manson
Africa
Epidemiology
S. haematobium
Middle East
Epidemiology
number of Endemic provinces
Philippine Situation
28
Epidemiology
number of Endemic municipalities
Philippine Situation
190
Epidemiology
National Prevalence Rate
Philippine Situation
4.68%
(DOH, 2017)
Epidemiology
In the latest survey, most cases are found in
Philippine Situation
Oriental Mindoro
Epidemiology
Endemic areas:
Philippine Situation
There are cases in most parts of mindanao:
- leyte and samar regions
- mindoro
- negros occidental
- cagayan valley
Epidemiology
higher among what sex?
Philippine Situation
males
Epidemiology
Higher among what age (adults or children)
Philippine Situation
adults
Epidemiology
Occur with other ___________
Philippine Situation
helminthic infections
Other Blood Flukes
Occurs in Western and Central Africa
Schistosoma intercalatum
Other Blood Flukes
Snail
Schistosoma intercalatum
Bulinis
Other Blood Flukes
Eggs are similar to S. haematobium; there is curvature
of spine; Presence of central bulge
Schistosoma intercalatum
Other Blood Flukes
Eggs appearance
Schistosoma intercalatum
Hourglass
Other Blood Flukes
Can be positive in Ziehl-neelsen Technique
Schistosoma intercalatum
Other Blood Flukes
Found in Asia, primarily found in Mekong River basin in Cambodia
Schistosoma mekongi
Other Blood Flukes
Eggs are smaller than S. japonicum
Schistosoma mekongi
Other Blood Flukes
Milder infection compared to S. japonicum
Schistosoma mekongi
Other Blood Flukes
IH
Schistosoma mekongi
Neotricula, Lithoglyphopsis (snails)
Other Blood Flukes
Primarily schistosome of birds, humans can get
infected
Avian Schistosoma
Other Blood Flukes
Cause swimmer’s itch, lake itch, duck itch
Avian Schistosoma
Other Blood Flukes
Allergic reaction due to penetration of _______
Avian Schistosoma
circaria
