(F) Trematodes: Monoecious Trematodes (module-based) Flashcards by ASHLEY JARED DEFENSOR

hermaphrodites, leaf-shaped, flattened dorsoventrally
need two intermediate hosts in their life cycle

Monoecious trematodes

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MONOECIOUS TREMATODES

Releases cercaria
Metacercaria
Snail Species
Infective stage to the definitive hosts

A. 1st Intermediate Host
B. 2nd Intermediate host

ABAB

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MONOECIOUS TREMATODES

Eggs laid may either be mature, with embryo called?

miracidium or immature

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Enumerate Liver flukes

FASCIOLA HEPATICA
OPISTORCHIS FELINEUS
OPISTHORCHIS VIVERRINI
CLONORCHIS SINENSIS

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commonly known as the sheep liver fluke
causes sheep liver rot or fascioliasis hepatica
has a cosmopolitan distribution but most prevalent in sheep-raising countries

FASCIOLA HEPATICA

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FASCIOLA HEPATICA

adult fluke inhabits the?

proximal biliary tracts

in where they rolled like a mat

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FASCIOLA HEPATICA

1st and 2nd intermediate host

1st: snail, Lymnea philippinensis
2nd: Nasturtium officinale

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FASCIOLA HEPATICA

a watercress which is a species of aquatic flowering plant in the cabbage family.

Nasturtium officinale

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FASCIOLA HEPATICA

Diagnostic feature of an Adult

cephalic cone

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FASCIOLA HEPATICA

Diagnostic feature of an egg

large, hen’s egg- shaped

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Adult
 Flat, leaf-like, moderately fleshy with spines on its skin, up to 30 mm x 13 mm, with prominent cephalic cone (diagnostic of the genus) at anterior end.
 Ventral sucker slightly bigger than the oral sucker.
 Highly branched intestinal ceca extended to the posterior end
 Two highly dendritic (or branched) testes, one behind the other at the posterior 3rd and 4th of the body.
 Branched vitellaria at the entire lateral side, and a dendritic ovary at the right side of the anterior testis.

Egg
 130-150 X 63-90m, large, hen’s egg- shaped (diagnostic feature), ovoid
 With broad operculum
 Light yellowish brown and immature
when laid

identify

FASCIOLA HEPATICA

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FASCIOLA HEPATICA: Pathogenesis, Pathology and Clinical Manifestations

TOF. Metacercaria passing through the intestinal wall does not produce significant pathologic damage.

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FASCIOLA HEPATICA: Pathogenesis, Pathology and Clinical Manifestations

Parasites traversing the (liver/kidney) parenchyma produce linear necrotic lesion with eosinophils infiltration and hyperplasia of the bile ducts.

liver

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FASCIOLA HEPATICA: Pathogenesis, Pathology and Clinical Manifestations

Urticaria may be present, leukocytosis may reach up to how many percent?

60%

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FASCIOLA HEPATICA: Pathogenesis, Pathology and Clinical Manifestations

developed because eggs can serve as nidus for stone formation

Gall stone (cholelithiasis)

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FASCIOLA HEPATICA: Pathogenesis, Pathology and Clinical Manifestations

due to the temporary lodgment of adult worms in the pharynx, which may happen when a person eats liver of infected animals such as sheep and goats

Halzoun or pharyngeal fascioliasis

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FASCIOLA HEPATICA: Diagnosis

Enumerate

DFS (eggs)
Duodenal aspirates
Biliary drainage

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FASCIOLA HEPATICA: Pathogenesis, Pathology and Clinical Manifestations

TOF. You can get a true case of fascioliasis if you ingested infected animal’s liver.

F (false)

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FASCIOLA HEPATICA: Pathogenesis, Pathology and Clinical Manifestations

How to confirm a person has a false fascioliasis

liver-free diet for 3 days or more and if stool examination showed no eggs, it is likely to be false fascioliasis

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FASCIOLA HEPATICA:

Treatment and Control

Treatment: triclabendazole, nitazoxanide, surgical treatment
Prevention is through sanitary way of human waste disposal but will not eliminate the parasite due to presence of reservoir hosts such as goats, sheep, and cows. Sanitary protection of watercress beds against the infection should also be considered. Thorough cooking of vegetable will kill metacercaria but may not be accepted as such will change the appearance and nutritional value of the vegetable.

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known as the cat liver fluke is the etiologic agent for opistorchiasis or cat liver fluke infection
This trematode can be found in Europe mainly in Spain, Italy, Greece, France, Switzerland, Germany, Poland, and Russia.

OPISTORCHIS FELINEUS

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OPISTORCHIS FELINEUS

Bithynia leachi, a species of small freshwater snail
freshwater or cyprinoid fishes, such as Idus melanotus and Tinca tinca

A. 1st IH
B. 2nd IH

A
B

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Adult
 7-12 x 2-3 mm, lancet-shaped with smooth cuticle, attenuate anterior, rounded posterior, thin, transparent.
 Oral and ventral suckers: nearly of equal sizes.
 Simple intestinal ceca, two lobed testes are in oblique position at the posterior part of the worm, small, slightly lobed ovary, transversely compressed vitellaria distributed at the middle 3rd of the body.

OPISTORCHIS FELINEUS

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Egg
 Elongate ovoid with prominent operculum resting on a prominent rim, appears like an old-fashioned electric bulb (diagnostic)
 With a miracidium inside, light yellowish- brown, and with a minute thickening at the posterior part of the shell.

OPISTORCHIS FELINEUS

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# OPISTORCHIS FELINEUS Diagnostic feature of an egg

old-fashioned electric bulb

# OPISTORCHIS FELINEUS: Pathogenesis, Pathology, and Manifestations Maturing parasite in the (proximal/distal) bile ducts cause inflammation and proliferative changes in the biliary epithelium leading to fibrosis.

distal

# OPISTORCHIS FELINEUS: Pathogenesis, Pathology, and Manifestations The liver may enlarge and may leads to

passive congestion of the spleen

# OPISTORCHIS FELINEUS: Pathogenesis, Pathology, and Manifestations Bile stones may form around nest of eggs that may lead

cholecystitis (inflammation of gall bladder)

# OPISTORCHIS FELINEUS: Pathogenesis, Pathology, and Manifestations causing engorgement of superficial veins of the abdomen and esophageal varices may develop

Edema and formation of collateral circulation

# OPISTORCHIS FELINEUS: Lab diagnosis

* demonstration of eggs in direct fecal smear or duodenal aspirates

# OPISTORCHIS FELINEUS: Treatment

* Tribendimidine (effective) * Anti-helminthic drugs (praziquantel, albendazole, and miltefosine)

# OPISTORCHIS FELINEUS: TOF. Praziquantel, albendazole, and miltefosine are effective in killing the metacercaria but not on the cercariae.

F (reverse)

# O. felineus Prevention

* avoiding of eating raw or undercooked freshwater fish * proper and sanitary disposal of human waste

* commonly known as the Southeast Asian liver fluke, is a food-borne parasite * another cause of which remains a major public health problem in many parts of Southeast Asia * infections usually affect the poor and little importance is given to it in comparison to other diseases, and it is considered a neglected disease in Asia

OPISTHORCHIS VIVERRINI

# OPISTHORCHIS VIVERRINI 1. first intermediate host 2. second intermediate host A. fresh and brackish water fishes like Cyclocheilichthys, Puntius, and Hampala. B. freshwater snails such as Bithynia goniompharus, B. funiculata and B siamensis

# OPISTHORCHIS VIVERRINI The definitive host like humans and other fish-eating animals ingests undercooked fish containing the (infective stage)

metacercaria

# OPISTHORCHIS VIVERRINI Where does themetacercaria encyst?

duodenum ## Footnote and ascend through the ampulla of Vater into the biliary ducts, where they attach, become adults and lay eggs

* associated with hepatobiliary diseases, such as cholangitis, obstructive jaundice, hepatomegaly, cholecystitis and cholelithiasis.

OPISTHORCHIS VIVERRINI

# OPISTHORCHIS VIVERRINI Mild symptoms

may include dyspepsia, abdominal pain, constipation, or diarrhea.

# OPISTHORCHIS VIVERRINI Inhabits (mainly)

bile ducts, the gall bladder and pancreatic duct

# OPISTHORCHIS VIVERRINI (organ) are usually dilated, and cause fibrosi

bile ducts

# OPISTHORCHIS VIVERRINI There will be inflammation, epithelial hyperplasia, goblet-cell metaplasia, , and periductal fibrosis of the?

gall bladder

# OPISTHORCHIS VIVERRINI Rarely some will develop (2)

cholangitis and cholecystitis.

# OPISTHORCHIS VIVERRINI Lab diagnosis

DFS

# OPISTHORCHIS VIVERRINI Prevention

The same with Opistorchis felineus.

* known as the Chinese liver fluke * mainly found in Korea, China, Taiwan, Vietnam, and Japan * Humans become infected by eating raw or undercooked freshwater fish containing the larvae

CLONORCHIS SINENSIS

# CLONORCHIS SINENSIS First intermediate hosts

Snails under genus Parafossarulus, Bulimus, Semisulcospira, Alocinma and Melanoides

# CLONORCHIS SINENSIS most common sources of infection to man and the secondary hosts.

Fresh water fishes, of the family Cyprinidae such as ide (Cten- ocephalides idellus)

# CLONORCHIS SINENSIS: TOF. The same as that of Opistorchis felineus.

# CLONORCHIS SINENSIS: Laboratory Diagnosis, Treatment and Prevention

The same as that of Opistorchis felineus

Adult  10–25x3–5mm,flatspatulate, transparent.  Anterior is attenuated, slightly rounded posterior,  Integument has no spines,  Oral sucker is slightly bigger than ventral sucker.  Two deeply lobed or branched testes, one behind the other, situated at the posterior 3rd of the body.  Small, lobed ovary at the medial side between the posterior and middle 3rd of the body.  Vitellaria consist of small granules distributed at the middle 3rd at the lateral field of the body. Egg  Same appearance with that of Opistorchis felineus.

CLONORCHIS SINENSIS

* commonly known as the Garrison’s fluke * produces the disease echinostomiasis, a food-borne infection * first discovered in residents of Manila in 1907 * also reported in Indonesia, China, Thailand, and India

ECHINOSTOMA ILOCANUM

# ECHINOSTOMA ILOCANUM * first intermediate hosts * second intermediate hosts

* The first intermediate hosts are the planorbid snails such as Gyraulus convexiusculus and Hippeutis umbilicalis. * Large snails such as Pila conica, P. luzonica (kuhol), and Viviparus javanicus are its second intermediate hosts.

Adult  2.5-6.5 mm long and 1-1.35mm wide.  Reddish-gray when alive, with plaque-like scales on cuticle. Attenuated posterior end.  Anterior end has a prominent circumoral disk surrounding the oral sucker  Provided with a collarette of spines  Ventral sucker about 4x bigger than oral sucker.  Two deeply lobed testes, one behind the other, situated at the 3rd fourth of body.  Ovary is just in front of the anterior testis, vitellaria are of medium sized follicles distributed at the lateral field of the posterior 3/4 of the body.

ECHINOSTOMA ILOCANUM

Egg  83-116umx58-69um  Straw colored  Immature, with a small operculum.  Often with a prominent germ ball inside.

ECHINOSTOMA ILOCANUM

# E. ilocanum: Pathology, Pathogenesis, and Manifestations TOF. Echinostoma are not highly pathogenic.

# E. ilocanum: Pathology, Pathogenesis, and Manifestations This often occurs due to the penetration of the sharp- spined collar of the worn into the intestinal mucosa, which can create ulcerative lesions.

Inflammation

# E. ilocanum Treatment and precenbtion

* Echinostomiasis can be treated with praziquantel, as for other intestinal trematode infections * It can be prevented from refraining from eating raw freshwater fishes that serve as the source of the metacercaria. Other measures applicable to other flukes are also of great help in reducing, if not eliminating, the infection in a community.

* a small parasitic intestinal fluke that infects humans from eating raw or undercooked fish infected with metacercaria * Humans are the definitive host, and the adult worms are attached deep into the walls of the intestine * This trematode is endemic the Middle East, Philippines, Taiwan, Korea, China and Japan

HETEROPHYES HETEROPHYES

# HETEROPHYES HETEROPHYES 1. freshwater snails 2. Pironella conica and Cerithidea cingulate 3. Mugil cephalus (mullet), Tilapia nilotica, and Aphanius fasciatus A. first intermediate hosts B. Secondary intermediate hosts | may item na two answers

1. AB 2. A 3. B

# HETEROPHYES HETEROPHYES: Pathogenesis, Pathology, and Manifestations It may burrow to the intestinal mucosa to produce further irritation, which may lead to?

superficial necrosis

# HETEROPHYES HETEROPHYES: Pathogenesis, Pathology, and Manifestations common among infected individuals

Diarrhea

# HETEROPHYES HETEROPHYES: Pathogenesis, Pathology, and Manifestations Where are eggs may be filtered?

# HETEROPHYES HETEROPHYES: Pathogenesis, Pathology, and Manifestations In heart, what can eggs cause which may develop into heart failure and death?

myocarditis

# HETEROPHYES HETEROPHYES: Laboratory Diagnosis

identification of the eggs in direct fecal smear

# HETEROPHYES HETEROPHYES: Treatment, Prevention and Control

* praziquantel (3x daily for one day) * Preventive: refraining from eating raw freshwater fishes that serve as the source of the metacercaria

* also known as Yokogawa’s fluke * the causative agent of metagonimiasis * pathogenesis, pathology, manifestations, diagnosis, prevention and control, and other aspects of infection are similar with Heterophyes heterophyes

METAGONIMUS YOKOGAWAI

Lung Flukes A. CLONORCHIS SINENSIS B. FASCIOLA HEPATICA C. PARAGONIMUS WESTERMANI D. ECHINOSTOMA ILOCANUM

C. PARAGONIMUS WESTERMANI

* also referred as the oriental lung fluke produces oriental distomiasis or paragonomiasis * Places once heavily infected include the Far East, such as Japan and Korea * Some isolated areas exist in China, Taiwan, the Philippines, Thailand, Malaysia, and Bengal, and reported to be endemic in New Guinea, Solomon Islands, Java, Sumatra, Zaire, Nigeria, Peru, Ecuador, Colombia, Costa Rica, Mexico, and Venezuela.

Paragonimus westermani

# Paragonimus westermani 1st and 2nd intermediate

* Snails like Semisulcospira libertina, Brotia asperata, and Brotia costula episcopalis are the first intermediate host. * Secondary hosts are freshwater crabs under the genera Parathelpusa, Potamon, and Siamthelpusa and crayfishes under the genera Cambaroides, Procamburus, and Palaemon.

# P. westermanni: Pathogenesis, Pathology, and Manifestations The maturing parasite in the lungs induce leukocytic infiltration followed with production of a broad layer of fibrous tissues resulting to the formation of a thick cystic capsule called?

pulmonary pocket ## Footnote that enclose the organism

# P. westermanni: Pathogenesis, Pathology, and Manifestations Small blood vessels form around pulmonary pockets, with production of blood-tinged, thick, purulent fluid with flecks of rusty material that contains

clusters of eggs

# P. westermani diagnostic feature of an adult worm

zigzag intestinal ceca

Adult  7.5-12mmlong,4-6mmwide,and3.5-5 mm thick  Plump, ovoid, rounded anterior and tapered posterior ends (coffee-bean shaped)  Reddish-brown hue when alive, and provided with scale-like spines on its skin  Oral and ventral suckers are sub-equal  Two irregular, deeply lobed testes situated side by side at posterior part of the body  Large and lobular ovary  Vitellaria consist of branching follicles, and with zigzag intestinal ceca (diagnostic)

P. westermani

Egg  80-118x48-60um  Ovoid with flattened operculum  Posterior part of shell is thick (thickened aboperculum)

P. westermani

# P. westermani Lab diagnosis

* demonstration of the eggs in the sputum * may also be recovered in patients’ stool * Serologic tests that can be used are intra-dermal test (uses specific antigen) * complement fixation test

# P. westermani: Lab diagnosis 1. (uses specific antigen) shows persistent positive results 2. positive only when the worms are still alive A. Complement dixation B. Serologic tests

# P. westermani: Treatment and Prevention

* Praziquantel is the drug of choice (both adults and children) * a short course of corticosteroids (for cerebral disease) * Infection can be prevented by refraining from eating raw or inadequately cooked freshwater crabs or crayfishes, proper and sanitary disposal of human waste.