(F) Trematodes: Monoecious Trematodes (module-based) Flashcards
- hermaphrodites, leaf-shaped, flattened dorsoventrally
- need two intermediate hosts in their life cycle
Monoecious trematodes
MONOECIOUS TREMATODES
- Releases cercaria
- Metacercaria
- Snail Species
- Infective stage to the definitive hosts
A. 1st Intermediate Host
B. 2nd Intermediate host
ABAB
MONOECIOUS TREMATODES
Eggs laid may either be mature, with embryo called?
miracidium or immature
Enumerate Liver flukes
- FASCIOLA HEPATICA
- OPISTORCHIS FELINEUS
- OPISTHORCHIS VIVERRINI
- CLONORCHIS SINENSIS
- 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
FASCIOLA HEPATICA
adult fluke inhabits the?
proximal biliary tracts
in where they rolled like a mat
FASCIOLA HEPATICA
1st and 2nd intermediate host
1st: snail, Lymnea philippinensis
2nd: Nasturtium officinale
FASCIOLA HEPATICA
a watercress which is a species of aquatic flowering plant in the cabbage family.
Nasturtium officinale
FASCIOLA HEPATICA
Diagnostic feature of an Adult
cephalic cone
FASCIOLA HEPATICA
Diagnostic feature of an egg
large, hen’s egg- shaped
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 63-90m, large, hen’s egg- shaped (diagnostic feature), ovoid
With broad operculum
Light yellowish brown and immature
when laid
identify
FASCIOLA HEPATICA
FASCIOLA HEPATICA: Pathogenesis, Pathology and Clinical Manifestations
TOF. Metacercaria passing through the intestinal wall does not produce significant pathologic damage.
T
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
FASCIOLA HEPATICA: Pathogenesis, Pathology and Clinical Manifestations
Urticaria may be present, leukocytosis may reach up to how many percent?
60%
FASCIOLA HEPATICA: Pathogenesis, Pathology and Clinical Manifestations
developed because eggs can serve as nidus for stone formation
Gall stone (cholelithiasis)
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
FASCIOLA HEPATICA: Diagnosis
Enumerate
- DFS (eggs)
- Duodenal aspirates
- Biliary drainage
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)
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
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.
- 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
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
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
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
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
- first intermediate host
- 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
BA
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
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.
T
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.
T
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
- freshwater snails
- Pironella conica and Cerithidea cingulate
- Mugil cephalus (mullet), Tilapia nilotica, and Aphanius fasciatus
A. first intermediate hosts
B. Secondary intermediate hosts
may item na two answers
- AB
- A
- 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
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
- (uses specific antigen) shows persistent positive results
- positive only when the worms are still alive
A. Complement dixation
B. Serologic tests
BA
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.
