LIVER FLUKES Fasciola hepatica

CN- Sheep Liver Fluke/Common Liver Fluke Disease-Sheep Liver Rot/Fascioliasis hepatica GD-WW

Morphology: ▪ large, flat, leaf-shaped ▪ Cephalic cone at the anterior end- ▪ posterior end is broadly pointed ▪ has a pair of intestinal ceca w/c have numerous lateral branches or diverticula ▪ monoecious/hermaphroditic

Male RS Female RS Ovum ▪ has 2 highly branched testes in tandem position-at the posterior ½ of the body ▪ 1 testes lies behind the other

▪ Has a single ovary w/c is dendritic and lies anterior to the testes ▪ Vitellaria: highly branched&extend thru the lateral fields ▪ Short Laurer’s canal but no Seminal receptacle

▪ Large,operculated, ovoidal and brownish yellow in color ▪ LARGEST egg in parasitology ▪ Immature when laid ▪ Inside egg—yolk cells (enclosed w/in VM&Shell Proper) ▪ Large hen’s egg-shaped-

Ingestion of fresh H2O plants(Water Cress) w/ metacercaria—excysts in duodenum—Adolescaria penetrate intestinal wall—abdominal cavity—Glisson’s capsule of liver—grow into adults in the Bile ducts—self-fertilization occurs—worms lay eggs w/c are passed to the duodenum and excreted w/ feces as immature or unembryonated eggs—mature in H2O—Miracidium hatch out thru the operculum—swim&enter the snail (Lymnea)—becomes Sporocyst—1st gen Redia—2nd gen Redia—cercaria are produced and escape out of snail host—swim&encyst in fresh H2O plants&grasses

Life Cycle looks for 2nd IH: cercaria 2nd IH: fresh H2O plants—water cress Infective stage to man: metacercaria Habitat: bile ducts looks for 1st IH: miracidium 1st IH: snail (Lymnea)

DH: sheep, goat, cattle, man Life Span of Adult Worm: 9-13 yrs

Diagnosis ▪ Recovery of eggs from stools, duodenal or biliary drainage ▪ Complement-Fixation and hemagglutination tests Intracutaneous test w/ antigens from adult fluke

Fasciola gigantica ▪ Larger and more lanceolate ▪ Short cephalic cone ▪ Large ventral sucker

▪ Testes has more anterior location ▪ Ovary is not dendirtic ▪ Eggs are larger

Chlonorchis sinensis CM: Chinese Liver Fluke/ Oriental Liver Fluke Disease: chlonorchiasis GD: Japan,Korea,Taiwan,South China and Indochina (Laos, Cambodia, Vietnam)

Morphology: ▪ MINUTE ▪ Flat, elongate, aspinose (integument is moved—no spine) w/ tapered anterior end and rounded posterior end ▪ Ventral sucker is smaller than Oral sucker-- ▪ Pair of long simple intestinal ceca w/c extend to the posterior end

Male RS Female RS Ovum Cercaria ▪ Pair of deeply lobulated or branched testes in tandem formation ▪ Poorly develop ejaculatory duct ▪ The Cirrus sac, Cirrus organ and Prostate gland are absent.--

▪ Small slightly lobed ovary located in the midline of the body ▪ Uterus: compactly coiled ▪ Vitellaria: delicate fine granular aggregates at the lateral fields

▪ Yellowish brown in color ▪ Old Fashioned Electric Bulb ▪ Fully embryonated when laid—inside: miracidium ▪ Narrow anterior end w/ distinct opercular shoulders ▪ Operculum-teapot-like appearance ▪ At posterior end. Small median protuberance w/c is usually comma-shaped ▪ Ave daily egg output—1000-2000/fluke

▪ Lophocercous w/ pigmented “eye-spots”-- ▪ Large fluted tail (grooves at sides of tail)

Ingestion of metacercaria in Cyprinoid fish—metacercaria excyst in duodenum—Adolescaria enters the Common Bile ducts thru—Ampula of Vater—Migrate to distal biliary passages—become adult worms—self-fertilization occurs&adult worms lay eggs in biliary passages—Eggs are passed into the duodenum, excreted w/ feces as fully embryonated eggs—Eggs ingested by snail (Bulimus)—Miracidium hatches out in midgut of snail—penetrates intestinal wall to vascular—Sporocyst—Redia—Cercariae are produced—Cercariae escape from snail into H2O—Encyst in Cyprinoid fish (scales/flesh)

Life Cycle looks for 2nd IH: cercariae 2nd IH: Cyprinoid fish Infective stage to man: metacercaria Habitat: distal biliary passages looks for 1st IH: eggs 1st IH: snail (Bulimus)

DH: Man, dog, cat, pig **in heavy infection worms are also found in larger bile ducts, gall bladder and pancreatic ducts Life Span of Adult Worm: 15-20yrs

Diagnosis

▪ Recovery of characteristic embryonated eggs from feces or duodenal aspirates ▪ Complement-Fixation test ▪ Indirect Hemagglutination test ▪ Intracutaneous test

Opistorchis felineus CN: Cat Liver Fluke *cat-also serves as DH Dis: Opistorchiasis GD: found in Europe and USSR-Georgia, also in Vietnam, Japan and India

Morphology: ▪ MINUTE ▪ Flat, elongate, lanceolate w/ tapering end ▪ Living worm is reddish-bile colored ▪ Aspinose ▪ OS and VS are equal.-- ▪ Pair of long simple ceca w/c run the entire length of body

Male RS Female RS Ovum Cercaria ▪ Pair of small lobate testes in tandem position ▪ Cirrus Sac, Cirrus Organ& Prostate gland are absent

▪ Small ovary w/c is oval/slightly lobed and found in the middle of body ▪ Vitellaria: numerous transversely compressed follicles at lateral fields

▪ Indistinguishable from the egg of C sinensis ▪ Yellowish brown. 3 times as long as broad (narrower)-- ▪ Posterior end: usually a minute tubercular thickening

▪ Lophocercous w/ pigmented “eye-spots” ▪ DH: man and cat ▪ 1st,2nd IH,LC&Diag: same in C sinensis ▪ Habitat: Biliary&pancreatic passages

How will you differentiate O felineus & C sinensis? ---adult worm & egg morphology Opistorchis viverrini

▪ Important parasite in NE Thailand—also found in Laos and Cambodia ▪ Can be differentiated from O felineus by:

1. greater proximity of ovary and testes 2. aggregation of its vitellaria into a few cluster of glandular material 3. egg measures 28x16u and may or may not possess terminal tubercle-like knob

▪ more like chlonorchis than felineus ▪ 1st IH: Bithynia spp or Bulimus snail ▪ 2nd IH: Punteus sp. (fish)

Liver Flukes Recap: Fasciola hepatica, F gigantica, Chlonorchis sinensis, Opistorchis felineus, O viverrini MINUTE: O felineus and C sinensis

INTESTINAL FLUKES Fasciolopsis buski

CN: Giant Intestinal Fluke Dis: Fasciolopsiasis GD: Central and South China, Taiwan, Vietnam, Thailand, Borneo-Malaysia, Sumatra-Indonesia LARGEST trematode parasitic to man

Morphology: ▪ Elongate ▪ OS is smaller than VS. OS-1/4 VS ▪ Pair of simple intestinal ceca with lateral indentations

Male RS Female RS Ova

▪ 2 highly large testes w/c lie in tandem position at the posterior ½ of the body

▪ single branched ovary ▪ ellipsoidal in shape w/ clear thick shell and small operculum ▪ almost identical to hepatica ovum ▪ Vitellaria: finely granular ▪ Short Laurer’s canal but no seminal receptacle ▪ Ave daily egg output: 21000-28000/fluke

▪ Ellipsoidal w/ small operculum ▪ Almost identical to F hepatica ▪ Large hen’s egg-shaped ovum—inside: yolk cells ▪ Immature-feces

Ingestion of fresh H2O vegetation w/ metacercaria—excyst in duodenum and develop into adults in the small intestine—self-fertilization occurs and worms lay eggs—Eggs passed out w/ feces as immature ova—find their way into the H2O where they mature and hatch thru-the operculum—miracidium is released. Swim and penetrate the 1st IH (Segmentina)—sporocyst—1st gen Redia—2nd gen Redia—Cercaria escapes from snail and encyst in fresh H2O vegetation

2nd IH= fresh H2O/aquatic vegetation: ▪ Water caltrops (Trapa bicornis, Trapa natans)—water buffalo nut ▪ Water chestnuts ▪ Water hyacinths ▪ Water bamboo ▪ Morning glory ▪ Lotus

Life Cycle

looks for 2nd IH: cercaria 2nd IH: fresh H2O vegetation Infective stage to man: metacercaria Habitat: small intestine looks for 1st IH: miracidium 1st IH: Segmentina

▪ DH: man and pig ▪ Life Span of adult worm: not more than 6 months ▪ Diagnosis: recovery of eggs in feces

Echinostoma Ilocanum CN:Garrison’s Fluke Dis: Echinostomiasis GD: Java, Celebes, China and the Phil. (Luzon, Leyte & Samar)

Morphology: ▪ Flat, elongate ▪ Reddish gray when alive ▪ Circumoral Disk w/ 2 alternating rows of spines

o Surrounds OS ▪ OS lies in the center of the circumoral disk and it is smaller than the ventral sucker ▪ Pair of simple intestinal ceca

Male RS Female RS Ovum ▪ Pair of deeply lobed testes in tandem position ▪ Has a single ovoidal ovary

▪ Vitellaria: medium sized follicles occupying the posterior ¾ of the lateral fields

▪ Straw colored. Ovoidal and operculated. ▪ Immature when laid—yolk cells ▪ Germinal area

Ingestion of raw snail (Pila luzonica/conica) w/ metacercaria—Excyst in duodenum and grow into adults in the small intestine—SF occurs and adults lay eggs—Immature eggs passed out w/ the feces—Eggs mature in H2O and miracidium hatch out thru-the operculum—Penetrate 1st IH (Gyraulus convexiusculus)—develop into mother redia—daughter redia—Cercariae are produced—escape from snail—Encyst in another snail (Pila luzonica/conica)

Life Cycle

looks for 2nd IH: cercaria 2nd IH: snail (Pila luzonica/conica) Infective stage to man: metacercaria Habitat: small intestine looks for 1st IH: miracidium 1st IH: Gyraulus convexiusculus

DH: Man SS: intestinal colic and diarrhea Lab Dx: recovery of immature ova in feces

Heterophyes heterophyes

CN: Von Siebold’s Fluke Dis: Heterophysiasis GD: Egypt, Central & South China, Japan, Korea, Taiwan & Philippines SMALLEST trematode infective to man

Morphology: ▪ MINUTE ▪ Elongate, pyriform/pear-shaped, flat w/ narrow anterior and broadly rounded posterior end ▪ OS is small and the VS is larger, thick and muscular ▪ Has a genital sucker —located at the left posterior border of the VS; surrounds genital pore ▪ Pair f simple intestinal ceca

Male RS Female RS Ovum Cercaria

▪ Pair of oval testes found at the posterior end of the body ▪ Cirrus Sac and Cirrus Organ are absent

▪ Small subglobose ovary ▪ Vitellaria: large polygonal follicles in the lateral posterior 3rd of the body; 14 follicles on each side

▪ Resembles chlonorchis ▪ Minute. Operculated, ovoidal w/ broad anterior end ▪ Indistinct opercular shoulders ▪ May or may not possess a knob at th posterior end ▪ Fully embryonated ▪ Hatch only when ingested by 1st IH

▪ Lophocercous w/ pigmented “eye-spots”

Ingestion of Mullet fish (eg tilapia) w/ metacercaria—excyst in small intestine and develop into adult worms—SF occurs and worms lay eggs w/c are passed out w/ feces as fully embryonated eggs—Eggs are ingested by snail (Potomididae)—miracidium escapes and becomes Sporocst—1st geb Redia—2nd gen Redia—Cercaria escapes from snail—encyst under scales, fins, gills or muscles of fish (Mullet)

Life Cycle looks for 2nd IH: cercaria 2nd IH: Mullet fish (eg tilapia) Infective stage to man: metacercaria Habitat: small intestine looks for 1st IH: Eggs 1st IH: snail (Potomididae)

DH: Cat, Dog, Wolf, Fox and Man Life Span of adult worm: 2 months Lab Dx: recovery of eggs from feces

Metagonimus yokogawai CN: Yokogawai’s Fluke Dis: Metagonimiasis GD: Japan, Korea, Taiwan, China, Philippines

Morphology: ▪ MINUTE ▪ Pyriform/ pear-shaped ▪ VS is deflected and situated to the right of the midline—off-center ▪ Anterior rim of the VS is fused w/ the muscular outer rim of the genital pore ▪ Pair of simple intestinal ceca

Male RS Female RS Ovum Cercaria ▪ pair of oval testes w/c lie obliquely side by side

▪ has a single globose ovary w/c is located anterior to the testes ▪ Vitellaria: coarsely granular in a parallel fan-shaped arrangement

▪ Minute ▪ Small, ovoidal, thick shelled and operculated ▪ Nodular thickening at the posterior end ▪ Opercular shoulders are slightly distinct ▪ Fully embryonated when laid ▪ Hatch only when ingested by 1st IH?

▪ Lophocercous w/ pigmented “eye-spots”

Life Cycle

DH: Man. Pig, dog, cat and pelican 1st IH: snail (Thiara sp. Or Semisulcospira libertina) 2nd IH: fresh water fish (Mullet fish) Life Span of adult worm: 1 year

same as H. heterophyes

Cathaemasia cabrerai ▪ An intestinal fluke (1986(; Echaque, Isabela ▪ 90 persons were afflicted after eating Birabid snails (2nd IH) ▪ Cathaemasiasis=stomach pains similar to peptic ulcer

Intestinal Flukes Recap: F. buski, E ilocanum, H heterophyes, M yokogawai MINUTE: Heterophyes heterophyes, Metagonimus yokogawai Largest trematode parasitic to man: F buski Smalles trematode infective to man: H heterophyes

LUNG FLUKES

Paragonimus wetermani CN: Oriental Lung Fluke Dis: Paragonimiasis, Pulmonary distomiasis or Edemic hemoptysis GD: WW, in the Phil Leyte, Samar, Mindanao (Cotabato), Sorsogon & Camarines

Morphology: ▪ Egg-shaped or coffee-bean shaped ▪ Thick and fleshy ▪ Living worm is reddish brown in color. When active shape resembles that of the spoon w/ 1 end contracted and the other end elongated ▪ Suckers are of equal size ▪ Pair of simple intestinal ceca ▪ Excretory bladder: long and slightly convoluted pouch reaching from posterior end to the level of the pharynx

Male RS Female RS Ovum Cercaria ▪ Pair of deeply lovbed testes at the posterior half f the body

▪ Large, lobed ovary situated anterior to the testes ▪ To the L or R of VS ▪ Vitellaria: appear as extensively branched follicles occupying the entire length of lateral fields ▪ Uterus: tightly coiled rosette opposite to that of ovary

▪ Ovoidal w/ distint flattened oerculum & hickened posterior end ▪ Golden brown in color ▪ Almost same w/ E ilocanum ▪ Immature when laid

▪ Microcercous-ellipsoidal body w/ minute oral stylet and a small knob-shaped tail w/ posteriorly directed spines

Ingestion of Crab/ Crayfish w/ metacercaria—excyst in duodenum—in 30-60 mins—Adolescaria migrate thru-intestinal wall—reach abdominal cavity—penetrate the diaphragm—pleural cavity—lungs—where they grow—SF occurs and worms lay eggs—these are passed out as immature ova w/c maybe:

1. coughed out w. sputum 2. swallowed and passed out w/ feces

--eggs mature in water—miracidium hatches out thru the operculum—swims and penetrates the snail ( S libertine—other countries and Brotia asperata—Phils.)—becomes sporocyst—redia—cercariae are produced—escape from snail and encyst in crabs and crayfish

Life Cycle looks for 2nd IH: cercariae 2nd IH: crab/crayfish Infective stage to man: metacercaria Habitat: lungs looks for 1st IH: miracidium 1st IH: snail ( S libertine—other countries and Brotia asperata—Phils.)

DH: man and domesticated animals **in heavy infection, worms are also lodged in ectopic foci like mesentery, pleura, brain and liver

SS ▪ Pulmonary condition: symptoms resemble Pulmonary TB; hemoptysis ▪ Abdominal Type: dull abdominal pains and diarrhea ▪ When the parasite is lodged in the brain: Epilepsy

Lab Dx

▪ Specific Dx is based on the recovery of eggs from sputum or feces. ▪ Complement-Fixation Test ▪ Intracutaneous Test ▪ Chest X-ray findings