الله بسمالرحیم الرحمن

PlatyhelminthesPlatyhelminthes

• Class:• 1- Trematoda

• 2-Cestoda

• 3-Turbellaria (planaria)

Classification of TrematodaClassification of Trematoda

• Trematoda: sub cl. 1-Monogenea• 2- Digenea• 3- Aspidogastrea• Digenea: 1- liver flukes• 2- Intestinal ″ ″• 3-Lung ″ ″• 4- Blood ″ ″

Trematoda (Flukes)Trematoda (Flukes)

• Morphology:• Biology• General characters:• - size• - digestive tract• - reproductive system• - excretory system

• Life cycle

F: FasciolidaeF: Fasciolidae

• Genus:The trematodes; Fasciola hepatica (the sheep liver fluke)

• Fasciola gigantica, parasites of herbivores that can infect humans accidentally.

• F.indicum parasites of herbivores: is reported in sheep from Iran

Fasciola hepaticaFasciola hepatica

• Morphology:• - Size: adult fluke

measures 20-30 * 8-13mm wide and is flat and leaf like, with a spiny tegument.

Adult form of Fasciola hepaticaAdult form of Fasciola hepatica

Egg of FasciolaEgg of Fasciola

The egg is large, 130-150 µm x 60- 90µm. Unembryonated, filled with yolk cells in which an indistinct germinal cell is imbedded.

Geographic Distribution

Fascioliasis occurs worldwide: specially in areas where sheep and cattle are raised, and where humans consume raw watercress, including Europe, the Middle East, and Asia.  Infections with F. gigantica and F.indicum have been reported, more rarely, in Asia, Africa, and Hawaii.

طغيان ناگهاني و بروز بزرگترين همه گيري آن طغيان ناگهاني و بروز بزرگترين همه گيري آن ده هزار موردده هزار موردطي دهه گذشته با فراواني حدود طي دهه گذشته با فراواني حدود

در استان گيالن، به عنوان يك بيماري بازپديد و با در استان گيالن، به عنوان يك بيماري بازپديد و با موارد انساني آن موارد انساني آن 13791379عنايت به اينكه تا سال عنايت به اينكه تا سال

در صفحات غرب كشور به اثبات نرسيده است در صفحات غرب كشور به اثبات نرسيده است اوّلين همه گيري آن در كرمانشاه به عنوان يك اوّلين همه گيري آن در كرمانشاه به عنوان يك

..بيماري نوپديد، تلقي، مي گرددبيماري نوپديد، تلقي، مي گردد

فاسيوليازيسفاسيوليازيس

Clinical FeaturesClinical Features

Acute phase manifestations

Chronic phase manifestations

  Ectopic locations of infection

بالینی عالئم و بالینی پاتوزنزیس عالئم و پاتوزنزیس: باتوژنز مکانیسم

کبدی ,تورم • پارانشیم آتروفی و کبدی فیبروز نکروزوصفراوی ,هیپرپالزی• مجاری انسداد و فیبروز و آدنوماتوز

کرمهای مکانیکی وتحریکات کرم سمی متابولیتهای از ناشیبالغ

: بالینی عالئمشکم ,تب,لرز فوقانی و راست سمت ناحیه شانه ,درد درد

پشت ,راست ناحیه کبد ,درد اختالالت ,زردی ,بزرگی ,کهیر , گوارشی

وزن همراه ,اسهال ,آسیت,کاهش خونی کمتا( گاهی %)90باهیپرائوزنیونیلی

• كرمانشاه در فاسيوليازيس به مبتلا بيماران باليني هاي يافته‌

•  

• كرمانشاه در فاسيوليازيس به مبتال بيماران شكايات ـ

Laboratory DiagnosisLaboratory Diagnosis

*Microscopic identification of eggs in the stools* or in material obtained by duodenal or biliary drainage.  They are morphologically indistinguishable from those of

Fasciolopsis buski. 

*False fascioliasis (pseudo-fascioliasis)

Antibody detection tests are useful especially in the early invasive stages or in ectopic fascioliasis.

تشخیصتشخیص : پاراکلینیک تشخیصاسکن ) • تی سی ( CTSانجامکبد • سونوگرافی

: یارازتیولوژیک تشخیصفاسیولوزیس • در انگل تخم جستجوی و مدفوع آزمایش

مزمندوازدهه • ترشحات در تخم جستجوی و دوازدهه توباژ

: سرولوژیک تشخیصحساسیت ) ELISA, IFAتستهای • ویژگی% 75/96با % (77/96و•C.C.I.E) درمان ) ند رو بررسی جهت

Antibody DetectionAntibody Detection•

Immunodiagnostic tests may be useful for:• - early indication of Fasciola infection as well as for -confirmation of chronic fascioliasis - for ruling out "pseudofascioliasis“

• The current tests are enzyme immunoassays (EIA) with excretory- secretory (ES) antigens combined with confirmation of positives by immunoblot.  

• • Antibody levels decrease to normal 6 to 12 months after

chemotherapeutic cure and can be used to predict the success of therapy.

TreatmentTreatment

Unlike infections with other flukes, Fasciola hepatica infections may not respond to praziquantel.

The drug of choice is Triclabendazole with bithionol as an alternative.

  Bithionol: 30-50mg/kg ; 10-15 intermittent days 

Triclabendazole: 10mg/kg 1-2 days

کبد در بالغ کبد کرم در بالغ بالغ کرم بالغ کرم کرم کرم تخم

F.hepatica, adult worm, liver biopsy

Laboratory diagnosisLaboratory diagnosis

Fasciola hepatica: observation of eggs in faecal smears

Immunodiagnosis by indirect immunofluorescence. Antigen: frozen sections of Fasciola hepatica.

Dicrocoelium dendriticumDicrocoelium dendriticum( D. lanceolatum)( D. lanceolatum)

• Life cycle of• D. lanceolatum

Clonorchis sinensisClonorchis sinensisThe trematode Clonorchis sinensis (Chinese or oriental

liver fluke ).

• Size: 10 to 25 mm by 3 to 5 mm reside in small and medium sized biliary ducts.

• (There can be a wide variation in the size of adults, depending upon the intensity of infection and on the diameter of the bile ducts in which they are living.)

•   In addition to humans, carnivorous animals can serve as reservoir hosts.

Adult wormAdult worm

Cercaria

The tegument has no spines.

The ventral sucker is smaller than the oral and is situated about a quarter of the length from the anterior end.

Geographic DistributionGeographic Distribution

• Endemic areas : in Asia including Korea, China, Taiwan, and Vietnam.

• in non endemic areas : including the United States

• In such cases, the infection is found in Asian immigrants, or following ingestion of imported, undercooked or pickled freshwater fish containing metacercariae.

Life Cycle of Life Cycle of ClonorchisClonorchis

Snail :Bulimus parafossarulusB.SemisulcospiraMelanoides

Clinical FeaturesClinical Features

• Most pathologic manifestations result from inflammation and intermittent obstruction of the biliary ducts. 

• In the acute phase, abdominal pain, nausea, diarrhea, and eosinophilia can occur. 

• In long-standing infections, cholangitis, cholelithiasis, pancreatitis, and cholangiocarcinoma can develop, which may be fatal.

Section of Clonorchis in liverSection of Clonorchis in liver

Laboratory DiagnosisLaboratory Diagnosis

Microscopic demonstration of eggs in the stool or in duodenal aspirate is the most practical diagnostic method.  The adult fluke can also be recovered at surgery

Microscopy:

Opisthorchis sppOpisthorchis spp..

Opisthorchis viverrini )Southeast Asian liver fluke( and O. felineus )cat liver fluke(.

The mammalian definitive host : cats, dogs, and various fish-eating mammals including humans

The adult size: O. viverrini: 5 mm to 10 mm by 1 mm to 2 mm; O. felineus: 7 mm to 12 mm by 2 mm to 3 mm

reside: in the biliary and pancreatic ducts of the mammalian host, where they attach to the mucosa.

O. felineus O. viverrini

Geographic DistributionGeographic Distribution

O. viverrini is found mainly in northeast Thailand, Laos, and Kampuchea. 

O. felineus is found mainly in Europe and Asia, including the former Soviet Unio

Life Life CycleCycleLife Cycle:

                                                                             

Snailsinvolved in Thailand are subspecies ofBithynia siamensis,

Clinical FeaturesClinical FeaturesMost infections are asymptomatic.

  In mild cases, manifestations include dyspepsia, abdominal pain, diarrhea or constipation.

  In chronic infections the symptoms can be more severe, and hepatomegaly and malnutrition , cholangitis, cholecystitis, and chlolangiocarcinoma may develop. 

• In addition, infections due to O. felineus may present an acute phase resembling Katayama fever (schistosomiasis), with fever, facial edema, lymphadenopathy, arthralgias, rash, and eosinophilia. 

• Chronic forms of O. felineus infections present the same manifestations as O. viverrini.

Laboratory DiagnosisLaboratory Diagnosis::

• Diagnosis is based on microscopic identification of eggs in stool specimens. 

• However, the eggs of Opisthorchis are practically indistinguishable from those of Clonorchis.

• Treatment:Praziquantel ( 25mg/kg 3 time daily/2 days)is the drug of choice to treat Opisthorchiasis.