Notes on Philippine Medically Important Trematodes Meccar Moniem Elino, BSBio IV , Davao Doctors College Instructor: Mrs. Chalee Sienes-Reyes, RMT, MSMT, Ph.D

Reference: Philippine textbook of Medical Parasitology 2nd ed.(2004) UP. Edited by

Vicente Y. Belizario, Jr. and Winifreda U. de Leon

Common Name 1st IH 2nd IH Definitive

Host Diagnostic

Stage

Fasciolopsis buski Giant Intestinal Fluke snail Segmentina and

Hippeutis Plant

T. bicornis, N. lotus, E. tuberculosa

Humans and Pigs

Egg in stool

Echinostoma ilocanum Garrison's Fluke snail

G. convexiusculus,

H. umbilicalis Snail

Pila luzonica, Lymnea

cummingiana Humans

Eggs in stool

Artyfechinostomum malayanum

Heterophyes heterophyes Minute Fish Fluke

snail Melania juncea, Thiara riquetti

(Brackish) Fishes

C. chanos (Bangus), C.bethiacus (Hito),

O. striatus (dalag), S. canalicatus(danggit),

T. nilotica (tilapia)

Human Eggs in Sputum

and Stool

Haplorchis taichui

Metagonimus yokogawai Intestinal Fish Fluke

Haplorchis yokogawai

Fasciola hepatica Temperate/SheepLiver

Fluke snail

Lymnea philippinen-sis,

Lymnea swinhoei Plants

Ipomea obscura (Kang Kong),

Nastorium officinale (Water Cress)

Human, cow,

cattle, sheep

Eggs in stool

Fasciola gigantica Tropical/Giant liver Fluke

Clonorchis sinensis Chinese Liver Fluke snail

Parafossarulus, Bulimus,

Semiculcoapira, Alocinma,

Melanoides

Fish Fish of Family Cyprinidae (Tilapia nilotica) St. Peter's

Fish

Humans and Fish eating

mammals

Eggs in stool

Opisthorcis felineus Cat Liver Fluke snail Bithynia Fish

Opisthorcis viverrini Sea Liver Fluke

Paragonimus westermani Oriental / Lung Fluke snail Ante-melania

dactylus/asperata crabs

Sundathelphusa philippina

Human Eggs in sputum

and stool

Eurytrema pancreaticum Pancreatic Fluke snail Macro-chlamys

indica Ant

Technomyrmex deterquens (ant)

Human

Schistosoma japonicum Oriental Blood Fluke snail O. hupensis quadrasi

X X

Human and

Domestic Animals

eggs in stool

Schistosoma mansoni Manson's Blood Fluke snail Biomphalaria and Australorbis

X X Human eggs in stool

Schistosoma haematobium Visceral Blood Fluke snail Bulimus X X Human eggs in urine

specimen

Ova Adult Pathogenesis Drug of Choice

Echinostoma ilocanum Straw-colored Operculated

Ovoid Similar to Fasciola and Fasciolopsis buski ova

Adult Reddish gray Horse-shape collar of spines (circum oral disk)

around the oral suckers 49-51 collar spines

Integument is covered by plaque like scales Simple intestinal caeca

Echinostomiasis, general intoxication, diarrhea,

Ulceration to the attachment site

Praziquantel

A. malayanum

with 43 to 45 collar spines, testes are large with six to nine lobes in tandem. The ovary is small rounded oval anterior to the testes and

pre equatorial

Heterophyes heterophyes minute operculate ovoidal and light

brown 28-30 x 15-17 micra

slight shoulder @ the rim of operculum & no abopercular

proturberance Mature when laid

intestine start from midpart elongated, pyriform & grayish 1-1.7 x .3x.4mm

cuticle covered with scale like spines Small Oral suckerwith thick wall and muscular

Genital sucker @ left posterior border with 2 ovoid testis post of 5th body subglobose ovary

anterior of testis vitellaria with large polygonal follicles in lateral posterior end

Dyspnea, Rusty/Bloody Sputum, Space Occupying

Lesions, Colicky Abdominal Pain and

Diarrhea

Praziquantel

Haplorchis taichui

Metagonimus yokogawai

Haplorchis yokogawai

Fasciolopsis buski

Immature operculated Yellowish brown

ellipsoidal 130-140 x 80-85 micra,

clear thick shell and operculated

Large, broadly Ovate and Narrow at posterior end

no cephalic cone 2-7.5 x .8 - 2cm

ALimentary tract simple and do not branch

Fasciolopsiasis, Intestinal Obstruction, Marked

Eosinophilia, colic Diarrhea and vomiting

Praziquantel

Fasciola hepatica (immature)

operculated stool 140-150 x 65-90 micra

(hepatica) 160-190 x 70-90 micra

(gigantica) Light yellow Biled

strained Transparent with thin

double walls Contain lecithin

granules (immature)

Longer cephalic zone with conical projection Highly Branched (dendritic) intestine

Biliary colic, Jaundice, Abdominal Pain, Mark

Eosinophilia, Biliary Tract obstruction

Bithionol, Fasciola gigantica

Shorter cephalic Zone with conical projection Highly Branched (dendritic) intestine

Clonorchis sinensis

Egg operculated mature electric bulb

shape Posterior has small

knob tea pot lid - shape of

operculum; Eggs passed out via the

common bile duct into the liver

simple or unbranched intestine bigger oral sucker than O. felineus

2 highly branched denritic testes post vitellaria: mid 3rd of the intestine

yolk gland 10-25 x 2-3mm

Cholangitis, biliary cirrhosis, obstructive jaundice, malignant

changes of the liver and pancreas

Praziquantel

Opisthorcis felineus Lobate highly branched testes; vitellaria: mid 3rd Opisthorcis viverrini

Paragonimus westermani

Yellowish, Thick shelled, operculated

with thickened abopercular egg

Body covered with spines Coffee Bean Shape, Found in Pairs or in threes in Fibrotic capsules

Paragonimiasis, Cough, hemoptysis,

Misdiagnosed as PTB Praziquantel

Eurytrema pancreaticum

Operculated Thick shelled

Dark brown in color Embryonated when

laid

Pancreatic fluke Stout worm with ruffled margins

oral sucker is larger than the ventral sucker Pancreatitis Praziquantel

(Next Table)

Diagnostic Test

Schistosoma japonicum Schistomiasis, Cercarial Dermatitis, Hepatosplenic Disease (Granulomatous

Reaction)

Kato katz, Immunodiagnostic

Test

Schistosoma mansoni

Schistosoma haematobium

Major Differences Among Schistosoma spp.

Feature S. japonicum S. mansoni S. haematobium

Testes (male) 6-7 in a single file 8 -9 in a zigzag row 4 -5 in groups

Ovary (Female) In the middle of the body; contains 50 or more eggs

Anterior to the middle of the body; contains 1-3 eggs

Behind the middle of the body; contains 20 – 30 eggs

Intestine short longest long

Egg Lateral knob Lateral spine Terminal spine

Intermediate Host Oncomelania Biomphalaria and Australorbis Bulimus (Physopsis)

Definitive Host Man and domestic animals Man Man