TREMATODES (MONOECIOUS FLUKES) Flashcards
1
Q
Sheep liver fluke
A
Fasciola hepatica
2
Q
Giant Liver Fluke
A
Fasciola gigantica
3
Q
Chinese Liver Fluke/Oriental Liver Fluke
A
Clonorchis sinensis
4
Q
Cat Liver Fluke
A
Opistorchis felineus
5
Q
Southeast Asian Liver Fluke
A
Opistorchis viverrini
6
Q
Lancet fluke/Lanceolate fluke
A
Dicrocoelium dendriticum
7
Q
➢ Large and ellipsoidal
A
Fasciola hepatica
8
Q
➢ Thin-shelled with distinct operculum
A
Fasciola hepatica
9
Q
➢ Yellowish to light brown in color
A
Fasciola hepatica
10
Q
➢ Immature when laid
A
Fasciola hepatica
11
Q
- Greater in length,
shorter cephalic cone
A
Fasciola gigantica
12
Q
- Larger ventral sucker
A
Fasciola gigantica
13
Q
- Reproductive organs are
located on the anterior
portion of the worm
A
Fasciola gigantica
14
Q
- The ovum is bigger
A
Fasciola gigantica
15
Q
The ova of F. hepatica and F. gigantica are similar although F. gigantica egg is bigger
A
Fasciola gigantica
16
Q
➢ Yellowish-brown with distinct convex operculum
A
Clonorchis sinensis
17
Q
➢ Resembles an “old fashion” electric bulb
A
Clonorchis sinensis
18
Q
➢ Fully embryonated when laid
A
C. sinensus
Opistorchis felineus
19
Q
➢ Yellowish-brown, ovoid
A
O. felineus
Opistorchis viverrini
20
Q
➢ Measuring about 26-30 um by 15-17 um
A
O. felineus
Opistorchis viverrini
21
Q
➢ With distinct convex operculum and a small protuberance at the abopercular end
A
O. felineus
Opistorchis viverrini
22
Q
➢ Fully embryonated when laid
A
C. sinensus
Opistorchis felineus
Opistorchis viverrini
23
Q
➢ Operculated and measure 35-45 μm long by 20-30 μm wide
A
Dicrocoelium dendriticum
24
Q
➢ The eggs are thick-shelled and usually dark brown in color
A
Dicrocoelium dendriticum
25
➢ Eggs are fully embryonated when shed in feces.
Dicrocoelium dendriticum
26
➢ Large broad and flat body which measures about 20-50 mm in length and 6-12 mm in width
Fasciola hepatica
27
➢ A distinguishing feature is the cephalic cone which has a marked widening at the base of the cone (“shoulder”).
Fasciola hepatica
28
➢ Testes: tandem formation and highly branched
Fasciola hepatica
29
➢ Vitellaria: branched, found in lateral and posterior portion
Fasciola hepatica
30
➢ Ovary: branched/dendritic; located posterior to uterus and anterior to testes
Fasciola hepatica
31
➢ Uterus: short and coiled
Fasciola hepatica
32
adult worm is longer and its “shoulder” (cephalic cone) is less developed
Fasciola gigantica
33
➢ Ceca are more branched
Fasciola gigantica
34
➢ Branches of ovary are longer and more numerous
Fasciola gigantica
35
➢ Flat, transparent, elongated, rounded posteriorly and attenuated anteriorly
Clonorchis sinensis
36
➢ Cuticle – smooth and shiny
Clonorchis sinensis
37
➢ Ventral sucker – smaller than oral sucker
Clonorchis sinensis
38
➢ Testes – branched, arranged in tandem
Clonorchis sinensis
39
➢ Resembles Clonorchis sinensis
Opistorchis felineus
40
➢ Slightly shorter than C. sinensis measuring about 8-12 mm long and 1.5 to 3 mm wide
Opistorchis felineus
41
➢ Leaf-like in shape with transparent tegument
Opistorchis felineus
42
location of vitellaria, which are found in the middle third of the body at the level of the uterus
Opistorchis felineus
43
➢ Whereas the main difference is in the morphology and arrangement of testes
Opistorchis felineus
44
➢ Lobate testes, arranged obliquely
Opistorchis felineus
45
➢ Slightly similar as O. felineus
Opistorchis viverrini
46
adult in that the are positioned close to each other and are more deeply lobulated
Opistorchis viverrini
47
➢ Slender, lancet- shaped, flat
Dicrocoelium dendriticu
48
➢ Testes: Slightly lobulated, situated obliquely to each other anterior to the small subglobous ovary
Dicrocoelium dendriticu
49
➢ Oral sucker: smaller than ventral sucker
Dicrocoelium dendriticu
50
➢ Vitellaria: Scanty
Dicrocoelium dendriticu
51
1st IH:
- Water snail (Lymnea)
Fasciola hepatica
Fasciola gigantica
52
1st IH: Operculated snails
o Parafossarulus
o Bulimus
o Semisulcospira
o Alocinma
o Thiara
o Melanoides
Clonorchis sinensis
53
1st IH:
- Bithynia leachi
Opistorchis felineus
54
1st IH:
- Bithynia spp.
Opistorchis viverrini
55
1st IH: Land snails
o Cochicella
o Helicella
o Zebrina
Dicrocoelium dendriticum
56
2nd IH:
- Ipomea obscura (kangkong) - Nasturtium officinale (water cress)
Fasciola hepatica
Fasciola gigantica
57
2nd IH: Fresh water fish o Tingea tingea
o Barbus barbus
Clonorchis sinensis
58
2nd IH:
- Fresh water fish (Idus melanotus, Tinca tinca, Cyprinos carpio)
Opistorchis felineus
59
2nd IH:
- Fresh water fish
Opistorchis viverrini
60
2nd IH: Ants (Formica fusca)
Dicrocoelium dendriticum
61
METACERCARIA
Fasciola hepatica
Fasciola gigantica
Clonorchis sinensis
Opistorchis felineus
Opistorchis viverrini
Dicrocoelium dendriticum
62
Bile passages/bile ducts of fish- eating mammals
Clonorchis sinensis
63
Distal ducts occasionally pancreatic duct
Opistorchis felineus
64
Biliary ducts
Opistorchis viverrini
65
found in areas where sheep and cattle are raised and where humans consume raw watercress (Europe, Middle East and Asia)
Fasciola hepatica
66
more rarely in Asia, Africa, and Hawaii
Fasciola gigantica
67
Europe and Asia, including the former Soviet Union
Opistorchis felineus
68
Europe and Asia
Opistorchis viverrini
69
common parasite of ruminants but humans can be accidental definitive hosts
Dicrocoelium dendriticum
70
o Liver rot disease/Fascioliasis hepatica
Fasciola hepatica
71
o Acute phase: (migration of the immature fluke through the hepatic parenchyma)
Fasciola hepatica
72
➢ Abdominal pain, diarrhea, vomiting
Fasciola hepatica
73
➢ Hepatomegaly, fever, urticaria
Fasciola hepatica
74
➢ Eosinophilia
Fasciola hepatica
75
o Chronic phase: (adult fluke within the bile ducts)
Fasciola hepatica
76
➢ Intermittent biliary obstruction and inflammation
Fasciola hepatica
77
➢ Ectopic locations of infection (intestinal wall, lungs, subcutaneous tissue, and pharyngeal mucosa)
Fasciola hepatica
78
Diagnosis
1. Direct fecal smear examination
Fasciola hepatica
79
Diagnosis
2. Concentration sedimentation techniques
Fasciola hepatica
80
Diagnosis
3. Antibody detection
Fasciola hepatica
81
o Fascioliasis
Fasciola gigantica
82
Diagnosis
Same with F. hepatica
Fasciola gigantica
83
o Clonorchiasis
Clonorchis sinensis
84
o Carcinoma of the liver, adenocarcinoma of the gall bladder, as well as pancreatitis
Clonorchis sinensis
85
o Inflammation and intermittent obstruction of the biliary ducts → irritation of the bile ducts
Clonorchis sinensis
86
o Early infection:
➢ Leukocytosis and eosinophilia
Clonorchis sinensis
87
o Acute infection:
➢ Chills and fever up to 40°C
➢ Enlargement and tenderness of the liver;
Clonorchis sinensis
88
o Chronic infection:
➢ In the chronic stage, the clinical presentation may range from asymptomatic to mild to severe disease
Clonorchis sinensis
89
o Chronic infection:
➢ Cirrhosis and portal hypertension are present
Clonorchis sinensis
90
o Chronic infection:
➢ Cholangitis, cholelithiasis, cholangiocarcinoma, and pancreatitis
Clonorchis sinensis
91
Diagnosis
1. Eggs in biliary drainage (most practical diagnostic method)
Clonorchis sinensis
92
Diagnosis
2. Adult worms can be recovered through surgery
Clonorchis sinensis
93
Diagnosis
3. Liver scan
Clonorchis sinensis
94
Diagnosis
4. Phosphoglycerate kinase (a glycolytic enzyme) – can be used as an immunoreagent in the serodiagnosis for clonorchiasis
Clonorchis sinensis
95
Diagnosis
5. Serologic tests: ELISA, EIA
Clonorchis sinensis
96
o Opistorchiasis
Opistorchis felineus
Opistorchis viverrini
97
o Most infections are asymptomatic
Opistorchis felineus
Opistorchis viverrini
98
o Mild cases:
➢ Dyspepsia, abdominal pain, diarrhea, constipation
Opistorchis felineus
99
o Acute infections:
➢ Resembles Katayama fever
➢ Fever, facial edema, lymphadenopathy, athralgia, rash, eosinophilia
Opistorchis felineus
100
o Chronic infections:
➢ Hepatomegaly and malnutrition
Opistorchis felineus
101
o Rare cases:
➢ Cholangitis, cholecystitis, cholangiocarcinoma
Opistorchis felineus
102
Diagnosis
1. Direct Fecal smear
Opistorchis felineus
103
Diagnosis
2. Eggs in duodenal aspirate
Opistorchis felineus
104
o Most pathologic manifestations result from inflammation and intermittent obstruction of the biliary ducts.
Opistorchis viverrini
105
o Clinical manifestations: same with O.felineus
Opistorchis viverrini
106
Diagnosis
Same as O. felineus
Opistorchis viverrini
107
the eggs of C. sinensis, O. viverrini, and O. felineus are difficult to differentiate. However, when stained with KMnO4 and examined under a 400x magnification of a light microscope show distinct melon- like ridges on the surface of
Opistorchis viverrini eggs
108
o Dricocoeliasis
Dicrocoelium dendriticum
109
o Chronic constipation and hepatomegaly
Dicrocoelium dendriticum
110
Diagnosis
o Diagnosis is based on microscopic identification of eggs in the stool, duodenal, and/or bile fluid
Dicrocoelium dendriticum
111
Diagnosis
o Note that eggs may be detected in stool following consumption of liver infected with adult flukes
Dicrocoelium dendriticum
112
Diagnosis
o Additional specimens should be collected to distinguish this spurious passage from a true infection.
Dicrocoelium dendriticum
113
Diagnosis
o Adult flukes are rarely recovered
Dicrocoelium dendriticum
114
1. Thorough washing or cooking of vegetable
Fasciola hepatica
Fasciola gigantica
115
2. Boiling of water in areas where the infection is endemic
Fasciola hepatica
Fasciola gigantica
116
3. Eradication/elimination of the snail intermediate hosts
Fasciola hepatica
Fasciola gigantica
117
1. Treatment of positive cases with praziquantel in order to eliminate human host reservoir
Clonorchis sinensis
Opistorchis felineus
Opistorchis viverrini
118
2. Health education for the promotion of cooked fish consumption in order to prevent infection
Clonorchis sinensis
Opistorchis felineus
Opistorchis viverrini
119
3. Proper human waste disposal in order to interrupt the transmission of the disease
Clonorchis sinensis
Opistorchis felineus
Opistorchis viverrini
120
1. Bithionol (treatment of choice)
Fasciola hepatica
Fasciola gigantica
121
2. Emetine hydrochloride
Fasciola hepatica
Fasciola gigantica
122
1. Praziquantel
Clonorchis sinensis
123
2. Chloroquine phosphate
Clonorchis sinensis
124
1. Praziquantel (drug of choice)
Opistorchis felineus
Opistorchis viverrini
125
It was first discovered by Busk in 1843, in the duodenum of an East Indian sailor who died in London. This fluke has been featured under a variety of names, due to its size, different shapes, and differences in integumentary spine pattern.
Fasciolopsis buski
126
Garrison first found the eggs of this fluke in native prisoners in Manila in 1907, and later recovered 21 adult worms after administration of oleoresin of aspidium. Tubangui in 1931 found that the Norway rat was a reservoir of the infection.
Echinostoma ilocanum
127
this minute fluke was first found by Bilharz in 1851 at the autopsy of a native Cairo
Heterophyes heterophyes
128
Largest Intestinal Fluke
Fasciolopsis buski
129
Garrison’s Intestinal fluke
Echinostoma ilocanum
130
Dwarf Intestinal Fluke; Von Seibold Fluke
Heterophyes heterophyes
131
Yokogawa’s human fluke;
smallest human fluke
Metagonimus yokogawai
132
Asia and the Indian subcontinent, especially in areas where humans raise pigs and consume freshwater plants
Fasciolopsis buski
133
Population of Ilocano in Luzon, Java and China where dogs are infected
Echinostoma ilocanum
134
Mostly the Far East, Siberia, Balkan States, Israel, and Spain
Metagonimus yokogawai
135
METACERCARIA
Fasciolopsis buski
Echinostoma ilocanum
Metagonimus yokogawai
136
Small intestine and sometimes in Large intestine and stomach
Fasciolopsis buski
137
Small intestine
Echinostoma ilocanum
Heterophyes heterophyes
138
▪ 1st snail IH: Planorbid snails o Segmentina
o Hippeutic
o Gyraulus
Fasciolopsis buski
139
▪ 1st snail IH: Planorbid snails
o Gyraulus convexiusculus (Philippines and Java) o Hippeutis (Philippines)
o Gyraulus prashadi (India)
Echinostoma ilocanum
140
▪ 1st intermediate host: Brackish water snails o Pirenella
o Cerithidea
Heterophyes heterophyes
141
▪ 1ST intermediate host: Semisulcospira, Thiara, Hua
Metagonimus yokogawai
142
▪ 2nd IH: Aquatic plants
o Trapa bicornis (water caltrop) o Eichuora (water hyacinth)
o Eliocharis tuberosa (water chestnut)
o Nymphaea lotus (lotus)
Fasciolopsis buski
143
▪ Definitive host: Man and Pigs
Fasciolopsis buski
144
▪ 2nd IH: Fresh water Mollusks
o Pila conica
Echinostoma ilocanum
145
▪ 2nd intermediate host: Fish
o Mugil cephalus o Tilapia nilotica
Heterophyes heterophyes
146
▪ 2nd intermediate host: Fresh water salmonoid fishes
Metagonimus yokogawai
147
1. Ova/Eggs
➢ Large, has a clear thin shell with a small operculum at one end
Fasciolopsis buski
148
1. Ova/Eggs
➢ Resembles “hen’s egg”
Fasciolopsis buski
149
1. Ova/Eggs
➢ Immature when passed in feces; usually it takes 3-7 weeks to embryonate in water
Fasciolopsis buski
150
1. Ova/Eggs
➢ Straw-colored with operculum at one end
Echinostoma ilocanum
151
1. Ova/Eggs
➢ Measures 83-116 um by 58-69 um
Echinostoma ilocanum
152
1. Ova/Eggs
➢ Immature when passed in the feces
Echinostoma ilocanum
153
1. Ova/Eggs
➢ Light brown in color, thick shelled, operculated minute egg
Heterophyes heterophyes
154
1. Ova/Eggs
➢ Contains fully developed miracidium
Heterophyes heterophyes
155
1. Ova/Eggs
➢ Indistinguishable from H. heterophyes
Metagonimus yokogawai
156
2. Adult
➢ Thick, flesh in color
Fasciolopsis buski
157
2. Adult
➢ Cuticle is covered with transverse row of spines
Fasciolopsis buski
158
2. Adult
➢ Testes: dendritic or highly branched and in tandem positioned at the posterior half of the worm
Fasciolopsis buski
159
2. Adult
➢ Ovary: branched and located at the middle of the body
Fasciolopsis buski
160
2. Adult
➢ Vitellaria: highly branched
Fasciolopsis buski
161
2. Adult
➢ Elongated, reddish-gray with horse-shoe shaped collar of spines surrounding the dorsal and lateral sides of oral sucker
Echinostoma ilocanum
162
2. Adult
➢ Cuticle: with minute spine-like scales
Echinostoma ilocanum
163
2. Adult
➢ Oral sucker is at the center of the body; ventral sucker is located at the anterior fifth of the body a
Echinostoma ilocanum
164
2. Adult
➢ Testes: lobate; located posterior to ovary
Echinostoma ilocanum
165
2. Adult
➢ Ovary: globular; located anterior to the testes
Echinostoma ilocanum
166
2. Adult
➢ Uterus: looped, anterior the ovary
Echinostoma ilocanum
167
2. Adult
➢ Vitellaria: with small follicles which fills the lateral border of the posterior two-thirds of the worm
Echinostoma ilocanum
168
2. Adult
➢ It is an elongate, piriform worm, with a broadly rounded posterior end and a more attenuate anterior end
Heterophyes heterophyes
169
2. Adult
➢ Cuticle is covered with minute scale-like spine
Heterophyes heterophyes
170
2. Adult
➢ Testes: ovoid and placed side by-side located at the posterior fifth of the body
Heterophyes heterophyes
171
2. Adult
➢ Ovary: globular located anterior of the testes
Heterophyes heterophyes
172
2. Adult
➢ Vitellaria: with large polygonal follicle in the lateral posterior third of the body
Heterophyes heterophyes
173
2. Adult
➢ 1 mm to 2.5 mm by 0.4 mm to 0.75 mm in size
Metagonimus yokogawai
174
2. Adult
➢ Slightly resembles H. heterophyes
Metagonimus yokogawai
175
2. Adult
➢ Cuticle: covered with minute scale like spines
Metagonimus yokogawai
176
2. Adult
➢ Ventral sucker: large, situated at the right side of the midline with its axis in a diagonal line
Metagonimus yokogawai
177
o Fasciolopsiasis
Fasciolopsis buski
178
o Most infections are light and asymptomatic
Fasciolopsis buski
179
o In heavier infections, symptoms may include diarrhea, abdominal pain, fever, ascites, anasarca, and intestinal obstruction
Fasciolopsis buski
180
o The patient may experience generalized toxic and allergic symptoms such as facial, abdominal walls, and lower limbs edema
Fasciolopsis buski
181
o Profound intoxication can result into death
Fasciolopsis buski
182
o Inflammatory lesions may develop at the sites of attachment to the intestinal wall together with a generalized toxic process
Echinostoma ilocanum
183
o Usual symptoms are intestinal colic and diarrhea
Echinostoma ilocanum
184
➢ The main symptoms are diarrhea and colicky abdominal pain.
Metagonimiasis
185
➢ Migration of the eggs to extraintestinal sites
(heart, brain) can occur, with resulting symptoms
Metagonimiasis
186
o Demonstration of eggs in the stool
Fasciolopsis buski
187
o Vomitous sample may be used for detection of eggs
Fasciolopsis buski
188
o NOTE: one should consider the resemblance between Fasciolopsis buski and Fasciola eggs
Fasciolopsis buski
189
Direct fecal smear examination
Echinostoma ilocanum
190
➢ Microscopic identification of eggs in the stool
Metagonimus yokogawai
191
➢ However, the eggs are indistinguishable from those of H. heterophyes and resemble those of Clonorchis and Opistorchis
Metagonimus yokogawai
192
➢ Specific diagnosis is based on identification of the adult fluke evacuated after antihelminthic therapy, or found at autopsy
Metagonimus yokogawai
193
1. Since metacercaria are very sensitive to dryness, soaking of aquatic plants in water should be avoided
Fasciolopsis buski
194
2. The time between harvest and consumption could also be prolonged to prevent infection
Fasciolopsis buski
195
3. Washing of the plants to remove metacercaria or boiling them to kill the parasite can also prevent infection
Fasciolopsis buski
196
4. Swamps or ponds, where aquatic plants are cultivated should be protected from pollution by untreated human or pig excreta
Fasciolopsis buski
197
5. Community education
Fasciolopsis buski
198
6. Eradication of snail intermediate hosts
Fasciolopsis buski
199
7. Avoid eating raw aquatic plants
Fasciolopsis buski
200
Individuals can avoid infection by not eating raw snails in endemic areas
Echinostoma ilocanum
201
Praziquantel
Fasciolopsis buski
Echinostoma ilocanum
Metagonimus yokogawai
202
Lung fluke, Oriental Lung Fluke
Paragonimus westermani
203
METACERCARIA
Paragonimus westermani
204
Lung Pockets
Paragonimus westermani
205
▪ 1ST intermediate host: snail of genus Hua (Semisulcospira, Syncera and Thiara, Pomatiopsis, Pomacea, Brotia asperata – most common in the Philippines)
Paragonimus westermani
206
▪ 2nd intermediate host: Fresh water crabs or crayfish
Paragonimus westermani
207
1. Ova/Eggs
➢ Operculated and ovoidal (80-120 um)
Paragonimus westermani
208
1. Ova/ Eggs
➢ Yellowish-brown to dark or golden brown on color
Paragonimus westermani
209
1. Ova/ Eggs
➢ Immature when laid with a germ cell and many yolk cells when oviposited
Paragonimus westermani
210
2. Adult
➢ Reddish brown in color
Paragonimus westermani
211
2. Adult
➢ Tegument is covered with single spaced spines
Paragonimus westermani
212
2. Adult
➢ Active state: spoon-shaped with one end contracted and other end is elongated
Paragonimus westermani
213
2. Adult
➢ Preserved state: oval, flattened, coffee bean shaped; has spinous cuticle and suckers of equal size
Paragonimus westermani
214
2. Adult
✓ Females:
– ovary is lobed, located anterior to the testes on the right side opposite the coiled uterus
Paragonimus westermani
215
➢(?) – at the extreme lateral fields on the entire length of the body
Vitellaria
216
2. Adult
✓ Males:
– irregular lobed testes are oblique to each other and located at the posterior third of the body
Paragonimus westermani
217
Paragonimiasis/Pulmonary Disturbances
Paragonimus westermani
218
➢ Patient with this disease most often complain of cough and hemoptysis, clinical manifestations are consistent with Pulmonary Tuberculosis (PTB). Hence, patients with this parasitic infection are often misdiagnosed with PTB.
Paragonimus westermani
219
✓ Chronic bronchitis
Paragonimus westermani
220
✓ Hemoptysis
Paragonimus westermani
221
✓ Abdominal pain
Paragonimus westermani
222
✓ Dry cough and later produces blood stained sputum with foul odor
Paragonimus westermani
223
✓ Chest pains, dyspnea
Paragonimus westermani
224
✓ Low grade fever, fatigue and generalized myalgia
Paragonimus westermani
225
o Definitive diagnosis is based on the detection of the characteristic eggs in sputum, stool, or less frequently, in aspirated material from abscessed or pleural effusion
Paragonimus westermani
226
o However, detection of eggs in sputum or feces of patients with paragonimiasis is often very difficult
Paragonimus westermani
227
o (?) – a typical finding is a ring-shadowed opacity, comprising several contiguous cavities that give the appearance of a bunch of grapes
X-ray
228
o Serologic methods (CFT, EIA, Immunoblot assay)
Paragonimus westermani
229
o Thorough cooking of crab meat
Paragonimus westermani
230
o Health education to change food habits of the population
Paragonimus westermani
231
o Praziquantel
Paragonimus westermani
232
o Bithionol
Paragonimus westermani
