TREMATODES testes aranged in one row above ventral

sucker
o Female
BLOOD FLUKES - 15- 26um by 0.3mm
- can live up to 30 years, shorter life span
5 species: S. japonicum(dominant in PH) - pyramidal ovary located in midline
S. mansoni
S. mekongi PATHOGENESIS AND CLINICAL
S. intercalatum MANIFESTATION
S. hematobium
“Swimmer’s itch” – cercarial penetration of
• 1977- last human case in Japan
skin is usually accompanied by dermatitis
• 1847- the disease was described by
with pruritus and localized reaction.
Fuji
• 1904- Adult S. japonicum described
“Snail fever”, Katayama fever/ Katayama
by Katsurada
syndrome –
• 1905- First Chinese case was
Fatigability, respiratory symptom,
diagnosed by Logan
arthralgias, myalgias, malaise, eosinophilia,
• 1906- Wooley reported the 1st case
fever, and abdominal pain
in the Philippines.
Clinical course of infection is arbitrarily
PARASITE BIOLOGY
divided into 3 stages, namely;
• SIZE: 100-500um in length and 40-
o Incubation
60um transversely
• TAIL TRUNK: 140-150um by 20- o Period of early egg deposition and
35um extrusion
• FORK: 50-70 um long o Period of tissue proliferation

OVA- is ovoid, round or pear-shaped. Pale COLONIC SCHISTOSOMIASIS

yellow in color. - chronic stage
-longer diameter 46-110um - usually asymptomatic, although
- short diameter 37-90um there may be occasional of diarrhea
- thin shell
HEPATOSPLENIC
INTERMEDIATE HOST: Oncomelania snail - the most serious consequence of
DEFINITIVE HOST: Dog, pigs, cats, chronic schistosomiasis
carabao, and cows - hepatosplenomegaly, portal
hypertension, ascites, and development of
o 10-12 days to embryonate and collateral circulation, which can lead to
mature esophageal and gastric varices.
o mature egg in feces can survive and
CEREBRAL MANIFESTATIONS
still
- motor or sensory
hatch for up to a week if desiccation is
disturbances depending on the site of egg
slow
deposition and granuloma formation
o Male
ACUTE CASES
- shorter but studier sex
- fulminating
- 12 to 20 mm in length by 0.4 to 0.5 mm in
meningoencephalitis with fever
dm
- headache
- gynecophoral canal
- confusion
 - lethargy • Snail control
- coma LUNG FLUKES
CHRONIC CASES
- give a clinical picture of a Paragonimus westermani
tumor with localizing signs and increased o Paragonimiasis is An infection of
intracranial pressure human and other mammals by
trematodes.
DIAGNOSIS o Also known as Oriental lung fluke
o Genus: Paragonimus
o Microscopic Technique o There are 40 known species and six
• Stool examination are reported to cause infections in
• Rectal imprint humans
o MIFC o P. Westermani is major species that
• For moderate and heavy causes Paragonimiasis in the
infection Philippines.
o Kato-Katz o In 1879, Ringer observed first case
• Suitable for quantification of of pulmonary Paragonimiasis in
eggs humans.
o Rectal snip and Imprint o 1880 : Baelz in Japan and Manson
• Most sensitive techniques in Formosa identified Paragonimus
ova in human sputum.
Locally evaluated immunodiagnosis test: o 1907 : Musgrave described human
A. intradermal test for Paragonimiasis in the Philippines.
immediate cutaneous o 1915 : Nakagawa discovered crabs
hypersensitivity act as 2nd intermidiate host And 2
B. indirect hemagglutination years later, he succeeded in
C. circumoval precipitin test infecting the snail Melania libertine
D. enzyme immunosorbent with Paragonimus miracidia.
assay or ELISA
PARASITE BIOLOGY
TREATMENT
o Praziquantel o Adult lung fluke : reddish brown
• 40-50 mg/kg (single o Measures : 7 to 12 mm in length
dose)
and 4 to 6 mm in width,3.5 to 5 mm
• 25 mg/kg (2 doses)
in thickness
• 20 mg/kg (3 doses
o Appearance : resembles a coffee
given every 4 hours)
bean
• 10 mg/kg (3x a day
o Tegument : covered with single-
for 2 days)
• 30 mg/kg (after spaced spines.
breakfast and after o Ovary: located anterior to the testes
lunch) and posterior to the ventral sucker,
o Artemisinins /Artemether and has a six long unbranched
lobes.
PREVENTION AND CONTROL o Cercaria: covered with spines, has
• Health education an ellipsoidal body and a small tail.
• Attention to the water o A stylet is present at the dorsal side
supply and sanitation of the oral sucker.
• Protective gear o Metacercaria: round and measures
(waders, boots) from 381 to 457 micrometer.
 o Ova: yellowish-brown, thick-shelled twice daily on alternative days, for
egg measures 80-188 micrometer by 10-15 days)
48-60 micrometer And has a
flattened but prominent operculum.
o Opposite the operculum is a PREVENTION AND CONTROL
thickened abopercular portion. It is o Avoid of ingestion of raw or
unembryonated at oviposition
insufficiently cooked crabs and other
crustaceans as well as meat.
MOT: o Safe food preparation
o Health education and promotion
o Eating inadequately cooked or
pickled crab or crayfish that harbor
metacercariae of the parasite.
PATHOGENESIS AND CLINICAL INTESTINAL FLUKES
MANIFESTATION
Fasciolopsis buski (Giant Intestinal Fluke”)
o It provoke granulomatous
reaction that gradually gives rise • Largest Intestinal Fluke of
to the development of a fibrotic humans and pigs
cyst containing blood-tinged
PARASITE BIOLOGY
purulent material, adult worms,
• MOT: Ingestion of encysted
and eggs. metacercariae from aquatic plants
Common symptoms: • INFECTIVE STAGE: Metacercariae
• DIAGNOSTIC STAGE:
o Chronic cough and hemoptysis Unembryonated Egg
o Chest pain, dyspnea,low-grade • DEFINITIVE HOST: PIGS AND
fever, fatigue and generalized HUMANS
myalgia may also occur. • INTERMEDIATE HOST:
1st I.H.: SNAIL ( Segmentina or Hippeutis )
2nd I.H.: Trapa bicornis (water caltrop)
DIAGNOSIS Eliocharis tuberosa (water chestnut)
Ipomea obscura (morning glory or
o Microscopy kangkong)
o Chest radiographs Nymphaea lotus (lotus)
o Peripheral blood count EGG:
o Immunological methods o Yellowish ellipsoidal egg
o Large, operculated, unembryonated
o Loop-mediated Isothermal
when first passed
amplification (LAMP)
o Indistinguishable from the eggs of
hepatica and F. gigantica
TREATMENT o Measures 130-140 um by 80– 85 um

o Praziquantel: Drug of choice. (25 ADULT

mg/kg, 3 times a day, for 2-3 days) • Elongated oval in shape
o Triclabendazole • Measures 20-75 mm in length and
o Bithionol: Alternative drug (given 8-20 mm in width.
orally at a dose of 15-25 mg/kg, • No cephalic cone
 • Intestinal ceca- Unbranched and • Since metacercariae are very
reach up to the posterior end sensitive to dryness, soaking of
• 2 TESTES- dendritic, arranged in aquatic plants in water should be
tandem in the posterior half of the avoided.
body • Cook all aquatic plants well before
• OVARY- lies to the right of the eating them (in boiling water).
midline
• FINE VITELLINE FOLLICLES-
situated throughout the lateral Echinostoma ilocanum
margin of the body. Artyfechinostomum malayanum

PATHOGENESIS AND CLINICAL PARASITE BIOLOGY

MANIFESTATION o Echinostomids are digenetic
trematodes characterized by collar
o Pathological changes caused by the of spines around their oral suckers
worms are traumatic, obstructive and o MOT: ingestion of metacercariae
toxic. (infective stage) encysted in snails
o Inflammation and ulceration occur at o Adult worms live in small intestine
the site of worm attachment, of definitive host (humans, dogs,
producing an increase in mucus cats, rats and pigs)
secretion, and minimal bleeding. o In Philippines,
o Gland abscesses are occasionally
formed in the mucosa. E. ilocanum
o In heavy infection, the worms may o First:
cause intestinal obstruction. -Gryaulus convexiusculus and
o Intoxication results from the Hippeutis umbilicalis
absorption of worm metabolites by o Second:
the host. -Pila luzonica (kuhol) and Vivipara
o The patient experiences generalized angularis (susong pampang)
toxic and allergic symptoms, such as
edema of the face, abdominal wall, A. malayanum
and lower limbs. o First:
o Profound intoxication can result in -Not yet identified but suspected
death of the host. to be same as E. ilocanum
o Second:
Diagnosis -Lymnaea (syn. Bullastra)
o detection of parasite eggs in the
cumingiana (birabid) or
stool. Ampullarius canaliculatus
o Fasciolopsis buski eggs resemble (golden apple snail)
Fasciola eggs under under the
microscope. o E. ilocanum is reddish-gray,
measures 2.5 to 6.6 mm in length
Treatment and 1-1.35 mm in width. Worm is
tapered at the posterior end. Has 49-
o Praziquantel is given in three doses 51 collar spines.
of 25 mg/kg over 1 day.
Prevention and Control
 o Oral suckers lies in the center of DIAGNOSIS
the circumoral disk, and the
-detection of eggs in stool
ventral sucker is situated at the
anterior fifth of the body. Rat- an important reservoir host of both
echinostomes
o Two testes are deeply bilobed,
arranged in tandem in the third PREVENTION AND CONTROL
quarter of the body
- avoiding ingestion of raw or
o Ovary is located just in front of the improperly cooked second intermediate
anterior testis snail hosts

o Follicular vitellaria are located in

the posterior half of the body and
HETEROPHYID FLUKES
uterine coils are found between
the ovary and ventral sucker. Habitat: intestines of fish eating host
MAJOR SPECIES:
o Intestinal ceca are simple
-Heterophyes
o E. ilocanum egg is straw-colored, heterophyes
operculated and ovoid, measuring -Metagonimus yokogawai
83-116 µm by 58-69 µm -Haplorchis taichui and
-Haplorchis yokogawai
o A. malayanum measures 5-12 mm
in length and 2-3 mm in width. PARASITE BIOLOGY
Has rounded posterior end and has o MOT: Ingestion of metacercariae
43-45 collar spines. encysted in fish.
o Two testes are large, each with six o Life span: 1 year
to nine lobes arranged in tandem. o The adult worm inhabits the small
The ovary is small, rounded or intestines of the definitive host.
oval, located anterior to the testes, o Intermediate host : Snail
and pre-equatorial. o The snail host can be fresh water,
brackish water, or marine species.
o A. malayanum egg is larger, golden o In the Philippines the snail host of H.
brown in color, operculated and taichui and Procerovum calderoni
measures 120-130 µm by 80-90 µm are the brackish water snails,
PATHOGENESIS AND CLINICAL Melania juncea, and Thiara
MANIFESTATIONS riquetti.
o Adult fluke:
-Inflammation (heavy infection) -elongated, oval or pyriform
-ulceration -measures less than 2mm in length
-diarrhea (sometimes bloody) o Egg:
-abdominal pain -light brown in color, ovoid in shape,
-absorption of metabolites from and
worms-result in intoxication -measures 20 to 30 micrometer by
TREATMENT 15 to 17 micrometer
-three doses of Praziquantel 25
mg/kg per dose over 1 day
PATHOGENESIS AND CLINICAL
MANIFESTATIONS
o Inflammation
o Excessive mucus production
o Sloughing off of the superficial layers
CLINICAL MANIFESTATION
LIVER FLUKES
o Peptic ulcer disease (PUD) or acid
o Large digenetic trematode species
peptic disease (APD)
belong to the family "Fasciolidae“
o Abdominal discomfort/pain
o Found in liver and biliary passages
o Gurgling abdomen
o 2 causative agents: Fasciola
o Colicky abdominal pain
hepatica(temperature liver flukes)
o Mucoid diarrhea
Fasciola gigantica(tropical liver
flukes)
DIAGNOSIS o 1379- reports of Fascioliasis
o 1523- detailed descriptions about
o Detection of eggs in the stool F.hepatica
o Kato thick method o 1760- F.hepatica during an autopsy
o PCR female in Berlin, Germany.
o Infections in rumknants result
TREATMENT significant economic loss estimated
3.2 billion US dollars
o Praziquantel 25 mg/kg per dose- o Fascioliasis most important helminth
drug of choice infection of cattle reported (30 to
90%).
PREVENTION AND CONTROL
o Avoiding ingestion of raw fish or
improperly cooked fish
PARASITE BIOLOGY
o MOT of F. hepatica and F. gigantica
– ingestion of metacercariae
o Life span of adult worm- 9 to 13
years(biliary passage of the liver)
o Unembryonated egg- carried by the
bile through the sphincter of oddi
o Infective stage: metacercariae in
DH
o Diagnostic stage: unembryoated
eggs in feces
o Eggs: mature in water(9-15days for
15 to 25 ˚C)
o 1st intermediate host- Snail
(Lymnaeidae)
 o 2nd intermediate host- aquatic fever, right upper quadrant
plants (Ipomea obscura/morning abdominal pain.
glory/ kangkong) and Nasturtium o TRIAD: high fever, hepatomegaly,
officinale/ watercress marked Eosinophilia
Chronic/latent phase:
o FIBROSIS.
o Other complications include
Obstructive jaundice, hemobilia,
biliary cirrhosis. Rare Complication
of Fascioliasis is ACUTE
Fasciola hepatica PANCREATITIS.
o Egg o FLUKES SURVIVING
o large, ovoidal, operculated MASTICATION attach to posterior
o -yellowish to brown color pharynx causing hemorrhagic
o -140-180um x63-90um nasopharynitis and dysphagia known
as HALZUON in Lebanon,
o Adult
MARRARA in Sudan.
o large, broad and flat body
o 18-51 mm x 4-13mm
o -it has distinguishable DIAGNOSIS OF Fasciola spp
cephalic cone
o -suckers( small and locate at o Overlapping symptoms or lack of
each conical projection) symptoms
o two testes(highly branched) o History of eating raw, improperly
and ovary (dendritic) cooked freshwater vegetation or of
o -ceca are long and highly living in or travel to an endemic area
branched) is suggestive of infection.
o Parasitological diagnosis:
Fasciola gigantica o identification of eggs in stool
or bile
o Egg o After treatment;
o slightly larger than F. o Recovery of adult worm
hepatica during surgical exploration
o -160-190um x70-90um o ELISA and Western Blot
o Adult o alternative methods
o -longer, 25-75mm x 3-12mm o Radiological examination may also
o -less developed shoulders & help in diagnosis
short cephalic cone o Sonography and Computed
o -ceca is branched Tomography (CT)
o ERCP (Endoscopic Retrograde
PATHOGENESIS AND CLINICAL Cholangiopancreatography)
MANIFESTATION
TREATMENT
Acute/invasive phase:
o migration of juvenile parasite from o Triclabendazole single dose
the intestine to the Liver. Dyspepsia, 10mg/kg (DOC)
Bithionol- 30 to 50mg/kg body
 weight on alternate days 10 to 15 7 family, 1 specie freshwater shrimp
doses. in C.sinensis
o Cure rates 58 to 100%. o Adult worms: found in the bile duct
o Peroxidic compounds- Single dose o Reservoir host: cats, dogs, pigs, and
200 to 400mg/kg oral doses. 6 other mammals

Adult
PREVENTION AND CONTROL
-leaf-like with transparent tegument
o Thorough washing or cooking of -C. sinensis 10-25mm x 3-5mm wide
vegetable, and boiling of water in -Opisthorchis 8-12mm x 1.5-3mm
endemic areas. wide
o Elimination of snail (intermediate -both have similar location of
host) through copper sulfate, and vitellaria
killing parasite by chemotheraphy. -differ in testes C. sinensis (2 large
o Vaccination of animals ( Fasciola and highly branched),
antigens) -Opisthorchis(lobate, arranged
o Fatty-acid binding (FABP), obliquely)
o Egg
glutathione-S-transferase (GST),
cathepsin L (CatL), protenaise, and -yellowish brown, ovoid
hemoglobin -26-20um x15-17um
-have convex operculum, small
protuberances at abopercular end
Clonorchis sinensis - three species are hard to
differentitate
Opisthorchis felineus and
Opisthorchis viverrine
PATHOGENESIS AND CLINICAL
o 2 subspecies : Opisthorchis MANIFESTATIONS
felineus and Opisthorchis viverrini
o Small digenetic trematode, family • Local trauma and irritation.
"Opisthorchiidae“ • Phases are as follows:
o Parasites of the bile duct and (a) desquamation of
gallbladder of humans and fish- epithelial cells;
eating mammals. (b) hyperplasia and
o 1892 & 1911- first recorded desquamation of epithelial
cells;
infections of humans
(c) hyperplasia,
o 1874- Clonorchis sinensis liver fluke
desquamation of epithelial
first reported in India during an
cells, and adenomatous
autopsy of a 20-year old Chinese
tissue formation; and
patient.
(d) marked proliferation of
the periductal connective
PARASITE BIOLOGY
tissue with scattered abortive
o MOT : ingestion of metacercaria
acini of epithelial cells, and
o First intermediate host: snail
fibrosis of the wall of the
o Second intermediate host: fresh biliary duct.
water fish (Cyprinidae) 31 species in
 • Cholangiocarcinoma is the most • Praziquantel - 25mg/kg, three times
serious complication of infection with a day for 2 days. May also be given
O. viverrini at 60mg/kg in three doses for 1 day.
• 1956, estimated 15% of primary liver • Artemisinins and synthetic
cancer in Hong Kong were peroxides
Cholangiocarcinomas associated • Tribendimidine – single 150mg/kg
with C. sinensis . of body weigh oral dose of either
artemether, artesunate, or
• Korea with has high prevalence of Tribendimidine
Clonorchis • OZ78 - single 300mg/kg oral dose
• Sakol Nakhon (upper Northeast
Thailand) highest mortality in liver
PREVENTION AND CONTROL
and bile duct cancer
(1) Stool examination; Praziquantel
• Chronic irritation and inflammation
(2) Health education for the promotion
result hyperplasia and adenomatous
of cooked fish consumption.
changes of the biliary epithelium.
(3) Proper human waste disposal.
• Liver fluke infection results in
*Irradiating fish at a dose of 0.15 kGy.
endogenous formation of N-nitroso
*Acetic acid (3-6%) pretreatment for 4 hours
compounds which may lead to
neoplastic transformation
BABESIA SPP.
• Macrophages and other
inflammatory cells, activated by
Babesia is a protozoan parasite of the
parasite-specific T-cells, synthesize
blood that causes a hemolytic disease
nitric oxide, which us a potential
known as Babesiosis.
carcinogen.
 There are over 100 species
• Mucin-producing activity is also a
of Babesia identified however only a
frequent feature
handful of species have been
documented as pathogenic in
DIAGNOSIS OF C.sinensis, O. felineus,
humans.
O. viverrine
 In the United States, Babesia
microti is the most common strain
• Detection of parasite egg in stool
associated with humans with other
• Cholangiography
species infecting cattle, livestock
-very useful tool for diagnosis
and occasionally domestic animals.
• Radiological features of biliary
 People who contract Babesiosis
- saccular dilations of intrahepatic
suffer from malaria-like symptoms.
bile ducts
As a result malaria is a common
- rapid ductal tapering (arrowhead
misdiagnosis for the disease.
sign)
• ELISA
o For centuries, Babesiosis was
- high degree of sensitivity
• EIA and Coproovoscopy known to be a serious illness for
• PCR wild and domestic animals
especially cattle.

TREATMENT o Victor Babes, a Romanian

scientist who first documented
 the disease in 1888, described mouse (Peromuscus Leucopus
symptoms of a severe hemolytic Rafinesque)
illness seen uniquely in cattle
PATHOGENESIS AND CLINICAL
and sheep.
MANIFESTATION
o Babesiosis can also be known as
Prioplasmosis. • 1. B. bovis- smaller forms (2.4 um by
1.5 um)
PARASITE BIOLOGY • 2. B. equi- more pathogenic (2 um
by 1 um)
• Babesia-heteroxenous parasite
• 3. B. bigemina- larger forms (4-5 um
• Mammals- Primary hosts
by 2-3 um)
• Ticks-Intermediate host or vector
• 4. B. caballi- less virulent (3 um by 2
Transmission to humans to rodent B. microti
um).
and cattle forms of Babesia is generally
associated with Ixodes spp.
SIGNS AND SYMPTOMS
• headache
• muscle pain
VECTORS:
• anorexia
 Babesia is transmitted by inoculation
• nonproductive cough (mucus is not
after the bite of Ixodidae ticks.
coughed up)
 There are many species
• arthralgias (noninflammatory joint
of Ixodidae that transmit the
pain unlike arthritis, which is
disease.
inflammatory)
 In the Americas Ixodidae
• nausea
scapularis is the most common
• vomiting
vector.
• sore throat
 This hard tick, commonly known as
• abdominal pain
a deer tick, is also the vector for
other tick-associated illnesses such
as Lyme disease. And the biological DIAGNOSIS
host of Babesia.
INCUBATION PERIOD:
TRANSMISSION: o Signs of infection usually arise 1 to 8
o Babesia is spread through the saliva weeks after a bite from an infectious
of a tick when it bites. tick.
o At its nymphal stage, a tick will bite MORPHOLOGY:
into the skin for a blood meal. o Babesia enters erythrocytes at the
sporozoite stage. Within the red
RESERVOIR: blood cell, the protozoa become
 Many species of Babesia only infect cyclical and develop into a
non-human mammalian hosts, most trophozoite.
commonly cattle, horses, and sheep. o Morphology of Babesia in an
erythrocyte . The trophozoites morph
into merozoites, which have a tetrad
 B. microti and B. divergens are the
structure coined a Maltese-cross
two main pathogenic species in
form.
humans. Their reservoirs are
theorized to be the white-footed
 o The tetrad morphology, which can
be seen with Geimsa staining of a
thin blood smear, is unique
to Babesia and serves as a
distinguishing feature
from Plasmodium falciparum, a
protozoan of similar morphology that
causes Malaria.
o Trophozoite and merozoite growth
ruptures the host erythrocyte leading
to the release of vermicules, the
infectious parasitic bodies, which
rapidly spread the protozoa
throughout the blood
o Antibody detection: detects even low
levels of parasitic invasion
o -Indirect Fluorescent antibody test
(IFA)- detects antibodies of patient
with B.microti infection.
o Polymerase chain reaction (PCR)-
considered to be the gold standard
for Babesia detection.

DIAGNOSTIC TEST –BLOOD SMEAR

As a protozoan parasite, the most effective
way to identify Babesia infection though
blood sample testing.
TREATMENT
o Standard Treatment of human
babesiosis-Clindamycin combined
with quinine or azithromycin and
atovaquone
PREVENTION AND CONTROL
o Avoiding tick-infested areas
o Bug repellents in clothes of parasite
o Rodent Population should be
controlled