TREMATODES OR FLUKES

Trematodes, or flukes, are parasitic flatworms with unique life cycles involving sexual
reproduction in mammalian and other vertebrate definitive hosts and asexual reproduction in
snail intermediate hosts.

These organisms are divided into four groups on the basis of their final habitats in humans.

• Intestinal Flukes (Fasciolopsis buski, Echinostoma ilocanum, Heterophyids)

• Hepatic/Liver Flukes (Fasciola hepatica, Fasciola gigantica, Clonorchis sinensis)
• Pulmonary/Lung Flukes (Paragonimus westermani)
• Blood Flukes

INTESTINAL FLUKES

Intestinal trematodes are flat hermaphroditic worms that vary in length from a few
millimeters to many centimeters.

INTESTINAL FLUKES – FASCIOLOPSIS BUSKI

COMMON NAME: Giant Intestinal Fluke

Kingdom : Animalia
Phylum : Platyhelminthes
Class : Trematoda
Order : Echinostomida
Family : Fasciolidae
Genus : Fasciolopsis Looss
Species : Fasciolopsis buski
Disease : Fasciolopsiasis

Eggs

• Eggs of Fasciolopsis buski are broadly ellipsoidal, operculated

• 130-150 µm long by 60-90 µm wide.
• The eggs are unembryonated when passed in feces.
 • Adults of F. buski measure 20-75 mm long and have poorly-developed oral and ventral
suckers.
• Adults reside in the intestine of the mammalian host.
HOSTS
  Fasciolopsis buski requires a snail intermediate host for completion of its life cycle.
 The snails used by F. buski are small planorbid snails in the
genera Hippeutis and Segmentina.

EPIDEMIOLOGY

F. buski is found throughout Far East and Southeast Asia including:

• China,
• Taiwan,
• Bangladesh,
• India,
• Indonesia
• Thailand

Pigs are important reservoirs of the infection, although dogs and rabbits also can be infected.

MODE OF TRANSMISSION

• Transmission of parasite occurs by swallowing the infected aquatic vegetation.

• When infected plants or its fruits are peeled with the teeth and swallowed by primary host
infection is caused.

LIFE CYCLE
 1. In the human host, unembryonated eggs are discharged into the intestine and pass out of
the body with the feces.
2. Eggs become embryonated in water.
3. The eggs release miracidia, which penetrate a snail (intermediate host).
4. In the snail, the miracidia develop into sporocysts, then rediae, and then cercariae.
5. The cercariae are released from the snail.
6. They encyst as metacercariae on aquatic plants and may be ingested by a mammalian host
(human or pig).
7. After ingestion, the metacercariae excyst in the duodenum and attach to the intestinal wall.
8. There, they develop into adult flukes in about 3 months.

PATHOLOGY AND SYMPTOMS

Fasciolopsiasis characterised by:
- Mild anaemia,
- Chromic diarrhea and
- Asthenia (Lack of strength and energy).

 The adult worm causes gastro-intestinal irritation, nausea and vomiting.

 At the point of attachment of the parasite to the intestinal wall, localized inflammation,
hemorrhage and abscess may occur.
 Incubation period is 3 to 6 months.

PREVENTION

1. Avoiding eating raw aquatic vegetables.

2. Aquatic vegetables before being consumed should be washed properly.
3. Night soil before being released into water body should be sterlised with quicklime which
destroy the parasite eggs.
4. Destruction of molluscan hosts by using copper sulphate (20 p.p.m) in ponds.

INTESTINAL FLUKES – ECHINOSTOMA SPECIES

SPECIES: ECHINOSTOMA ILOCANUM

COMMON NAME: Garrison’s Fluke

Kingdom : Animalia
Phylum : Platyhelmithes
Order : Plagiorchiida
Family : Echinostomatidae
Genus : Echinoatoma

Disease : Echinostomiasis

Echinostomiasis is a food-borne infection caused by an intestinal trematodes belonging to

the family Echinostomatidae.
EGGS

• Echinostoma ilocanum reaches a size of 7 × 1.5 mm

• The excreted eggs are unembryonated, measure 90–115 × 60–70 μm, and are found in the
feces of their hosts.
• Adults are 2 to 6 mm long and 1 to 1.5 mm wide.
• Characterized by an anterior collar, which bears 49–51 spikes

HOSTS

• The major source of infection with E. ilocanum is the snail Pila conica, which is eaten
uncooked in parts of the Philippines.
• The Viviparus javanicus, large fresh water snail (in Indonesia)
EPIDEMIOLOGY

• In countries in Southeast Asia such as the Philippines, Japan, and India, several hundred
thousand humans are infected (probably more, since symptoms are mostly low graded).
• Other sources of infections are clams, tadpoles, frogs, and fish, all serving as second
intermediate hosts for echinostomes.
• Rats, dogs, cats, birds, and other fish-eating animals are reservoirs of infection.

MODE OF TRANSMISSION

 The principal mode of human infection is consumption of raw or undercooked snails.

LIFE CYCLE

1. Unembryonated eggs passed in feces of infected definitive hosts and develop in water.
2. Miracidia usually take about 3 weeks to mature after hatching.
3. After which, they swim freely and penetrate the first intermediate host – a snail.
 4. The intramolluscan stages include the sporocyst stage, one or two generations of of rediae
and cercariae are released from the snail.
5. The cercariae may encyst as metacercariae within the same first intermediate host or
leave the host and penetrate a new second intermediate host.
6. The definitive host becomes infected after eating metacercariae in infected second
intermediate hosts.
7. Metacercariae excyst in the duodenum.
8. The adults reside in the small intestine.

PATHOLOGY AND SYMPTOMS

Symptoms related to inflammation at the attachment site of adult flukes include:

• Abdominal pain,
• Diarrhea,
• Anorexia. 

PREVENTION

 Eating raw or improperly cooked freshwater fish and fresh or brackish water snails should be
avoided to prevent echinostome metacercarial infections.

TREATMENT

 In human infections, praziquantel is the drug of choice for echinostomiasis. Mebendazole

and albendazole have also been shown to have an effect against echinostomiasis.
 INTESTINAL FLUKES – HETEROPHYES HETEROPHYES

COMMON NAME: Minute Intestinal Fluke

Kingdom : Animalia
Phylum : Platyhelmithes
Class : Trematoda
Order : Opisthorchiida
Family : Heterophyidae
Genus : Heterophyes Cobbold
Species : Heterophyes heterophyes
Disease : Heterophyiasis

EGG

• The egg is ovoid, operculate, elongate and light brown (almost yellow) in colour.
• The egg contains the embryo (miracidium). It measures 27 - 30µm by 15 – 17µm
• The mature adult measures 1.0 to 1.7mm by 0.3 to 0.4mm.
• The body is covered by scales.
• The female fluke ovary is located near the end of the body.

HOSTS
 • The first intermediate host of
H. heterophyes are snails,
Cerithidia sp. and Pironella
sp.
• Mullets, gobies, perches,
and Tilapia are important fish
intermediate hosts.

EPIDEMIOLOGY

• Heterophyes heterophyes is endemic in East Asia, the Middle East, Sudan, Egypt, and
southeast Europe. 
• H.heterophyes is commonly found in the Middle East, Philippines, Taiwan, Korea, China
and Japan.

MODE OF TRANSMISSION

 Infects humans who eat raw or undercooked fish infected with the metacercaria stage of the
parasite.

LIFE CYCLE
 1. Adults release embryonated eggs each with a fully-developed miracidium, and eggs are
passed in the host’s feces.
2. After ingestion by a suitable snail (first intermediate host), the eggs hatch and release
miracidia which penetrate the snail’s intestine.
3. The cercariae are released from the snail
4. And encyst as metacercariae in the tissues of a suitable fresh/brackish water fish (second
intermediate host).
5. The definitive host becomes infected by ingesting undercooked or salted fish containing
metacercariae
6. After ingestion, the metacercariae excyst, attach to the mucosa of the small intestine and
mature into adults.

PATHOLOGY AND SYMPTOMS

Infection usually remains asymptomatic and mild. Symptoms of a heavy infection include:
• Abdominal discomfort,
• Loss of appetite,
• Chronic mucous diarrhea,
• Nausea and
 • Inflammatory reactions in the area where the parasite entered the intestine.

PREVENTION

• Prevention involves not eating raw or undercooked fish that may contain these intestinal
flukes.
• Fish and snails should be carefully cleaned and scaled and well-cooked.

TREATMENT
• Praziquantel is the drug of choice for infection of H.heterophyes with 75 mg/kg in one
day divided in three dose. Albendazole have also been shown to have an effect against
heterophyiasis.