Trematodes PDF

Trematodes S. mansoni, S. japonicum, S. haematobium, P. westermani 11:11PM n Header Section Header Section Header Section Header Section Header Section Header Section Header Section H Blood Fluk...

Trematodes S. mansoni, S. japonicum, S. haematobium, P. westermani 11:11PM n Header Section Header Section Header Section Header Section Header Section Header Section Header Section H Blood Flukes Schistosoma mansoni Schistosoma japonicum Schistosoma haematobium Lung Flukes Paragonimus westermani Back to Agenda Page n Header Section Header Section Header Section Header Section Header Section Header Section Header Section H  Schistosoma spp. elongated and cylindrical Dioecious Most romantic parasite due to their perpetual copulation inhabit caval venous and mesenteric-portal blood vessels Ingest RBS contain hemoglobinase Hemoglobinase - a protein that break down hemoglobin Schistosoma spp. Morphology: 1. Egg (Diagnostic Stage) 2. Larva Miracidia Sporocyst Cercariae (Infective Stage) - skin penetration 3. Adult Back to Agenda Page Miracidia Moves through the water as the outer surface is covered with numerous cilia Size reaches 150-180 micrometer in length and 70 to 80 micrometer in width The energy required by the miracidium takes 4 to 6 hours to search for appropriate freshwater snail host. terebratorium (apical papilla) facilitates attachment to the snail host tegument Back to Agenda Page Miracidia Back to Agenda Page Sporocyst multiplies asexually within a freshwater snail Back to Agenda Page Cercariae (Forked-tail) It is a swimming larva because of its bifurcated tail The oral sucker and the ventral sucker (known as acetabulum) facilitate attachment to the tegument of the definitive host Pre-and post-acetabular glands facilitate host penetration thanks to their proteases The tail is shed upon penetration Back to Agenda Page Cercariae Back to Agenda Page Schistosoma mansoni Afrobilharzia mansoni, Schistosomum americanum, Distoma haematobium Back to Agenda Page Schistosoma mansoni Common Name: Common Disease Associated: Manson's Blood Manson’s intestinal Fluke schistosomiais or Swamp Fever Schistosomiasis mansoni (Bilharziasis) Acute schistosomiasis (Katayama fever) Back to Agenda Page Schistosoma mansoni First reported by Theodore Bilharz digenetic protozoan parasite Found in sub-Saharan Africa and some South American countries (Brazil, Venezuela, Suriname) and the Caribbean, with sporadic reports in the Arabian Peninsula Habitat: Inferion mesenteric vein and colon/rectum Snails are the intermediate host: Definitive host: 1. Biomphalaria spp. 1. Man Biomphalaria straminea Biomphalaria tenagophila Biomphalaria glabrata 2. Australorbis spp. 3. Tropicorbis spp. 4. Planorbis spp. Back to Agenda Page  MORPHOLOGY Egg 1-2 eggs capacity of uterus 100 - 300 eggs per day Light yellowish brown Have large lateral spine on one side (rose-thorn appearance) Fully mature when laid (hatch when in contact with water) could be present in urine and stool Adult Living a life span of 20 to 30 years funnel-shaped sucker called oral sucker at the anterior end of the body small thorn are present Many prominent tuberculations are present in the tegument Back to Agenda Page Adult Male: 8 to 9 testes arranged in a zig-zag row size of 6 - 12 mm long have diploid number of chromosome (16) flattened, forming gynaecophoric canal and within this grove the female worm is held membranocalyx - bilayered external part of the tegument which is renewed and shed continuously Back to Agenda Page Adult Female: cylindrical body held within the gynecophoric canal held within the gynecophoric canal of the male 7-17 mm in length can digest ten times more RBC’s uterus is short and contains only 1 egg at a time Laurer’s canal is absent Back to Agenda Page Adult Back to Agenda Page  Clinical Symptoms Acute infection (Katayama fever) Chronic infection can persist for years and can cause scarring and can occur weeks after infection inflammation in the affected organs Symptoms include: Symptoms include: Hematemesis or melena Fever Enlarged liver (hepatomegaly) Chills Blood in urine (hematuria) Weakness Difficulty or pain while urinating (dysuria) Headache Anorexia Rare complications Nausea eggs can enter the brain or spinal cord causing seizures, paralysis, or spinal cord inflammation Vomiting Diarrhea Most people have no symptoms Cough An itchy rash may develop at the site of Abdominal pain penetration when the schistosomes first enter the skin  Laboratory Diagnosis 1. Stool examination 2. Rectal biopsy 3. Sedimentation techniques 4. Faust Meleney’s egg hatching technique 5. Circumoval Precipitin Test (COPT) Definitive test for schistosomiasis Demonstrates “bleb formation” Specimen: Serum checked for antibodies Reagent: Lyophilized eggs (of trematodes in powder form) from rabbit  Laboratory Diagnosis 6. Cercarial Hullen Reaction Demonstrates shrinking of cercaria Specimen: Serum Reagent: Lyophilized cercaria On a glass slide with lyophilized cercaria add serum that contain antibodies against Schistosoma. Observe the slide with a microscope, if the cercaria shrinks, it means the patient is infected Treatment Praziquantel Prevention and Control Treatment of patient Public health education & programs Environmental sanitation Control of snails Protection from skin penetration of the cercariae Schistosoma japonicum Smallest among blood flukes Back to Agenda Page Common Name: Common Disease Associated: Blood Fluke Oriental/Japonica Schistosomiasis Japanese Blood Fluke Acute Schistosomiasis (Katayama Oriental Blood Fluke fever) Chronic Schistosomiasis Intestinal Schistomiasis Neuroschistosomiasis - Central Nervous System Manifestation/Lesion Back to Agenda Page MORPHOLOGY EGG Size: Relatively large, measuring approximately 70-100 micrometers in length and 55-64 micrometers in width. Shape: Round or oval. Spine: Possesses a small, inconspicuous lateral spine. This spine is a key characteristic used to differentiate S. japonicum eggs from those of other Schistosoma species. 50 eggs capacity of uterus 1500 - 3000 eggs per day  MORPHOLOGY ADULT Male: Size: Shorter and stouter than the female. Gynecophoral Canal: Possesses a gynecophoral canal, a groove on its ventral surface where the female worm resides. Oral Sucker: A muscular organ used for attachment to the host's blood vessel wall. Ventral Sucker (Acetabulum): Another muscular organ for attachment. Tegument: A protective outer layer.  MORPHOLOGY ADULT Female: Size: Longer and more slender than the male. Oral Sucker and Ventral Sucker: Similar to the male. Tegument: Protective outer layer. Reproductive System: Well-developed reproductive organs for producing eggs. MORPHOLOGY  EPIDEMIOLOGY Geographical Distribution: Transmission: China Fecal-Oral Route: Philippines (Mindoro, Leyte, contact with contaminated water Sorsogon, and Mindanao) Indonesia Vietnam Laos Cambodia Back to Agenda Page  CLINICAL SYMPTOMS Oriental/Japonica Schistosomiasis Acute Schistosomiasis (Katayama fever): Neuroschistosomiasis (Central Nervous System Manifestation/Lesion): Fever Seizures Chills Headaches Cough Focal neurological deficits Abdominal pain Acute encephalopathy Diarrhea Paralysis Hepatosplenomegaly (enlarged liver Cognitive impairment and spleen) Eosinophilia (increased eosinophil count in blood) Back to Agenda Page  CLINICAL SYMPTOMS Intestinal Schistosomiasis: Chronic Schistosomiasis: Diarrhea Hepatosplenomegaly Blood in stool Portal hypertension Abdominal pain Ascites (fluid accumulation in the Tenesmus (feeling of abdomen) incomplete bowel emptying) Variceal bleeding Pulmonary hypertension Fibrosis of the liver, spleen, intestines, and bladder Cognitive impairment in children Back to Agenda Page Laboratory Diagnosis Microscopic Examination Kato-katz Formalin-Ethyl Acetate Concentration Serological Test ELISA Molecular Diagnostic Technique PCR  Treatment Praziquantel Prevention & Control Snail Control: Reducing the population of intermediate host snails through molluscicides or biological control agents. Improved Sanitation: Promoting proper sanitation practices and access to clean water. Health Education: Raising awareness about the disease, its transmission, and prevention measures. By implementing comprehensive control programs, it is possible to reduce the burden of schistosomiasis japonica and improve the health of affected populations. Schistosoma haematobium Back to Agenda Page Schistosoma haematobium Common Name: Common Disease Urinary Associated: Schistosome Urinary Vesical Blood Schistosomiasis Fluke Back to Agenda Page Snails are the intermediate Habitat: host: Vesical, prostatic, 1. Biomphalaria spp. uterine venous 2. Bulinus spp. plexuses 3. Phyopsis spp. Urinary bladder Definitive host: 1. Man Back to Agenda Page Morphology Eggs: Oval-shaped with a larg terminal spine. 20 - 290 eggs per day Adult Male: Cylindrical, 10-18 mm long, with a gynaecophoric canal to hold the female, 4-5 testes arranged in groups Female: Slender, thread-like, 12-20 mm long, 20 - 30 egg capacity of uterus Epidemiology Primarily found in Africa and Middle East Nile River Valley A few cases were also reported in India such as Ratnagiri in Maharashtra. Transmission Through contact with contaminated water with infected snails. Skin penetration Clinical Symptoms Acute Schistosomiasis: Skin irritation at the site of cercarial penetration (swimmer’s itch) Fever, chills, cough, and muscle aches Chronic Schistosomiasis: Haematuria (blood in urine) Dysuria (painful urination) Frequent urination Bladder inflammation and fibrosis Kidney damage Bladder cancer (long-term complication)  Laboratory Diagnostic Microscopic Examination: Urine microscopy to detect Schistosoma haematobium eggs Stool microscopy (less sensitive for S. haematobium) Serological Tests: ELISA to detect antibodies against Schistosoma antigens Treatment Drug of choice: praziquantel Alternative: Metrifonate (Bilarcil) Prevention and Control Improved sanitation Safe water supply Snail control Health education Mass drug Mass Drug Administration Environmental management Paragonimus westermani Back to Agenda Page Paragonimus westermani Common Name: Common Disease Oriental lung Associated: fluke Paragonimiasis Japanese lung fluke Back to Agenda Page  Morphology: EGG Size: 80-120 µm long by 45-70 µm wide. Color: Yellowish-brown. Shape: Ovoid or elongated, often asymmetrical with a slightly flattened end (but prominer operculum). Shell: Thick with a visible operculum at the large end; opposite end is thickened Thickened abopercular Similar with D. latum (cestode) Back to Agenda Page Adult Shape: Coffee bean-like Size: 7.5-12 mm long, 4-6 mm wide, 3.5-5 mm thick live in the lungs, usually in pairs in cystic spaces that communicate with bronchi It's anterior end is slightly broader than the posterior end. The ventral sucker in situated near about the middle of the body. Wavy or succulent intestine ceca Life span of the adult worm is about 6 to 7 years Hermaphroditic, reddish-brown Back to Agenda Page Epidemiology 1st Intermediate Host East and Southeast Asia, including Freshwater Snails Japan, Korea, China, the Philippines Antemelania asperata (formerly (Sorsogon), and parts of Thailand Brotia asperata) A. dactylus Cases have also been reported in parts of Africa and South America, 2nd Intermediate Host: though less frequently Crustaceans It is common in areas where raw Sundathelphusa philippina freshwater crabs and crayfish are consumed Back to Agenda Page Life Cycle Infective Stage: Metarcercariae Diagnostic Stage: Unembryonated eggs Back to Agenda Page Paragonimus westermani CLINICAL SYMPTOMS Acute Phase - Diarrrhea, abdominal pain, fever, cough, urticaria, hepatosplenomegaly, pulmonary issues, and eosinophilia. Chronic Phase - Chronic cough, chest pain, hemoptysis, dyspnea, with cough progressing to rusty or blood-tinged mucus. Extrapulmonary Infections - Occur when worms migrate, especially to the brain. Seizures, aphasia, paresis, and visual disturbances. Paragonimus westermani LABORATORY DIAGNOSIS Microscopic Detection - Examining Lung Biopsy - Confirms diagnosis sputum or stool for eggs after 2-3 when other methods are months is the primary diagnostic inconclusive, especially for approach. extrapulmonary or atypical Antibody Detection - Useful for presentations. early or light infections, especially Morphologic Comparison - Useful if in extrapulmonary cases or where eggs resemble those of other infection mimics TB. parasites, to avoid misdiagnosis. Imaging - Chest X-rays or CT scans help identify lung lesions but can resemble other diseases, so they’re Unembryonated when passed in sputum or feces. best used with other tests. Paragonimus westermani TREATMENT Praziquantel Bithionol PREVENTION AND CONTROL Avoid eating raw or undercooked freshwater crabs and crayfish Thank you!