Trematodes

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Trematodes

• Gregory L. Brower, D.V.M., Ph.D.
• Cell Biology and Anatomy
• School of Medicine
• Columbia, South Carolina

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Trematodes (Flukes)

• Schistosoma
• S. mansoni
• S. hematobium
• S. japonicum
• Fasciolopsis buski
• Fasciola hepatica

• Opisthorchis
• O. sinensis
• O. felineus
• O. viverini
• Paragonimus
• P. westermani
• P. kellicotti

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Schistosomiasis

• It is believed that Napoleon's army in North
  Africa was defeated not by the enemy but by
  infestation of his soldiers with Schistosomal
  infections.

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SchistosomiasisGeographical Distribution
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The Schistosome
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SchistosomaLife Cycle
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A Case of Hematuria

• An 8-year-old son of an Egyptian immigrant family
  is referred to the nephrology clinic with a 2-yr
  history of painless macroscopic hematuria. Smear
  from a centrifuged urine sample revealed this
  object
• NEJM 2000

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SchistosomiasisSymptoms
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SchistosomiasisSymptoms
Cercarial Dermatitis
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SchistosomiasisHistologic Appearance
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SchistosomiasisDiagnosis
S. Mansoni Lateral Spine
S. Hematobium Terminal Spine
S. Japonicum Smaller egg Minute Spine

• History
• Symptoms
• Histology
• Eggs in the urine or stool

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SchistosomiasisTreatment and Control

• Praziquantel is effective
• Avoid swimming in snail infested water
• Sanitary disposal of sewage
• Elimination of snails

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SchistosomiasisTreatment and Control
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Fasciolopsis buskiGiant Intestinal Fluke
Geographic Distribution
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Fasciolopsis buskiMorphology
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Fasciolopsis buskiLife Cycle
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Fasciolopsis buskiLife Cycle
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Fasciolopsis buski Symptoms

• Epigastric pain
• Nausea
• Diarrhea
• Generalized edema and ascitis in heavier
  infections

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Fasciolopsis buski Diagnosis

• Symptoms
• History of eating uncooked water chestnuts in
  endemic areas
• Eggs in stool

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Fasciolopsis buski Treatment and Control

• Praziquantel is effective
• Avoid eating uncooked water chestnuts in endemic
  areas
• Sanitary disposal of sewage
• Elimination of snails

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Fasciola hepaticaLife Cycle
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Fasciola hepaticaLife Cycle
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Fasciola hepatica Symptoms

• Upper quadrant tenderness and pain
• Chills and fever
• Eosinophilia
• Hepatitis
• Hyperplasia and blockage of bile duct

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Fasciola hepatica Diagnosis

• Symptoms
• History of eating uncooked watercress from
  infested locale
• Eggs in stool

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Fasciola hepatica Treatment and Control

• This species of fluke is Praziquantel resistant
• Triclabendazole is effective
• Avoid eating uncooked watercress in endemic areas
• Elimination of snails

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Treatment of Hermaphrodiditic Flukes
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Opisthorchis sinensis Geographic Distribution
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Opisthorchis sinensis Morphology
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Opisthorchis sinensis Life Cycle
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Opisthorchis sinensis Symptoms

• Epigastric pain
• Indigestion
• Liver necrosis and tenderness
• Liver dysfunctions related to fluke burden
• Diarrhea, hepatomegaly, jaundice and ascites in
  heavier infections

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Opisthorchis sinensis Diagnosis

• Symptoms
• History of eating improperly cooked fish in
  endemic areas
• Eggs in the stool

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Opisthorchis sinensis Treatment and Control

• Praziquantel is effective
• Avoid eating improperly cooked fish in endemic
  areas
• Sanitary disposal of sewage
• Elimination of snails

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Paragonimus westermaniGeographic Distribution
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Paragonimus westermaniMorphology
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Paragonimus westermaniLife Cycle
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Paragonimus westermani Symptoms

• Dry cough, pleurisy
• Pulmonary pain
• Blood-stained rusty brown sputum
• Fluke may migrate to brain, produce eggs and
  cause epilepsy-like symptoms

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Paragonimus westermaniDiagnosis

• Symptoms
• History of eating improperly cooked crab-meat in
  endemic areas
• Eggs in the sputum

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Helminthic Eggs