Intestinal trematodes
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  • 1. Intestinal Trematodes Prof. CM.Kihamia
  • 2. FASCIOLOPSIS BUSKI (GIANT INTESTINAL FLUKE)
    • MORPH: Largest fluke. Thick, fleshy, ovate. Flesh-coloured. 2-7.5 x 1-2 cm.
    • Oral sucker and ventral suckers present. Typical trematode alimentary canal with unbranched intestinal caeca.
    • Two dendritic testes.
    • Single branched ovary.
    • Vitellaria on lateral sides and a convoluted uterus and genital pore that is anterior to the ventral sucker.
  • 3. Contd.
    • EGG: Yellowish and oval. 130-140 x 80-85 µ. Thin walled with small operculum. Undeveloped ovum.
    • HABITAT: Small intestine esp. duodenum and jejunum. Adults feed on intestinal contents.
  • 4. LIFE CYCLE:
    • Adults in intestine produce eggs.
    • Egg hatches to free-swimming miracidium in 3 weeks. Miracidium penetrates snail within 2 hrs. Segmentina and Hippeutis spp.
    • In the snail: Sporocyst  Redia  Daugher redia  Cercaria.
    • Cercaria leave the snail and attaches to fresh water plants and becomes metacercaria.
    • Water plants include water callrop, water hyacinth, water chestnut and water bamboo.
    • These plants are grown in ponds and eaten raw.
    • Ponds are fertilized by human faeces.
    • When metacercaria is ingested it excysts in the duodenum and is attached to the intestinal wall.
  • 5. Epidemiology:
    • Common in China, Vietnum, Thailand, Laos, Cambodia. Transmission is by eating fresh water plants with metacercariae. Pigs harbour infection. Incidence is highest in China. Dried plants are safer.
    • PATHOLOGY:
      • Attached to intestine by suckers.
      • Mucosa inflamed, ulcerated and abscesses form. Epigastric pain, nausia, diarrhoea.
      • Heavy infection leads to oedema, ascites and anarsaca.
      • Toxic products of worm.
      • Anaemia, leukocytosis, lymphocytosis, and oesinophilia.
      • Good prognosis if worm treated early.
      • 1000-2000 worms affect intestinal secretions and food passage and intoxication and sensitization.
  • 6. Diagnosis, Treatment, & Control
    • DIAGNOSIS:
      • Eggs in faeces. Diffentiate from F. hapatica , Gastrodiscoides and Echinostoma sp.
      • Adult worms vomited or passed in stool.
    • TREATMENT:
      • Praziquantel is the drug of choice: 15 mg/kg body weight, single dose.
    • CONTROL
      • Sanitary disposal of human faeces.
      • Discourage use of night soil.
      • Restrict pigs.
      • Snail control.
      • Health education.
      • Cooking or steeping of water plants.
  • 7. The End
  • 8. HETEROPHYES HETEROPHYES
    • MORPH: Pyriform, greyish, 1.3 x 0.5 mm. Oral, Ventral and Genital suckers.
    • EGG: Light brown in colour, thick shell, operculated, 29 x 16 µm, Fully developed miracidium.
  • 9.
    • LIFE CYCLE:
    • Adult in man  Egg  Miracidium  Snail (Sporocyst  Redia  Cercaria). Cercaria enter fish and encysts as Metacercaria in fish (mullet ( Mugil cephalus ) and minnow ( Gambusia affinis ). Metacercaria swallowed in undercooked fish, excysts in small intestine and develops into adult in 7 days.
    • EPIDEMIOLOGY:
    • Egypt, Greece, Israel, China, Japan, Korea, Taiwan, Philippines.
    • Fishermen are important in polluting water.
  • 10. Pathology/Symptomatology
    • :
    • Mucosal irritation.
    • Intestinal penetration and egg dissemintion.
    • Abdominal pains and tenderness.
    • Diarrhoea.
    • Cardiac and brain granuloma due to deposited eggs.
    • DIAGNOSIS:
    • Eggs in faeces: differentiate from those of Clonorchis and Opisthorchis.
  • 11. Treatment & Control
    • TREATMENT:
    • Praziquantel 10-20 mg/kg body weight, single dose.
    • CONTROL:
    • Thorough cooking of fish.
    • Health education.
    • Sanitary disposal of human faeces.
  • 12. METAGONIMUS YOKOGAWAI
    • MORPH: Small, 1.4 x 0.6 mm. Pyriform shape with rounded posterior and tapering anterior. Large ventral sucker.
    • EGG: Light yellow-brown, thin-shelled, operculated, 28x17 µm, mature miracidium.
    • LIFE CYCLE:
    • Similar to Heterophyes. Adult in jejunum of man (but also cats, dogs, pigs, and pelican). Egg ingested by snail. Miracidium in intestine of snail. Sporocyst  Mother redia  Daughter redia  Cercaria. Metacercaria in fish. Ingested metacercaria excysts in duodenum and develops into adult in jejunum.
  • 13. Contd.
    • EPIDEMIOLOGY:
    • Far East: Japan, China, Korea, Philippines, Taiwan also Greece and Spain.
    • Infection is through consumption of raw fish.
    • Infection spread by contamination of water with human and animal excreta.
    • PATHOLOGY/SYMPTOMATOLOGY:
    • Similar to Heterophyes.
    • Heart and CNS granulomatous lesions may occur through eggs.
    • DIAGNOSIS:
    • Eggs in faeces.
    • TREATMENT:
    • Praziquantel 10-20 mg/kg body weight single dose.
    • CONTROL:
    • Thorough cooking of fish.
    • Health education.
    • Sanitary disposal of excreta.
    • THE END.