Food borne trematode infections

Food must be raw or improperly

cooked -> infectve stage
Fresh water fish
Shellfish and vegetables
Belong to the same superfamily/
family
Same life cycle and some
morphology
Echinostomatidae = smaller worms
Echinostoma ilocanum (sa ng
ilocos) Artyfechinostomum malayum
(uncommon)
Faciolidae = giant worms
Fasciola hepatica (liver) ,
gigantica (very large worm)
Fasciolopsis buski (intestine)
Adults inhabit different organs,
share similar life cycles
Oposthorchiidae (liver flukes) not
endemic in Philippines, snail
intermediate host not found , fish lang
-> problematic kasi pwede mag
introduce ng snail intermediate host
-> magstart ng panibagong lfie cycel
Clonorchis sinensis,
Heterophyidae = even smaller flukes ;
meron sa Philippines lalo na sa
mindanao
Heterophyes heterophyes
Intestinal Flukes
Fasciolopsis buski = not found
in PH, walang 2nd intermediate host
Heterophyes , Echinostoma =
found everywhere
Fasciolopsis buski = largest parasitic
trematode
Attaches to duodenum
Obstruction with heavy
infection, toxic effects due to
metabolic products. Animal reservoir
= Pig
Anterior sucker, ventral sucker ,
uterus testes (dendritic = sangasanga) , simple intestinal caeca =
unbranched digestive tract (ends
blindly) No cephalic cone
Segmentina hemisphaerula =
nakikita sa Philippines , 1st
intermediate host
Harbors larval stages
May asexual multiplication
Aquatic plants = 2nd
intermediate host, mukang kalabaw =
water caltrop (kinakain ng hilaw),
water chesnuts , water _____
Harbors infective stage
(metacecaria) sa skin
Binabalitan nila gamit yong
teeth nila = doon kumakapit
Children are most often heavily
infected due to toxic metabolic
products
Pag hindi kinain = no infection

Problem in Vietnam
Echinostomisis
Oral sucker , ventral sucker ,
circlet of spines = imbeds in small
intestine = irritation of intestinal
mucosa , wound = bleeding = bloody
diarrhea
Skin is marked by tubercles
Benign testes ( Spherical
testes , round )
Egg can be seen in Kato-Katz,
difficult to distinguish
Man can be definitive
Birds are reservoir , snail eating
birds (determined sa beaks)
Adult can be found in
duodenum
Eggs are released in feces (pag
may toilet edi wow)
Eggs are passed
unembryonated -> development ->
embryonated stage -> hatch into
miracedia -> ciliated -> penetrate soft
tissue -> sporocyst -> cercaria ->
asexual multiplication -> encyst in
proper snail intermediate host ->
eating raw snail (kuhol) Pila luzonica ,
Endemic in northern Luzon, leyte
samar and Mindanao
Ulceration due to spines , diarrhea ,
abdominal pain
Differentiate eggs , (Fasciola ,
Fasciolopsis >>> size)
Praziquantel
Avoid ingestion of raw or improperly
cooked
Not much a problem
Heterophyid
Emerging problem in Mindanao
Very small worms , few mm
Oral sucker, ventral sucker , pharynx
-> caeca (ends blindly) ovary , testes ,
vitellarium
Capable of burrowing in intestinal
mucosa until they cannot go out
anymore -> die -> decay -> eggs are
released -> blood stream -> cardiac
muscles , brain , spinal cord
(embolism) -> life threatening
conditions -> immediate treatment
Fish born
Other reservoir host (dogs cats birds)
Adults in SI -> eggs are released in
environment -> eggs are
EMBRYONATED (miracidium) [unlike
Fasciola , echinostoma] -> will not
hatch unless ingested by proper snail
intermediate host -> hatch sporocyst
-> radiae -> cercariae (with asexual
multiplication -> released of snail ->
encyst in fish -> gills , skin , tail ->
ingestion of uncooked fish

Madaming species pero common ang

Heterophyes heterophyes,
Metagonimus yokogawai, Haplorchis
taichui , Haplorchis yokogawai
Pinakamarami sa Mindanao (davao del
sur , compostela valley , , pockets sa
Luzon , Visayas
Low host specific , not strict. Involved
several species of snails and fishes.
Thiara tuberculate (lahat sila may
spired and broken) and Oreochormis
niloticus (tilapia)
Pathology:
Abdominal discomfort
Edema
Toxic metabolites
Heterophyd myocarditis ->
granuloma foramation
Praziquantel -> all trematodes
Fasciola hepatica -> not killed with
praziquantel, bithionol/triclabendazole

Disease
Confined to liver
Inflammation of bile ducts
Bleeding from bile ducts, rarely
bilary cirrhosis
Sheep liver rot =hyperinfection
Halzuon = armanian tribe ,
requires eating raw liver -> liver flukes
attach to larynx or pharynx ->
inflammation -> mahirap lumunok,
huminga -> or pag nilunok -> false
fascioliasis , adult passes out egg ->
treat with praziquantel
Clonorchis sinensis
Widely distributed in E. Asia
Long life span , 10 years
Opisthorchis felineus
Confined to eastern Europe
Cats
Cannot be differentiated from
others
Hyerophyid kasi yon lang nasa
pilipinas
Associated with improper
cooked fished

Liverflukes
Giant liver flukes fasciola hepatica
(liver), gigantica (giant)
Not of medical importance , vet.
Importance. Cows, karabaws sheep
goats , ruminants
Clonorchis sinensis (Chinese liverfluke)
Opisthorchis felines (cat) , viverrini (PH
importance in Thailand)
Fasciola
Worldwide distribution
Well-known liver fluke infection
1st trematode whose life cycle
worked up
Important parasite In cattle ->
eating of contaminated grass
Increasing cases in human
Lifecycle
Vietnam has noted increased
fascioliasis
Eggs in liver-> small intestine
via common bile duct -> eggs are
mixed in feces -> contaminate
environment -> unembryonated eggs
-> embryonated -> miracidia ->
penetrate snail intermediate host ->
cercaria leaves snail intermediate host
-> encyst aquatic vegetation or encyst
in water -> mahirap icontrol kasi
pwede macontaminate ang water ->
ingestion of plant or water
Treatment with triclabendazole
10,20mg/kg 1x
Can be found in ectopic sites ,
mammary gland, knee

Testes is dendritic in clonirchis

Testes in ophistorchis 0 looped
Mas elaborated ang testes ng
clonirchis
Snail intermediate host are not found
in Philippines
Related with cholangiocarcinoma ,
heavy condtionwithout treatment big
problem
Fresh water fish, cats dogs become
reservoir pag iniwan na ng tinder yong
mga tirang isda. Herbs and vegetables
mask fishy smell
Contamination of fishpond with human
feces
Prevention and control
Case finding (stool exam)
Cook food well -> best measure
Echinoccocus , Hymenopelis
Not common
Not major PH problems
Echinococcus granulosus
Common in temperate countries
Hydatid cyst -> echonococcus
disease
May E. multilocularis
Present sa PH but not prevalent
No survey in Philippines
More common in sheep raising
countries
Contact bet. Sheep and dog
Exposure to transmission
Humans are accidental host
Morphology
No live echinococcus wala sa
practical exam

Testes and ovaries are found in

gravid segment, -> Eggs are not easy
to identify, unable to differentiate from
taenia.
Life cycle
Complicated
Dog -> eats sheep -> sheep is
infected with hydatid cyst ->
contains scolex -> attach to intestinal
mucosa of dog -> strobilization ->
adults are formed -> climate
determines capability of parasite
development (temperate countries) ->
lay eggs -> passed out in feces ->
sheep are infected with dog feces

Human can serve as accidental host

pag hinahalikan ng mga tao yong mga
aso (kailangan ang aso at
tupa/kambing sa life cycle) -> scolex
of hexacanth embryo penetrates
duodenum -> enters circulation ->
hydatid cyst (larval) -> reach other
organs -> no further development
(kailangan sa aso mag mature)
Hydatid cyst
Brood capsules may scolex sa
loob sa bawat isang scolex, cyst have
brood capsules -> ruptures -> scolex
->