Trematode Parasites: A Comprehensive Guide to Morphology, Life Cycles, and Treatment | Cheat Sheet Parasitology

Trematode

Other Name

Geographical

Distribution

Definitive Host

First Intermediate

Host (SNAILS)

Second

Intermediate Host

Diagnostic Stage

Infective Stage

Location of

Adult

Eggs Produced

Treatment

LUNG FLUKES

Paragonimus

westermani

Oriental lung fluke

P. africanus –

Africa

P. mexicanus –

Central and South

America

P. kellicotti –

Midwestern and

Southern US

Humans

Thiara and

Semisulcospira

Fresh water

crustaceans/crab

Unembryonated

eggs in sputum or

feces

Metacercariae in

crustacean

Lungs

Unembryonated

Praziquantel

INTESTINAL FLUKES

Fasciolopsis

buski

Giant intestinal fluke

Central and

Southeast Asia

(SEA)

Humans

Hippeutis and

Segmentina

Water chestnut

Unembryonated

eggs in feces

Metacercariae in

water tubers or

water chestnut

Small intestine

Unembryonated

Praziquantel

Echinostoma

(Euparydium)

ilocanum

Garrison’s fluke

Philippines, SEA,

Orient

Humans, aquatic

birds, carnivores

Gyraulus

Pila snail,

bivalves (clams,

oysters, scallops,

mussels), fish,

tadpoles

Unembryonated

eggs in feces

Metacercariae in

snails, bivalves,

fish, tadpoles

Small intestine

Unembryonated

Praziquantel

Heterophyes

heterophyes

Dwarf intestinal

fluke

Egypt, Middle

East, Far East

Humans,

fish-eating

mammals (dogs,

cats), and birds

Pironella and

Cerithidea

Fresh/brackish

water fish (tilapia,

catfish, trout, bass)

Embryonated eggs

in feces

Metacercariae in

fresh/brackish

water fish

Small intestine

Embryonated

Praziquantel

Metagonimus

yokogawai

Yokogawa’s fluke,

Intestinal fish fluke,

Von Siebold’s fluke

Far East

Humans,

fish-eating

mammals (dogs,

cats), and birds

Semiculcospira

Fresh/brackish

water fish (salmon)

Embryonated eggs

in feces

Metacercariae in

fresh/brackish

water fish

Small intestine

Embryonated

Praziquantel

LIVER FLUKES

Fasciola

hepatica

(more common)

Sheep liver fluke

Worldwide, more

common in US

and UK

Definitive –

sheep, cattle

Accidental -

humans

Lymnaea

Aquatic vegetation

(watercress, alfalfa)

Unembryonated

eggs in feces and

bile fluid

(occasional)

Metacercariae in

water plants

Liver

Unembryonated

Bithionol,

triclabendazole

(Praziquantel

doesn’t work!)

Fasciola

gigantica

Tropical liver fluke

Clonorchis

sinensis

Chinese or Oriental

liver fluke

SEA

Humans, dogs,

cats

Parafossarulus

manchouricus

Fresh water fish

(cyprinoid) – carps

and barbs

Embryonated eggs

in feces, bile fluid,

and duodenal

aspirates

Metacercariae in

cyprinoid fish

Liver

Embryonated

Praziquantel,

Albendazole

GALLBLADDER AND BILE DUCT FLUKES

Opisthorchis

felineus

Cat liver fluke

Europe

Humans, cats

Bithynia

Fresh water fish

(cyprinoid)

Embryonated eggs

found in feces or

bile fluid

Metacercariae in

cyprinoid fish

Bile ducts

Embryonated

Praziquantel

Opisthorchis

viverrine

SEA liver fluke

SEA

Humans, dogs,

other fish-eating

mammals

Dicrocoelium

dendriticum

Lanceolate/lancet

fluke

D. hospes – sub-

Saharan West

Africa

D. dendriticum –

Europe, Asia, North

Africa, North

America

Definitive –

cattle, sheep

Accidental –

humans, dogs

Cochlicopa, Helix,

Xerolenta, and

Zebrina

Ants (Formica spp.)

Embryonated eggs

in feces or bile fluid

Metacercariae in

ants

Bile ducts

Embryonated

Praziquantel

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Trematode Other Name Geographical Distribution Definitive Host First Intermediate Host (SNAILS) Intermediate Host^ Second Diagnostic Stage Infective Stage Location of Adult Eggs Produced Treatment LUNG FLUKES Paragonimus westermani Oriental lung^ fluke P. africanus – Africa P. mexicanus – Central and South America P. kellicotti – Midwestern and Southern US Humans (^) SemThiaraisulcospira^ and crustaceans/crab^ Fresh water Unembryonated eggs in sputum or feces Metacercariae in crustacean Lungs^ Unembryonated^ Praziquantel INTESTINAL FLUKES Fasciolopsis buski Giant intestinal fluke Central and Southeast Asia (SEA) Humans Hippeutis^ and Segmentina Water chestnut Unembryonated eggs in feces Metacercariae in water tubers or water chestnut Small intestine Unembryonated Praziquantel Echinostoma (Euparydium) ilocanum Garrison’s fluke Philippines, SEA, Orient Humans, aquatic birds, carnivores Gyraulus Pila snail , bivalves (clams, oysters, scallops, mussels), fish, tadpoles Unembryonated eggs in feces Metacercariae in snails, bivalves, fish, tadpoles Small intestine Unembryonated Praziquantel Heterophyes heterophyes Dwarf intestinal fluke Egypt, Middle East, Far East Humans, fish-eating mammals (dogs, cats), and birds Pironella and Cerithidea Fresh/brackish water fish (tilapia, catfish, trout, bass) Embryonated eggs in feces Metacercariae in fresh/brackish water fish Small intestine Embryonated Praziquantel Metagonimus yokogawai Yokogawa’s fluke, Intestinal fish fluke, Von Siebold’s fluke Far East Humans, fish-eating mammals (dogs, cats), and birds Semiculcospira Fresh/brackish water fish (salmon) Embryonated eggs in feces Metacercariae in fresh/brackish water fish Small intestine Embryonated Praziquantel LIVER FLUKES Fasciola hepatica (more common) Sheep liver fluke (^) Worldwide, more common in US and UK Definitive – sheep, cattle Accidental - humans Lymnaea Aquatic vegetation (watercress, alfalfa) Unembryonated eggs in feces and bile fluid (occasional) Metacercariae in water plants Liver^ Unembryonated Bithionol, triclabendazole (Praziquantel doesn’t work!) Fasciola gigantica Tropical liver fluke Clonorchis sinensis Chinese or Oriental liver fluke SEA^ Humans, dogs, cats Parafossarulus manchouricus Fresh water fish (cyprinoid) – carps and barbs Embryonated eggs in feces, bile fluid, and duodenal aspirates Metacercariae in cyprinoid fish Liver^ Embryonated^ Praziquantel, Albendazole GALLBLADDER AND BILE DUCT FLUKES Opisthorchis felineus Cat liver fluke^ Europe^ Humans, cats Bithynia Fresh water fish (cyprinoid) Embryonated eggs found in feces or bile fluid Metacercariae in Opisthorchis^ cyprinoid fish^ Bile ducts^ Embryonated^ Praziquantel viverrine SEA liver fluke^ SEA Humans, dogs, other fish-eating mammals Dicrocoelium dendriticum Lanceolate/lancet fluke D. hospes – sub- Saharan West Africa D. dendriticum – Europe, Asia, North Africa, North America Definitive – cattle, sheep Accidental – humans, dogs Cochlicopa, Helix, Xerolenta, and Zebrina Ants ( Formica spp. ) (^) in feces or bile fluidEmbryonated eggs^ Metacercariae in ants Bile ducts Embryonated Praziquantel

BLOOD FLUKES

Trematode Diagnostic Feature of Eggs^ Geo Distributiongraphical Definitive Host Intermediate Host (Freshwater Snails) Infective Stage Diagnostic Stage Main Sites Affected Produced^ Eggs Treatment Other Features Schistosoma haematobium (Vesical Blood Fluke) Large terminal spine with rounded middle portion Africa, Middle East Humans Bulinus, Physopsis, Biomphalaria Cercariae from snail IH Eggs in the feces/urine Veins of the urinary bladder (vesicular and pelvic venous plexus) Unoperculated Praziquantel Metrifonate (Bilarcil)— organophosphorus cholinesterase inhibitor Integument: Minute tubercles Testes: 4 - 5 Uterus: 2/3 of the body length Disease: Vesical Schistosomiasis Schistosoma japonicum (Oriental Blood Fluke) Small/Inconspicuous lateral spine/knob Nile Valley, Philippines (Leyte, Mindoro, Mindanao) Humans Oncomelania hupensis quadrasi Cercariae from snail IH Eggs in the feces Veins of the small intestine (superior mesenteric vein) Unoperculated Praziquantel Integument: Smooth to fine spines Testes: 7 Uterus: 1 /2 of the body length Disease: Intestinal Schistosomiasis Schistosoma mansoni (Manson’s Blood Fluke) Large lateral spine Africa, Latin America (Caribbean) Humans Biomphalaria glabrata, Tropicorbis Cercariae from snail IH Eggs in the feces Veins of colon and liver (inferior mesenteric vein and portal vein) Unoperculated Praziquantel Integument: Coarse tubercles Testes: 6 - 9 Uterus: 1/3 of the body length Disease: Intestinal Schistosomiasis Schistosoma mekongi Inconspicuous lateral protuberance Mekong basin: China, Burma, Laos, Thailand Humans Tricula aperta Cercariae from snail IH Eggs in the feces Venule Intestines of Small Unoperculated Praziquantel Disease: manifestations^ GIT Schistosoma intercalatum Large terminal spine with bulging at the middle portion Africa (^) Humans Bulinus spp. Cercariae from snail IH Eggs in the feces Venules of the colon— Inferior mesenteric plexus (lower in the bowel than S. mansoni) Unoperculated Praziquantel Disease: Hepatosplenic pathology

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BLOOD FLUKES