Trematodes Notes Pdf

[Holly Coffell]

Trematodais a class of flatworms known as flukes or trematodes. They are obligate internal parasites with a complex life cycle requiring at least two hosts. The intermediate host, in which asexual reproduction occurs, is usually a snail. The definitive host, where the flukes sexually reproduce, is a vertebrate. Infection by trematodes can cause disease in all five traditional vertebrate classes: mammals, birds, amphibians, reptiles, and fish.

Trematodes are flattened oval or worm-like animals, usually no more than a few centimeters in length, although species as small as 1 millimetre (0.039 in) are known. Their most distinctive external feature is the presence of two suckers, one close to the mouth, and the other on the underside of the animal.[12]

The body surface of trematodes comprises a tough syncytial tegument, which helps protect against digestive enzymes in those species that inhabit the gut of larger animals. It is also the surface of gas exchange; there are no respiratory organs.[12]

The mouth is located at the forward end of the animal, and opens into a muscular, pumping pharynx. The pharynx connects, via a short oesophagus, to one or two blind-ending caeca, which occupy most of the length of the body. In some species, the caeca are themselves branched. As in other flatworms, there is no anus, and waste material must be egested through the mouth.[12]

Although the excretion of nitrogenous waste occurs mostly through the tegument, trematodes do possess an excretory system, which is instead mainly concerned with osmoregulation. This consists of two or more protonephridia, with those on each side of the body opening into a collecting duct. The two collecting ducts typically meet up at a single bladder, opening to the exterior through one or two pores near the posterior end of the animal.[12]

The brain consists of a pair of ganglia in the head region, from which two or three pairs of nerve cords run down the length of the body. The nerve cords running along the ventral surface are always the largest, while the dorsal cords are present only in the Aspidogastrea. Trematodes generally lack any specialized sense organs, although some ectoparasitic species do possess one or two pairs of simple ocelli.[12]

Body wall musculature: Formed of three different muscle layers: circular, longitudinal, and diagonal. The outermost layer is formed by the circular muscle fibers, directly behind that are the longitudinal muscle fibers. The inner layer is formed by the diagonal muscle fibers. Together these muscle fibers form the segmented body wall of trematodes.[13]

Most trematodes are hermaphrodites, as are many internal parasites. Blood flukes (Schistosoma) are the only form of trematodes that are dioecious (have both a male and female sex). Blood flukes are unique in the way that they can undergo both asexual and sexual reproduction. Asexual reproduction occurs in the hepatopancreas of a freshwater snail, which serves as an intermediate host. Sexual reproduction occurs later in the life cycle, in the definitive (vertebrate) host.

The male reproductive system usually includes two testes, though some species may have more. The testes are located posterior and dorsal to the ventral sucker. Spermatogenesis produces biflagellate sperm (sperm with two tails). Sperm is stored in the seminal vesicles, which are connected to the testes by the vas deferens. The male reproductive system varies considerably in structure between species; this can be very useful in species identification.

Trematodes have a very complex life cycle and depending on what taxa they belong to, their life cycles can be completed with as little as one host compared to the typical three hosts. When there is one host, this is normally a specific species of snail of the family Lymnaeidae. Almost all trematodes infect molluscs as the first host in the life cycle, and most have a complex life cycle involving other hosts. Most trematodes are monoecious and alternately reproduce sexually and asexually. The two main exceptions to this are the Aspidogastrea, which have no asexual reproduction, and the schistosomes, which are dioecious.

In the definitive host, in which sexual reproduction occurs, eggs are commonly shed along with host feces. Eggs shed in water release free-swimming larval forms (Miracidia) that are infective to the intermediate host, in which asexual reproduction occurs.

A species that exemplifies the remarkable life history of the trematodes is the bird fluke, Leucochloridium paradoxum. The definitive hosts, in which the parasite reproduces, are various woodland birds, while the hosts in which the parasite multiplies (intermediate host) are various species of snail. The adult parasite in the bird's gut produces eggs and these eventually end up on the ground in the bird's feces. Some eggs may be swallowed by a snail and hatch into larvae (miracidia). These larvae grow and take on a sac-like appearance. This stage is known as the sporocyst and it forms a central body in the snail's digestive gland that extends into a brood sac in the snail's head, muscular foot and eye-stalks. It is in the central body of the sporocyst where the parasite replicates itself, producing many tiny embryos (redia). These embryos move to the brood sac and mature into cercaria.

Trematodes have a large variation of forms throughout their life cycles. Individual trematode parasites life cycles may vary from this list. They have five larval stages along with the cystic and fully matured adult phases.

The first stage is the miracidium that is triangular in shape and covered by a ciliated ectoderm which is the outermost layer of the three germ layers. The epidermis and epidemic tissues of the parasite will develop from the miracidium. They also have an anterior spin which helps them drill into the snail. The miracidium develops into the sporocyst, which is a sac-like structure, and in this sac the larvae begin to develop. The cells multiply. The rediae and cercariae develop from the larvae which are then released and encyst as metacercariae, for instance on aquatic plants. Humans as well as larger sea creatures get infected when they eat these plants.

Liver flukes, one of the different species, are responsible for causing liver fluke disease which is also known as fasciolosis. They are hermaphroditic internal parasites. They are caused by the migration of a large number of immature flukes through the liver passageway or by adult flukes that migrate to the bile ducts. Liver flukes infect all grazing animals and infect humans when they eat raw or undercooked fish.

Like other flukes, the liver flukes need intermediate hosts and as a result, the transmission from animals to humans happens in three phases. The first phase is the infection of the snail (the first intermediate host) via feces. They complete their gestation and hatch as cercariae. They leave their snail hosts and infect fish who are their second intermediate host. Lastly, larger animals ingest the metacercariae in raw and undercooked fish. In humans or grazing animals, the metacercariae complete their life cycle and become full grown liver flukes.

Trematodes can cause disease in many types of vertebrates, including mammals, birds, reptiles, and fish. Cattle and sheep can become infected by eating contaminated food. These infections lead to a reduction in milk or meat production, which can be of significant economic importance to the livestock industry.[14]

Human trematode infections are most common in Asia, Africa and Latin America. However, trematodes can be found anywhere where untreated human waste is used as fertilizer. Humans can be infected by trematodes by immersion in or ingestion of contaminated water, or by consuming raw or undercooked contaminated animals or plants.[16]

Albendazole can be used to treat clonorchiasis and opisthorchiasis. Triclabendazole is often used to treat fasciolosis,[17] and may also be useful in the treatment of paragonimiasis[18] and dicrocoeliasis.[19] Praziquantel is effective in the treatment of all diseases caused by flukes (clonorchiasis, dicrocoeliasis, echinostomiasis, fasciolopsiasis, fasciolosis, gastrodiscoidiasis, heterophyiasis, metagonimiasis, opisthorchiasis, paragonimiasis, and schistosomiasis).[20]

The helminths are worm-like parasites. The clinically relevant groups are separated according to their general external shape and the host organ they inhabit. There are both hermaphroditic and bisexual species. The definitive classification is based on the external and internal morphology of egg, larval, and adult stages.

Adult flukes are leaf-shaped flatworms. Prominent oral and ventral suckers help maintain position in situ. Flukes are hermaphroditic except for blood flukes, which are bisexual. The life-cycle includes a snail intermediate host.

Helminths develop through egg, larval (juvenile), and adult stages. Table 86-1 gives the names applied to various larval helminths. Knowledge of the different stages in relation to their growth and development is the basis for understanding the epidemiology and pathogenesis of helminth diseases, as well as for the diagnosis and treatment of patients harboring these parasites. The contributions of various stages to disease are listed in Table 86-2.

Platyhelminths and nematodes that infect humans have similar anatomic features that reflect common physiologic requirements and functions. The outer covering of helminths is the cuticle or tegument. Prominent external structures of flukes and cestodes are acetabula (suckers) or bothria (false suckers). Male nematodes of several species possess accessory sex organs that are external modifications of the cuticle. Internally, the alimentary, excretory, and reproductive systems can be identified by an experienced observer. Tapeworms are unique in lacking an alimentary canal. This lack means that nutrients must be absorbed through the tegument. The blood flukes and nematodes are bisexual. All other flukes and tapeworm species that infect humans are hermaphroditic.

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