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Fasciola & Taenia Trematode & Cestode Fasciola & Taenia Human Pathogen 2 Dr. Pongsri Tippawangkosol Dept. of Parasitology, Tel. 053-935343-5 1 Parasitology Protozoa Helminths Entomology Roundworm Cestode (Tapeworme) Amoeba Ciliate Flagellates Trematode (Fluke) Sporozoa 2 Helminths Cestode Trematode Nematode (tapeworm) (Fluke) (roundworm) 3 Phylum nematoda Phylum Platyhelminthes Roundworm Trematoda Cestoda (flukes) (tapeworms) Class Phasmidia - Ascaris lumbricoides Lung flukes (block respi) Order Pseudophyllidea - Toxocara spp. - Paragonimus spp. - Dipyllobothrium latum (ตืดปลา) - Spirometra spp. (assigned reading) - Gnathostoma spinigerum Liver flukes - Angiostrongylus cantonensis - Clonorchis spp. Order cyclophyllidea - Enterobius vermicularis - Opisthorchis spp. - Dipylidium caninum (ตืดสุนัข) - Strongyloides stercoralis - Fasciola spp.(ใบไม้ตับ) - Hymenolepis nana (ตืดแคระ) - Capillaria philippinensis - Dicrocoelium spp. - Hymenolepis diminuta (ตืดหนู) - Trichuris trichiura - Eurytrema - Taenia spp.(ตืด) - Necator americanus - Echinococcus spp. (assigned reading) - Ancylostoma duodenale Intestinal flukes - Multiceps multiceps - Wuchereria bancrofti - Fasciolopsis buski - Brugia malayi - Gastrodiscoides hominis - Heterophyes spp. Class Aphasmidia - Haplochis taichui - Trichinella spiralis - Trichuris trichiura Blood flukes (block hemato) Block GI - Capillaria phillipinensis - Schistosoma spp. 4 Outline - Introduction to trematode (Flukes) - Fasciola spp. (Liver fluke) Lecture - Introduction to cestode (tapeworm) - Taenia saginata (Beef tapeworm) - Spirometra spp. (Dog tapeworm) Assignment-Demon - Echinococcus spp. (Dog tapeworm) 5 Trematode (Fluke) Cestode (Tapeworm) Tape measure-like Leaf-like flattened body & non-segmented flattened body & segmented 6 Trematode (Fluke) Lung fluke Liver fluke Intestinal fluke Blood fluke Blood vessels in intestine Habitat : Lung Bile duct Small intestine or bladder 7 How many Trematode (Flukes)? Lung flukes Paragonimus spp. (block Respi) Liver flukes Clonorchis spp. (block GI) Opisthrochis spp. Fasciola spp. Dicrocoelium spp. Eurytrema pacreaticum Intestinal flukes Fasciolopsis buski (block GI) Gastrodiscoides hominis Echinostoma spp. Heterophyes spp. Haplochis taichui Blood flukes Schistosoma spp. (block Hemato) 8 Size (1 mm.-8 cm.) Liver fluke Lung fluke Intestinal fluke 9 Trematode (Fluke) Oral sucker Integument pharynx Intestine (cecum) Vitelline glands Ventral sucker (egg shell formation) uterus ovary Collecting tubes Digestive system testes Excretory system Reproductive system Excretory bladder Muscular system (fibers) Excretory pore Nervous system (ganglion, 3 pairs of nerve trunk) 10 Complex life cycle 1st intermediate host 2nd intermediate host Trematodes (Flukes) (for larva multiplication) (for larva deposit ) Lung fluke Liver fluke Intestinal fluke Fresh water plants snail Blood fluke No 2nd intermediate host 11 Flukes Blood fluke Development Egg Egg (passed with feces or urine) Miracidium Miracidium Sporocyst Sporocyst Larva Redia I (daughter sporocyst) in snail Redia II (daughter redia) Cercaria Cercaria (infective stage) Metacercaria (infective stage) Adult in human 12 Trematode development Infective stage in 2nd IH Larva Asexual multiplication in snail (1st IH) 13 Parasite 1. Liver fluke Fasciola spp. Disease : Fascioliasis Waterborne and foodborne zoonotic disease Less common infect human Caused by Fasciola gigantica and Fasciola hepatica 14 How many Fasciola species ? Fasciola gigantica Fasciola hepatica 5-7 cm. long 3 cm. long Tropical areas Temperate areas (Thailand) 15 Where is Fasciola distribute? Area endemic for facioliasis - Affect 2.4 million people in > 70 countries worldwide - F. hepatica : Europe, South & Central America, Asia, Africa - F. gigantica : Asia, Africa - Thailand (F. gigantica, 85%) 16 Fascioliasis cases in Thailand 1967 : 1st case, from northeastern presenting with cholecystitis and gallstones (F. gigantica) 1990 : 25 cases mainly caused by F. gigantica 2014 : 7 cases in Maharaj Nakorn Chiang Mai hospital (F. gigantica) 2016 : 1 case in Maharaj Nakorn Chiang Mai hospital (F. gigantica) Human are accidental host infected by ingesting raw green vegetables or drinking water contaminated with encysted metacercariae 17 How do you get the Fasciola ? DH DH Adult in bile duct Eat metacercaria Infective larva on water plant 2nd IH Egg pass in feces Miracidium hatch from egg 1st IH Sporocyst, redia Larva develop in snail 18 How dose human infect with Fasciola ? Morning glory (ผักบุ้ง) Water mimosa (ผักกระเฉด) Lotus (สายบัว) Water chestnut Watercress Swamp grass แห้ว ต้นแพงพวย 19 Chinese water chestnut water caltrops water chestnut buffalo nut 20 Adult live in intrahepatic bile ducts Where dose Fasciola live? 21 Liver Bile duct Fasciola Fasciola 22 Fresh Fasciola gigantica fluke Fasciola gigantica stained with carmine stain Size : 37x10 x 0.5 mm Extracted from the common bile duct 23 Cephalic cone Uterus ovary, testes, intestine Ovary branches Testes Intestine 24 Egg operculum Thin shell Yolk Large, ovoid, yellowish-brown, unembryonated egg 25 How do you get Fasciola ? Eat raw or uncooked infected water plants Drink water contaminated with metacercaria 26 1. Human or animal ingest raw water 4. Develop to adult in bile duct plants contaminated with metacercaria 3. Larva migrate 2. Larva excyst in stomach across peritoneal cavity to liver cell 3. Larva enter to small intestine How dose Fasciola develop ? 27 How dose Fasciola cause the disease ? Fasciola (larger & powerful) Fasciola Bile duct & liver tissue Irritation & traumatic to liver & bile ducts - bile duct dilation - bile duct wall thickening Bile duct - blie duct inflammation (cholangitis) - bile duct obstruction 28 Clinical diagnosis - history of obstructive jaundice (bile duct obstruction) - fever and right-upper-quadrant pain - intrahepatic cystic lesions - eosinophilia - ultrasonography and CT scan show biliary dilation in the intrahepatic and extrahepatic bile duct, with duct wall thickening - ERCP (Endoscope) to remove the fluke from the common bile duct by balloon catheter) 29 Chronic phase : cholangitis, portal fibrosis, Adult in bile duct bile duct obstruction, hepatomegaly Larva migrate across peritoneal cavity to liver cell Acute phase : asymptomatic, fever, gastrointestinal bleeding, inflammation, abdominal pain, and diarrhea. 30 How to diagnose ? 1. Stool examination to find egg 2. Blood test : to find Ab, Ag by ELISA 3. X ray, CT scan, ultrasound 4. ERCP (endoscope) 5. Clinical signs and symptoms Fever Hepatomegaly Jaundice Bile duct dilation (CT, ultrasound) Bile duct obstruction (CT, ultrasound) 31 Fresh = Fasciola spp. ERCP คือ Endoscopic retrograde cholangiopancreatography Stained = Faciola gigantica ? Confirmed by PCR Faciola gigantica 32 How to prevent? cooked water plants Wash water plants or vegetable Drink clean water 33 How to treat? 1. Bithionol (30-50 mg/kg/day, oral dose 3 time a day, 15 days, every other day) 2. Triclabendazole (10 mg/kg, a single oral dose) 34 The Liver fluke Disease: Fascioliasis Water chestnut Adult with cephalic cone Egg (water plant) Cause : eat raw water plant contaminated with metacercaria Symptoms : cholangitis, bile duct obstruction 35 Cestode (tapeworm) Taenia spp. The flatworms (tape measure-like) Long body with segments size: 2-4 mm. – 20 m. in length 36 Head (Scolex) Strobila (Proglottids) hooks Sucker uterus testes ovary Neck Immature Mature Gravid Immature Mature reproductive organs Uterus fill with egg Reproductive organ Male (testes) & female (ovary) 37 Cestode Order Pseudophyllidea - Dipyllobothrium latum (fish tapeworm),16 million - Spirometra spp. (dog tapeworm) Assigned reading Order cyclophyllidea - Dipylidium caninum (dog tapeworm) - Hymenolepis nana (dwarf tapeworm), 36 million - Hymenolepis diminuta (rat tapeworm) - Taenia saginata, 80 million - Taenia solium??????????? - Echinococcus spp. (dog tapeworm) Assigned reading - Multiceps multiceps (dog tapeworm) 38 Cyclophyllidea Pseudophyllidea Hook without hook Cup-shaped sucker spoon-shaped with bothria Genital pore Genital pore middle lateral 39 Taenia spp. - D. latum - Spirometra spp. Hymenolepis spp. Multiceps spp. Echinococus spp. 40 Specimen : size (2x0.5 cm.) White color A little movement passed with stool What ?........................................ Diagnosis ?……………………… Disease ?...................................... 41 Parasite 2. Disease : Taeniasis saginata Beef tapeworm (Taenia saginata) 42 Raw beef steak ลาบวัว Are there any cestode in raw beef? What ? 43 Where is Taeniasis saginata distribute? In countries with free-roaming cattle poor sanitation Informal animal slaughter 44 Current status of Teaniasis in Thailand All regions of Thailand, except the South Prevalence 2.53% - 0.63% (1957- 2001) Highest in the North and Northeast (rural area & border area) 2.3% in Tungchang District of Nan 3.7% in Ubon Ratchathani 3.3% in Kanchanaburi Taenia saginata is the most common species Male > female, age 7-83 years Anuntaphruti, 2013 45 Taenia saginata Common name beef tapeworm Diseases 0.6% pop. (2001) Taeniasis saginata Parasite Taenia saginata Distribution World wide Habitat Adult live in small intestine in human Definitive host Human Intermediate host Cattle Infective stage Cysticercus bovis in beef Mode of transmission Ingest raw infected beef 46 Taenia saginata 3 months egg (eat cyst – fine proglottid) Infective cyst cyst (cattle) (10-12 weeks) Size : 7-10x5 mm. adult (human) Egg or proglottid in feces Adult worm life span in human = 30-40 years 47 Egg (human feces) cyst (cattle) adult
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