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Home , Cyclophyllidea, Fasciola gigantica, Fasciolopsis, Gastrodiscoides, Pseudophyllidea, Taenia saginata

Trematode & Cestode &

Human Pathogen 2

Dr. Pongsri Tippawangkosol Dept. of , Tel. 053-935343-5 1 Parasitology

Protozoa Helminths Entomology

Roundworm Cestode (Tapeworme) Amoeba

Ciliate

Flagellates

Trematode (Fluke) Sporozoa 2 Helminths

Cestode Trematode (tapeworm) (Fluke) (roundworm)

3 Phylum nematoda Phylum Platyhelminthes

Roundworm (flukes) (tapeworms) Phasmidia - flukes (block respi) - Toxocara spp. - Paragonimus spp. - Dipyllobothrium latum (ตืดปลา) - spp. (assigned reading) - spinigerum Liver flukes - Angiostrongylus cantonensis - Clonorchis spp. Order - Enterobius vermicularis - Opisthorchis spp. - (ตืดสุนัข) - Strongyloides stercoralis - Fasciola spp.(ใบไม้ตับ) - nana (ตืดแคระ) - Capillaria philippinensis - Dicrocoelium spp. - (ตืดหนู) - - Eurytrema - Taenia spp.(ตืด) - - spp. (assigned reading) - Intestinal flukes - Multiceps multiceps - - buski - - hominis - Heterophyes spp. Class Aphasmidia - Haplochis taichui - - Trichuris trichiura flukes (block hemato) Block GI - Capillaria phillipinensis - spp. 4 Outline

- Introduction to trematode (Flukes) - Fasciola spp. () Lecture - Introduction to cestode (tapeworm) - (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 : Lung Bile duct 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 Integument

Intestine (cecum) Vitelline glands Ventral sucker (egg shell formation) Collecting tubes Digestive system testes Excretory system Excretory bladder Muscular system (fibers) Excretory pore Nervous system (ganglion, 3 pairs of nerve trunk) 10 Complex life cycle

1st intermediate 2nd intermediate host Trematodes (Flukes) (for multiplication) (for larva deposit )

Lung fluke

Liver fluke

Intestinal fluke Fresh water 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 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 and

14 How many Fasciola ?

Fasciola gigantica Fasciola hepatica 5-7 cm. long 3 cm. long Tropical areas Temperate areas ()

15 Where is Fasciola distribute?

Area endemic for facioliasis

- Affect 2.4 million people in > 70 countries worldwide

- F. hepatica : , South & Central America, , - 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 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 ingest raw water 4. Develop to adult in bile duct plants contaminated with metacercaria

3. Larva migrate 2. Larva excyst in 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 (cholangitis) - bile duct obstruction

28 Clinical diagnosis

- history of obstructive jaundice (bile duct obstruction) - fever and right-upper-quadrant pain - intrahepatic cystic lesions - - 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, , and . 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 (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 ( tapeworm),16 million - Spirometra spp. (dog tapeworm) Assigned reading

Order cyclophyllidea

- Dipylidium caninum (dog tapeworm) - (dwarf tapeworm), 36 million - Hymenolepis diminuta ( tapeworm) - Taenia saginata, 80 million - ??????????? - 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 : 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 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 – 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 (human)

Human eat raw beef contaminated with cyst Taeniasis saginata

Medium rare beef steak

Eat cyst in raw beef with cyst

Adult in small intestine

Egg in human feces

49 Scolex Gravid proglottid (head)

4 suckers without rostellum Uterine branches on each side and hook (15-30)

Uterus fill with eggs

testes Genital pore 2 lobes of ovary open at lateral side

Mature proglottid 50 Teania spp. egg

Radially striated thick shell

Hook

Oncosphere with 3 pair of hooks (hexacanth embryo)

Spherical in shape

51 Cyst in beef (Cysticercus bovis)

No hook

Size : 7-10 x 5 mm. Scolex without rostellum & hook

52 Adult in human

Length 4-12, up to 25 m.

Proglottids (Number) 1,000-2,000 Scolex 4 suckers without rostellum & hook

Gravid proglottid 5-7x16-20 mm. (2 x 0.5 cm.) fresh specimen . (white ribbon, little movement)

Gravid proglottid (stain with indian ink) number of uterine branches on each side = 15-32

53 Fresh specimen Indian ink injection Count uterine branch (20)

Slide

2 x 0.5 cm.

54 Taeniasis saginata

- Adult lives in small intestine - Egg or proglottid passed in human feces

Symptoms

• No symptom in most patients (asymptomatic) • mild & non-specific signs and symptoms

55 Symptoms weight loss, weakness, chronic

abdominal pain diarrhea

Complication

intestinal obstruction 56 How to diagnose ?

1. Stool examination to find egg

Report : Taenia spp. (Taeniasis)

2. Recovery gravid proglottid in feces and count number of uterine branches on each side = 15-32 branchs

Report : Taenia saginata 57 First line drug or effective drug 10-20 mg/kg single oral dose, followed by laxative 1-2 h

Alternative drugs

Niclosamide 2 gm, single oral dose or 4 tablets (500 mg each) 300 mg/day, 3-4 days 58 Prevention & control

- Avoid of raw or inadequately cooked beef - Temperature > 56 oC, -20 oC (2 days), -5 oC (3 days), can kill the cysticerci

cooking beef well

Good hygiene & widespread sanitary 59 Taeniasis saginata

Caused eat raw beef with cyst Parasite Taenia saginata Symptom Asymptomatic, intestinal obstruction

60 egg adult egg proglottid (20)

water plant Raw beef

Habitat : Bile duct) Disease : Fasioliasis Parasite : Fasciola spp. Habitat : Small intestine Disease : Taeniasis saginata Parasite : Taenia saginata

61 Lab demonstration

62 Cephalic cone

63 ไข่ไก่

64 Order pseudophylidea ตืดปลา

หัวช้อน Spoon shaped

65 66 Order cyclophylidea ตืดวัว

หัวไม่มีหนาม

67 รังไข ่ 2 lobes

68 20 แขนง (ด้านเดียว)

69 ยางรถยนต์

70 Taenia saginata

ส่วนหัวของตัวอ่อนไม่มีหนาม

71 Lab assignment demonstration

72 Order pseudophylidea ตืดสุนัข Spirometra spp.

ตัวตืดไม่มีปล้อง

หัวมีรอยหยัก

ลาตัวแบนไม่มีปล้อง

73 Order cyclophylidea ตืดสุนัข

3 ปล้อง

74 Hydratid cyst Hydratid cyst

Hydratid sand หัวพยาธิในซิสต์

75 หัวพยาธิตัวอ่อน (หัวอยู่ด้านใน)

หัวพยาธิตัวอ่อน (หัวอยู่ด้านใน) หัวพยาธิตัวอ่อน (หัวโผล่ด้านนอก)

Hydratid sand

76