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Chapter 17 : Blood Trematodes: Schistosomes

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Abstract:

Schistosomes belong to the phylum Platyhelminthes, family , and are a group of digenetic, dioecious trematodes requiring definitive and intermediate hosts to complete their life cycles. Four species are important agents of human disease: , , , and . is of less epidemiologic importance. The earliest known instance of schistosomiasis was found in Egyptian mummies of the predynastic period, using enzyme-linked immunosorbent assay (ELISA) to detect circulating anodic antigen. Schistosomes are somewhat different from other human trematodes since they (i) have two sexes, (ii) live in the blood vessels, (iii) have nonoperculated eggs, and (iv) have no encysted metacercarial stage in the life cycle. Cercarial dermatitis follows skin penetration by cercariae, and the reaction may be partly due to previous host sensitization. Few clinical manifestations are associated with primary exposure, but both humoral and cellular immune responses are elicited on subsequent exposure. After infection and the transformation of cercariae to schistosomula, the schistosomulum expresses antigens on its surface that evoke a host immune response that provides some degree of resistance to reinfection. Symptoms of acute schistosomiasis include fever, diarrhea, abdominal pain, weight loss, and eosinophilia. Symptoms of chronic disease include chronic diarrhea, abdominal pain, and hepatomegaly or hepatosplenomegaly. Patients who have been treated for schistosomiasis should be monitored posttherapy to determine the effectiveness of the treatment.

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17

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Figures

Image of Figure 17.1
Figure 17.1

Life cycle of schistosomes.

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.2
Figure 17.2

Schistosome cercariae. (Top, illustration by Sharon Belkin.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.3
Figure 17.3

Scanning electron micrograph of male and female schistosome in copula.

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.4
Figure 17.4

male and female in copula; note the female within the male worm.

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.5
Figure 17.5

egg with a mature miracidium. (Illustration by Nobuko Kitamura; adapted from Figure 27.15A P. C. Beaver, R. C. Jung, and E. W. Cupp, , 9th ed., Lea & Febiger, Philadelphia, Pa., 1984.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.6
Figure 17.6

eggs. Note the large lateral spine.

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.7
Figure 17.7

miracidium. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.8
Figure 17.8

Hepatic fibrosis with multiple schistosome egg granulomas. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.9
Figure 17.9

Schistosome eggs in tissue. (Left) , (right)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.10
Figure 17.10

Pipe-stem fibrosis in the liver as a result of (Original photograph by L. Millman; from A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.11
Figure 17.11

Schistosomiasis. Note the engorgement of collateral circulation of the abdomen. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.12
Figure 17.12

infection showing liver and splenic enlargement; 800 worms were removed from this patient. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of R. Goldsmith and B. H. Kean.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.13
Figure 17.13

eggs in crushed rectal biopsy tissue. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Algorithm 17.1
Algorithm 17.1

Schistosomiasis.

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.14
Figure 17.14

(top), (middle), and (bottom) eggs. Note how much smaller the egg normally is than those of the other two species, and note the small size of the lateral spine. (Illustration by Nobuko Kitamura.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.15
Figure 17.15

eggs. Note the small lateral spine.

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.16
Figure 17.16

paired adult male and female in a mesenteric vein. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.17
Figure 17.17

eggs. Note the subspherical shape and smaller size than eggs.

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.18
Figure 17.18

eggs. Note the terminal spine and slight size variations.

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.19
Figure 17.19

(Upper) Egg in the appendix. Note the terminal spine. (Lower) Eggs in a rectal biopsy specimen. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.20
Figure 17.20

Calcified eggs in a crushed sliver of fixed tissue from the bladder of an Egyptian patient. Unstained, ×239. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.21
Figure 17.21

: (Left) X ray of the pelvis in a 24-year-old Egyptian with schistosomal obstructive uropathy. Linear calcification is seen in the base of the bladder and along the lower ureters, which are dilated (arrows). (Armed Forces Institute of Pathology photograph. Courtesy of Marcia Young.) (Right) Urinary bladder. An exophytic squamous cell carcinoma is present in the central portion of the photograph, and infiltrating squamous cell cancer extends to the left. Magnification, ×4. (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Image of Figure 17.22
Figure 17.22

egg. The miracidium tends to be somewhat narrower in the middle, giving it an hourglass shape. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
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Tables

Generic image for table
Table 17.1

Characteristics of blood trematodes

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
Generic image for table
Table 17.2

Improved immunologic testing for the diagnosis of infection

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
Generic image for table
Table 17.3

Management and therapy of schistosomiasis

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
Generic image for table
Table 17.4

Pathogenesis, pathology, and symptoms seen with infection

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
Generic image for table
Table 17.5

Distribution of infection and morbidity due to in northern Cambodia

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
Generic image for table
Table 17.6

Disease manifestations seen with infection

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
Generic image for table
Table 17.7

Mechanisms of bladder carcinogenesis due to

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17
Generic image for table
Table 17.8

Schistosomiasis control measures

Citation: Garcia L. 2007. Blood Trematodes: Schistosomes, p 445-477. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch17

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