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Chapter 144 : Trematodes

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Abstract:

Adult trematodes have distinctive morphology, often with a leaf-like body plan. Despite the diverse range of body sites infected by adult trematodes, the eggs of most digenean flukes are voided with feces. There are many subtle variations in life cycle patterns, but two predominant life cycle strategies exist for these trematodes. Two features of the digenean life cycle are noteworthy. First, digeneans often display high specificity in their choice of first intermediate host. Second, most human parasites are zoonotic, requiring the cooccurrence of other mammalian or avian hosts in an area of endemicity to maintain human infection. In urinary schistosomiasis, granulomatous inflammatory response to embolized eggs gives rise to dysuria, hematuria, and proteinuria, calcifications in the bladder, obstruction of the ureter, renal colic, hydronephrosis, and renal failure. Examination of stools with the Kato-Katz technique is used in field studies for quantification of fecal egg burdens. An interesting development is that of the use of real-time PCR to detect cell-free schistosome DNA in host plasma. This method utilizes a 121-bp tandem repeat sequence that represents approximately 12% of the genome as the target sequence for amplification. Members of the families Echinostomatidae, Heterophyidae, Fasciolidae, and Troglotrematidae are commonly encountered in some countries. Many species of heterophyid trematodes are known to infect humans. Diagnosis of heterophyids is facilitated by observation of eggs in feces.

Citation: Jones M, Keiser J, McManus D. 2011. Trematodes, p 2230-2242. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch144

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Image of FIGURE 1
FIGURE 1

Five species of Schistosoma are known to infect humans. Infection with , , , or adults occurs in mesenteric veins; adults occur in the vesicle plexus. Humans are infected after cercarial penetration of the skin. After penetration, the cercariae shed their bifurcated tails, and the resulting schistosomula enter capillaries and lymphatic vessels en route to the lungs. After several days, the worms migrate to the portal venous system, where they mature and unite. Pairs of worms then migrate to the site of patent infection. Egg production commences 4 to 6 weeks after infection. Eggs pass from the lumens of blood vessels into adjacent tissues, and many then pass through the intestinal or bladder mucosa and are shed in the feces or urine (see the text). In freshwater, the eggs hatch, releasing miracidia that, in turn, infect specific freshwater snails ( Table 1 ). Reprinted from the ( ) with permission.

Citation: Jones M, Keiser J, McManus D. 2011. Trematodes, p 2230-2242. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch144
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Image of FIGURE 2
FIGURE 2

Life cycles of five different food-borne trematodes, including intestinal flukes (, , and ), a liver fluke (), and a lung fluke (). Reprinted from ( ) with permission.

Citation: Jones M, Keiser J, McManus D. 2011. Trematodes, p 2230-2242. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch144
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Image of FIGURE 4
FIGURE 4

Eggs of trematode parasites. (A) (magnification, ×400); (B) (magnification, ×1,200); (C) (magnification, ×1,200); (D) (magnification, ×1,200); (E) (magnification, ×480); (F) (magnification, ×600). (Panels B through D are from reference 3; used with permission.)

Citation: Jones M, Keiser J, McManus D. 2011. Trematodes, p 2230-2242. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch144
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Image of FIGURE 3
FIGURE 3

Eggs of schistosome species (magnification, ×480). (A) ; (B) egg with typical lateral spine not in view; (C) ; (D) ; (E) ; (F) . (Panels C through E are from reference ; used with permission.)

Citation: Jones M, Keiser J, McManus D. 2011. Trematodes, p 2230-2242. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch144
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Tables

Generic image for table
TABLE 1

Geographical distribution, intermediate hosts, and egg morphology of the major schistosomes infecting humans

Citation: Jones M, Keiser J, McManus D. 2011. Trematodes, p 2230-2242. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch144
Generic image for table
TABLE 2

Geographical distribution, hosts, and life histories of lung and hepatic digeneans of humans

T, triclabendazole; P, praziquantel.

Citation: Jones M, Keiser J, McManus D. 2011. Trematodes, p 2230-2242. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch144
Generic image for table
TABLE 3

Geographical distribution, hosts, and life histories of digeneans of the human intestinal tract

Modified from reference with permission. Abbreviations: NR, not recorded; MB, mebendazole; P, praziquantel.

Citation: Jones M, Keiser J, McManus D. 2011. Trematodes, p 2230-2242. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch144

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