TREMATODES OF THE

BLOOD
BLOOD FLUKES OR
SCHISTOSOMES
 BLOOD FLUKES OR
SCHISTOSOMES
Schistosomes are fluke Trematode that live in the blood vessels of
the final hosts including human.
Species of this group infect about 200 millions of the world's
populations living in Africa, Asia and South America.

are flukes which break some cardinal fluke rules.

1. Firstly, schistosomes are not hermaphroditic - they have two
sexes, with the male being larger than the female (normally in
parasites, the female is larger because eggs take up more room
than sperm).
2. Another substantial deviation from the normal fluke way of doing things
is that the schistosome life-cycle does not feature a metacercaria stage.
Instead, the cercariae emerge from the snail in water and penetrate the
skin of the definitive host, finding their way to the blood stream in the
process.
The male and female worms average about
10 mm in length and live in the veins
of the abdominal cavity. Here they
mate and the females produce eggs.
The adult worms can live 20-30 years and,
depending on the species, and each
female can produce several hundred
eggs each day. The eggs escape
from the body by penetrating the walls
of the veins and small intestine or
urinary bladder, and they are passed
in the feces or urine. The eggs hatch
in water, the first intermediate host (a
snail) is infected, and cercariae are
liberated from the snails. When
humans come in contact with water
containing cercariae, the cercariae
penetrate their skin and they become
infected. This occurs when the
humans swim, bath, wash clothes,
etc., in rivers and streams. After the
cercariae penetrate the skin the
immature worms enter the circulatory
system and migrate to the veins of the
abdominal cavity, and in about six
weeks they reach sexual maturity
Schistosomes have
also 2 suckers, both
located at the anterior
end of the worm. Sexual
organs, such as the
number of testes in the
male and location of
ovary and ootype are
important in
identification of
different species. Eggs
have also different
shape and size in
various species.
The elongated, leaf-like shape males, by rolling up the margins
of their bodies has form a tube, in which the cylindrical female
is enclosed (paired flukes). For this reason the body of the
male seems to have a longitudinal split (Gynaecophoric canal).
The sexually mature worms which according to the species,
are 10-20 mm long, live chiefly in the mesenteric blood vessels
of the intestine, the liver and bladder of the host
 There are three major species of
schistosome infecting humans :
Schistosoma mansoni-
 S. mansoni lives in the veins draining the intestines, so
infection with this species results in intestinal upset and
produces eggs in the faeces.
Schistosoma haematobium
 S. haematobium lives in the veins draining the bladder
and causes cystitis and blood in the urine, with eggs
passed out with the urine as well.
Schistosoma japonicum
 S. japonicum is found in Asia, and lives in the veins
draining the intestines,
 Bilharzia and Condoms

In some parts of Egypt, infection with S. haematobium was

so high that by the time people reached puberty,
everyone was showing signs of infection. In fact the
appearance of blood in the urine of boys was so common
that it was regarded as natural - a male version of
menstruation. Carvings and paintings from ancient Egypt
show what appear to be male figures wearing condoms.
While this could be artistic license, these figures never
appear without a hieroglyph which bears a striking
resemblance to a S. hamematobium egg. Schistosome
eggs are among the largest of the parasitic worm eggs
(up to 150µm long), but one still needs a fairly strong
magnifying glass to see them in that amount of detail.
Were the ancient Egyptians aware of this little parasite,
and were the condoms a means of stopping blood
dripping out and staining their white robes ? You be the
Judge !
 EPIDEMIOLOGY OF SCHISTOSOMIASIS:
Major human schistosomes are endemic in 74 countries with
an estimated total population at risk of approximately 600
million. Total number infected is estimated at 200 millions
Prevalence and intensity of the infection is related to age and
sex. In most infested area, both prevalence and intensity
increase gradually by age to a peak approximately at 10 to 19
years of age.

There are several factors that govern the outcome of the

transmission process in areas where schistosomiasis is
endemic such as the infection rates among snails and degree
of human contact with water, which depends on social and
cultural habits of the populations.
Schistosomiasis is difficult to diagnose, due to the fact that the
female worms produce very few eggs, and that the eggs are not
concentrated by routine faecal concentration techniques. Because
the worms are found deep in the tissues, drugs used to treat them
must be capable of reaching them, and frequently have nasty side
effects on the human host.
 Schistosomiasis is an infection caused by one of the five species of
the parasite, Schistosoma.
Alternative Names Bilharzia; Katayama fever; Swimmer's itch; Blood
fluke
Causes, incidence, and risk factors
 Schistosoma infections are contracted through contact with
contaminated water. The parasite in its infective stages is called a
cercaria. It swims freely in open bodies of water.
 On contact with humans, the parasite burrows into the skin, matures
into another larval stage (schistosomula), then migrates to the lungs
and liver (where it matures into the adult form).
 The adult worm then migrates to the anatomic area of its
preference, depending on which species is involved. Likely areas
include the bladder, rectum, intestines, liver, portal venous system,
spleen, and lungs.
 Schistosomiasis is not usually found in the United States. However,
it is prevalent in many tropical or subtropical areas, and it is a
common illness thought to affect more than 200 million people.
 Prevention
 Avoid swimming or bathing in water known to be contaminated or
potentially contaminated
 Avoid bodies of water of unknown safety
 Eradication of snails (an intermediate host for the parasite) in areas
used by humans
Symptoms
 Symptoms vary with the species of worm and the phase of infection.
 Initial invasion of the skin may cause itching and a rash (swimmer's
itch).
 Heavy infestation may cause fever, chills, lymph node enlargement,
and liver and spleen enlargement.
 Urinary symptoms may include frequency, painful urination
(dysuria), and blood in urine (hematuria).
 Intestinal symptoms include abdominal pain and diarrhea (which
may be bloody).
 In addition to diseases resulting as the complications of
schistosomiasis such as cancer, schistosomiasis is found
associated with some bacterial and viral infections.

1. Bacterial infections: Association of Salmonella spp. with schistosomiasis

infection has been
confirmed. The bacteria are found in the teguments of S.haematobium,
S.mansoni adult worms and S. intercalatum.

Clinical symptoms such as fever, hepathosplenomegaly and eosinophilia are

more sever. Blood culture for Salmonella is positive. Treatment of
schistosomiasis will eleminate the above symptoms.
Other infection associated with Schistosoma infection is Escherichia coli which
will cause hepatoslenic disease due to S.mansoni and renal disease in
S.haematobium.

2. Viral infections:
Association between human immunodeficiency virus (HIV) and schistosomiasis
may occur because of the alteration of immune function in both infections.
Association between S.mansoni and AIDS has been observed in Puerto Rico.
Autopsy of cases who died from AIDS has shown that 7 to 10% have been
infected with S.mansoni (Hillyer and Climent, 1988). Of intercurrent infections
observed with schistosomiasis are viral hepatitis reported from Egypt
 Schistosomes and Swimmers' Itch
Have you ever been swimming in freshwater and felt and
incredible itching all over your skin ? If so, it's likely that
you've come into contact with zoonotic schistosomes.
Although Australia is free of the human schistosomes,
our native fauna have their own species. In standing
bodies of freshwater such as ponds or dams the
waterfowl that live around the area may harbour their
own species of schistosome. These worms have similar
life-cycles in birds as the human species, except when
the cercaria try to penetrate our skin, they stop halfway
through. Our body mounts an inflammatory response
and that causes the "swimmers' itch". In the ocean, bird
schistosomes are believed to be the source of "sea lice",
that stinging sensation you may feel washing over you as
the swell passes
 CONTROL OF
SCHISTOSOMIASIS
Chemotherapy-This is the most effective method for reducing
the infection rates of schistosomiasis.

Diagnostic techniques available for schistosomiasis are

parasitological, immunological and indirect techniques.
1. parasitological method, infection will be detected by finding
Schistosoma eggs in the urine or stool of persons examined
and thus establish the rate of infection. This is a qualitative
technique.

2. Immunological methods are used for diagnosis of

schistosomiasis in health facilities.
Antibody-based tests cannot differentiate between current and
previous infections or reinfection.
3. An inexpensive epidemiological method was the use of
questionnaires of reported blood in urine as an indicator of the
prevalence of S.haematobium infection in schools (Guyatt et
al, 1999).
 This method has been used to identify communities at highest
risk of urinary and intestinal schistosomiasis in several
schools and found to be reliable

There are various approaches in using community-based

chemotherapy which are:
- Mass treatment: treatment of entire populations of a
community.
- Selective population treatment: treatment of infected persons
identified by a case finding among the whole population.
- Selective group treatment: treatment of all or of infected
members of a high-risk age or occupational group such as
school children.
- Phased treatment: use of the above strategies according to
the outcome of each approach..
 snail control-can be achieved by destruction of snail hosts by
using snail killing chemicals (molluscicides), elimination or
modification of snail habitats, reducing snail population by
biological control, and water management.
In addition to chemical molluscicides, plant molluscicides,
biological agents and environmental management are also used
for snail control.

Water supply and Sanitation- Provision of sanitation facilities in

infested areas will result in reducing the contact of population
with infested water.
 Schistosomiasis can only be transmitted by water contacts
mostly for domestic and recreational purposes and also
occupational. Therefore, providing safe water supply and
sanitary facilities safe including safe drinking-water, washing
facilities, cattle watering facilities, and bathing, not only reduce
the risk of infection with schistosomiasis, but also reduce the
source of infection with other parasite and bacterial infections
 Health education- In every community bases
approach and control of infections, success
can not be achieved without the full
cooperation of inhabitants.
 In control of schistosomiasis, awareness of
the people in avoiding contamination of
water and contact with infected water is best
achieved by health education. Proper case
finding and treatment of infected cases and
especially the use of mass-chemotherapy
cannot be achieved without full cooperation
of inhabitants of infested foci.