Trematodes (Flukes)

Blood flukes-

• Schistosoma 

Lung flukes-

• Paragonimus westermani 

Liver flukes- [UPSC CMS 2024]

• Opisthorchis 

• Clonorchis 
• Fasciola hepatica and gigantica

Intestinal flukes-

• Fasciolopsis buski

Trematodes
(Flukes)

Primary
host

1st intermediate
host

2nd intermediate
host

Schistosoma

Man 

Snail
[UPSC CMS 2024]

Paragonimus
westermani 

Man

Snail

Crab / Cray fish

Opisthorchis 

Man

Snail

Fish

Clonorchis 

Man

Snail

Fish

Fasciola hepatica

Man
/ Sheep

Snail

Fresh aquatic plant

(Water chestnut plant)

Fasciolopsis buski

Man

Snail

Fresh aquatic plant

(Water chesnut plant)

Halzoun syndrome- 

Caused by the migration of Fasciola hepatica larvae from the digestive tract to the throat.

Symptoms:

• Severe sore throat

• Difficulty swallowing

• Swelling of the throat or even the uvula

• Some cases can cause laryngitis and asphyxia (suffocation) if not treated.

 

All Trematodes

Schistosoma

(Mnemonic: SSSSS)

Infective form

Metacercaria larva

S – Cercaria larva

Mode of infection 

Ingestion

S – Skin penetration

Eggs

Operculated egg

S – Spinous egg

Hermaphrodites

All

S – Seprate sex (Male & Female)

DOC 

Praziaquantel

Exception: 

F. Hepatica-

Triclabendazole

Praziaquantel

Stages 

MCRCM

MC_R_M

M – Miracidia

C – Cyst

R – Redia

C – Cercaria
M – Metacercaria

Schistosoma haematobium

Schistosoma mansoni

Schistosoma japonicum

Egg- Terminal spine

Egg- Lateral spine 

(Mnemonic: MaLa)

Egg- Rudimentary

Location- 

Vesical & Pelvic

venous plexus

Location-

Inferior mesenteric vein

(drain from
sigmoid rectal region)

Location-

Superior mesenteric vein

(drain from
ilio cecal region)

– Hematuria

– Bladder cancer 

(Squamous CC > Transitional
Cell Ca)

Swimmer’s itch

More severe Swimmer’s itch 

Normally, the urinary bladder is lined with transitional epithelium. Schistosoma causes metaplasia, where the transitional epithelium is replaced by squamous epithelium, which can lead to cancer.

Cancer

Cause by

Cholangiocarcinoma

(Bile duct cancer) 

– Clonorchis sinensis 

– Opisthorchis viverrini

Bladder carcinoma 

Schistosoma haematobium 

Gastric cancer 

Helicobacter pylori 

Cervical cancer 

HPV (Human papilloma virus)

Liver cancer

Afla toxin (Aspergillosis)

 

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