??????????????? (Blood Flukes)

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??????????????? (Blood Flukes)
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??????????????? (Blood Flukes) ?????????????????
?????????????????? ???????????????????
1. ??????????? ( Dioecious) 2.
?????????? ( no operculum) 3. cercaria
????????????????? Forked tail 4.
????????? Metacercaria
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Blood Fluke ??????????? 4 ???? ??????
.. Schistosoma haematobium (Bilharz
, 1852 Weinland , 1858) Schistosoma
mansoni (Sambon , 1907) Schistosoma
japonicum (Katsurada ,
1904) Schistosoma mekongi (Voke
Bruce , 1975)
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????????????????????????????????
Schistosomiasis ???? Bilharziasis
Schistosome ???? 4 ???????????????????? ,
???????????????????????? ??????????????????
???????????????????????????? ???
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????????????? (Geographical distribution) S.
haematobium ????? ???????
???????????? ??????? S.
mansoni ????? ?????????? ????????
??????????????? S.
japonicum ????? ??? ??????? ???????
?????????? ???
???????????????? S. mekongi
?????????????????????
??????????? ??????????????????
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??????? (Morphology) - ??????
?????????????????????? ?? gynaecophoric
canal ???????????????????????????????? - ??????
?? ventral sucker ???????? Oral sucker
??????? ?? ventral sucker ???????? Oral
sucker - ????????????????? pharynx Esophagus
??????? 2 intestines ????????????? ??????
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• Genital organ
• ?????? ?? Testes ???????? Ventral sucker
• ??????? ?? Ovary ???????? Reunion ???
  Intestine
• - ????????????????? Schistosome ???? 4 species
• ??????????????????
• 1. ??????
• Tubercle ??? Cuticle
• ???????? arrangement ??? Testes
• ??????? Reunion ??? Intestine

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• 2. ???????
• ?????????? Ovary
• ?????????? Uterus ??? ????????????
• ????????????? Uterus
• 3. Egg
• ????? Operculum ????? Spine
• ?????????????????????? Spine ??????????
• ???????species

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S. japonicum ?????? 90 X 65 um
S. mekongi ?????? 45 X 40 um
S. mansoni ?????? 150 X 60 um S.
haematobium ?????? 150 X 60 um
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Schistosoma mekongi
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Schistosoma mansoni
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Schistosoma haematobium
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??????????????????
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- ????????????????????? ?????????????????????
?????? Venule ???????? ?????? S.
japonicum ????????????? Superior mesenteric
veins (venule
????????????) S. mekongi
????????????? Superior mesenteric
??? Portal veins
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S. mansoni ????????????? Inferior
mesenteric veins (venule ???
?????????) S. Haematobium
????????????? Venule
??? Pelvic region ??????
Vesical hemorrhoidal
vein ???? Urinary
bladder Rectum
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??????? (Life cycle) ???? 4 species ????????
?????????????????
?????????????? ??? Adult worms ?????????
?????????????????????????? ????
??????????????????????????????????
??? ????? ????? Miracidium
???????????????????
????????????????????????
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- Miracidium ????????????????????????????
???? 1st Intermediate host S. japonicum
Oncomelania sp. S. mansoni Biomphalaria
sp. S. haematobium Bulinus sp. Physopsis
sp. S. mekongi Tricula sp. ???
miracidium ?????????????????? 16-32 ??.
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- ????????
miracidium ???????????
mother
sporocyst daughter sporocyst
redia ??????? Cercaria ????
Forked tail cercaria
????????????????????? 1-2 ????? -
??????? Cercaria ??????????? ?????????
????????? Host
?????? Cercaria ???????? infective stage
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• ???????????? Definitive host
• Cercaria ?????????????
  ???????????????????
• 
  ???????????????
• 
  ????????????????
• (????????????? 2-3 ???) ???
• ??????????????????????????????
  ?????????????

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Portal vein ?????????? ????????? Adult
Flukes ????????? ?????????????????? venule
??????????????? - ?????? 4-5 ???????
????????????? infection ????????????????????
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????????? (Pathology) - ???????
Schistosomiasis ???? Bilharziasis -
?????????????????????????????? adult ???
?????????????? S.
japonicum ?????????????????? ??? S.
mansoni ????????????? S.
mekongi ??? ??????? S.
haematobium ????????????????????
Bladder ?????????????
???????
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• ???? Pathologic stage ???? 3 ????
• 1. Incubation Period (Prepatent Period)
• 2. ???? Egg deposition and extrusion
• - ???????? acute
• 3. Tissue proliferation and repair
• - ???????? chronic

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1. Incubation Period (Prepatent period) -
????????????????????? infection ?????????
???????????????? Adult - ?????????????????
cercaria ????????????? ????????????? ???
(??????????????) ?????????? ??????
Bacteria ????????????? ???? Dermatitis
- Cercaria ?????????????????????? 24-36 ??.
????????????????????? ????
?????????????? ??????????????? 2-3 ???
???????? young worms
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- ????????????????????????????????????
(Haemorrahage) ????? Eosinophils epitheloid
cell , giant cell ???????????????????
pulmonary - young worms ????????????????????
?????????? ???????????????? intrahepatic
portal blood vessels ???????????????????????
?? ????????????????????? ?????????????????
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- ??????????????????????? , ?????
????????????? ???????????????
(?????????????????????? ???????)
??????????? Eosinophil ??? ??????????????
????????????? , ???????? , ???????? ,
??????????????? ????????????
????????????????????????? ???? ???????? -
??????????????????????????????????????????????
???????????????????? ????????? ?????????
????????????????? venule ?????????????
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2. Egg deposition extrusion - ??????????????
??????????????????? ?????? ???????????????????
???????????????? ?? ???? venule ?????????? -
?????????????????????????????????????
?????????????????? Lumen ??? ????? ????
Urinary Bladder (?????????????? ?????)
????????????????????????? ????????????
???????????
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- ?????????????????????????????????????
?????????? - Miracidium ???????????????????????
?? 21 ??? ??????? - ???????????
???????????????? Tissue ?????????? Focus
????????? Lesion ????????????????????? 3
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- ?????????????? Schistosome
?????????????????? ??????????????????????????
?????????????? ??????????????????????????????
Portal veins ????????????????????? -
????????? ??????? Back pressure ???????????
?????? - ????????? infection ???
???????????????????? ????????????????
??????????????????
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3. Tissue proliferation Repair -
???????????????? Portal vessel ?????????????
???????????????????????? - ???? Round cell
infiltration ??????? - ???? Pseudo-abscess
????????????????????? ???? Leukocytes
????????? ?????????????? Toxic product
??????????? ????????????? Inflamatory cells
??????????????????????? - ???????????????????????
?? , ??? , ????? ??? ???????????
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S. japonicum S. mekongi ????????????????????? S.
mansoni S. haematobium ???? Lesion ???
Bladder ,
Urethra - Miracidium ???????????? ???????? 21
??? ????? ????????????????????????
(Calcification) ?????????? Tissue
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- ????????????????????????????
(Toxic-sensitization reaction)
????????????????????? ???? ?????? 25 ??
???????????????????????????? ????????????
Pseudo- abscess ?????? Proliferation ???
Round cells ??????? ?????????????????????????
??????????????????? organ ???????????????????
- ??????????????????????????????
????????????????????? ???????????????????
???? ??????????? Pneumonia ???? Carcinoma
???
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??????????????? (Diagnosis) 1. ??????????
clinic ???? ??????
?????????????? Eosinophil ???
2. ?????????????? ????? endemic area 3.
?????????????? - ??????????????? S.
Haematobium - ???????????? S.
japonicum S. mekongi
S. mansoni
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4. Rectal biopsy ????????????????? Rectum
??????? Urinary Bladder ??????????? 5.
Immunodiagnosis - Intradermal test ??????
antigen ??????? ??????????? - Complement
fixation test ??????????? 90-100
?????????????????? - Seroimmunologic diagnosis
test ??????????????????????????????
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???????? (Treatment) - ?????????????
Praziquantel ????? ???? 20-30 mg/kg Body
Weight ????-???? 1 ??? (1 ???? 600 mg)
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??????????????????? (Control and Prevention)
1. ??????????????????????? 2.
??????????????????? 3. ????? Host (??????????
Host) 4. ???????????????????? , ???????
???????? ?????????? (??
Water Supply)
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Non-human Schistosome dermatitis Schistosome
???????????????????????? ?? 1. Schistosoma
spindale 2. Orientobilharzia harinasutai 3.
Trichobilharzia maegraithi 4. Schistosoma
incognitum
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- Schistosome ???????????? Blood fluke
???????? ??? ??? ???? ???? ??? -
Cercariae ??????????????? ??????????????????
????????????????????????? ???? ??? ???
cercaria ?????????????? Adult ????
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- ??????????? ????? Schistosoma spindale ??
Intermediate Host ??????????? Indoplanorbis
exustus ??? Definitive Host ???? ???
??????? - ??? infect ?? ??????????????????????
???? ???????? Cercarial dermatitis
Swimmers itch Clam
diggers itch Sawah itch
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???????? (Treatment) - ???????? antihistamine
????????? - ????? Steroid
?? ??????????????????? (Control and
Prevention) - ?????????????????????????? -
???????????????????????
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Schistosoma incognitum
Schistosoma spindale
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