Trematodes are leaflike, symmetrical flatworms lacking a body cavity but possessing a ventral sucker to hold their position. They live in intermediate hosts such as snails, crabs, and fish and shed their eggs from the human host in the feces ( Schistosoma, Clonorchis, and Fasciola), urine (Schistosoma haematobium), or sputum (Paragonimus).
SCHISTOSOMA Schistosomes penetrate the skin, creating a papular pruritic rash. The adult form resides in the venous system. Symptoms of acute disease—fever, lymphadenopathy, and hepatosplenomegaly (so-called Katayama fever)—are rarely seen. More typically, patients present in the chronic stage with granulomas in the liver (portal hypertension) and bladder (obstructive hydroureter). Patients may present with diarrhea, abdominal pain, melena, hepatosplenomegaly, hematemesis, and, in the late stages, ascites and liver failure. With S. haematobium, dysuria and hematuria may be found. The diagnosis is suggested by a positive immunofluorescent antibody test result and confirmed by finding eggs in the feces or on rectal biopsy. Treatment is with praziquantel.
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