LIVER FLUKES and LUNG FLUKE

Note: Italicized text were taken from the manual

FASCIOLA HEPATICA

ADULT

EGG

SHEEP LIVER FLUKE

Family Fasciolidae
Large LEAF-SHAPED
Disease produced: Sheep liver rot, Fascioliasis
Tegument covered with scale-like spines
Metacercaria excyst in small intestine
penetrate wall creep over viscera liver
wander for 2 months bile ducts produce
eggs in another month
Adult flukes live as long as 11 years
Accidental Definitive Host: Man
DEFINITIVE HOST: sheep
1st INTERMEDIATE HOST: (snail) Lymnae,
Fossaria, Stagnicola
2nd INTERMEDIATE HOST: (aquatic vegetation)
water chestnuts, watercress and other
waterplants like kangkong
Veterinary Fascioliasis major economic
problem
SEX: Monoecious
INFECTIVE STAGE: Metacercaria
Diagnostic Stage: Egg
Free swimming larva: lophocercus cercaria,
simple, small
Measures up to 30 mm long by 13mm wide
Moderately fleshy, relatively flat and leaf-like
Scales of skin with variable sizes, pattern and
distribution
Anterior part is conical, designated as
cephalic cone (diagnostic), broadly pointed
posterior part
With oral and ventral sucker.
Branched
intestinal
ceca
Two
dendritic
testes, one is
behind the
other
located at the middle of the body
Ovary and vitellaria highly branched
Large, ovoid (hens egg-shaped),
light yellowish-brown with broad
operculum at the narrow end
Contains disorganized yolk
material (unsegmented)
Immature, operculated

LIFE CYCLE

UNEMBRYONATED EGG passed in the feces

EMBRYONATED EGGS in water MIRACIDIA hatch and
penetrate SNAIL SPOROCYST REDIAE
CERCARIAE cercaria leaves 1st IH free swimming
cercariae encyst on WATER PLANTS METACERCARIA
on water plants ingested by HUMAN, SHEEP or CATTLE
excyst in DUODENUM motile metacercaria penetrate
intestinal layer viscera to reach LIVER adult in proximal
part of BILIARY DUCTS
EPIDEMIOLOGY

No infestation in extreme weather conditions

Most parts of the world (Europe, South America)

Eggs do not develop in 10 degrees Celsius

PATHOGENESIS/CLINICAL MANIFESTATION
(Late complication: Hepatic Biliary Cirrhosis)

Classical Fascioliasis
o
Ingested metacercaria penetrate
intestinal wall Glissons capsule
liver parenchyma proximal biliary
passage produce classical ova
o
(+) ova = patient with signs and
symtopms
o
Liver damage
o
Worm burden

Cystic dilation Inflammation/acute

infiltration
o
Hyperplasia of blood vessel
endothelium and epithelium of biliary
passage

Heals fibrosis

obstruction

Page 1 of 4
palindrome.2012

LIVER FLUKES and LUNG FLUKE

Note: Italicized text were taken from the manual
WORST = destroy lumen deposit ova
in liver parenchyma abscess in liver
tissue

Heaptomegaly, difficulty of
breathing, dyspnea, liver
pushed up

Jaundice (hepatocellular,
obstructive)

Emanciation
False Fascioliasis
o
(+) ova, asymptomatic patient
Pharyngeal Fascioliasis
o
Halzoun
o
(+) young fluke in posterior pharynx
with muscular sucker for attachment;
s/sx: Edema, 3Ds, 1A (Dyspnea,
Dysphagia, Deafness, Asphyxia)
o
Localized infection

DIAGNOSIS

Stool Exam: Eggs (relatively large, operculated)

reach the intestine via the bile

Duodenal aspiration / biliary aspiration

Serology

Ultrasound, CT scan

Early diagnosis and treatment to prevent

irreparable liver damage

Bachman intradermal test wheal of 10cm = (+)

Ouchlersony test (Gel diffusion test)

EGG

Spatulate and flat with attenuated anterior

and a bit rounded
posterior
Oral sucker is slightly
larger than the ventral
sucker
With two large and
deeply lobed or
branched testes situated one behind the other
at the posterior third of the body (diagnostic)
The small lobular ovary is medial to the junction of
the middle and posterior third of the body
Vitellaria are delicate, granular and distributed at
the lateral part of the middle and posterior 3rd of
the body
With simple intestinal ceca
Ovoid with moderately thick,
light yellow to brown eggshell
The prominent and convex
operculum is resting on a
rimmed extension of the
shell (similar to o. felineus
egg)
Fully embryonated or with miracidium already
when laid

LIFE CYCLE

TREATMENT

Triclabendazole: 2 doses of 20 mg/kg q 12h

Bithionol: 50 mg/kg q other day x 10 days

Rafoxanide
CLONORCHIS SINENSIS

ADULT

CHINESE LIVER FLUKE / ORIENTAL LIVER

FLUKE
Medium to small flukes
LANCET-SHAPED
Pitcher-like or urn-shaped, very small eggs with a
small operculum at the upper pole
Mature bile ducts produce 4000 eggs/day
Excyst in the LIVER
Adult worms can live up to 25years
1st INTERMEDIATE HOST: Parafossaraulus
manchouricus (most important) operculated
snails
2nd INTERMEDIATE HOST: freshwater fish
DEFINITIVE HOST: man
Sex: Monoecious
INFECTIVE STAGE: Metacercaria
DIAGNOSTIC STAGE: Unembryonated Egg
Free swimming larva: Lophocercus, keel tail

EMBRYONATED EGG passed in feces eggs are ingested

by SNAIL develop into MIRACIDIA SPOROCYST
REDIAE CERCARIAE free swimming cercariae encyst
in skin or flesh of fresh water FISH METACERCARIA in
fish ingested by MAN excyst in DUODENUM enter
AMPULLA of VATER but does not penetrate viscera
stays in distal biliary passage in LIVER
CLINICAL MANIFESTATION

Cystic dilation inflammatory reaction

hyperplasma of vessel heal fibrosis

Page 2 of 4
palindrome.2012

LIVER FLUKES and LUNG FLUKE

Note: Italicized text were taken from the manual

Varicosity, hemorrhoids
Spider angioma, caput medusa
Portal hypertension
o
Death from ruptured varicosities
Associated with malignancies
Hepatocarcinoma > Cholangiosarcoma
Synergistic = infection + 2CH3 nitrosamine
malignancy

PATHOLOGY

Erosion of bile duct epithelium

SIGNS AND SYMPTOMS

Light infection do not cause important

symptoms

Heavy infection liver enlargement

Cirrhosis, Ascites, Edema
EPIDEMIOLOGY

East Asia, China, Japan

DIAGNOSIS

Eggs in stool

Intradermal test

Duodenal aspirate

EGG

With simple, cylindrical intestinal ceca

Elongate, ovoid and yellowishbrown in color

Operculum rest on a prominent
thickened part of the shell looking
like a rim (old fashioned electric
bulb appearance diagnostic)
Contains miracidium (mature already) when laid
With minute inconspicuous tubular thickening at
the posterior end of the shell

OPISTHORCHIS VIVERRINI

Similar to C. sinensis and O. felineus

but
o
Testis position close to each
other and are more deeply
lobulated
May also cause Bile duct Cancer
more common cause that O. felineus
DIAGNOSTIC STAGE: embryonated
larva
Cholangiocarcinoma >
hepatocarcinoma

PREVENTION

Cook fish thoroughly

TREATMENT

DOC: Praziquantel
PREVENTION

Treat night soil sterilize using CuSO4 NH3Cl

Destroyed at 100 degrees Celsius = cooked food

OPISTHORCHIS FELINEUS

ADULT

CAT LIVER FLUKE

Very similar to C. sinensis but occurs in Europe
as well as in Asia
May cause Bile Duct Cancer
DIAGNOSTIC STAGE: Embryonated egg
Lancet-shaped, thin with attenuated
anterior and rounded posterior
Ventral sucker is subterminal; oral
sucker are nearly equal in size
Two lobular testes are situated
obliquely to each other at the
posterior 4th of the body
Ovary is small, oval or slightly lobular
located at the median of the body
The transversely compressed
vitellaria (diagnostic) are at the
lateral middle 3rd

PARAGONIMUS WESTERMANI

ADULT

ORIENTAL LUNG FLUKE

Disease caused: PARAGONIMIASIS
1st INTERMEDIATE HOST: snail
2nd INTERMEDIATE HOST: crab, crayfish
DEFINITIVE HOST: Man
Egg: Operculated, Immature
Sex: Monoecious
INFECTIVE STAGE: Metacercaria
DIAGNOSTIC STAGE: Unembryonated egg
Ovoid, plump, rounded anterior
COFFEE-BEAN shaped, tapered
posterior
Reddish brown
Skin has scale-like spines
Nearly equal oral and ventral
suckers
Two irregular testes situated side
by side near junction of posterior
3rd and 4th of body
Large, lobed ovary at right or left
acetabulum (ventral sucker)
Lateral margins with branched vitellaria
Simple, zigzag intestinal ceca

Page 3 of 4
palindrome.2012

LIVER FLUKES and LUNG FLUKE

Note: Italicized text were taken from the manual
EGG

Flat operculum, thickening at base

Chocolate color, golden yellowish-brown in color
Broadly ovoid with distinct
flattened operculum
Thick abopercular end
Disorganized yolk material
Immature when laid

DIAGNOSIS

Acid fast stain to rule out PTB

Identification of egg: stool and sputum exam

Chest x-ray

Serology: ELISA
TREATMENT:

Praziquantel

LIFE CYCLE

UNEMBRYONATED EGG passed in feces EMBRYONATE

in water MIRACIDIA hatch and penetrate SNAIL
SPOROCYST REDIA CERCARIA cercaria goes into
the water invade the CRUSTACEAN and encyst into
METACERCARIA MAN ingest inadequately cooked or
pickled crustaceans containing metacercaria excyst in
DUODENUM penetrate intestinal wall diaphragm
adult develop in capsule in cystic cavities in LUNGS
(middle portion) lay eggs which are excreted in the
sputum; alternately eggs are swallowed and passed with
stool
PATHOGENESIS/CLINICAL MANIFESTATION

Enclosed by a CAPSULE

1-2 parasite per capsule, surrounded by

granuloma in bronchioles

Once they invade periphery produce

PLEURITIC PAIN

Effusion: fluid in pleural cavity

Signs and symptoms similar to TB

o
Difference: Site of Pathology

Apex of lungs in PTB

emaciated

Middle of lungs in
Paragonimiasis healthy
patient, no emaciation

Cerebral Paragonimiasis: 6 months after

diagnosis of pulmonary paragonimiasis
o
Skull xray: soap bubble appearance

Page 4 of 4
palindrome.2012