Parasitology

Intestinal and Lung Flukes

February 2008

INTESTINAL FLUKES Adult in Undevelopd Miracidium

small eggs passed frpm egg and
FASCIOLOPSIS BUSKI intestine in feces into penetrates snail
● Scientific name : Fasciolopsis buski freshwater

● Common name : giant intestinal fluke Cyst

digested, Miracidium in
● Disease : Fasciolopsiasis worm ssnail develops
● Geographic Distribution attaches to into
intestinal
● Found in Central and South China as far north as mucosa LIFE CYCLE
OF sporocysts
the Yangtze valley, Taiwan, Thailand, Laos, Vietnam, FASCIOLOP
Cambodia, India, Korea, Indonesia Man eats SIS BUSKI
metacercaria
● Chief endemic area in Kwangtung and Chekiang on raw water
plants redia I
provinces of China

Cercaria
MORPHOLOGY encysts on Cercaria
● Thick, fleshy, ovate, flesh colored water plants, breaks out of redia II
secretes cyst the redia II
● Measures 2.0-7.5 cm by 0.8-2.0 wall; and snail
becomes into water
● Cuticle covered with transverse rows of small spines
metacercaria
● Oral sucker about ¼ the size of the ventral sucker man eats
metacercaria
● Intestinal tract consists of a short prepharynx, bulbous
pharynx, a short esophagus, and a pair of unbranched
ceca with two characteristics lateral indentations. PATHOLOGY AND SYMPTOMATOLOGY

● Two dendritic testes lie in tandem of the posterior half ● Areas of imflammation, ulceration, and abscesses at the

of the worm site of attachment

● Single branched ovary in the middle of the body to the ● Epigastric pain, nausea, and vomiting

right of the midline ● In heavy infections: edema, ascitis and anasarca

● Vitellaria lateral to the ceca extend from ventral sucker ● Slight anemia, often leukocytosis, sometimes a

to the posterior end of the body leucopenia or lymphocytes

● Convoluted uterus opens in the common genital atrium ● Complete recovery follows removal of the worms

at the anterior border of the ventral sucker ● Clinical manifestations due to toxic products of the
worm

MIRACIDIUM
● Covered with cilia EPIDEMIOLOGY

● Has spined head, pigmented eye spot, two flame cells, ● The natural definitive hosts are humans. hogs and dogs

cephalic glands and germinal cells ● The first immediate hosts are the planorbis snails
Segmentiba, hippeutis, Gyraulus

CERCARIAE ● The second immediate hosts are aquatic vegetation like:

● With slender muscular tails and heavy bodies 195 by o water caltrop (Trapa bicomius)

145 µ o water hyacinth (Eichomia)

o water chestnut (Eliocharis tuberosa)

METACERCARIAE o water bamboo (Zizania)

● 216 by 187µ o water morning glory (Ipomaea aquatica)

● outer friable cyst and firm inner wall o lotus (Nymphaea lotus)
● Human infection usually results from the ingestion of
metacercariae on fresh edible water plants that grow in
ponds fertilized by night soil
● When eaten raw, the pods of the water caltrop and the
bulbs of the water chestnut are peeled with their teeth,
thus enabling the detavhed metacercariae to enter the
digestive tract.

DIAGNOSIS
● Clinical symptoms in an endemic area
● Final diagnosis
ian & virns 1 of 6
 Parasitology – Intestinal and Lung Flukes Page 2 of 6

o finding eggs in the feces ● Cuticle covered with fine scalelike spines
Egg: ● Large ventral sucker in the anterior middle third of the
● yellowish ellipsoidal body
● 130-140 µ by 80-85 µ ● Nonprotrusible, nonadhesive genital sucker at the left
● Has clear thin shell with a small operculum at posterioborder of the ventral sucker
one end ● Two ovoid testes side by side in posterior fifth of the
● Undeveloped when passed into feces body
● Absence of cirrus and cirral sac, the seminal vesicle
Eggs resemble those of: opening within the genital sucker
● Fasciola hepatica except for the distribution of ● Subglobose ovary anterior to the testes
yolk granules ● Vitellaria with large polyglonal follicles in the lateral
● Gastrodiscoides hominis – narrower and greenish posterior third if the body
brown Adults in
Mature eggs
● Echino perfoliatus – smaller small
passed out in
o adult flukes sometimes vomited or passed in the intestine of
feces and
Metacercariae humans and
feces reach water
excyst in fish eating
duodenum mammals
TREATMENT
● Praziquantel 25 mg/kg TID ingested by
● Niclosamide 100 mg/kg as single dose Definitive hosts fresh water
ingest raw or LIFE CYCLE snail ( 1st IH)
● Dichlophen 2-3 gm evry 8 hrs for 3 doses
insufficiently OF
cooked infected HETERPHYE
PREVENTION fish S
● Avoid eating raw aquatic plants Miracadium
HETERPHYE
develops into
● thorough cooking or the steeping of the plant\s in
sporocyst
boiling
Encystation as
metacercariae
CONTROL in fish (2nd IH)
● Treatment of human sources of infection
radiae 1 or 2
● Reduce infestation of water palnts by: Fresh
generation
o treating night soil containing eggs by storage or
swimming
circarae
unslaked lime
o killing the eggs, miracidia, and cercariae in the
water with unslaked lime (100 ppm) or copper
sulfate (20ppm)
● restrain infected hogs from contaminating areas where
water plants are growing
● Destroy immediate snail host
● Education of the public and fundamental changes in
eating habits

HETEROPHYES HETEROPHYES
● Scientific name : Heterophyes heterophyes PATHOLOGY AND SYMPTOMATOLOGY
● Common name : Von Siebold’s fluke ● No marked symptoms nor appreciable injury too the
● Disease : Heterophyiasis intestine except with heavy infections
● Geographic Distribution ● in heavy infections
o Found in Egypt, particularly the Lower Nile valley, ● chronic intermittent mucoid diarrhea with colicky pains
Greece, Israel, Central and South China, Japan, and abdominal discomfort due to irritation of the
Korea, Taiwan, Philippines intestinal mucosa
o High incidence of infection near Port Said, Egypt ● presence of eosinophilia but not anemia
where local fishermen continually pollute the water ● eggs may cause granulomatoous lesions in the heart
and a high percentage of mullets are infected and brain when worms Penetrate the intestinal walls
and gel into the lymphatics or venules cardiac
MORPHOLOGY beriberi and cerebral hemorrhage respectively
● Pyriform grayish fluke
● Small size: 1.3-0.5 mm EPIDEMIOLOGY
 Parasitology – Intestinal and Lung Flukes Page 3 of 6

● The definitive hosts are man, domesticated and wild fish ● Cuticle covered with minute scalelike spines more
eating mammals numerpous at the anterior end
● The first intermediate hosts are brackish water snails ● Large ventral sucker, situates to the right of the midline
such as Pirenella in Egypt and Cerithidea in Japan with a genital opening at its anterior rim
● The second intermediate host is a fish chiefly Mugit ● Two oval testes, obliquely side by side in the posterior
(mullet) and tilapia in Egypt and Acanthogius in Japan third of the body
● Humans acquire thr infection by eating raw fresh mullet ● Globose ovary at the junction of the middle and lower
or fessik (salted mullet) pickled for less than 14 days third of the body
● Coarse vitellaria in a fan shape distribution in the
DIAGNOSIS posterior lateral fields
● By finding the eggs in the feces
Adults in
Eggs: small Mature eggs
o Light brown, thick shelled, operculated intestine of passed out in
o Measures 29 by 16 µ humans and feces and
Metacercariae fish eating reach water
o Contains fully developed miracidia at ovipostion
excyst in mammals
o Shell has a slight shoulder at the rim of the duodenum
operculum and sometimes a knob at the posterior ingested by
pole fresh water
Definitive hosts
LIFE CYCLE snail ( 1st IH)
ingest raw or
It differs from Clonorchis sinensis eggs by: insufficiently OF
cooked infected METAGONIM
o their broad ends with indistinct opercular shoulders
US Miracadium
fish
o less developed posterior spine develops into
sporocyst
It differs from Metagonimus yokogawi by:
Encystation as
o light yellow color
metacercariae radiae 1 or 2
o thin shell
in fish (2nd IH) generation

TREATMENT Fresh
● Praziquantel- 20 mg per kg 3x a day for 2 consecutive swimming
circarae
days

PREVENTION
● Avoid eating raw or improperly cooked or recently salted
fish in endemic areas
● Sanitary disposal of waste or excreta

CONTROL
● General measures are impracticable because of:
o impossibility of detecting and treating human carrier
o presence of animal reservoir hosts
o difficulty of enforcing sanitary measures PATHOLOGY AND SYMPTOMATOLOGY
● Similar to Heterophyes heterophyes
METAGONIMUS YOKOGAWI ● Eggs may enter the lymphatics or mesenteric venules
● Scientific name : Metagonimus yokogawi and set up granulomatous lesions in distant foci such as
● Common name : Yokogawa’s fluke the heart and nervous system causing cardiac beriberi
● Disease : Metagonimiasis and cerebral hemorrhage respectively
● Geographic Distribution
o Most common heterophyid in the FarEast EPIDEMIOLOGY
o Has been reported in Japan, China, Korea , ● The definitive hosts are man, domesticated and wild fish
Philippines, Taiwan,m Siberia and Balkans, Greece eating mammals
and Spain ● The first intermediate hosts are sp of the genera
Semisulcospira, Thiara and Hua
nd
MORPHOLOGY ● The 2 intermediate hosts are the fresh water
● Small size 1.4 by 0.6 mm salmonoid fishes of the genera Plecoglossus and Salmo
● Pyriform shape with a rounded posterior and a tapering and thw cyprinoids of the genera Richardsonian
anterior end (Leusciscus) and Odontubutis
 Parasitology – Intestinal and Lung Flukes Page 4 of 6

● Humans and other mammals acquire the infection by

eating raw infected fish
● The waters inhabited by susceptible snails and fish are
contaminated by the fecal discharges of humans and
other mammals

LABORATORY DIAGNOSIS
● Identification of the eggs in feces
Eggs:
o Light yellow brown, tyhin shelled, operculated, 28 by
17 µ
o With nodular thickening on the posterior end
o Contains a mature miracidia at ovipostion

TREATMENT
● Praziquantel : 20 mg/kg TID for 2 days

PREVENTION
● Avoid ingestion of inadequately cooked or raw fish
● Sanitary disposal of waste or excreta

ECHINOSTOMA ILOCANUM
● Scientific name : Echinostoma ilocanum
PATHOLOGY AND SYMPTOMATOLOGY
● Common name : Garrison’s fluke
● Inflammation at the site of attachment of the worm in
● Disease : Echinostomiasis
the intestinal wall
● Geographic distribution :
● In heavy infections, diarrhea sometimes bloody, and
o Infection is prevalent in Northern Luzon, Leyte,
abdominal pain
Samar and Mindanao
● General intoxication may result from absorption of the
o It is also found in Indonesia, India, China and
metabolites of the worm
Thailand

EPIDEMIOLOGY
MORPHOLOGY
● The natural definitive hosts are humans
● Reddish gray, 2.5 – 6.5 mm by 1.0 – 1.35 mm
● The first intermediate snail host are Gyraulus
● Integument covered with plaquelike scales
convexiusculus and Hippeutis umbilicalis
● Anterior end provided with a circumoral disk
● The second intermediate hosts are the snails Pila
surrounded with a crown of 49 – 51 spines
luzonica (“kuhol”)
● Oral sucker lies at the center of the disk
● Rats mayserve as an important reservoir host
● Ventral sucker in the anterior fifth of the body
● Infection is acquired by ingestion of raw snails that
● Testes deeply lobed and in tandem
serves as second intermediate hosts of the parasite
● Ovary located in front of the testes
● Uterus between the intestinal ceca bounded
LABORATORY DIAGNOSIS
by the ventral sucker and ovary
● Demonstration of eggs in the stools
● Crescent shaped vitelleria in the lateral
o Straw colored, operculated, ovoid, 83 – 116
fields of the posterior 2/3 of the body
by 58 – 69 u
o Immature when passed in the feces
o Morphologically similar to eggs of Fasciola and
LIFE CYCLE
Fasciolopsis

TREATMENT
● Hexylresorcinol
● Tetrachlorethylene
● Praziquantel

PREVENTION AND CONTROL

 Parasitology – Intestinal and Lung Flukes Page 5 of 6

● In enedemic areas, raw or insufficiently cooked snails PATHOLOGY AND SYMPTOMATOLOGY

should not be eaten Four types of lesions produced in the tissues
● Drinking water also should be boiled 1) Nonsuppurative
o Eggs infiltrated the tissues causing round cell and
LUNG FLUKE connective tissue reaction  abscess
PARAGONIMUS WESTERMANI 2) Tubercle like lesion
● Scientific name : Paragonimus westermani o Contains caseous material
● Common name : Oriental lung fluke 3) Suppurative lesions
● Disease : Paragonimiasis 4) Ulcerative
: Pulmonary distomiasis o Partial healing
: Endemic hemoptysis
● Geographic distribution : Organs involved
o Cosmopolitan distribution among mammals ● Lungs
o Presence in humans is chiefly confined in the Far ● Abdominal cavity – abscess formation common
east ● Muscular tissue – ulceration most common
o Principal endemic regions are in Japan, South Korea, ● Liver
Thailand, Taiwan, China and the Philippines ● Intestinal wall
o Human infections also reported in South and ● Mesenteric lymph nodes
Southeast Asia, Indonesia, islands of the South ● Testes
Pacific, and northern South America ● Brain
● Peritoneum
MORPHOLOGY ● Pleura
● Reddish brown fluke
● Measures 8 – 16 mm by 4 – 8 mm Clinical
● Active: resembles a spoon with one ● Chronic course and insidious onset
contracted ● Most common symptoms are referable to the
of preserved –oval, coffee bean o Chest
● Suckers of equal size, the ventral just o Abdomen
anterior to o Lymph nodes
the equatorial plane o Brain
● Irregularly lobed testes, oblique to each other,
in posterior third of worm Chest
● Lobed ovary anterior to testes on right side ● Similar to bronchopneumonia or bronchiectasis with
opposite closely coiled uterus pleural effusion
● Vitellaria in extreme lateral fields for entire length of o Blood streaked sputum
body o Frank hemoptysis
o Persistent and distressing cough
LIFE CYCLE o Chest pain

Abdomen
● Rigidity and tenderness

Lymph node glandular fever

● Abscess in the skin over the involved nodes

Brain
● Jacksonian type of epilepsy
● Hemiplegia
● Monoplegia
● Paresis of varying degrees
● Visual disturbances

EPIDEMIOLOGY
● The natural final hosts are humans and a variety of
carnivores like cats, dogs, aquatic animals, the
mongoose, opossums and rats
 Parasitology – Intestinal and Lung Flukes Page 6 of 6

● The first intermediate hosts are operculated snails of the o Intradermal tests with a Paragonimus antigen
genera:
o Far east : Hua, Semisulcospira, Syncera, and MORPHOLOGY
Thiara ● Large
o North America : Pomatiopsis ● Moderately thick, dark shell
o South America : Pomacea ● Prominent operculum at the broad end
● The second intermediate hosts are the: ● Tickened abopercular end
o Fresh water crabs ● Unembryonated at oviposition
 genera Eriocheir, Potamon, Sesarma and ● Paragonimus westermanii ova is larger, has thicker and
Parethelpusa more deeply stained shell and the thickened abopercular
o Crayfishes end lacks the knob so often seen in Diphyllobothrium
 Far East –Astacus latum ova
 North America - Cambarus
o Man gets the infection by eating uncooked infected TREATMENT
freshwater crabs and crayfish ● Praziquantel – 25 mg/kg TID for 3 days
o Metacercariae dislodges during food preparation may ● Corticosteroids – cerebral involvement
contaminate eating and cooking utensils
o Crushed crab juice may be a source of infection in PREVENTION AND CONTROL
children in Korea ● Avoid eating raw, freshly pickled, or imperfectly cooked
freshwater crustaceans
DIAGNOSIS ● Refrain from drinking unfiltered or unboiled creek water
● Clinical – in endemic areas it is based on: in endemic districts
o Pulmonary symptoms ● Public education
o Blood tinged sputum
o Eosinophilia
o Chest x-ray
 Ring shadowed opacity, 5 to 10 cm, comprising
small contiguous cavities that give the
appearance of a bunch of grapes

DIFFERENTIAL DIAGNOSIS
● Pulmonary
o Bronchopneumonia
o Bronchiectasis
o Pulmonary tuberculosis
o Pleural effusion and other chest disease
● Cerebral
o Cysticercosis
o Hydatid cyst
o Encephalitis
o Meningitis

GENERALIZED PARAGONIMIASIS
● Filariasis bancrofti
● Myositis
● Glandular fever

LABORATORY
● By finding the eggs
o Sputum
o Feces
o Aspirated material from abscesses or pleural
effusions
● Adult worm – exploratory operation
● In ectopic infections
o Complement-fixation