Flukes in other locations than INTESTINAL FLUKES: • buski • heterophyes • yokogawai • Echinostoma spp FLUKES: • • viverrini • /gigantica LUNG FLUKES: • • Paragonimus mexicanus & P. spp.

1 Intestinal flukes

• Fasciolopsis buski • • • Echinostoma spp (self-reading)

2 Fasciolopsis buski

3 Egg Fasciolopsis buski 130-150 µm long by 60-90 µm wide

4 Adult Fasciolopsis buski 20-75 mm long

5 Water chestnuts vector (Planorbidae)

6 Fasciolopsiasis Diagnosis & Management

DIAGNOSIS: • Faecal examination: Stoll’s dilution, formalin- ether concentration, direct smear, Kato • Distinguishing from Fasciola eggs is difficult MANAGEMENT: • Drug of choice: (15mg/kg) • Risk of exacerbating obstruction or acute ! toxaemia with treatment !

7 Heterophyes heterophyes

8 Adult of H. heterophyes . Oral sucker (OS), pharynx (PH), intestine (IN), ventral sucker, or acetabulum (AC), and eggs within the uterus (UT)

9 Chlonorchiasis

10

11 O. felineus – adult

O. viverrini – egg

12 An intrahepatic bile duct of a rabbit infected with Clonorchis sinensis .

13 Opisthorchiasis & Epidemiology

O. felineus O. viverrini C. sinensis Europe in Asia , Hongkong, Man infected by Man infected by Man infected by eating raw eating raw fish eating raw fish

• Prevalence & intensity of increase with age and is higher in males

14 Cholangiocarcinoma

15 Fasciola spp

16 Fascioliasis Cycle

F. hepatica Def. : sheep Temperate &sub- Vector: snail tropical climate (South F. Lymnaeidae Europe, Middle-East, Central/ South America, Africa F. gigantica Def. host: mainly South-East Asia & Africa Vector: snail cattle F. Lymnaeidae • Both species can co -exist • Cysts are ingested by and excyst in duodenum then migrate through intestinal wall to the bile ducts. Eggs are produced after 3-4 m • May live many years • High humidity, moderate T°c & rainfall favour transmission 17 Fascioliasis

Water cress

Fossaria truncatula

18 F. hepatica adult

19 F. gigantica adults up to 75 mm

20 F. hepatica egg 130-150 µm long by 60-90 µm wide

21 LUNG FLUKES • Agents:

Paragominus ASIA westermani P. miyazakii P. skrjabini P. heterotremus P. africanus AFRICA P. uterobilateralis P. mexicanus LATIN/SOUTH P. ecuadoriensis AMERICA

22 Paragonimus spp.

23 Paragonimus westermani

Adult (18-20 mm) Egg (80-120 µm)

24 Table 83.1 -- Sources of common food-borne trematodes and affected organs in man From Manson’s Tropical Diseases, 22 nd edition

Fresh water food as sources of Trematodes Habitat in man infection Fish Clonorchis sinensis Biliary system Crab and crayfish Paragonimus spp Pleural cavity and lungs, occasional brain invasion Water plants Fasciola hepatica Liver and biliary system Fasciolopsis buski Snails, clams fish and tadpoles Echinostomes Small intestine

Various species of fish, shrimps, Heterophyes spp Small intestine insect Larvae and other aquatic foods Haplorchis spp Metagonimus spp Stellantchasmus spp 25