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(Liver) Flukes Intestinal Flukes Lung Flukes F HEPATIC (LIVER) FLUKES INTESTINAL FLUKES LUNG FLUKES F. Gigantica & F.Hepatica Fasciolopsis Buski (LI) Heterophyes Heterophyes Paragonimus Westermani Distribution common parasite of common in Far East especially in Common around brackish watr lakes (North Far East especially in Japan, Korea herbivorous animals. China. Egypt, Far East) and Taiwan. Human infection reported from many regions including Egypt , Africa & Far East . Adult morphology Size & shape - Large fleshy leaf like worm largest trematode parasite to Like trematodes (flattened) Ovoidal, thick, reddish brown. - 3-7 cm infect man Elongated, pyriform/ pear shape. Cuticles is covered w spines - Lateral borders are parallel. 7× 2cm. Rounded posterior end Rounded anteriorly oval in shape covered with small Pointed anterior end Tapering posteriorly spines. some scales like spines cover the 1cm x 5mm thickness cuticle especially anteriorly , help to “pin” the parasite between the villi of small intestine where it lives 1.5 – 3mm x 0.5mm Suckers Oral s. smaller than vs No cephalic cone, the oral sucker Small oral sucker Oral & ventral suckers are equal is ¼ the ventral sucker Larger ventral sucker Digestive intestinal caeca have compound two simple undulating intestinal Simple intestinal caeca Simple tortous blind intestinal system lateral branches and medial caeca. caeca extending posteriorly branches T and Y shaped. Genital system Testes 2 branched middle of the body in Two branched testes in the Two ovoid in the posterior part of the body. (Hermaphrodite) front of each other. posterior half Deeply lobed situated nearly side by side Ovary Branched & anterolateral to testes. A branched ovary in the middle single globular in front of the testes. Large, lobed situated behind the of the body. ventral sucker. Uterus lies opposite to it Vitelline Branching lateral fields. few, large follicles on both sides in the Highly branched follicles & extend glands posterior third of the body. along the lateral fields of body worm genital pore in front of ventral sucker. open in the genital sucker nutrition: feed on biliary secretion (Posterolateral to ventral sucker) Thug’s LIFE CYCLE HEPATIC (LIVER) FLUKES INTESTINAL FLUKES LUNG FLUKES F. Gigantica & F.Hepatica Fasciolopsis Buski (LI) Heterophyes Heterophyes Paragonimus Westermani Habitat liver, in bile ducts of man & cattle. The adult fluke lives in the small Small Intestine (dep btwn villi) Worms generally live in pairs intestine encapsulated in pockets of lungs Definitive H man and animals (sexual Man. Man Man multiplication). Intermediate Snail, Lymnea cailliaudi snail segmentina hemispharula Paratenic Host 1st: snail Melania & semisulcospira H in China 2nd: crustaceans (crabs & crayfish) Reservoir H Herbivourous animals as cattle & Pigs, dogs Fish eating animals Dog, fox, wolf, tiger & pigs camels (zoonosis) Diagnostic Immature eggs in feces stage Infective stage Encysted metacercaria (EM) in water Encysted metacercaria on edible EM in fish muscle & on aquatic plants. water plants. Mode of ingestion of EM on aquatic plants Ingestion of contaminated Ingestion EM in undercooked/unsalted fish infection (lettuce, water cress) or in water. aquatic vegetations (caltrop & (Tilapia/Mungil) chestnut) Cercaria Cercaria: Leptocercous cercaria Cercariae come out of snail and get lodged between muscles, secrets a cyst microcercous with a knob like tail. Body : swim in water searching for their wall for protection and called encysted The released cercariae penetrate 2 suckers, primitive gut, excretory transport host (Mugil and Tilapia metacercariae. They need 2-3 weeks to the crustaceans second I.H (crabs system, & cystogenous glands that = Boury and Bolty) fish (the 2nd become infective. and crayfish) then develop into secrete the cyst wall. (0.3 mm) I.H.) penetrate its skin lose the metacercariae (infective stage) Tail : simple tail (0.7 mm). tail Body: 2 suckers, primitive gut, 2 dark eye spots, 7 pairs of penetration glands. Thug’s 1. HEPATIC (LIVER) FLUKES DISEASE: FASCIOLIASIS Pathology: mechanical + toxic irritation (necrosis & fibrosis) Abdominal pain, Peritonitis & tender hepatomegaly (pain in Rt. Hypochondrium) Liver rot : this condition occurs by mechanical and toxic destruction of Fever, oesinophilia (early, 60%), jaundice. liver tissue by passage of large number of immature worms through the liver tissue leads to necrosis, fibrosis , hepatitis. Halzoun: Pharyngeal fascioliasis False fascioliasis (Spurious infection) Ectopic fascioliasis in Syria, Lebanon. passage of Fasciola eggs in stool without Cause: ingestion of living adult Fasciola in raw liver. presence of adult in bile duct. this occurs when metacercaria enter into the Mechanism: sucker irritation of mucosa oedema ± Cause: ingestion of infected raw liver, some eggs circulation and are distributed in abnormal sites suffocation. pass undigested in stool false diagnosis. all over the body e.g. peritoneum, lungs, brain, Treatment: alcoholic gargle ± tracheostomy. Diagnosis eyes and cause fibrosis. Control: proper cooking of animal liver (X: plant washing). re-examination of stool, after liver-free diet for 1 week eggs disappear. 2. INTESTINAL FLUKES 3. LUNG FLUKES Fasciolopsis Buski (large intestine) Heterophyes Heterophyes (heterophyiasis) Paragonimus Westermani ulceration, foci of inflammation and haemorrhage. This is attachment by 3 suckers focal inflammation or fibrous cyst opens to bronchi. manifested clinically by abdominal pain (colic), diarrhea and superficial necrosis of nearby villi. blood-tinged material containing eggs. vomiting Chronic intermittent diarrhoea (mucoid ± 1- paroxysmal coughs rusty sputum (eggs). Heavy infection results in chronic diarrhea, anaemia, blood), 2- Haemoptysis, chest pain,fever. intestinal obstruction, Abdominal colic. Toxic metabolites may cause generalized oedema. COMPLICATIONS HEPATIC INTESTINAL LUNG FLUKES Fascioliasis Heterophyes heterophyes Paragonimus Westermani 1. Liver abscesses (small, multiple), egg embolism to heart or brain. 1- lung abscess. 2. cholangitis, cholecystitis, b. calculi. Heart failure, brain haemorrhage, epilepsy 2- Pleural effusion. 3. obstructive jaundice: biliary obstruction is due to: mechanism: uterus opens into genital sucker, injects 3- Ectopic worms (brain: epilepsy, mechanical, epithelial hyperplasia, cellular infiltration eggs into damaged venule enter circulation haemorrhage). & fibrosis around b. duct). Pirenella Conica Heterophyes Brackish water Operculum Engulf egg Lymnea Snail Fasciola Fresh Water Miracidium enter snail Thug’s DIAGNOSIS HEPATIC INTESTINAL LUNG FLUKES EGG IN STOOL DS Immature egg Mature egg Immature egg (= fasciola) Size 140×70 u small 30×15 u. 100×50 u (medium). Shape oval. oval. oval Shell thin, operculate thick, shouldered operculum + post. knob. thick +flat operculum Content immature embryo. mature miracidium. Ovum yolk cells Colour yellowish-brown. yellowish-brown. Yellowish brown Direct: 1) stool examination. 1) Stool analysis for the characteristic eggs. finding the characteristic egg in sputum or stool 2) Duodenal aspiration. 2) Clinical features and marked (90%)./ in aspirated pleural effusion. 3) Enterotest capsule (in all oesinophilia. duodenal parasites). Indirect (early): serological tests to detect specific 1) specific serological tests to detect Ab.s (eg: antibodies (Ab) ELIZA, IHAT) (esp. in ectopic paragonimiasis). e.g. ELIZA, IHAT detect early & chronic infection (2) X-ray chest: nodular opacities. TREATMENT HEPATIC INTESTINAL LUNG FLUKES F. Gigantica & F.Hepatica Fasciolopsis Buski Heterophyes Heterophyes Paragonimus Westermani Triclabendazole Praziquantel Praziquantel (Biltricide) Praziquantil (Biltricide) (10 mg/kg), once, oral. 40 mg / kg in a single oral dose. oral, 25 mg/kg × 3x daily (1day) oral tablets: 600 mg: 25 mg/kg × 3 (times daily) 3 days. CONTROL proper washing of green salad (K- Avoid contamination of water Proper cooking of fish. Proper cooking of crabs and crayfish permanganate) ½ hr. streams with human faeces. (Fried/ grilled) (boiling). water filtration Boiling these edible water plants Proper salting of fish snail destruction before eating it. (Feseekh) >10 days animal mass treatment Snail control . Fisherman mass treatment &health education Thug’s .
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