Other flukes Cestodes

Kingdom

Animalia Protozoa Sarcomastigophora Apicomplexa Ciliophora Microspora Metazoa Nematoda

Taxonomy

Subkingdom Phylum Phylum Phylum Phylum Subkingdom Phylum Phylum

Platyhelminthes cestodes (tapeworms) trematodes (flukes)

Trematodes = flatworms
adult Schistosoma Opisthorchis Paragonimus Fasciola human (blood) human (liver) human (lung) human (liver) Source (cercaria/metacercaria) water freshwater fish freshwater crabs, cray fish watercress

Liver flukes
Opisthorchiidae: Clonorchis sinensis Opisthorchis viverini Opisthorchis felineus Metorchis conjunctus Fasciolidae Fasciola hepatica Fasciola gigantica
Oriental liver fluke Oriental liver fluke North American Liver fluke

Clonorchis
10-25 mm

Metorchis
4 mm

Fasciola
30 mm

Metagonimus
2.5 mm

Paragonimus
7-16 mm

Paragonimus

Clonorchis

Fasciola

Metorchis

Fasciolopsis

Metorchis

Diphyllobothrium

Trematode life cycle

Human Egg Fish, crabs, watercress metacercaria

Miracidium

Cercaria

Snail Redia/sporocysts

Fasciola

Clonorchis Opisthorchis Metorchis

Liver flukes
Opisthorchis viverini Clonorchis sinensis Fasciola hepaticum Metorchis conjunctus Oriental Oriental Worldwide Canada

Liver fluke

Opisthorchis/Clonorchis
Ultrasoundmultiple liver abscesses cystic or mulberry-like dilations of intrahepatic bile ducts normal extrahepatic bile ducts Laparoscopydilated intrahepatic ducts and white tortuous linear structures

Treatment
Opisthorchis, Clonorchis, Metorchis.praziquantel Fasciola triclabendazole, bithional.

LUNG FLUKES

Pulmonary
Often asymptomatic. Variable incubation period at times years. Initially dry cough becoming productive of rusty to bloody sputum.. Chest pain, pleuritic at times. Little fever; general health often unimpaired. Initial eosinophilia disappearing with time.

Paragonimus in lung

Tapeworm A flat, hermaphroditic, gutless freight train of a worm.

Diphyllobothrium spp.
(Fish tapeworms)

Diphyllobothrium latum/dendriticum/pacificum/ursi
Geography..world wide (dendriticum in north) Risk..raw freshwater fish consumption Presentationasymptomatic intermittant abdominal pains TreatmentPraziquantel 600 mg once

B12 deficiency in D. latum

Serum B12 level Pg/100ml

Tapeworm egg negative Tapeworm egg positive

273.8 116.4 <100 in 52%

Pernicious anemia in 1:50 carriers

Taenia saginata beef tapeworm Taenia solium pork tapeworm

T. solium

pork

T. saginata

beef

Taenia spp.

scolex (head)

Taenia saginata/solium
Geography. saginata ..raw beef eating countries eg. Ethiopia, Lebanon . soliumpig raising/poor sanitation Risk.raw meat eating Presentation.asymptomatic rare intermittant abdominal pains solium cysticercosis Treatment.Praziquantel

Taenia solium larval stage

cysticercosis

cysticercus

Taenia solium (cysticercosis)

clinical picture 1. intracerebral space occupying (1.5 cm) lesion (headaches, seizures, focal neurological defects) 2. C.S.F flow obstruction (hydrocephalus) 3. basalar meningitis (cranial nerve palsies, hydrocephalus)

Treatment: Albendizole 400 mg bid x 21 days Praziquantel 15 mg/kg/day in 3 doses or

Echinococcosis

Echinococcus granulosis in Canada

William Osler 1883 31 positive of 1037 pigs in Montreal 8-10 human cases in eastern Canada Experimentally infected a dog and found tapeworms 7 weeks later

Echinococcus

Echinococcus granulosis

sylvatic (Canadian)_ pastoral

Echinococcus multilocularis Echinococcus ologarthus Echinococcus vogeli

protoscolices

Admission day 1

Jan 2003

Echinococcus life cycle (sylvatic) HYDATID CYST

human caribou (reindeer) moose (elk)

ADULT TAPE WORM

wolf dog

Echinococcus granulosis

adult E. granulosis on dog small intestine

Echinococcus granulosis in dog feces

Echinococcus granulosis

Complications of liver cysts

ruptureperitoneum biliary tract pleura lung anaphylaxis superinfection.liver abscess mass effect.cholestasis, portal hypertension, Budd-Chiari syndrome (dissemination) (cholangitis) (dissemination) (bronchopleural fistula)

Therapeutic Modalities: Indications

Surgery: leaking cysts, infected cysts, multiple daughter cysts, biliary tree communication PAIR: pregnancy, little internal echogenic material, concomitant disease

Chemotherapy: inoperable, in-aspiratable Observation: pastoral strain, extreme age, much calcification, well padded small cysts

Tapeworm A flat, hermaphroditic, gutless freight train of a worm.

Diphyllobothrium spp.
(Fish tapeworms)

Diphyllobothrium latum/dendriticum/pacificum/ursi
Geography..world wide (dendriticum in north) Risk..raw freshwater fish consumption Presentationasymptomatic intermittant abdominal pains TreatmentPraziquantel 600 mg once

B12 deficiency in D. latum

Serum B12 level Pg/100ml

Tapeworm egg negative Tapeworm egg positive

273.8 116.4 <100 in 52%

Pernicious anemia in 1:50 carriers

Taenia saginata beef tapeworm Taenia solium pork tapeworm

T. solium

pork

T. saginata

beef

Taenia spp.

scolex (head)

Taenia saginata/solium
Geography. saginata ..raw beef eating countries eg. Ethiopia, Lebanon . soliumpig raising/poor sanitation Risk.raw meat eating Presentation.asymptomatic rare intermittant abdominal pains solium cysticercosis Treatment.Praziquantel

Taenia solium larval stage

cysticercosis

cysticercus

Taenia solium (cysticercosis)

clinical picture 1. intracerebral space occupying (1.5 cm) lesion (headaches, seizures, focal neurological defects) 2. C.S.F flow obstruction (hydrocephalus) 3. basalar meningitis (cranial nerve palsies, hydrocephalus)

Treatment: Albendizole 400 mg bid x 21 days Praziquantel 15 mg/kg/day in 3 doses or

Echinococcosis

Echinococcus granulosis in Canada

William Osler 1883 31 positive of 1037 pigs in Montreal 8-10 human cases in eastern Canada Experimentally infected a dog and found tapeworms 7 weeks later

Echinococcus

Echinococcus granulosis

sylvatic (Canadian)_ pastoral

Echinococcus multilocularis Echinococcus ologarthus Echinococcus vogeli

protoscolices

Admission day 1

Jan 2003

Echinococcus life cycle (sylvatic) HYDATID CYST

human caribou (reindeer) moose (elk)

ADULT TAPE WORM

wolf dog

Echinococcus granulosis

adult E. granulosis on dog small intestine

Echinococcus granulosis in dog feces

Echinococcus granulosis

Complications of liver cysts

ruptureperitoneum biliary tract pleura lung anaphylaxis superinfection.liver abscess mass effect.cholestasis, portal hypertension, Budd-Chiari syndrome (dissemination) (cholangitis) (dissemination) (bronchopleural fistula)

Therapeutic Modalities: Indications

Surgery: leaking cysts, infected cysts, multiple daughter cysts, biliary tree communication PAIR: pregnancy, little internal echogenic material, concomitant disease

Chemotherapy: inoperable, in-aspiratable Observation: pastoral strain, extreme age, much calcification, well padded small cysts