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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
● Single branched ovary in the middle of the body to the ● Epigastric pain, nausea, and vomiting
● Vitellaria lateral to the ceca extend from ventral sucker ● Slight anemia, often leukocytosis, sometimes a
● 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
● With slender muscular tails and heavy bodies 195 by o water caltrop (Trapa bicomius)
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
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
Abdomen
● Rigidity and tenderness
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