FINALS: LIVER TREMATODES Flashcards
Temperate Liver Fluke
Fasciola hepatica
Tropical Liver Fluke
Fasciola gigantica
▪ Large, ovoidal, operculated, and yellowish to brownish
▪ Measures 140 to 180 um by 63 to 90 um in size
▪ Immature, containing a large unsegmented mass of
viteline cells
Fasciola hepatica Egg
▪ Slightly larger than F. hepatica egg (160-190 um by
70-90um)
Fasciola gigantica Egg
▪ 18 to 51 mm in length and 4 to 13mm in width
▪ Marked widening at the base of the cone
(“shoulder ”)
▪ Large, broad, flat body
▪ Leaf-shaped
▪ Small oral and ventral suckers
▪ Long and highly branched intestinal caeca
Fasciola hepatica ADULT
▪ 25 to 75mm and 3 to 12 mm in width
▪ Longer, less developed shoulders and a shorter
cephalic cone
▪ More branched caeca towards the midline of the
body
▪ Ovary branches are longer and more numerous
Fasciola gigantica ADULT
Fasciola hepatica 1ST IH?
▪ Snails belonging to the family of Lymnaeidae
▪ Snail species
* Lymnaea truncatula (Europe and North
Asia)
* Lymnaea bulmoides (North America)
* Lymnaea tomentosa (Australia)
▪ Snails from family planorbidae
Fasciola species 2ND IH:
▪ Ipomea obscura (morning glory or kangkong)
▪ Nasturtium officinale (watercress)
Fasciola species DH
▪ Human
▪ Sheep
▪ Goat
▪ Cattle
Human Fascioliasis
▪ Coincides with larval migration and worm
maturation
* Dyspepsia
* Fever
* Right upper quadrant abdominal pain
Acute or invasive phase
Human Fascioliasis
▪ Coincides with the persistence of Fasciola worms
in the biliary ducts
* Biliary obstruction
* Biliary cirrhosis
* Obstructive jaundice
Chronic or latent phase
PATHOGENESIS
- Human Fascioliasis
Ingestion of raw liver of infected sheep results in a
condition called _____in Lebanon and ______in Sudan
halzoun = LEBANON
mariara = SUDAN
F. spp DIAGNOSIS
- Identification of eggs in stool
- Duodenal contents, or bile, or the recovery of adult worms during surgical exploration
- Enzyme-linked immunosorbent assay (ELISA) and western blot
- Radiological examinations
- Endoscopic retrograde cholangiopancreatography (ERCP)
F. spp TREATMENT
- Triclabendazole
o Single 10 mg/kg oral dose of triclabendazole following
food intake
o For individuals with heavy infection
▪ Two doses of 10 mg/kg spaced by 12 hours - Bithionol
o 30 to 50 mg/kg body weight on alternate days to complete
10 to 15 doses
Fascioliasis has a worldwide distribution and is great economic importance in livestock -raising countries :
o Asia – Iran
o Eastern Asia – Japan, Korean Peninsula, Thailand
o Europe – France, Spain, Portugal, and the former USSR
- Common name: CHINESE LIVER FLUKE
- C. sinensis was first reported in India in 1874, during an autopsy of
a 20-year old Chinese patient. - Belong to family Opisthorchiidae
- Are parasites of the bile duct and gallbladder of humans and fisheating mammals
Clonorchis sinensis
- Common name: SOUTHEAST ASIAN LIVER FLUKE
- Infection first recorded in 1911
Opisthorchis viverreni
- CAT LIVER FLUKKE
- Infection first recorded in 1892
Opisthorchis felineus
▪ 19 – 30 um long by 10 -20 um wide
▪ Operculated, possess prominent opercular
‘shoulders’ and abopercular knob
Opisthorchis spp. EGG
▪ 27 to 35 um by 11 to 20 um
▪ Yellowish – brown
▪ Oval shaped with a convex operculum that rests on
visible “shoulders”
▪ Opposite (abopercular) end, a small knob or hooklike protrusion is often visible
▪ Miracidium is visible inside
Clonorchis sinensis EGG
▪ Flat, transparent, spatulate body; pointed anteriorly
and rounded posteriorly
▪ 10 – 25 mm in length and 3 – 5 mm broad
▪ Highly branched testes
Clonorchis sinensis ADULT WORM
▪ Flat, elongated, leaf or lanceolate shaped
▪ Approximately 7 mm long by 1.5 mm wide
▪ Rounded testes
▪ Smaller than C. sinensis
Opisthorchis spp. ADULT WORM
IH
- 1st Intermediate host: Snail
o C. sinensis
▪ Parafossarulus (P. manchouricus, P. anomalospiralis,
and P. stratulus)
▪ Bulinus (B. striatulus)
▪ Semisulcospira, Alocinma (A. longicornis)
▪ Thiara (T. granifera)
▪ Melanoides (M. tuberculatus)
o O. felineus and O. viverrine
▪ Bithynia - 2nd intermediate host: fresh water fish
o Cyprinidae
DH
Human
Reservoir host
Dog and other fish eating canines
- In clonorchiasis, metacercariae reaching the biliary system mature
and provoke pathological changes as a result of local trauma and
irritation - These phases are as follows:
a. Desquamation of epithelial cells,
b. Hyperplasia and desquamation of epithelial cells,
c. Hyperplasia, desquamation of epithelial cells, and
adenomatous tissue formation, and
d. Marked proliferation of the periductal connective tissue
with scattered abortive acini of epithelial cells, and fibrosis
of the wall of the biliary duct
o Asymptomatic
o Non-specific clinical signs: diarrhea abdominal pain
Light infection of C. sinensis (<100 flukes)
o Fever
o Diarrhea
o Loss of appetite
o Rash
o Edema
o Night blindness
o Swollen abdomen
o Enlargement of the liver
Moderate infection of C. sinensis (101-1,000 flukes)
o Acute pain in the right upper quadrant
High infection of C. sinensis (up to 25,000 flukes)
O. viverrini
- Light infection
o Flatulence
o Fatigue
o Dyspepsia
o Right upper quadrant abdominal pain
o Anorexia
o Mild hepatomegaly
O. viverrini
- Severe infection
o Obstructive jaundice
o Cirrhosis
o Cholangitis
o Acalculous cholecystitis or bile peritonitis
is the most serious complication of infection
with O. viverrini
Cholangiocarcinoma
Cholangiocarcinoma
o Fever and hepatitis-like symptoms
o Upper quadrant abdominal pain
o Nausea
o emesis
O. felineus Chronic infection
o Biliary tract obstruction
o Inflammation
o Fibrosis
o Liver abscess formation
o Pancreatitis
o Suppurative cholangitis
DIAGNOSIS
- Detection of parasite egg in stool
- Cholangiography
- ELISA
- Enzyme immunoassay (EIA)
- Coproovoscopy
- Polymerase chain reaction (PCR)
TREATMENT
- Praziquantel 25mg – 3 times a day for 2 days
- Praziquantel 60mg – 3 doses for 1 day
- Albendazole
- Praziquantel-albendazole
- Tribendimidine
