FINALS: LUNG TREMATODE

Question 1

• Also known as oriental lung fluke
• Causes paragonimiasis
• Its infection was first described in 1878, by Coenrood Kerbert, in a
  Bengal tiger with pneumonia at the Amsterdam Zoo

Answer 1

Paragonimus westermani

Question 2

1879
o P. westermani was discovered in the lungs of human by

Answer 2

Ringer

Question 3

Paragonimus westermani was named after the zookeeper _______

Answer 3

Pieter westermani

Question 4

• 78 – 120 um in length and 45 – 60 um wide
• Yellow-brown in color, ovoid or elongate, with a thick shell, and
  often asymmetrical with one end slightly flattened
• An opercular rim (shoulders) surrounds the prominent operculum.
• An obvious terminal shell thickening is located on the end opposite
  the operculum

Answer 4

Paragonimus westermani EGG

Question 5

Paragonimus westermani EGG are ______________ when passed in sputum or feces

Answer 5

UNEMBRYONATED

Question 6

• Infective stage
• Encysted in tissue
• The exterior is spined
• Has two suckers

Answer 6

Paragonimus westermani METACERCARIA

Question 7

• Reddish brown and ovoid
• Measures 7 – 16mm by 4 – 8mm
• Hermaphroditic, with a lobed ovary located anterior to two
  branching testes
• Has oral and ventral suckers

Answer 7

Paragonimus westermani ADULT STAGE

Question 8

P.westermani IH

Answer 8

o 1st intermediate host
▪ Snail
* Antemelania asperata
o 2nd intermediate host
▪ Cray fish or crabs
* Sundathelphusa philippina

Question 9

P.westermani DH

Answer 9

Human

Question 10

P.westermani CLINICAL MANIFESTATION:

Fever, cough, chest pain

Answer 10

Primary infection

Question 11

P.westermani CLINICAL MANIFESTATION:

o Hemoptysis, pulmonary paragimonimiasis
o Cerebral paragonimiasis

Answer 11

Secondary infection

Question 12

P.westermani CLINICAL MANIFESTATION:

Clinical symptoms are less severe after

Answer 12

5 – 6 years

Question 13

P.westermani CLINICAL MANIFESTATION:

• Serious sequelae, occasionally:

Answer 13

o Chronic bronchiectasis
o Pleural fibrosis
▪ Secondary to severe parenchymal and pleural
damage

Question 14

P.westermani CLINICAL MANIFESTATION:

Aberrant worms may localize in the:

Answer 14

o Lung pleura
o Pericardium
o Myocardium
o Abdominal wall
o Omentum
o Liver
o Mesenteric lymph nodes
o Adrenals
o Urogenital organs
o Eye

Question 15

P.westermani CLINICAL MANIFESTATION:

Classic forms of ectopic infection:
* Slow-moving, nodular lesion in the subcutaneous tissue on the abdomen or chest is the characteristic symptom

Answer 15

Cutaneous paragonimiasis

Question 16

P.westermani CLINICAL MANIFESTATION:

Classic forms of ectopic infection:
* most serious complication
* juvenile P. westermani may migrate from the pleural cavity into the cranial cavity through the soft tissues along the internal jugular vein.
* Migration of the worm can cause congestion, vasculitis, and capillary rupture which may result in exudative aseptic inflammation, infarction, hemorrhage and necrosis in subcortical areas
* After invasion, multiple conglomerated and
interconnected granulomas form around the parasite, containing abscess material and eggs

Answer 16

cerebral paragonimiasis

• May present with:
  o Headache
  o Meningismus
  o Seizures
  o Hemiparesis
  o Blurring of vision
  o Diplopia
  o Homonymous hemianopsia
  o Aphasia

Question 17

DIAGNOSIS OF P. westermani
o Most basic and most readily available diagnostic tool.
o Detection of characteristics in stool or sputum

Answer 17

Microscopy

Question 18

OTHER DIAGNOSIS OF P. westermani

Answer 18

• Sputum concentration with 3% sodium hydroxide provides best
  sensitivity for microscopic diagnosis
• Chest radiographs for high index of suspicion
• Blood count for elevation of Eosinophils and IgE
• Complement fixation (CF) test
• Intradermal test
• Double diffusion in agarose gel
• Immunoelectrophoresis
• ELISA
• immunoblotting (IB)

Question 19

TREATMENT FOR P. westermani

o drug of choice
o suitable for adults and children over 4 years of age
o 25mg/kg 3 times a day, for 2 to 3 days

Answer 19

praziquantel

Question 20

TREATMENT FOR P. westermani
o Binds to B-Tubulins of trematodes, leading to
depolymerization of microtubule, based processes

Answer 20

Triclabendazole

Question 21

TREATMENT FOR P. westermani
o Alternative drug
o 15 – 25mg/kg twice on alternate 10-15 days

Answer 21

Bithionol

Question 22

P. westermani EPIDEMIOLOGY
In the Philippines, paragonimiasis is endemic in?

Answer 22

Mindoro, Camarines, Sorsogon, Leyte, Samar, Zamboanga del Norte, Davao Oriental, Basilan, and Cotabato