Liver Flukes: Fasciola hepatica Flashcards
Common name of Fasciola hepatica
- Sheep liver fluke
- Temperate liver fluke
Disease produced by Fasciola hepatica
- Fascioliasis (Sheep)
- Sheep liver rot (Temperate)
MOT of Fasciola hepatica
- Ingestion of Metacercaria encysted on raw edible aquatic plants
- Drinking water with metacercaria
Diagnostic stage of Fasciola hepatica
- Operculated
- Unembryonated egg
1st Intermediate host of Fasciola hepatica
Snail: Family of Lymnaeidae
● L. truncatula
● L. bulmoides
● L. tomentosa
● L. rubiginosa
● L. philippinensis
● L. auricularia
2nd Intermediate host of Fasciola hepatica
Aquatic Plants
- Ipomea obscura (Kangkong)
- Nasturtium officinale (Watercress)
Scientific name for Kangkong
Ipomea obscura
Scientific name for Watercress
Nasturtium officinale
Definitive/Final Host of Fasciola hepatica
Human
Clinical Manifestation of Fasciola Hepatica, there are 6.
- Hepatic Fascioliasis
- Inflammation in biliary epithelium
- Liver atrophy
- Liver cirrhosis
- Liver cancer
- Halzoun/Pharyngeal Fascioliasis
- Ectopic Fascioliasis
What Clinical manifestation of asciola hepatica is this?
Asymptomatic fever, RUQ Abdominal Pains, Inc. PBS for Eosinophil, Hepatomegaly
a. Hepatic fascioliasis
b. Ectopic Facioliasis
c. Halzoun (Pharyngeal fascioliasis)
A
What Clinical manifestation of asciola hepatica is this?
Parasite wanders hematogenously; causes necrosis, abscess, fibrosis (lungs/brain/orbit)
a. Hepatic fascioliasis
b. Ectopic Facioliasis..
c. Halzoun (Pharyngeal fascioliasis)
B
What Clinical manifestation of Fasciola hepatica is this?
Ingesting raw sheep’s liver leading to edema and congestion
a. Hepatic fascioliasis
b. Ectopic Facioliasis
c. Halzoun (Pharyngeal fascioliasis)
C
What Clinical manifestation of Fasciola hepatica is this?
Subcutaneous nodules
a. Skin involvement
b. Biliary obstruction
c. Triad
A
What Clinical manifestation of fasciola hepatica is this?
Cholecystitis, cholangitis, cholelithiasis
a. Skin involvement
b. Biliary obstruction
c. Triad
B
What Clinical manifestation of fasciola hepatica is this?
Sudden onset of high fever, hepatomegaly, marked eosinophilia
a. Skin involvement
b. Biliary obstruction
c. Triad
C
Diagnosis of Fasciola hepatica
- DFS/Stool exam: detection of coproantigens (immunologic method: ELISA, Western blot)
- Duodenal Aspiration
- Serologic test
- NAT (Nucleic Acid Test -> PCR)
- FECT
- Kato-Katz
- Recovery of adult worms during surgery
Treatment for Fasciola hepatica
Triclabendazole
Bithionol
Stain used to be injected in liver flukes to see internal organs
Potassium permanganate or India Ink
Habitat of Fasciola hepatica
- Biliary passages of the liver
- Bile duct
Infectiv stage of Fasciola hepatica
Metacercaria
Pathology of F. hepatica
● Hepatic Fascioliasis
● Inflammation in biliary epithelium
● Liver atrophy
● Liver cirrhosis
● Liver cancer
● Halzoun/Pharyngeal Fascioliasis
What is the causative agent of Halzoun (Pharyngeal Fascioliasis)?
Egg or adult worm of Fasciola hepatica?
Adult worm of Fasciola heptica
When Fasciola hepatica is layed, is it immature or mature?
Immature
What is the Faciola hepatica egg called?
Hen’s egg
Life Cycle of Fasciola hepatica
(own words)
- Metacercaria
- Adult will produce egg (environment)
- Embryonation
- Creation of 1st stage larva (miracidium)
- Sporocyst
- Rediae
- Metacercaria
F. hepatica
1st IH in Europe and North Asia
Lymnaea truncatula
1st Intermediate host of Fasciola hepatica in North America
Lymnaea bulmoides
1st Intermediate host of Fasciola hepatica in Australia
Lymnaea tomentosa
1st Intermediate hosts of Fasciola hepatica
- L. truncutula (Europe & North Asia)
- L. bulmoides (North America)
- L. tomentosa (Australia)
- L. rubiginosa
- L. philippinensis
- L. auricularia
1st IH: ______
2nd IH: ________
of Fasciola hepatica
1st IH: Snail
2nd IH: Aquatic Plants
The testes of F. hepatica is in what form?
a. branched
b. unbranced
a. branched
The uterus of F. hepatica is in what form?
Coiled
The intestinal ceca of F. hepatica is in what form?
a. branched
b. unbranced
a. branched
When the egg of f. hepatica is layed, is it embryonated or unembryonated?
+ What is its appearance in terms of size and color?
Unembryonated, Large, Yellow to Brown
What is the appearance of the cephalic cone of F. hepatica?
wide or thin
Wide cephalic cone
MOT of F. hepatica/gigantica
Ingestion of undercooked or raw aquatic plants containing metacercaria
Adult Morphology of F. Hepatica
● Leaf-like appearance
● Rounded in shape
● Shorter, smaller, flat, broad body
● Has smaller cephalic cone
● Flesh or pinkish color
F. hepatica
- Has cephalic cone
- Prominent shoulders
- Cephalic cone: triangular/pyramidal structure
F. hepatica
- Ovary is dendritic
n/a
F. hepatica eggs when released is _____ (mature/immature)
Immature when released
Fasciola eggs are quite difficult to distinguish, there is no clear distinction between F. hepatica and F. gigantica. Hence, the matter of reporting would be ________?
Fasciola egg
Fasciola eggs are also quite similar to Fasciolopsis eggs, hence, in other references they are reported as _______?
Fasciola/Fasciolopsis eggs.
F. hepatica: Shape of cephalic cone
- triangular/pyramidal structure
F.hepatica/gigantica: Life Cycle
- Ingestion of Kangkong/Water plants (with METACERCARIA)
- Meta would exist in duodenum, will burrow until it reaches the liver and will mature to become adult.
- Eggs released sa feces (unembryo)
- After 9-15 days, it will embryonate and hatch the MIRACIDIUM
- Miracidium will penetrate the snail, develop from SPOROCYST, REDIAE, to CERCARIAE in the snail tissue.
- CERCARIAE will eventually infect the 2nd IH, repeating the life cycle
F. hepatica/F. gigantica: Disease Manifestations
Fascioliasis
F. hepatica/F. gigantica: Disease Manifestations - Fascioliasis
Its Clinical stages: Acute Stage
Acute Stage: Larval migration and Worm maturation
- Fever
- Jaundice: yellowing of the skin and sclera of the eyes
○ This happens because the parasite might cause obstruction in the bile duct, where the pigment bilirubin passes through.
- Pain
- Anorexia
- Hepatomegaly: enlargement of the liver
- Triad of Manifestations: High fever, hepatomegaly, and marked eosinophilia are of diagnostic significance
- Occurrence of Liver rot: severe or significant destruction of the liver due to the migrating larva
F. hepatica/F. gigantica: Disease Manifestations - Fascioliasis
Its Clinical stages: Chronic Stage
Chronic Stage: Persistence of the adults in the biliary ducts
- Obstruction and inflammation leading to fibrosis (scarring of the liver)
Determine what F. hepatica/F. gigantica: Disease Manifestations
temporary lodgement of the fluke in the pharynx
- Happens when person ingest raw liver of sheep, cattles, or beef that is infected with the parasite
- Delicacies in Mediterranean countries
- Once ingested, it could cause suffocation and respiratory problems
a. Fascioliasis
b. Halzoun/Marrara
c. Spurious Infections
B. Halzoun/Marrara
Determine what F. hepatica/F. gigantica: Disease Manifestations
a.k.a. Pseudofascioliasis (False infection)
- not real infections
- usually happens to patients who ingests cooked liver
- cooked liver might still contain parasite eggs
- Stool specimen might indicate Fasciola infection but in reality, it is a false infection
- Avoid eating liver 3 days before the scheduled stool examination to avoid a
diagnosis of false infection.
a. Fascioliasis
b. Halzoun/Marrara
c. Spurious Infections
c. Spurious Infections
What do you call the Infection where cooked liver might still contain parasite eggs?
Pseudofascioliasis (False Infection)
T/F: Fasciola spp. is difficult to distuish from F. buski
True
Fasciola spp. Reservoir hosts
- Hares
- Rabbits
What country has the increased numer of cases in Fasciola spp.?
Vietnam
