Trematodes Flashcards
What are the liver flukes
Fasciola hepatica, fasciola gigantica, clonorchis sinensis, opistorchis
What are the lung flukes
Paragonimus
What are the blood flukes
Schistosoma
What is the intestinal fluke
Fasciolopsis Buski
What type of digestive system do flukes have
incomplete digestive system (mouth, pharynx, esophagus bifurcates, sucker, no anus)
All trematodes except schisto:
Eggs?
Larvae?
Life Cycle?
Transmission?
Eggs: Operculated
Larvae: five larval forms -miracidium, sporocyst, redia 1st gen, 2nd redia, cercaria, metacercaria
Life Cycle: 1st: freshwater snails or mollusc. 2nd aquatic plant, fish, or crab
All trematodes except schisto:
Eggs?
Larvae?
Life Cycle?
Transmission?
Eggs: Operculated
Larvae: five larval forms -miracidium, sporocyst, redia 1st gen, 2nd redia, cercaria, metacercaria
Life Cycle: 1st: freshwater snails or mollusc. 2nd aquatic plant, fish, or crab
Transmission: By eating host plants with metacercariae
Definitive host, int host of schistosoma
Def: Man; Int: Snail
Infective form of trematodes (except schisto)
metacercaria larva
infective form of schisto
cercaria larva
Fasciola life cycle
Unembryonated eggs in feces of humans/sheep/cows–>eggs become embryonated in water–>miracidia hatch from eggs, seek out snail intermediate hosts –>miracidia penetrate the snail (spococysts–>rediae–>cercariae)–>Free-swimming cercariae encyst on aquatic vegetation–>metacercariae on vegetation ingested by definitive host–>immature flukes excyst in duodenum, penetrate the intestinal wall, migrate through liver
Watercress
Fasciola hepatica
unembryonated egg 120-140um of fasciola
-operculum with bile stained shell, thin
Differences between fasciola hepatica and fasciolopsis buski adult worms
Paragonimus infective, diagnostic, intermediate hosts, definitive host
Infective stage: Metacercariae
Diagnostic: Unembryonated egg
Int Hosts: Snail, Crustacean
Definitive host: Human
paragonimus infective stage (metacercariae)
paragonimus unembryonated egg, asymmetrical oval, operculum
S. Mansoni (large lateral spine)
S. Haematobium (large terminal spine)
S. Japonicum (rounded, small lateral spine)
Schistosoma Life cycle
Eggs shed in stool or urine–>eggs hatch in water releasing mircidia in the water–>mircidia penetrate and develop over 1-2 weeks as 2 generations of sporocysts in snails –>Snails release cercariae and the cercariae can penetrate the skin causing swimmers itch –>schisto migrate to the blood in the liver and mate for life–>bladder or liver –>katayama fever–>eggs shed in stool
Which Fluke causes periportal fibrosis
schistosoma mansoni
Which fluke causes chronic salpingitis
schistosoma hematobium
How do you diagnose schisto
direct smear (Kato); Urine (proteinuria + hematuria), serology (good for expats)
Treatment of schisto
Prednisone for katayama fever Praziquantel (adulticidal) ; then repeat prazi in at least 4-6 weeks so the other worms mature into adults
What are your co-infections with schisto
Malnutrition, Viral hepatitis, Salmonella, Bladder cancer
Patient with lifelong freshwater exposure and eosinophilia and periportal fibrosis
Schistosomiasis
Schistosoma Mansoni
Treatment: PRednisone for katayama + praziquantel x 2 (kill all adult forms of the worm)
41 year old male with 30 days of chills, fever at night, moderate sweating, abdominal pain in the epigsatrium, chronic alcoholic. Eosinophilia +
Organism?
Diagnosis?
Definitive host? Location? 1st Int Host? Infective stage?
Treatment?
Fasciola Hepatica
ELISA
Def: Sheep, cattle
1st int host: Snails
Worldwide (hepatica); Gigantica is more africa, asia, south america
Infective stage: Metacercariae in the 2nd host (watercress)
Treatment: Triclabendazole
Which fluke can cause sclerosing cholangitis, biliary cirrhosis
Fasciola hepatica and Fasciola gigantica
Patient with migrating larval flukes, reddish cutaneous tracks, subcutaneous nodules, pruritic, painful, inflamed , +eos
Cutaneous Fasciolasis
How to diagnose f. hepatica and f gigantica
ELISA, Serology
Treatment of fasciola
Triclabendazole 1-2 days
If you’re in the chronic stage, 500mg BID x 7 days
Clonorchis and opistorchis epidemiology, definitive host, intermediate host?
Clonorchis Sinensis: Korea, China, Taiwan, Vitenam, Indo-China
Opistorchis Viverrini: Laos, Thailand
Opistorchis Felineous: Eastern Europe
Definitive hosts: cats, dogs, pigs, rats, fish eating mammals
1st int host; snails
Infectious stage: metacercariae
2nd int host: fresh water fish
Clinical manifestations of clonorchis and opistorchis
induce fibrosis around bile ducts, small portal vessels; depends on how many flukes for severe illness; abdominal pain, diarrhea, abdominal distention, anorexia, indigestion, fullness, atigue, weight loss; can have enlarged gallbladder, ascites. Will see raised alk phosph
clonorchis and opistorchis life cycle
eggs passed in feces, ingested by snail (miracidia–>sporocysts–>rediae–>Cercariae) free-swimming cercariae encyst in the skin or flesh of fresh water fish–>metacercariae in flesh of fresh water fish are ingested by humans–>cause excyst in duodenum–>adults in biliary tract
patient with recurrent ascending cholangitis. What is the organism? What is the treatment?
Organism: clonorchis sinensis, opsitorchis viverrini/felineus
Treatment: praziquantel x2 days; albendazole x 7 days
Giant intestinal fluke? Where is it found? Who is the definitive host? Intermediate host?
Fasciolopsis Buski, China/India/SE Asia, Pigs are def host, 1st int host snails
Fasciolepsis clinical manifestations
anorexia, nausea, vomiting, foul smelling idarrhea, eosinophilia, malabsorption, hypoalbuminemia
Patient with fever, eosinophilia, low B12, hypoalbuminemia, foul smelling diarrhea and undigested food, comes from india . Organism? Treatment?
Fasciolopsis Buski
Tx: Praziquantel 15-25mg/kg
34year old male with 13m of cough, blood streaked sputum, chills nocturnal sweating, back pain, negative AFB. +Eos
Paragonimus Westermani
where do you find paragonimus westermani?
Far east, China, Japan, Korea, Taiwan, Philippines
Hosts of paragonimus
definitive: felines, canids, weasel, opposum
1st intermed host: snails
2nd int : crab crayfish hrimp
paratenic host: wild boards
gelatinous brownish sputum, chronic fough, fishy odor, marked eosinophila. organism? treatment?
paragonimus westermani
tx: Praziquantel
