44 Hermaphroditic Flukes

Paul Pottinger DD/MM/YY

Tissue Trematodes/Tissue Flukes/Hermaphroditic Flukes

Way less important than schisto

44.1 Paragonimus

Macroscopic (2cm)

Each worm has testis and ovaries,

44.1.1 Life Cycle

live in lungs, eggs coughed up and swallowed into intestine

go into water

hatch

go to snail (1st intermediate host)

go to cercaria,

go to crabs (2nd intermediate host)

metacercaria

44.1.2 Epi

  1. westermani most common (found in far east)

but there other forms (also p. africanus)

5 million courses world wide

Far east, inadequately cooked food

korea, crab juice used to treat measles!

camerooon, crab juice used to treat infertility!

back to humans

44.1.3 Clinical

  • Easinophilic granuloma in lungs
  • chronic bronchitis and bronchiectasis, bloody sputum (hemoptysis)
  • Can look like a lung abscess or even cancer
  • can cause abdo mass/pain/dysentry
  • brain involvement rarely
  • migratory subcut nodules

44.1.4 Diagnosis

  • eosinophilia
  • faeces/sputum
  • cxr changes
  • serology sometimmes

44.1.5 Treat

  • Praziquantel
  • Cook your shellfish!

44.2 Fascioliasis

The liver fluke / fasciola hepaticum

Sheep liver rot. Wherever sheep and people eat watercress

44.2.1 COTD

46yr in Peru who sells berros (watercress) in the market

presents with acute abdominal pain/nausea/vomiting/eosinophilia

had gallbladder taken out, worm in it!

44.2.2 Disease

44.2.2.1 Acute

Eat water cress with a circeria gone into metacircarea, larvae go in human.

You’re the sheep in it’s cycle

  • Hepatitis
  • Influenza like illness
  • Eosinophilia

This now settles.

44.2.2.2 Chronic

Kind of like chronic schisto

Biliary inflammation and obstruction. By the adults.

Death of liver tissue. Cholecystitis.

44.2.3 Diagnosis

Acute - use the clinical picture and epidemiology. Nodular lesions on liver (kind of like an abscess). ELISA to the antigens. Non distinct lesions on liver kind of look like amoeba

Chronic - Huge eggs on stool (trapdoor on top). Eosinophilia. Positive serology

44.2.4 Treatment

Triclabendazole - can’t use praziquantel. 10mg/kg single dose. Not easily available in USA. You sometimes have to use vetinary form

44.3 Oriental Liver Fluke / Clonorchis sinensis

Consume fish (undercooked fresh water). In the flesh there is a metacircaria. This goes into human liver. Make eggs. Eggs to stool. Stool in water and then eggs in snail then fish.

Extremely common in some parts of south east asia. Goes away as sanitation improves

You can also have an acute and chronic phase.

Chronic long term problem of portal hypertension, and attacks of bacterial cholangitis, can even cause cholangiocarcinoma!

Treat with praziquantel Prevent through cooking fish

Eggs in stool look “urn shaped”