Flukes

A short description about intestinal and liver flukes

1. INTESTINAL & LIVER FLUKES JASIL

2. LIVER FLUKES CLONORCHIS SINENSIS FASCIOLA HEPATICA OPISTHORCHIS DICROCOELIUM DENDRITICUM

3. Clonorchis sinensis DISTRIBUTION Human clonorchiasis occurs in japan, korea , Taiwan, china and Vietnam affecting about 10 million people HABITAT Adult worm lives in the biliary tract & sometimes in the pancreatic duct

4. morphology ADULT WORM It has flat, transparent, spatulate body; pointed anteriorly & rounded posteriorly 10-25mm long & 3-5mm broad

5. EGGS Eggs are broadly ovoid, 30 um by 15 um with a yellowish brown shell It has an operculum at one pole & a small hook like spine at the other Eggs do not float in saturated solution of common salt The eggs passed in feces contain the ciliated miracidia

6. LIFE CYCLE DEFINITIVE HOST - Humans INTERMEDIATE HOST - first- snail second- fish INFECTIVE FORM - Metacercaria larva

7. Pathogenicity The migration of the larva up the bile duct induces desquamation , followed by hyperplasia , & sometimes adenomatous changes Cholangitis Calculus formation Biliary cirrhosis Portal hypertension cholangiocarcinoma

8. diagnosis Stool microscopy Serological tests- CFT, gel precipitation, IHA Intradermal allergic tests

9. Treatment DOC- praziquantel 25 mg/kg, 3 doses in 1 day Surgical intervention

10. prophylaxis Proper cooking of fish Proper disposal of feces Control of snails

11. Fasciola hepatica DISTRIBUTION Worldwide in distribution, being found mainly in sheep rearing areas largest & most common liver fluke Causes liver rot disease in sheep HABITAT The parasite resides in the liver & biliary passages of the definitive host

12. MORphology ADULT WORM Large, leafy shaped fleshy fluke, 30mm long & 15 mm broad, grey or brown in colour It has a conical projection anteriorly containing an oral sucker & is rounded posteriorly

13. EGGS Large, ovoid, operculated , bile stained 140 um by 80 um in size Contain immature larva, the miracidium Do not float in saturated solution of common salt Eggs are unembryonated when freshly passed

14. LIFE CYCLE DEFINITIVE HOST - sheep, goat, cattle & man INTERMEDIATE HOST - first-snail second- aquatic plants INFECTIVE FORM - metacercaria

15. pathogenicity The disease caused is known as fascioliasis, it occurs as Acute infection : traumatic or necrotic lesions leading to hepatomegaly , fever , abdominal pain , nausea , vomiting , diarrhea and jaundice Chronic infection : Adult worm in bile duct causes biliary obstruction , pain , jaundice , secondary bacterial infections

16. diagnosis Stool microscopy Blood picture- eosinophilia Serodiagnosis - IF, ELISA, CFT Imaging- USG, CT, ERCP

17. TREATMENT DOC- Oral triclabendazole 10 mg/kg once Bithionol prednisolone

18. PROPHYLAXIS Health education Preventing water pollution Proper disinfection of water

19. INTESTINAL FLUKES FASCIOLOPSIS BUSKI HETEROPHYES METAGONIMUS YOKOGAWAI WATSONIUS WATSONI ECHINOSTOMA GASTRODISCOIDES HOMINIS

20. Fasciolopsis buski DISTRIBUTION South east asian countries In india it occurs in assam & Bengal HABITAT The adult worm lives in duodenum or jejunum of pigs & man

21. MORPHOLOGY ADULT WORM Large, fleshy worm 20-75 mm long, 8-20 mm broad Elongated ovoid in shape, with a small oral sucker and a large acetabulum

22. EGGS Operculated eggs, similar to those of F. hepatica Eggs are laid in the lumen of intestine

23. LIFE CYCLE DEFINITIVE HOST - man & pigs INTERMEDIATE HOST - first- snails second- aquatic plants INFECTIVE FORM - encysted metacercariae

24. pathogenesis Larvae that attatch to the duodenal & jejunal mucosa cause inflammation & local ulceration In heavy infections, adult worms causes partial obstruction of the bowel , malabsorption , protein losing enteropathy , & impaired vit b12 absorption Initial symptoms are diarrhea & abdominal pain Toxic & allergic symptoms appear as edema , ascites , prostration & persistent diarrhoea

25. DIAGNOSIS H/O residence in endemic areas Demonstration of the egg in feces

26. treatment DOC- praziquantel Hexylresorcinol & tetrachlorethylene

27. PROPHYLAXIS Treatment of infected persons Adequate washing of vegetables Preventing contamination of ponds & other waters with pig or human excreta Control of snails

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