New - Lung Flukes - PPT P Westeman

LUNG FLUKES
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Paragonimus westermani
Paragonimus skrjabini
(Paragonimus szechuanensis)
The Lung Flukes
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 Genus paragonimus
 Zoonotic parasite (cause zoonosis)
 Animal infection> human infection
 Pathogen of lung disease
 Endemic hemoptysis
 Favorite lodging site: lung
 Ectopic site: brain, abdomen, muscle, etc.
Introduction
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 Paragonimiasis is a parasitic disease acquired when

trematodes of the genus Paragonimus are accidentally
consumed by a human host.
 The adult Paragonimus (or lung fluke) commonly
localizes to the bronchioles after ingestion.
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 While pulmonary involvement is the most common

clinical complication of infection, the disease is
often asymptomatic.
 Manifested by pleuritic chest pain.
 A careful epidemiologic history and a high clinical
suspicion for diagnosis are necessary when
considering paragonimiasis in a patient with
suspected pulmonary disease.
Geographic Distribution and
Epidemiology
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 Global
main continent except Europe
 China (23 provinces)
 Paragonimus is a parasite of mammalian
carnivores and omnivores whose diet includes
fresh-water crustaceans (crabs, crayfish).
 First described in tigers more than a century ago, a
variety of wild and domesticated carnivores have
been found to harbor Paragonimus species
worldwide.
6 Paragonimus westermani
EPIDEMIOLOGY:
•Human lung fluke, Paragonimus westermani,

infects 22 million people in Africa, Asia and South
and Central America.
•Southeast Asia in particular is affected because

raw seafood is very popular there.
•Humans get infected with the disease,

paragonimiasis, by eating raw crabs or fish that
are carrying the parasite.
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•Even properly cooked sushi can cause infection, if the
cook or waiter is careless when preparing the food.
•In Asia about 80 % of freshwater crabs are infected

with the lung fluke.
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MORPHOLOGY:
•Adult lung flukes are 4–6 mm wide, 3–5 mm thick and

7–12 mm long.
•They are red-brown looking almost like a coffee bean.
•They hold on to tissue with two suckers. The oral

sucker is in the front and just before the center of its
lower body is the ventral sucker.
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ADULT LUNG FLUKE:
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ADULT EGG
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LIFE CYCLE:
•The adult worms live in the lungs, usually in pairs in

cystic spaces that communicate with bronchi.
•They have a lifespan of up to 20 years in humans.
•Besides humans other definitive hosts include cats,

tigers, leopards, foxes, dogs, pigs, beavers, civet-cats,
mongoose and many other crab-eating mammals.
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•The life cycle of lung fluke begins when the female
lays eggs in the human lungs, and the eggs escape
into the bronchi and are coughed up and voided in
sputum or swallowed and passed in faeces.
•The eggs mature in about two weeks and hatch to

release free-living miracidia. These infect the first
intermediate molluscan host, snails belonging to the
genera Semisulcospira and Brotia.
•Cercariae that are released from the snails after

several weeks are microcercus, having a short
stumpy tail.
13
•The cercariae that swim about in streams are drawn
into the gill chambers of the second intermediate
crustacean host, crabs or crayfish.
•They encyst in the gills or muscles as metacercariae.
•Definitive hosts are infected when they eat such crabs

or crayfish raw or inadequately cooked.
•The metacercariae excyst in the duodenum and the

adolescariae penetrate the gut wall reaching the
abdominal cavity in a few hours.
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•They then migrate up through the diaphragm into the
pleural cavity and lungs finally reaching near the
bronchi, where they settle and develop into adult worms
in 2-3 months.
•The worm is hermaphroditic but usually it takes two for

fertilization.
•Sometimes the migrating larvae lose their way and reach

ectopic sites such as the mesentery, groin or brain.
15
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CLINICAL FEATURES:
•Patients present with cough, chest pain and

haemoptysis. The viscous sputum is speckled with
the golden-brown eggs.
•Occasionally, the haemoptysis may be profuse.

Chronic cases may resemble pulmonary
tuberculosis.
•Paragonimiasis may also be extra pulmonary, the

clinical features varying with the site affected.
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•In the abdominal type there may be abdominal pain
and diarrhoea.
• The cerebral type resemble cysticercosis and may

cause Jacksonian epilepsy.
•Glandular involvement causes fever and multiple

abscesses.
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DIAGNOSIS:
•Demonstration of the eggs in sputum or faeces

provides definitive evidence.
•Complement fixation test is positive only during

and shortly after active infection, while the
intradermal test remains positive for much longer
periods.
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TREATMENT:
Bithionol, praziquantel and niclofolan are effective

in treatment.
PREVENTION:
•Adequate cooking of crabs and crayfish and

washing the hands after preparing them for food can
prevent human infections.
•Improved sanitary conditions.
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LUNG FLUKES

 Paragonimiasis is a parasitic disease acquired when

 While pulmonary involvement is the most common

•Human lung fluke, Paragonimus westermani,

•Southeast Asia in particular is affected because

•Humans get infected with the disease,

•In Asia about 80 % of freshwater crabs are infected

•Adult lung flukes are 4–6 mm wide, 3–5 mm thick and

•They are red-brown looking almost like a coffee bean.

•They hold on to tissue with two suckers. The oral

•The adult worms live in the lungs, usually in pairs in

•They have a lifespan of up to 20 years in humans.

•Besides humans other definitive hosts include cats,

•The eggs mature in about two weeks and hatch to

•Cercariae that are released from the snails after

•They encyst in the gills or muscles as metacercariae.

•Definitive hosts are infected when they eat such crabs

•The metacercariae excyst in the duodenum and the

•The worm is hermaphroditic but usually it takes two for

•Sometimes the migrating larvae lose their way and reach

•Patients present with cough, chest pain and

•Occasionally, the haemoptysis may be profuse.

•Paragonimiasis may also be extra pulmonary, the

• The cerebral type resemble cysticercosis and may

•Glandular involvement causes fever and multiple

•Demonstration of the eggs in sputum or faeces

•Complement fixation test is positive only during

Bithionol, praziquantel and niclofolan are effective

•Adequate cooking of crabs and crayfish and

•Improved sanitary conditions.

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