FINALS: LIVER TREMATODES

Question 1

Temperate Liver Fluke

Answer 1

Fasciola hepatica

Question 2

Tropical Liver Fluke

Answer 2

Fasciola gigantica

Question 3

▪ Large, ovoidal, operculated, and yellowish to brownish
▪ Measures 140 to 180 um by 63 to 90 um in size
▪ Immature, containing a large unsegmented mass of
viteline cells

Answer 3

Fasciola hepatica Egg

Question 4

▪ Slightly larger than F. hepatica egg (160-190 um by
70-90um)

Answer 4

Fasciola gigantica Egg

Question 5

▪ 18 to 51 mm in length and 4 to 13mm in width
▪ Marked widening at the base of the cone
(“shoulder ”)
▪ Large, broad, flat body
▪ Leaf-shaped
▪ Small oral and ventral suckers
▪ Long and highly branched intestinal caeca

Answer 5

Fasciola hepatica ADULT

Question 6

▪ 25 to 75mm and 3 to 12 mm in width
▪ Longer, less developed shoulders and a shorter
cephalic cone
▪ More branched caeca towards the midline of the
body
▪ Ovary branches are longer and more numerous

Answer 6

Fasciola gigantica ADULT

Question 7

Fasciola hepatica 1ST IH?

Answer 7

▪ Snails belonging to the family of Lymnaeidae
▪ Snail species
* Lymnaea truncatula (Europe and North
Asia)
* Lymnaea bulmoides (North America)
* Lymnaea tomentosa (Australia)
▪ Snails from family planorbidae

Question 8

Fasciola species 2ND IH:

Answer 8

▪ Ipomea obscura (morning glory or kangkong)
▪ Nasturtium officinale (watercress)

Question 9

Fasciola species DH

Answer 9

▪ Human
▪ Sheep
▪ Goat
▪ Cattle

Question 10

Human Fascioliasis
▪ Coincides with larval migration and worm
maturation
* Dyspepsia
* Fever
* Right upper quadrant abdominal pain

Answer 10

Acute or invasive phase

Question 11

Human Fascioliasis
▪ Coincides with the persistence of Fasciola worms
in the biliary ducts
* Biliary obstruction
* Biliary cirrhosis
* Obstructive jaundice

Answer 11

Chronic or latent phase

Question 12

PATHOGENESIS
- Human Fascioliasis
Ingestion of raw liver of infected sheep results in a
condition called _____in Lebanon and ______in Sudan

Answer 12

halzoun = LEBANON
mariara = SUDAN

Question 13

F. spp DIAGNOSIS

Answer 13

• Identification of eggs in stool
• Duodenal contents, or bile, or the recovery of adult worms during surgical exploration
• Enzyme-linked immunosorbent assay (ELISA) and western blot
• Radiological examinations
• Endoscopic retrograde cholangiopancreatography (ERCP)

Question 14

F. spp TREATMENT

Answer 14

• Triclabendazole
  o Single 10 mg/kg oral dose of triclabendazole following
  food intake
  o For individuals with heavy infection
  ▪ Two doses of 10 mg/kg spaced by 12 hours
• Bithionol
  o 30 to 50 mg/kg body weight on alternate days to complete
  10 to 15 doses

Question 15

Fascioliasis has a worldwide distribution and is great economic importance in livestock -raising countries :

Answer 15

o Asia – Iran
o Eastern Asia – Japan, Korean Peninsula, Thailand
o Europe – France, Spain, Portugal, and the former USSR

Question 16

• Common name: CHINESE LIVER FLUKE
• C. sinensis was first reported in India in 1874, during an autopsy of
  a 20-year old Chinese patient.
• Belong to family Opisthorchiidae
• Are parasites of the bile duct and gallbladder of humans and fisheating mammals

Answer 16

Clonorchis sinensis

Question 17

• Common name: SOUTHEAST ASIAN LIVER FLUKE
• Infection first recorded in 1911

Answer 17

Opisthorchis viverreni

Question 18

• CAT LIVER FLUKKE
• Infection first recorded in 1892

Answer 18

Opisthorchis felineus

Question 19

▪ 19 – 30 um long by 10 -20 um wide
▪ Operculated, possess prominent opercular
‘shoulders’ and abopercular knob

Answer 19

Opisthorchis spp. EGG

Question 20

▪ 27 to 35 um by 11 to 20 um
▪ Yellowish – brown
▪ Oval shaped with a convex operculum that rests on
visible “shoulders”
▪ Opposite (abopercular) end, a small knob or hooklike protrusion is often visible
▪ Miracidium is visible inside

Answer 20

Clonorchis sinensis EGG

Question 21

▪ Flat, transparent, spatulate body; pointed anteriorly
and rounded posteriorly
▪ 10 – 25 mm in length and 3 – 5 mm broad
▪ Highly branched testes

Answer 21

Clonorchis sinensis ADULT WORM

Question 22

▪ Flat, elongated, leaf or lanceolate shaped
▪ Approximately 7 mm long by 1.5 mm wide
▪ Rounded testes
▪ Smaller than C. sinensis

Answer 22

Opisthorchis spp. ADULT WORM

Question 23

IH

Answer 23

• 1st Intermediate host: Snail
  o C. sinensis
  ▪ Parafossarulus (P. manchouricus, P. anomalospiralis,
  and P. stratulus)
  ▪ Bulinus (B. striatulus)
  ▪ Semisulcospira, Alocinma (A. longicornis)
  ▪ Thiara (T. granifera)
  ▪ Melanoides (M. tuberculatus)
  o O. felineus and O. viverrine
  ▪ Bithynia
• 2nd intermediate host: fresh water fish
  o Cyprinidae

Question 24

DH

Answer 24

Human

Question 25

Reservoir host

Answer 25

Dog and other fish eating canines

Question 26

- In clonorchiasis, metacercariae reaching the biliary system mature and provoke pathological changes as a result of local trauma and irritation - These phases are as follows:

Answer 26

a. Desquamation of epithelial cells, b. Hyperplasia and desquamation of epithelial cells, c. Hyperplasia, desquamation of epithelial cells, and adenomatous tissue formation, and d. Marked proliferation of the periductal connective tissue with scattered abortive acini of epithelial cells, and fibrosis of the wall of the biliary duct

Question 27

o Asymptomatic o Non-specific clinical signs: diarrhea abdominal pain

Answer 27

Light infection of C. sinensis (<100 flukes)

Question 28

o Fever o Diarrhea o Loss of appetite o Rash o Edema o Night blindness o Swollen abdomen o Enlargement of the liver

Answer 28

Moderate infection of C. sinensis (101-1,000 flukes)

Question 29

o Acute pain in the right upper quadrant

Answer 29

High infection of C. sinensis (up to 25,000 flukes)

Question 30

O. viverrini - Light infection

Answer 30

o Flatulence o Fatigue o Dyspepsia o Right upper quadrant abdominal pain o Anorexia o Mild hepatomegaly

Question 31

O. viverrini - Severe infection

Answer 31

o Obstructive jaundice o Cirrhosis o Cholangitis o Acalculous cholecystitis or bile peritonitis

Question 32

is the most serious complication of infection with O. viverrini

Answer 32

Cholangiocarcinoma

Question 33

Cholangiocarcinoma

Answer 33

o Fever and hepatitis-like symptoms o Upper quadrant abdominal pain o Nausea o emesis

Question 34

O. felineus Chronic infection

Answer 34

o Biliary tract obstruction o Inflammation o Fibrosis o Liver abscess formation o Pancreatitis o Suppurative cholangitis

Question 35

DIAGNOSIS

Answer 35

- Detection of parasite egg in stool - Cholangiography - ELISA - Enzyme immunoassay (EIA) - Coproovoscopy - Polymerase chain reaction (PCR)

Question 36

TREATMENT

Answer 36

- Praziquantel 25mg – 3 times a day for 2 days - Praziquantel 60mg – 3 doses for 1 day - Albendazole - Praziquantel-albendazole - Tribendimidine