Trematodes

Question 1

What are the liver flukes

Answer 1

Fasciola hepatica, fasciola gigantica, clonorchis sinensis, opistorchis

Question 2

What are the lung flukes

Answer 2

Paragonimus

Question 3

What are the blood flukes

Answer 3

Schistosoma

Question 4

What is the intestinal fluke

Answer 4

Fasciolopsis Buski

Question 5

What type of digestive system do flukes have

Answer 5

incomplete digestive system (mouth, pharynx, esophagus bifurcates, sucker, no anus)

Question 6

All trematodes except schisto:
Eggs?
Larvae?
Life Cycle?
Transmission?

Answer 6

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

Question 7

All trematodes except schisto:
Eggs?
Larvae?
Life Cycle?
Transmission?

Answer 7

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

Question 8

Definitive host, int host of schistosoma

Answer 8

Def: Man; Int: Snail

Question 9

Infective form of trematodes (except schisto)

Answer 9

metacercaria larva

Question 10

infective form of schisto

Answer 10

cercaria larva

Question 11

Fasciola life cycle

Answer 11

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

Question 12

Watercress

Answer 12

Fasciola hepatica

Question 13

Answer 13

unembryonated egg 120-140um of fasciola
-operculum with bile stained shell, thin

Question 14

Differences between fasciola hepatica and fasciolopsis buski adult worms

Answer 14

Question 15

Paragonimus infective, diagnostic, intermediate hosts, definitive host

Answer 15

Infective stage: Metacercariae
Diagnostic: Unembryonated egg
Int Hosts: Snail, Crustacean
Definitive host: Human

Question 16

Answer 16

paragonimus infective stage (metacercariae)

Question 17

Answer 17

paragonimus unembryonated egg, asymmetrical oval, operculum

Question 18

Answer 18

S. Mansoni (large lateral spine)
S. Haematobium (large terminal spine)
S. Japonicum (rounded, small lateral spine)

Question 19

Schistosoma Life cycle

Answer 19

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

Question 20

Which Fluke causes periportal fibrosis

Answer 20

schistosoma mansoni

Question 21

Which fluke causes chronic salpingitis

Answer 21

schistosoma hematobium

Question 22

How do you diagnose schisto

Answer 22

direct smear (Kato); Urine (proteinuria + hematuria), serology (good for expats)

Question 23

Treatment of schisto

Answer 23

Prednisone for katayama fever Praziquantel (adulticidal) ; then repeat prazi in at least 4-6 weeks so the other worms mature into adults

Question 24

What are your co-infections with schisto

Answer 24

Malnutrition, Viral hepatitis, Salmonella, Bladder cancer

Question 25

Patient with lifelong freshwater exposure and eosinophilia and periportal fibrosis

Answer 25

Schistosomiasis Schistosoma Mansoni Treatment: PRednisone for katayama + praziquantel x 2 (kill all adult forms of the worm)

Question 26

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?

Answer 26

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

Question 27

Which fluke can cause sclerosing cholangitis, biliary cirrhosis

Answer 27

Fasciola hepatica and Fasciola gigantica

Question 28

Patient with migrating larval flukes, reddish cutaneous tracks, subcutaneous nodules, pruritic, painful, inflamed , +eos

Answer 28

Cutaneous Fasciolasis

Question 29

How to diagnose f. hepatica and f gigantica

Answer 29

ELISA, Serology

Question 30

Treatment of fasciola

Answer 30

Triclabendazole 1-2 days If you're in the chronic stage, 500mg BID x 7 days

Question 31

Clonorchis and opistorchis epidemiology, definitive host, intermediate host?

Answer 31

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

Question 32

Clinical manifestations of clonorchis and opistorchis

Answer 32

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

Question 33

clonorchis and opistorchis life cycle

Answer 33

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

Question 34

patient with recurrent ascending cholangitis. What is the organism? What is the treatment?

Answer 34

Organism: clonorchis sinensis, opsitorchis viverrini/felineus Treatment: praziquantel x2 days; albendazole x 7 days

Question 35

Giant intestinal fluke? Where is it found? Who is the definitive host? Intermediate host?

Answer 35

Fasciolopsis Buski, China/India/SE Asia, Pigs are def host, 1st int host snails

Question 36

Fasciolepsis clinical manifestations

Answer 36

anorexia, nausea, vomiting, foul smelling idarrhea, eosinophilia, malabsorption, hypoalbuminemia

Question 37

Patient with fever, eosinophilia, low B12, hypoalbuminemia, foul smelling diarrhea and undigested food, comes from india . Organism? Treatment?

Answer 37

Fasciolopsis Buski Tx: Praziquantel 15-25mg/kg

Question 38

34year old male with 13m of cough, blood streaked sputum, chills nocturnal sweating, back pain, negative AFB. +Eos

Answer 38

Paragonimus Westermani

Question 39

where do you find paragonimus westermani?

Answer 39

Far east, China, Japan, Korea, Taiwan, Philippines

Question 40

Hosts of paragonimus

Answer 40

definitive: felines, canids, weasel, opposum 1st intermed host: snails 2nd int : crab crayfish hrimp paratenic host: wild boards

Question 41

gelatinous brownish sputum, chronic fough, fishy odor, marked eosinophila. organism? treatment?

Answer 41

paragonimus westermani tx: Praziquantel