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Chapter 56 Paragonimiasis Lung Fluke Kimberly Hayden Biol 423 SP 2010 General Characteristics Class: Trematodes Red/Brown short, leaf-like worm Bilateral symmetry Operculated eggs -golden brown Discovery (2010) Morphology Two suckers: oral and ventral

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paragonimiasis

Chapter 56

Paragonimiasis

Lung Fluke

Kimberly Hayden

Biol 423 SP 2010

general characteristics
General Characteristics

Class: Trematodes

Red/Brown short, leaf-like worm

Bilateral symmetry

Operculated eggs

-golden brown

Discovery (2010)

morphology
Morphology

Two suckers: oral and ventral

aid in attachment and

locomotion

Hermaphrodite: ovaries

above testes and on the

right side of body

Rohde (2010)

history
History

Paragonimiasis has infected 22 million people globally.

Discovered by Kerbert 1878 in the lungs of Bengal tigers from India, which had later died in a zoo.

geographic distribution
Geographic Distribution

Far East: Japan, China, Taiwan, Indonesia, Manchuria, New Guinea, Philippines, and other areas of Southeast Asia

Recent spread to :

Latin America

P. mexicanus

South America

Africa

P. africanus

Eastern U.S. and Canada:

P. kellicotti

-rarely results in

human infection

Baumann (2001)

epidemiology
Epidemiology

High prevalence in the Far East due to cultural eating habits and proximity to infected crabs/crayfish.

Food preparation such as drunken crab or crab soaked in soybean-sauce will not kill Paragonimiasis.

Spread by contamination by crab juice to other work areas.

epidemiology south korea
Epidemiology- South Korea

Paragonimiasis was widespread across S. Korea by the late 1960’s.

Industrialization in the 1970’s and 1980’s caused runoff polluting many streams.

Pollution killed many crab and crayfish almost to extinction.

Subsequently, rates of those infected by Paragonimiasis dramatically decreased to 1/100th of previous numbers.

TODAY: A priority on health education and surveillance to control infection rates.

pathogenesis
Pathogenesis

The Imaging of Tropical Diseases

pathogenesis9
Pathogenesis
  • Eggs are excreted from human host

-found in stool or sputum

-golden eggs are coughed up along with blood

-eggs must find their way to a freshwater source

-upon finding fresh water the eggs will hatch and turn into ciliated larvae: miracidia

pathogenesis10
Pathogenesis

2. Primary host: SnailApprox. 3-5 months

-miracidia infect the snail

-asexual reproduction inside snail results in thousand of larvae: cercariae

-cercariae leave the snail and swim around until they find the secondary host

Thompson (2004)

pathogenesis11
Pathogenesis

3. Secondary Host: Freshwater crab/crayfish

Approx. 6-8 weeks

-cercariae infect crab and undergo a second transformation

-transformation into the infective stage: metacercariae

-infected crab ingested by human

France-Presse (2007)

pathogenesis12
Pathogenesis

4. Human infection

- once ingested the metacercariae burrow themselves through the gut and eventually up into the lungs*

- in the lungs they will reach maturity in 5-6 weeks

- flukes encapsulate themselves and lay eggs

-capsules burst into the bronchioles to be coughed up

*migration to other sites possible, most commonly the brain

manifestations diagnositc indicators
Manifestations/Diagnositc Indicators

Migration stage:nonspecific symptoms

-diarrhea -abdominal & chest pain

-allergic rxn - fever & chills

Once Established in Lungs:elicit eosinophilic inflammatory rxn

-one or more parasites become encapsulated in 1-2cm lesions

-secondary infections occur after capsules burst : may clinically appear as chronic bronchitis

-cough -night sweats

-haemoptyisis -general malaise

Severe Infections:

-pleurisy -persistent rales

-clubbed fingers -pneumothorax

*Ectopic infection in the brain will exhibit neurological symptoms: paralysis, epilepsy, homonymous hemianopsia, optic atrophy, papilledema

(brain infections occur most commonly in children)

paragonimiasis vs tb
Paragonimiasis vs. TB

10-20% of radiograph findings will be normal

Abnormal Findings:

Most show infiltrates that eventually lead to calcification and look clinically similar to TB on x-rays

Many cases of P. westermani are diagnosed after TB treatment has failed, therefore a careful differential diagnosis is key in determining Paragonimiasis infections.

HeathToKnow (2008)

definitive diagnosis
Definitive Diagnosis

75% of infected individuals will have eggs detectible in their sputum after the first 3 months have passed so retesting of sputum is necessary

Complement Fixation (CF) Test: standard test; sensitive and good indicator of cure

Enzyme Immunoassay Tests: antibodies

-can be used but cannot distinguish between past and current infection

Immunoblot (IB) assay: antibodies

Used by CDC but may not be able to detect for other species of Paragonimiasis besides P. westermani

treatment and prevention
Treatment and Prevention

Bithionol:phenol drug class

- uncouples phosphorylation

- NOT available in the United States

Praziquantel:causes severe spasms and paralysis of the worms muscles- worms destroyed in intestines or excreted in feces

Dosage: 25mg/kg 3 times a day-3 days

>90% effective in case studies

PREVENTION: adequate cooking of shellfish before consuming.

text sources
Text Sources
  • Cho, SY. “Epidemiology of paragonimiasis in Korea.” U.S. National Library of Medicine National Institutes of Health. 1997. Accessed 04/21/2010. <http://www.ncbi.nlm.nih.gov/pubmed/9656345>
  • Ghaffar, Dr. Abdul and Dr. Gregory Brower. “Parasitology-Chapter Six Trematodes.” Microbiology and Immunology On-line: University of South Carolina School of Medicine. Updated April 15, 2010. Accessed: 04/19/2010. <http://pathmicro.med.sc.edu/parasitology/trematodes.htm>
  • Govinden, Kughan. “The Human Lung Fluke- Paragonimus Westermani (Domain Eukarya, Kingdom Animalia, Phylum Plathyhelminthes, Class Trematoda).” The Macrae Group LLC. 2009. Accessed 04/19/2010. < http://www.themacraegroup.com/2009-symposia/xi-international- symposium-on-respiratory-viral-infections/poster-abstracts/the-human-lung-fluke-2013- paragonimus-westermani-domain-eukarya-kingdom-animalia-phylum-plathyhelminthes-class- trematoda>
  • Micromedex. “Praziquantel (Oral Route).” MayoClinic.com. 11/1/2009. Accessed: 4/21/2010. < http://www.mayoclinic.com/health/drug-information/dr601147>
  • Ryan, Kenneth J. and George Ray. “Trematodes.” Sherris Medical Microbiology Fifth ed. McGraw-Hill Companies, Inc. 2010. 776-777, 879-884.
  • Sadun, Elvio H. and Alfred A. Buck. “Paragonimiasis in South Korea- Immunodiagnostic, Epidemiologic, Clinical, Roentgenologic and Therapeutic Studies.” The American Journal of Tropical Medicine and Hygiene. 1960. Accessed 04/20/2010. < http://www.ajtmh.org/cgi/content/abstract/9/6/562>
  • Singh, TN. “Pleuropulmonary Paragonimiasis Mimicking Pulmonary Tuberculosis- A Report of Three Cases.” Indian Journal of Medical Microbiology. 2005. Accessed 04/21/2010. < http://medind.nic.in/iau/t05/i2/iaut05i2p131.pdf>
  • Slemenda, SB. “Paragonimiasis: Antibody Detection.” Diagnostic Findings. Accessed: 4/20/2010. < http://www.dpd.cdc.gov/dpdx/html/frames/M- R/Paragonimiasis/body_Paragonimiasis_serol1.htm>
picture sources
Picture Sources

Baumann (2001) http://www.stanford.edu/class/humbio103/ParaSites2001/paragonimiasis/Paragonimiasis_Home.html HealthToKnow (2008) http://www.health2know.com/mini-lobsters/

Discovery (2010) http://animal.discovery.com/invertebrates/monsters-inside-me/lung-fluke-paragonimus-westermani/

France-Presse (2007)

http://www.cosmosmagazine.com/news/1375/freshwater-crabs-thrive-roman-ruins

Rohde (2010) http://knol.google.com/k/flukes-trematodes-the-biology-morphology-and-medical-economic-importance-of#

The Imaging of Tropical Diseases http://www.isradiology.org/tropical_deseases/tmcr/chapter22/epidemiology.htm

Thompson (2004) http://www.flmnh.ufl.edu/malacology/fl-snail/snails1.htm