PARAGONIMUS WESTERMANI

(Oriental Lung Fluke)

main species that causes human paragonimiasis in the Philippines
patients often complain of cough and hemoptysis
clinical manifestation consistent with pulmonary tuberculosis (PTB)
patients with this parasitic infection are often misdiagnosed with PTB
DISEASE
Paragonimiasis
OTHER NAMES:
lung fluke disease
pulmonary distomiasis
endemic hemoptysis
Parasitic hemoptysis
MORPHOLOGY
Adult
Color: reddish brown
Dimensions: 7-12mm x 4-6mm x 3.5-5mm
(lwt)
Shape: resembles coffee bean; round anteriorly, tapers posteriorly
Integument: covered with single spaced spines
Reproductive organs:
Two -lobed testes opposite each other
midway between ventral sucker and
posterior border
ovary anterior to testes and posterior to
ventral sucker; w/ six unbranched lobes
other: vitellaria extensively branched
Cercaria
- covered with spines
- has ellipsoidal body and a small tail
- stylet present at dorsal side of oral sucker
Metacercaria
round
measures 381-457 um.
Egg
yellowish-brown
Thick-shelled
Oval-shaped
flattened but prominent operculum
Thickened Aboperculum
Unembryonated at oviposition
Dimensions: 80-118um x 48-60 um
LIFE CYCLE
Adult worms
Found in pairs or in threes in fibrotic capsules or cysts in lungs of the host
Capsules have openings that allow eggs to escape into the respiratory tract wher
e they are moved up and out by ciliary epithelium along with lung exudates
In the pharynx, are either coughed out or swallowed into the alimentary canal an
d passed out with feces
Eggs
immature egg embryonates in water, moist soil or
leached feces
Miracidium
develops from eggs w/in 2 to 7 weeks
pushes the operculum and swims in search of an
appropriate snail host
1st intermediate host: Antemelania asperata and Antemelania dactylus
Sporocyst and Redia
inside the snail the miracidium passes through one sporocyst and 2 redial stages
Cercaria
cercariae emerge from the snail to seek a 2nd
intermediate host
2nd intermediate host: mountain crab
(Sundathelphusa philippina)

Metacercaria
The cercaria penetrates the soft parts of the crustacean and encysts as a metace
rcaria in the gills, body muscles and viscera or legs
crab may also be infected by eating infected snails
Infective stage: metacercaria
Definitive host: Man
Adolescent worm
following ingestion, the metacercaria excysts in the duodenum
traverses the intestinal wall, into the peritoneal
cavity where it wanders and embeds itself in the
abdominal wall for several days
parasite returns to the coelom, migrates through
the diaphragm to the pleural cavity where it
penetrates the lungs and develops into adulthood
completion of development in the definitive host is 65 to 90 days
worms persist for as long as 20 years
Reservoir hosts: dogs, cats, field rats, rodents
PATHOGENESIS & CLINICAL MANIFESTATIONS
Lungs: worms provoke a granulomatous reaction that proceeds to the development
of fibrotic encapsulation
within the cyst is a blood-tinged purulent material containing eggs
early stages of infection are asymptomatic
in heavy infections, patient may suffer from dry cough
and later produce bloodstained or rust-colored sputum
with foul fish odor (pronounced in the morning)
Symptoms: chest pains, dyspnea, hemoptysis, low-grade fever, fatigue, myalgia
often misdiagnosed for PTB
symptoms less severe after five to six years
complications: lodge in abdominal wall, abdominal cavity, mesenteric lymph nodes
, omentum, pericardium, myocardium and intestinal wall causing erratic paragonim
iasis
Cerebral involvement most serious and may cause:
Jacksonian epilepsy
Cerebral hemorrhage
Edema
Visual disturbances
Meningitis
prognosis with light infection is good and chemotherapy
has a high cure rate
DIAGNOSIS
based on detection of characteristic eggs in sputum, stool, or less frequently,
aspirated material from abscesses or pleural effusions
serology helpful; standard test is complement fixation (CF) â has advantage to det
ect rapid decline in antibody levels
· EIA and Immunoblot (IB)
TREATMENT
Praziquantel; higher doses required in ectopic
Paragonimiasis
Bithionol (alternative)
Triclabendazole also effective
EPIDEMIOLOGY
global distribution in freshwater crabs
major endemic areas: Asia (Japan, South Korea, Thailand, Taiwan, China and Phil.
)
PREVENTION AND CONTROL
Proper food preparation (Cooking of crab and meat of paratenic hosts
Change in dietary habits
Health education and promotion
Elimination of reservoir and intermediate hosts