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Updated: Oct 15 2021

Flukes (Trematodes)

  • Snapshot
    • A 15-year-old boy presents to the emergency room for a 2-month history of shortness of breath on exertion and cough. He recently moved from Laos to the United States for school. He reports having an unintentional 8-lb weight loss in the past few months, occasional fevers, and night sweats. He also reports having occasional hemoptysis. Prior to immigrating, he had a normal tuberculin skin test. A chest radiograph shows a linear streak and right-sided consolidation. A sputum sample is procured and sent for microscopy, which demonstrates oval-shaped eggs. (Paragonimiasis)
  • Introduction
    • Introduction
      • flukes are parasitic trematodes
        • characteristics
          • possess 2 suckers (trematos = “pierced with holes”)
          • unsegmented and flattened worms
        • blood fluke
          • Schistosoma species
        • liver fluke
          • Clonorchis sinensis
        • lung fluke
          • Paragonimus species
    • Treatment
  • Schistosoma
    • Schistosoma species (blood flukes)
      • organisms
        • Schistosoma haematobium (Africa and Middle East)
          • causes genitourinary tract disease
        • Schistosoma mansoni (Africa and South America)
          • causes intestinal tract and hepatosplenic disease
        • Schistosoma japonicum (East Asia)
          • causes intestinal tract and hepatosplenic disease
      • epidemiology
        • most occur in sub-Saharan Africa
      • transmission
        • snails are intermediate hosts
        • via penetration of skin
      • risk factors
        • exposure to fresh water
        • farming
    • Presentation
      • Katayama fever
        • fevers, hives, weight loss, and cough
        • acute illness after initial infection
      • chronic infections
        • S. mansoni and S. japonicum
          • hepatosplenomegaly with fibrosis and inflammation
            • portal hypertension
          • intestinal tract infection
            • abdominal pain
            • diarrhea
        • S. haematobium
          • squamous cell bladder cancer
            • hematuria (classic symptom)
            • dysuria
    • Studies
      • microscopy of urine or stool
        • S. haematobium
          • eggs with terminal spine
        • S. mansoni and S. japonicum
          • eggs with lateral spine
      • serology or PCR within 2 months of exposure
      • eosinophilia
    • Complications
      • portal hypertension
      • bladder stones
      • squamous cell bladder cancer
  • Clonorchis
    • Clonorchis sinensis (liver flukes)
      • epidemiology
        • east Asia
        • Russia
      • transmission
        • via ingestion of undercooked, dried, or pickled fish
      • pathogenesis
        • causes biliary tract inflammation
    • Presentation
      • chronic symptoms
        • right upper quadrant abdominal pain
        • anorexia
        • weight loss
        • diarrhea
        • jaundice
      • cholecystitis
      • ascending cholangitis
      • cholelithiasis with pigmented gallstones
    • Studies
      • microscopy of stool
        • flask-shaped C. sinensis eggs
      • eosinophilia
      • elevated alkaline phosphatase
    • Complications
      • cholangiocarcinoma
  • Paragonimus
    • Paragonimus species (lung flukes)
      • organisms
        • Paragonimus westermani (east Asia, Africa, and South America)
        • Paragonimus heterotremus (India)
      • transmission
        • via ingestion of undercooked crabs or crayfish
      • pathogenesis
        • inhabits lung parenchyma by penetrating through intestinal wall and peritoneal cavity to diaphragm
    • Presentation
      • tuberculosis-like illness
        • pleural effusion
        • pleuritic chest pain
        • recurrent bacterial pneumonia
        • hemoptysis
        • shortness of breath
        • fever, weight loss, and night sweats
    • Imaging
      • chest radiograph
        • consolidations
        • “ring shadow” of an oval thin-walled cyst
        • linear streak or fluke tract
    • Studies
      • microscopy of sputum or stool
        • ovoid and thick-shelled Paragonimus eggs
    • Complications
      • pulmonary abscess
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