tag:blogger.com,1999:blog-21800198363705556882024-03-05T18:53:56.679-08:00Parasitology 101Diagnostic Parasitology: In bullet-point formatRobert Herrimanhttp://www.blogger.com/profile/16844146002845854017noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-2180019836370555688.post-10332231663821391992014-06-05T17:42:00.001-07:002014-06-05T17:42:58.637-07:00Taenia saginata<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO6fG8lBMWEdqIwZyqEmy_r1X1PNZA-f7Gfjc0-jIGYhnTjLLVRWDQjNKzmjwz7u9L5jwuNqoKzsqCpyFfhwDHpQJDkoJh7zijUlqEUrqDv7yomZP-L_21PPHhOOD98YgxpLCyt_PENbJJ/s1600/adult.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO6fG8lBMWEdqIwZyqEmy_r1X1PNZA-f7Gfjc0-jIGYhnTjLLVRWDQjNKzmjwz7u9L5jwuNqoKzsqCpyFfhwDHpQJDkoJh7zijUlqEUrqDv7yomZP-L_21PPHhOOD98YgxpLCyt_PENbJJ/s1600/adult.jpg" height="303" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">T. saginata adult/CDC</td></tr>
</tbody></table>
<u><br /></u>
<u>General Information</u><br />
<u><br /></u>
<br />
<ul>
<li>Beef tapeworm</li>
<li>Definitive host is humans, herbivores are intermediate hosts</li>
</ul>
<div>
<u>Geography</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Worldwide, particularly where beef is eaten raw or undercooked</li>
</ul>
<div>
<u>Morphology (adults)</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Strobila is 15-20 ft</li>
<li>1000-3000 proglottids</li>
<li>Gravid proglottids are longer than wide</li>
<li><b>Mature proglottid has 12-30 lateral uterine branches, can be differentiated from Taenia solium (7-13)</b></li>
<li><b>Quadrate (four suckers), unarmed scolex</b></li>
</ul>
<div>
<u>Morphology (eggs)</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>30-35 um in diameter, radial striated</li>
<li>Internal oncosphere contains three pairs of hooklets</li>
<li><b>Indistinguishable from Taenia solium eggs</b></li>
</ul>
<div>
<u>Life Cycle</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Adult in small intestine</li>
<li>Gravid proglottids with infective eggs passed in feces</li>
<li>Eggs can survive for months in the environment</li>
<li>Eggs ingested by cattle</li>
<li>Eggs hatch> onchospheres released> invade intestinal wall> becomes lodged in striated muscle</li>
<li>Develop into cysticerci (survive for years)</li>
<li>Humans are infected by eating raw or undercooked beef</li>
<li>Cysticerci attach to small intestine and mature to adults</li>
</ul>
<div>
<u>Pathology</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Most patients asymptomatic</li>
<li>Mild abdominal symptoms</li>
<li>Migrating proglottids- appendicitis or cholangitis possible</li>
</ul>
<div>
<u>Diagnosis</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Identification to the species level not possible based solely on microscopic exam of eggs</li>
<li><b>Egg stage a potential health hazard (T. solium)</b></li>
<li>Identification of proglottids and/or scolex</li>
</ul>
<div>
<u>Treatment</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Praziquantel or niclosamide</li>
</ul>
<div>
<u>Epidemiology</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Cattle infected while grazing on contaminated vegetation</li>
</ul>
<div>
<u>Prevention</u></div>
<div>
<u><br /></u></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div>
<ul>
<li>Cook beef thoroughly</li>
</ul>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiT0_J4M6i3MRuavIPQikTPjyi2rRBMfJozoruuv2Ht2LGQljn5oqK0Nq0M0TT4jks9eznkJSnP6mEvX4bIpRo5MBhnFas6xMVMfRHs21zA5ZJEpx91j6ylc3ZJ83jEAy9u8Adi6eJwwenR/s1600/t+sag+proglottid.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiT0_J4M6i3MRuavIPQikTPjyi2rRBMfJozoruuv2Ht2LGQljn5oqK0Nq0M0TT4jks9eznkJSnP6mEvX4bIpRo5MBhnFas6xMVMfRHs21zA5ZJEpx91j6ylc3ZJ83jEAy9u8Adi6eJwwenR/s1600/t+sag+proglottid.jpg" height="263" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">T. saginata proglottid<br /><br /></td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9lKWkZ2cZtnlb2-WHvnIgFHh4I8UV0yA0K1AFcVbztxDfnAZ1fazuGDJtKGkQJxxQWkHB_AdJqj29ci2PAUbi8K-2I-LLsLXmk3ZftVgIuB2LUj4VSLkGYhfP3GGtYbrKRY090Y3mjJcB/s1600/taenia+saginata+scolex.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9lKWkZ2cZtnlb2-WHvnIgFHh4I8UV0yA0K1AFcVbztxDfnAZ1fazuGDJtKGkQJxxQWkHB_AdJqj29ci2PAUbi8K-2I-LLsLXmk3ZftVgIuB2LUj4VSLkGYhfP3GGtYbrKRY090Y3mjJcB/s1600/taenia+saginata+scolex.jpg" height="265" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">T. saginata scolex</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_0P2LqaT6HCZrW-fdiYDQ_Wjm3tQ1Lu8kYntPlRbv6aUCVEyYUaeD7t5uoCjipXQI-gPTpJA86UUPYsHt_6Q2PqJADisv4AQ7quxFfbyeqdfhhXxugUdxnXnFL1EXw4gm-of9VUsApCRJ/s1600/taenia+egg.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_0P2LqaT6HCZrW-fdiYDQ_Wjm3tQ1Lu8kYntPlRbv6aUCVEyYUaeD7t5uoCjipXQI-gPTpJA86UUPYsHt_6Q2PqJADisv4AQ7quxFfbyeqdfhhXxugUdxnXnFL1EXw4gm-of9VUsApCRJ/s1600/taenia+egg.jpg" height="288" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Taenia spp. egg</td></tr>
</tbody></table>
<div>
<br /></div>
</div>
</div>
</div>
<br />
<div>
<div>
<div>
<ul></ul>
</div>
<div>
<br /></div>
</div>
<div>
<b><br /></b></div>
</div>
Robert Herrimanhttp://www.blogger.com/profile/16844146002845854017noreply@blogger.com1tag:blogger.com,1999:blog-2180019836370555688.post-24640939386259218482014-06-01T06:45:00.000-07:002014-06-01T06:45:24.123-07:00Diphyllobothrium latum<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6VJ5_SmUAOCfEAVxwX8gMWrVASirsQOzE1BskZsdUxeLTfOTHeiV0wHr3j0CWm3uiJNs4kYvMd1qG5jFdgQ-ctPpvRwFn8Tm0MIdKNgqWX4fWQCKdF9YKw18mNcUcwcbTJ6n_0Gmo7CBl/s1600/4838_lores.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6VJ5_SmUAOCfEAVxwX8gMWrVASirsQOzE1BskZsdUxeLTfOTHeiV0wHr3j0CWm3uiJNs4kYvMd1qG5jFdgQ-ctPpvRwFn8Tm0MIdKNgqWX4fWQCKdF9YKw18mNcUcwcbTJ6n_0Gmo7CBl/s1600/4838_lores.jpg" height="266" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">D. latum egg/CDC</td></tr>
</tbody></table>
<u><br /></u>
<u>General Information</u><br />
<u><br /></u>
<br />
<ul>
<li>Also known as "Fish Tapeworm" and "Broad Tapeworm"</li>
<li><b>Largest human tapeworm</b>, strobila can reach 30-45 ft in length</li>
</ul>
<div>
<u>Geography</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Worldwide, particularly in cool lake regions of the Northern hemisphere (North America, Europe and Asia) and South America</li>
</ul>
<div>
<u>Morphology (adults)</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>30-45 ft in length, 1 cm in width</li>
<li>Scolex (head) spatulate with two slit-like grooves (bothria)</li>
<li>3000 proglottids, each with<b> "rosette-shaped" uterus.</b> </li>
<li><b>Proglottids wider than long</b></li>
</ul>
<div>
<br /></div>
<div>
<u>Morphology (eggs)</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Oval or ellipsoidal, 75 um x 45 um</li>
<li>Operculated</li>
<li>Undeveloped embryo (coracidium)</li>
<li>Small, terminal abopercular knob</li>
</ul>
<div>
<u>Life Cycle</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Adult in small intestine</li>
<li>Immature eggs shed from gravid proglottids, passed in feces</li>
<li>Eggs develop in fresh water> develop into coracidium</li>
<li>Coracidium emerge from egg, ingested by freshwater crustacean (<b>copepod</b>, Cyclops sp.) First intermediate host</li>
<li>Develops into procercoid larva</li>
<li>Infected crustacean ingested by small freshwater fish (minnows for example) (second intermediate host)> develops into plerocercoid larva (sparganum)</li>
<li>Infected small fish ingested by larger "predatory fish" (perch, trout, etc)> plerocercoid larva released and penetrates muscles of predator fish</li>
<li>Humans infected when consuming raw or undercooked infected fish</li>
<li>Plerocercoid larva develops to adult in small intestine</li>
<li>From beginning of infection> approximately 6 weeks until eggs passed in feces</li>
<li>Adult can live for up to 20 years, each adult can shed 1 million eggs/day</li>
</ul>
<div>
<u>Pathology</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Usually asymptomatic, patient becomes aware when worm segments passed in stool</li>
<li>Clinical manifestations may include <b>pernicious anemia due to vitamin B12 deficiency</b></li>
<li>Abdominal discomfort, diarrhea, vomited, weight loss</li>
<li>Heavy infections can result in intestinal obstruction</li>
</ul>
<u>Diagnosis</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Microscopic identification of eggs in stool sample. Examination of characteristic proglottids also useful.</li>
</ul>
<div>
<u>Treatment</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Praziquantel or nicolsamide</li>
</ul>
<div>
<u>Epidemiology</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Freshwater transmission dependent on available human/mammal definitive host, suitable intermediate hosts, consumption of raw or undercooked freshwater fish</li>
<li>Pollution of freshwater with infected human feces</li>
</ul>
<div>
<u>Prevention</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Thorough cooking of freshwater fish, or</li>
<li>Freezing fish for 24 hours at -18C (0F), or</li>
<li>Irradiation</li>
</ul>
<div>
<br /></div>
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6mnr2RP97SIwd6hIOBa1yelcOsI8l84z6zWioDCVdSIaEXYbIcAXEiFbg6Xa818YbOf_5738FqSaorZcokim5NOxccHO-KioYPOCCVPLg0zfBRIIvB7MmJQ63a9it5ctdYJjdL779Xw2Z/s1600/1516_lores.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6mnr2RP97SIwd6hIOBa1yelcOsI8l84z6zWioDCVdSIaEXYbIcAXEiFbg6Xa818YbOf_5738FqSaorZcokim5NOxccHO-KioYPOCCVPLg0zfBRIIvB7MmJQ63a9it5ctdYJjdL779Xw2Z/s1600/1516_lores.jpg" height="263" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">D. latum gravid proglottids/CDC</td></tr>
</tbody></table>
<div>
<br /></div>
<div>
<u><br /></u></div>
<div>
<u><br /></u></div>
<div>
<br /></div>
</div>
Robert Herrimanhttp://www.blogger.com/profile/16844146002845854017noreply@blogger.com0tag:blogger.com,1999:blog-2180019836370555688.post-18475067888425373382014-05-30T09:49:00.000-07:002014-05-30T09:49:20.707-07:00The Schistosomes<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYZHurc4QOvpgBeOKHjOsCKnrDS4U2yzGdr3duybRgvw2gmT61u3V_4mR0Lfvb386YmONeBlknYQmwVUJDAnPP6nvTG6xyaJ5ogHaGbp0XTAjk84LWrdye8QdQU0hGhMu3hS7S8ygq3gv_/s1600/schistadults.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYZHurc4QOvpgBeOKHjOsCKnrDS4U2yzGdr3duybRgvw2gmT61u3V_4mR0Lfvb386YmONeBlknYQmwVUJDAnPP6nvTG6xyaJ5ogHaGbp0XTAjk84LWrdye8QdQU0hGhMu3hS7S8ygq3gv_/s1600/schistadults.jpg" height="209" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">S. mansoni adults/CDC</td></tr>
</tbody></table>
<u><br /></u>
<u>General Information</u><br />
<u><br /></u>
<br />
<ul>
<li>Trematodes from the genus Schistosoma that live in the blood vessels of humans and other mammals</li>
<li>Adults have separate sexes (different from other trematodes)</li>
<li>Disease called schistosomiasis or Bilharziasis, named after Theodore Bilharz</li>
<li>Can cause acute and chronic disease, a disease-complex</li>
<li>Most important helminth infection in terms of worldwide distribution, prevalence and morbidity</li>
<li>Sometimes considered a "man-made" disease with the construction of hydroelectric dams and irrigation systems in developing nations</li>
<li>The three most important human species are Schistosoma mansoni, S. haemotobium and S. japonicum</li>
</ul>
<div>
<br /></div>
<div>
<u>Geography</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>S. mansoni is found in Africa (including Madagascar), the Arabian Peninsula, Brazil, Suriname, Venezuela and some Caribbean islands</li>
<li>S. haemotobium is found in Africa and the Middle East</li>
<li>S. japonicum is found in China, the Philippines and parts of Indonesia</li>
</ul>
<div>
<br /></div>
</div>
<div>
<u>Morphology (adults)</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Separate sexes</li>
<li>Cylindrical in shape</li>
<li>Male: short (10-20 mm in length) with copulatory groove</li>
<li>Female: Long and slender (20-26 mm in length)</li>
</ul>
<div>
<br /></div>
</div>
<div>
<u>Morphology (eggs)</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>S. mansoni: 180 um x 80 um, developed miracidium and a large lateral spine</li>
<li>S. haemotobium: 160 um x 80 um, developed miricidium and a large terminal spine</li>
<li>S. japonicum: 80 um x 60 um, developed miricidium and a small lateral knob (spine)</li>
</ul>
<div>
<br /></div>
</div>
<div>
<u>Life Cycle</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Eggs laid in blood vessels, pass from vessels into tissue, some reach the intestine or bladder, excreted in the feces or urine</li>
<li>Eggs that reach freshwater, miricidia hatches, swims to find appropriate snail host (intermediate) and penetrate</li>
<li>In the snail- two generations of sporocysts> produce cercariae> cercariae migrate out of snail into water (Snail cycle requires 3-5 weeks)</li>
<li>Cercariae: 0.1-0.2 mm in length, fork-tailed (infective stage) swims to find human host</li>
<li>Penetrates through skin or mucous membranes</li>
<li>Loses tail upon penetration> schistosomula</li>
<li>Schistosomula enter peripheral veins> pass through heart, lungs to portal veins> to intestinal or bladder veins depending on species</li>
<li>Adults have long life span 5-7 years and up to 30 years</li>
<li>Eggs appear in feces or urine 1-3 months after cercarial penetration</li>
</ul>
<div>
<br /></div>
</div>
<div>
<u>Pathology</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Itchy papular eruption during cercarial penetration</li>
<li>Response to antigenic and toxic secretions of larval and adult worms and eggs</li>
<li>Acute stage- Katayama syndrome: fever, chills , nausea, abdominal pain, marked eosinophilia, enlarged and tender liver</li>
<li>Daily egg outputs: S. haemotoboium 100, S. mansoni 300 and S. japonicum 1000-3500</li>
<li>Late complications from chronic infections include liver fibrosis, portal hypertension and its sequelae</li>
<li>Bowel obstruction, uropathy, superimposed bacterial infection (Salmonella) and bladder cancer</li>
<li>Eggs depositied in ectopic sites like brain, spinal cord</li>
</ul>
<div>
<br /></div>
<div>
<u>Diagnosis</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li><span style="font-family: inherit;"><span style="background-color: white; line-height: 15.960000038146973px;">Microscopic identification of eggs in stool or urine is the most practical method for diagnosis. Stool examination should be performed when infection with </span><em style="background-color: white; line-height: 15.960000038146973px; margin: 0px; padding: 0px;">S. mansoni</em><span style="background-color: white; line-height: 15.960000038146973px;"> or </span><em style="background-color: white; line-height: 15.960000038146973px; margin: 0px; padding: 0px;">S. japonicum</em><span style="background-color: white; line-height: 15.960000038146973px;"> is suspected, and urine examination should be performed if </span><em style="background-color: white; line-height: 15.960000038146973px; margin: 0px; padding: 0px;">S. haematobium</em><span style="background-color: white; line-height: 15.960000038146973px;"> is suspected.<span style="font-size: x-small;"> </span></span></span></li>
<li><span style="background-color: white; line-height: 15.960000038146973px;"><span style="font-family: inherit;">Kato-Katz, Ritchie technique</span></span></li>
<li><span style="background-color: white; line-height: 15.960000038146973px;"><span style="font-family: inherit;">Antibody detection</span></span></li>
</ul>
<div>
<span style="line-height: 15.960000038146973px;"><br /></span></div>
</div>
<div>
<span style="line-height: 15.960000038146973px;"><u>Treatment</u></span></div>
<div>
<span style="line-height: 15.960000038146973px;"><u><br /></u></span></div>
<div>
<ul>
<li><span style="line-height: 15.960000038146973px;">Infections with all major Schistosoma species can be treated with praziquantel</span></li>
</ul>
<div>
<span style="line-height: 15.960000038146973px;"><br /></span></div>
</div>
<div>
<span style="line-height: 15.960000038146973px;"><u>Epidemiology</u></span></div>
<div>
<span style="line-height: 15.960000038146973px;"><u><br /></u></span></div>
<div>
<ul>
<li><span style="line-height: 15.960000038146973px;">Exposure to contaminated freshwater that is used for agricultural, household, industrial or recreational purposes</span></li>
</ul>
<span style="line-height: 15.960000038146973px;"><div>
<span style="line-height: 15.960000038146973px;"><br /></span></div>
<u>Prevention</u></span></div>
<div>
<span style="line-height: 15.960000038146973px;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div>
<ul>
<li><span style="line-height: 15.960000038146973px;">Prevent exposure to contaminated freshwater</span></li>
<li><span style="line-height: 15.960000038146973px;">Proper disposition of feces and urine </span></li>
<li><span style="line-height: 15.960000038146973px;">Educating the public, treatment</span></li>
<li><span style="line-height: 15.960000038146973px;">Molluskicides for treating snail-breeding sites</span></li>
</ul>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuoNKZnqw93hEcjKeD8HWwHVglLoYxw8eGqlmyf4J1M9_L2V7p5xh_c4J3Kbo187UWwcNtMBBrJY4dQuEkOkKyOC2KtktgIhiaaIGyF6bEqErVYKPk9WtTiAOZyqUAymRhPOAC_PyqjxoE/s1600/shaemo.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuoNKZnqw93hEcjKeD8HWwHVglLoYxw8eGqlmyf4J1M9_L2V7p5xh_c4J3Kbo187UWwcNtMBBrJY4dQuEkOkKyOC2KtktgIhiaaIGyF6bEqErVYKPk9WtTiAOZyqUAymRhPOAC_PyqjxoE/s1600/shaemo.jpg" height="210" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">S. haemotobium egg/CDC<br /><br /><div style="text-align: left;">
<br /></div>
</td></tr>
</tbody></table>
<div>
<span style="line-height: 15.960000038146973px;"><br /></span></div>
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifdVxf4VIk-2pBi-z9N9z3x0Nf0ZeYOoRTtLLSREVbWuclBRWNeWg5nJzsA17V7cfs63pnOAMssmVi2-htUveGdvh3dmPB831t5slb6nB_agexm-FBeAf0bcnifDad2o3Z402hEDF4cdJM/s1600/sman.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifdVxf4VIk-2pBi-z9N9z3x0Nf0ZeYOoRTtLLSREVbWuclBRWNeWg5nJzsA17V7cfs63pnOAMssmVi2-htUveGdvh3dmPB831t5slb6nB_agexm-FBeAf0bcnifDad2o3Z402hEDF4cdJM/s1600/sman.jpg" height="207" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">S. mansoni egg/CDC<br /><br /></td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDimKKTKmwYZAnOQR6I8K4N4LsPQFWyq5IFPybNdhKiHtkbYn5jTSLz3uksoESYwGgdz8qOLThC8eX29_eCSU3rEs2p_a5-Soe3uwUHXsPsFVE85R4CAJLS3m9ZsgUtxtcgLjq2Ju4pDSm/s1600/sjap.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDimKKTKmwYZAnOQR6I8K4N4LsPQFWyq5IFPybNdhKiHtkbYn5jTSLz3uksoESYwGgdz8qOLThC8eX29_eCSU3rEs2p_a5-Soe3uwUHXsPsFVE85R4CAJLS3m9ZsgUtxtcgLjq2Ju4pDSm/s1600/sjap.jpg" height="212" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">S. japonicum egg/CDC</td></tr>
</tbody></table>
<div>
<br /></div>
</div>
Robert Herrimanhttp://www.blogger.com/profile/16844146002845854017noreply@blogger.com0tag:blogger.com,1999:blog-2180019836370555688.post-85210454085528334662014-05-24T08:24:00.000-07:002014-05-24T08:24:29.775-07:00Fasciolopsis buski<div class="separator" style="clear: both; text-align: center;">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBIlWbQ1hfL8KOwhL8udKaBg12ZUMDWXfVGpOHqTjcWZ_tYeyvH1S5H9tCt5n_xwG91eg1sP6qoxW8_80uWqaYS5kgO1TyRFlml3iGu4J_ih8IPvyXt9s6DFJus9EbmC4L_r3mj90rJy_P/s1600/F.+buski+egg.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBIlWbQ1hfL8KOwhL8udKaBg12ZUMDWXfVGpOHqTjcWZ_tYeyvH1S5H9tCt5n_xwG91eg1sP6qoxW8_80uWqaYS5kgO1TyRFlml3iGu4J_ih8IPvyXt9s6DFJus9EbmC4L_r3mj90rJy_P/s1600/F.+buski+egg.jpg" height="210" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fasciolopsis buski egg/CDC</td></tr>
</tbody></table>
<u><br /></u>
<u>General Information</u><br />
<u><br /></u>
<br />
<ul>
<li>Human intestinal trematodiases are associated with eating habits</li>
<li>They are localized to areas where there is water, snail vectors and reservoir hosts</li>
</ul>
<div>
<br /></div>
<div>
<u>Geography</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Widely found in rural southeast Asia, in particular central and south China, parts of India and Thailand</li>
</ul>
<div>
<br /></div>
</div>
<div>
<u>Morphology (adults)</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Fasciolopsis buski is the largest fluke to infect humans, aka Giant Intestinal Fluke</li>
<li>7.0 x 1.5 cm</li>
<li>Large, leaf-shaped, lacks a cephalic cone</li>
</ul>
<div>
<br /></div>
</div>
<div>
<u>Morphology (eggs)</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Large, thin-shelled, unembryonated, operculated</li>
<li>130-150 x 78-98 um</li>
<li>Found in large numbers in feces, too similar to F. hepatica to differentiate</li>
</ul>
<div>
<br /></div>
</div>
<div>
<u>Life Cycle</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Adults in the small intestine</li>
<li>Eggs pass in feces to water where they embryonic</li>
<li>After few weeks, miracidium emerges</li>
<li>Miracidium swims to find suitable snail (Segmentina sp.) as first intermediate host</li>
<li>In the snail-sporocysts>rediae>cercariae</li>
<li>Cercariae released from snail to water</li>
<li>Encyst on aquatic plant as metacercariae</li>
<li>Plant eaten raw by mammalian host (humans and pigs)</li>
<li>Metacercariae excysts and attach to the gut mucosa</li>
<li>Develop into adults in about 3 months</li>
<li>Lives for one year</li>
</ul>
<u>Pathology</u></div>
<div>
<br /></div>
<div>
<ul>
<li>More worms, more disease- usually asymptomatic</li>
<li>Large number of worms attaching to mucosa - bleeding, inflammation and ulceration</li>
<li>Diarrhea (foul smelling greenish-yellow stools), abdominal pain, intestinal obstruction, edema</li>
<li>Toxic products from worms may be absorbed and cause toxemia</li>
<li>Death is rare</li>
</ul>
<u>Diagnosis</u></div>
<div>
<u><br /></u></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div>
<ul>
<li>Travel history</li>
<li>Demonstration of eggs in feces or vomit (eggs indistinguishable from F. hepatica)</li>
<li>Rarely by identifying adult fluke</li>
</ul>
<div>
<u>Treatment</u></div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Praziquantel is the drug of choice</li>
</ul>
<div>
<u>Epidemiology</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Pigs are reservoir hosts</li>
<li>Metacercariae encysts on hard surface, particularly water plants like water caltrop and water chestnuts</li>
<li>The outer cover of plant is peeled off with teeth and metacercariae are released into the mouth</li>
<li>Children more frequently infected--eat water plants going to and from school</li>
</ul>
<div>
<u>Prevention</u></div>
</div>
<div>
<u><br /></u></div>
<div>
<ul>
<li>Treatment</li>
<li>Education</li>
<li>Changing eating habits- do not eat without boiling first</li>
<li>Keep pigs from contaminating areas where water plants grow</li>
<li>Do not feed water plants to pigs</li>
</ul>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_a-6AfU25PVr9vgZJqjLXEXXz9D1D7oJS6qkz5cT6ndEZMOjQcmu8t-Rov3FSwlpRLcWBEmpn2TPAQlt8lQrcZiOO7w3OVtXsSD7s6DMbWBM3S1FTeoYTe5LLjGzGvMbpgHigVQJJNx63/s1600/F.+buski+life+cycle.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_a-6AfU25PVr9vgZJqjLXEXXz9D1D7oJS6qkz5cT6ndEZMOjQcmu8t-Rov3FSwlpRLcWBEmpn2TPAQlt8lQrcZiOO7w3OVtXsSD7s6DMbWBM3S1FTeoYTe5LLjGzGvMbpgHigVQJJNx63/s1600/F.+buski+life+cycle.jpg" height="320" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">F. buski Life Cycle</td></tr>
</tbody></table>
<div>
<br /></div>
</div>
</div>
Robert Herrimanhttp://www.blogger.com/profile/16844146002845854017noreply@blogger.com0tag:blogger.com,1999:blog-2180019836370555688.post-58977149088092130052012-07-15T16:43:00.000-07:002014-05-24T08:25:03.416-07:00Paragonimus westermani<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7HxyDLUbz4Sjk14K5cNNwTf3DziBMO6wWXu3cVIf5krIFTnuSX8Qu5fCtXfveM9deRXQ2d7sgf1e8ZvyzqQz4JDu_aOmcfTVUVC8Spbv2NvfYWKkCujsDtG2ZixV7clNwYxhOsTdkzE3r/s1600/paragonimus.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7HxyDLUbz4Sjk14K5cNNwTf3DziBMO6wWXu3cVIf5krIFTnuSX8Qu5fCtXfveM9deRXQ2d7sgf1e8ZvyzqQz4JDu_aOmcfTVUVC8Spbv2NvfYWKkCujsDtG2ZixV7clNwYxhOsTdkzE3r/s400/paragonimus.jpg" height="266" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Paragonimus westermani egg/CDC</td></tr>
</tbody></table>
<span style="font-family: 'Courier New', Courier, monospace;"><u>General Information</u></span><br />
<span style="font-family: 'Courier New', Courier, monospace;"><u><br /></u></span>
<ul>
<li><span style="font-family: 'Courier New', Courier, monospace;">There are numerous species in the genus Paragonimus that are found worldwide; primarily in Asia, but also Africa (P.africanus and P. uterobilteralis) and South America (P. peruvianus)</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">P. kellicotti is found in North America</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Paragonimus westermani (most common)is also known as the "Oriental Lung Fluke".</span></li>
</ul>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u>Geography</u></span></div>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u><br /></u></span></div>
<div>
<ul>
<li><span style="font-family: 'Courier New', Courier, monospace;">Found throughout Asia</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">China is the major endemic area with 20 million people infected</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Also seen with low prevalence in Japan, Korea, the Philippines, Thailand</span></li>
</ul>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u>Morphology (adults)</u></span></div>
</div>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u><br /></u></span></div>
<div>
<ul>
<li><span style="font-family: 'Courier New', Courier, monospace;">Large, plump flukes</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">7-16 mm length x 4-8 mm width x up to 5 mm thick</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Found in pairs in the lungs; looks like coffee beans</span></li>
</ul>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u>Morphology (eggs)</u></span></div>
</div>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u><br /></u></span></div>
<div>
<ul>
<li><span style="font-family: 'Courier New', Courier, monospace;">Large, thick-shelled </span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">large, flattened operculum</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">80-120 um x 50-65 um</span></li>
</ul>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><br /></span></div>
</div>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u>Life Cycle</u></span></div>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u><br /></u></span></div>
<div>
<ul>
<li><span style="font-family: 'Courier New', Courier, monospace;">Unembryonated eggs passed into lung tissue and excreted in sputum; or swallowed and excreted in the feces</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Eggs embryonate in the water and miracidia emerge from egg and search for specific species of snail (first intermediate host)</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">In the snail, miracidia goes transforms-sporocyst> rediae> cercariae</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Cercariae leaves snail and invades second intermediate host, a crustacean, typically a crab or crayfish</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">The cercariae encysts into metacercariae (infective stage for human or animal host)</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Human infected after eating inadequately cooked crustacean</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Metacercariae excysts in small intestine and penetrates the gut wall</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Peritoneal cavity> abdominal wall> diaphragm> lungs</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Develop into adults in the lungs</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Prepatent period is 2-3 months</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Infection can last for years to decades</span></li>
</ul>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u>Pathology</u></span></div>
</div>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u><br /></u></span></div>
<div>
<ul>
<li><span style="font-family: 'Courier New', Courier, monospace;">Migration of young worms (acute)may produce diarrhea and abdominal pain</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">When established in the lungs: Fever, cough, rusty-brown sputum, hemoptysis (often thought to be tuberculosis at first)</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Migration of worms to other organs(erratic paragonimiasis) can be very severe, particularly when brain is involved</span></li>
</ul>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u>Diagnosis</u></span></div>
</div>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u><br /></u></span></div>
<div>
<ul>
<li><span style="font-family: 'Courier New', Courier, monospace;">The presence of eggs in sputum or stool.</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Serodiagnosis</span></li>
</ul>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u>Treatment</u></span></div>
</div>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u><br /></u></span></div>
<div>
<ul>
<li><span style="font-family: 'Courier New', Courier, monospace;">Praziquantel is the drug of choice</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Bithionol is alternate treatment</span></li>
</ul>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u>Epidemiology</u></span></div>
</div>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u><br /></u></span></div>
<div>
<ul>
<li><span style="font-family: 'Courier New', Courier, monospace;">Humans or other mammals are definitive host</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Humans get infected eating undercooked crabs or crayfish</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">China- "Drunken crabs" soaked in rice wine</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Philippines- roast crabs</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Thailand- raw crayfish salad</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Korea- soak crab in soy sauce</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Use of crab juice for seasoning and medicinal purposes</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Africa- undercooked crabs for fertility</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Pickled crabs</span></li>
</ul>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><u>Prevention</u></span></div>
</div>
<div>
<ul>
<li><span style="font-family: 'Courier New', Courier, monospace;">Stress the importance of fully cooking crustaceans</span></li>
<li><span style="font-family: 'Courier New', Courier, monospace;">Proper disposal of sputum and feces</span></li>
</ul>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizjGVSvlqF8-OmEzBg3s2EVcmPTeGJTQz1jcofaWTe-iMcZbPY6JJ93nr9I2X_hGRhHN-SL3tBspGsM7DFiaSkopLw_ON-oa1CHU8O4TLt1P-jUcFLs3EETDMjsc3wELy4EGVhhpmknYq7/s1600/Paragonimus_westermani_adult.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizjGVSvlqF8-OmEzBg3s2EVcmPTeGJTQz1jcofaWTe-iMcZbPY6JJ93nr9I2X_hGRhHN-SL3tBspGsM7DFiaSkopLw_ON-oa1CHU8O4TLt1P-jUcFLs3EETDMjsc3wELy4EGVhhpmknYq7/s320/Paragonimus_westermani_adult.jpg" height="212" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Paragonimus westermani adult/CDC</td></tr>
</tbody></table>
<div>
<span style="font-family: 'Courier New', Courier, monospace;"><br /></span></div>
</div>
Robert Herrimanhttp://www.blogger.com/profile/16844146002845854017noreply@blogger.com0tag:blogger.com,1999:blog-2180019836370555688.post-90386398882400668842012-04-22T16:59:00.002-07:002012-04-22T17:00:36.722-07:00Clonorchis sinensis<br />
<div class="MsoNormal">
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGCmOJfpa2dX7NfDeP03Z1UnuIgskdpNKTbLQ4qtycg41a7NbqsEgTCokJxPGEt-clzh2vHUSlNks81JuAZOpeyAVquuONmlljmYnd6W4XMy6FfpNfoVlr5wrbtD4NX5403rDl_1Ra6Zhf/s1600/clonorchis+egg.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGCmOJfpa2dX7NfDeP03Z1UnuIgskdpNKTbLQ4qtycg41a7NbqsEgTCokJxPGEt-clzh2vHUSlNks81JuAZOpeyAVquuONmlljmYnd6W4XMy6FfpNfoVlr5wrbtD4NX5403rDl_1Ra6Zhf/s400/clonorchis+egg.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Clonorchis sinensis egg Photo/CDC</td></tr>
</tbody></table>
<br />
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';"><br /></span></u></div>
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';">General
Information<o:p></o:p></span></u></div>
<div class="MsoListParagraphCxSpFirst">
</div>
<ul>
<li><span style="font-family: 'Courier New';">Clonorchis
sinensis is a trematode or fluke also known as the “Chinese liver fluke” or “Oriental
liver fluke”</span></li>
<li><span style="font-family: 'Courier New';">Clonorchiasis
is a trematode disease of the bile ducts</span></li>
<li><span style="font-family: 'Courier New';">Adult
flukes produce an estimated 4,000 eggs per day per worm</span></li>
</ul>
<br />
<div class="MsoNormal">
<span style="font-family: 'Courier New';"><u><br /></u></span></div>
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';">Geography<o:p></o:p></span></u></div>
<div class="MsoListParagraphCxSpFirst">
</div>
<ul>
<li><span style="font-family: 'Courier New';">Asia
only</span></li>
<li><span style="font-family: 'Courier New';">Mainland
China, highly endemic in southeastern China</span></li>
<li><span style="font-family: 'Courier New';">Taiwan,
Korea, Vietnam</span></li>
<li><span style="font-family: 'Courier New';">Reports
outside of Asia are important (imported cases)</span></li>
</ul>
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';">Morphology
(adults)<o:p></o:p></span></u></div>
<div class="MsoListParagraphCxSpFirst">
</div>
<ul>
<li><span style="font-family: 'Courier New';">Slender,
pointed anterior, rounded posterior</span></li>
<li><span style="font-family: 'Courier New';">1-2
cm long and 3-5 mm wide</span></li>
<li><span style="font-family: 'Courier New';">Characteristic
branching testes posterior</span></li>
</ul>
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';">Morphology (eggs)<o:p></o:p></span></u></div>
<div class="MsoListParagraphCxSpFirst">
</div>
<ul>
<li><span style="font-family: 'Courier New';">Small,
26-30 x 15-17 um</span></li>
<li><span style="font-family: 'Courier New';">Ovoid,
yellowish color</span></li>
<li><span style="font-family: 'Courier New';">Operculated
at one end, small knob at opposite end</span></li>
</ul>
<br />
<div class="MsoNormal">
<span style="font-family: 'Courier New';"><u><br /></u></span></div>
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';">Life Cycle<o:p></o:p></span></u></div>
<div class="MsoListParagraphCxSpFirst">
</div>
<ul>
<li><span style="font-family: 'Courier New';">Adults
in biliary ducts, embryonated eggs pass to intestine and out with the feces</span></li>
<li><span style="font-family: 'Courier New';">Eggs
reach water, ingested by suitable snail (P. manchouricus)</span></li>
<li><span style="font-family: 'Courier New';">In
the snail (first intermediate host, eggs release miracidium and goes through
several stages in host (sporocyst>rediae>cercariae)</span></li>
<li><span style="font-family: 'Courier New';">Cercariae
released from snail, free-swimming in water, penetrates under scales of an
appropriate freshwater fish (second intermediate host)</span></li>
<li><span style="font-family: 'Courier New';">Metacercariae
encyst in the fish muscle</span></li>
<li><span style="font-family: 'Courier New';">Humans
infected by eating raw, partially cooked, smoked or pickled fish</span></li>
<li><span style="font-family: 'Courier New';">Metacercariae
excysts in the duodenum</span></li>
<li><span style="font-family: 'Courier New';">Ascends
up through intestine to bile ducts</span></li>
<li><span style="font-family: 'Courier New';">Matures
to adult in 30 days</span></li>
<li><span style="font-family: 'Courier New';">Worms
may live 30-40 years in final host</span></li>
<li><span style="background-color: white; font-family: 'Courier New';">Carnivorous animals can serve as reservoir hosts</span></li>
</ul>
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';">Pathology<o:p></o:p></span></u></div>
<div class="MsoListParagraphCxSpFirst">
</div>
<ul>
<li><span style="font-family: 'Courier New';">Most
infections are asymptomatic</span></li>
<li><span style="font-family: 'Courier New';">More
progressive infections may see anorexia, jaundice, diarrhea, epigastric pain,
fever</span></li>
<li><span style="font-family: 'Courier New';">Some infections
associated with severe complications:</span><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; font-family: Verdana, sans-serif;"> </span></span><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; font-family: 'Courier New';">pancreatitis</span><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; font-family: Verdana, sans-serif;">,</span><span style="font-family: 'Courier New';"> cholangitis and cholangiocarcinoma (bile
duct cancer)</span></li>
</ul>
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';">Diagnosis<o:p></o:p></span></u></div>
<div class="MsoListParagraph">
</div>
<ul>
<li><span style="font-family: 'Courier New';">Finding the
characteristic eggs in feces or duodenal aspirate</span></li>
</ul>
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';">Treatment<o:p></o:p></span></u></div>
<div class="MsoListParagraph">
</div>
<ul>
<li><span style="background-color: white; font-family: 'Courier New';">Praziquantel or albendazole are the drugs of choice</span></li>
</ul>
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';">Epidemiology<o:p></o:p></span></u></div>
<div class="MsoListParagraphCxSpFirst">
</div>
<ul>
<li><span style="font-family: 'Courier New';">Clonorchiasis
is endemic where there is poor sanitation, and</span></li>
<li><span style="font-family: 'Courier New';">The
right snail host, and</span></li>
<li><span style="font-family: 'Courier New';">The
right fish (cyprinoid fish) as the second intermediate host, and</span></li>
<li><span style="font-family: 'Courier New';">A
population who eats raw, poorly pickled, smoked, dried or salted freshwater
fish</span></li>
</ul>
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<u><span style="font-family: 'Courier New';">Prevention<o:p></o:p></span></u></div>
<div class="MsoListParagraphCxSpFirst">
</div>
<ul>
<li><span style="font-family: 'Courier New';">Thoroughly
cook all freshwater fish, irradiate or freeze at -10C for at least 5 days</span></li>
<li><span style="font-family: 'Courier New';">Educate
the public in endemic areas about the dangers of eating raw or improperly
cooked fish</span></li>
<li><span style="font-family: 'Courier New';">Proper
disposal of feces</span></li>
</ul>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSCCqxGCp-h0mbOQqCAafgyf55z9nyJaqk90DcqMbAjM-tGTqBwNBtiCX8uQ7gXZb6sqLDJKaLSNJz1mZOfovstYsN5bpk499NBQkYp5GhKLUvwRfHYqg08Ko-8hGoCGIx-d8x61f7QW-n/s1600/204px-Clonorchis_sinensis_2.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSCCqxGCp-h0mbOQqCAafgyf55z9nyJaqk90DcqMbAjM-tGTqBwNBtiCX8uQ7gXZb6sqLDJKaLSNJz1mZOfovstYsN5bpk499NBQkYp5GhKLUvwRfHYqg08Ko-8hGoCGIx-d8x61f7QW-n/s400/204px-Clonorchis_sinensis_2.png" width="135" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">C. sinensis adult</td></tr>
</tbody></table>
<span style="background-color: #f9f9f9; font-family: sans-serif; font-size: 12px; line-height: 19px;">Photo/Banchob Sripa, Sasithorn Kaewkes, Paiboon Sithithaworn, Eimorn Mairiang, Thewarach Laha, Michael Smout, Chawalit Pairojkul, Vajaraphongsa Bhudhisawasdi, Smarn Tesana, Bandit Thinkamrop, Jeffrey M. Bethony, Alex Loukas & Paul J. Brindley via Wikimedia Commons</span><br />
<div class="MsoListParagraphCxSpLast">
<br /></div>
<br />Robert Herrimanhttp://www.blogger.com/profile/16844146002845854017noreply@blogger.com1tag:blogger.com,1999:blog-2180019836370555688.post-4093395461061189102012-04-15T15:05:00.000-07:002012-04-15T15:05:13.025-07:00Fasciola hepatica<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUNNc85xmnLhIBDcrxk7f9VhQJr-cJnGybuTxZFHgb7k6NmH9T0P2r8tkP7RhQtW5vdPigDOnnDYlJhrN3dDOtKk-kv56VmzppqVdUrpzWkq2d6Ou43WuWbdhcHL4igZZQMwsmLvS_QOo9/s1600/fasciola.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="262" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUNNc85xmnLhIBDcrxk7f9VhQJr-cJnGybuTxZFHgb7k6NmH9T0P2r8tkP7RhQtW5vdPigDOnnDYlJhrN3dDOtKk-kv56VmzppqVdUrpzWkq2d6Ou43WuWbdhcHL4igZZQMwsmLvS_QOo9/s400/fasciola.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Fasciola hepatica egg Photo/CDC</td></tr>
</tbody></table><br />
<div class="MsoNormal"><u><span style="font-family: "Courier New";">General Information<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Fasciola hepatica is a trematode or fluke also known as the “sheep liver fluke”<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">All trematodes are parasitic<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">All trematodes have a phase of their life cycle in snail or other molluscan host<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">All trematodes are associated with water<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Facioliasis is a zoonotic disease<o:p></o:p></span></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";">Geography<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 55.5pt; mso-add-space: auto; mso-list: l4 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Human infection has been reported from over 60 countries, mainly in sheep-raising areas<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 55.5pt; mso-add-space: auto; mso-list: l4 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Important public health problem in Latin America (Peru, Bolivia, Cuba), Russia, parts of Europe and Iran<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 55.5pt; mso-add-space: auto; mso-list: l4 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Reported sporadically in the US<o:p></o:p></span></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";">Morphology (adults)<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Leaf-shaped with cephalic cone<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">3.0 x 1.3 cm<u><o:p></o:p></u></span></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";">Morphology (eggs)<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l8 level1 lfo4; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Large, ovoid, thin-shelled, operculated, yellowish-brown in color<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l8 level1 lfo4; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">130-150 x 90 um in size<u><o:p></o:p></u></span></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";">Life Cycle<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Adult fluke in biliary passages<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Immature eggs are discharged in feces<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Eggs embryonate in the water<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Eggs hatch and release miracidia<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Miracidia invade suitable snail host (intermediate host)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Development in snail (sporocyst>rediae>cercariae)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Cercariae leaves snail and encyst on aquatic vegetation as metacercariae<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Metacercariae on uncooked water plant is ingested by human, sheep or cattle (F. gigantica)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Metacercariae excyst in the duodenum<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Migrates through intestinal tract, peritoneal cavity and liver parenchyma into bile ducts<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Matures into adults<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Maturation from metacercariae to adult fluke takes up to 4 months<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l1 level1 lfo5; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">In humans, adult flukes can produce eggs for 9 years<o:p></o:p></span></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";">Pathology<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l7 level1 lfo6; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Migrating flukes can cause abdominal pain, liver enlargement and fever<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l7 level1 lfo6; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Blockage of bile ducts, portal cirrhosis, eosinophilia, jaundice, diarrhea and anemia<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l7 level1 lfo6; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Halzoun: In humans that eat raw sheep liver. Adult flukes leave liver and attach to throat causing blockage<u><o:p></o:p></u></span></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";">Diagnosis<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l9 level1 lfo7; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">In endemic areas, symptoms suggest infection<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l9 level1 lfo7; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">History of eating uncooked watercress and water lettuce<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l9 level1 lfo7; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Finding eggs in feces or biiary drainage. Eggs of F. hepatica and Fasciolopsis buski too similar to differentiate. Check travel history.<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l9 level1 lfo7; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Antibody detection: <span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial;">enzyme immunoassays (EIA) with excretory-secretory (ES) antigens combined with confirmation of positives by immunoblot</span></span><u><o:p></o:p></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";">Treatment<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraph" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l2 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: 'Courier New';">The drug of choice is triclabendazole with bithionol as an alternative</span><u><span style="font-family: "Courier New";"><o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";">Epidemiology<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l2 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Sheep-raising countries (and cattle) where there is a suitable snail host (Lymnea sp).<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l2 level1 lfo8; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Where humans eat uncooked watercress and other aquatic plants in salads or on sandwiches<u><o:p></o:p></u></span></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";">Prevention and Control<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l6 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Educate public in endemic areas not to eat wild (uncooked) watercress and other water plants<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l6 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Avoid using livestock feces to fertilize water plants<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l6 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Treat animal infections<u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l6 level1 lfo9; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Courier New";">Using molluskicides<u><o:p></o:p></u></span></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";">Other Information<o:p></o:p></span></u></div><div class="MsoNormal"><u><span style="font-family: "Courier New";"><br />
</span></u></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l5 level1 lfo10; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: 'Courier New';">False fascioliasis (pseudofascioliasis): this is the presence of eggs in the stool resulting not from an actual infection but from recent ingestion of infected livers containing eggs. </span><u><span style="font-family: "Courier New";"><o:p></o:p></span></u></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l5 level1 lfo10; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: 'Courier New';">Have the patient follow a liver-free diet several days and repeat stool examination. </span><u><span style="font-family: "Courier New";"><o:p></o:p></span></u></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l5 level1 lfo10; text-indent: -.25in;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: 'Courier New';"><br />
</span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxodsSuakmi8gA3lFgTGkNgt2jhrBAzQKQxPT4jpO4X_rIpep5MbtilfUiAuvvc-FOuGQhdd7GPZd8_m6Uh8upoVjeD6yPzFRGZbyGATeLNxRma1Sn6YCfCvxQVO9ySsEiOTDyi7ohFM0-/s1600/Fasciola_hepatica+adult.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="170" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxodsSuakmi8gA3lFgTGkNgt2jhrBAzQKQxPT4jpO4X_rIpep5MbtilfUiAuvvc-FOuGQhdd7GPZd8_m6Uh8upoVjeD6yPzFRGZbyGATeLNxRma1Sn6YCfCvxQVO9ySsEiOTDyi7ohFM0-/s400/Fasciola_hepatica+adult.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Adult Fasciola hepatica Photo/Adam Cuerden via Wikimedia Commons</td></tr>
</tbody></table><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l5 level1 lfo10; text-indent: -.25in;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; font-family: 'Courier New';"><br />
</span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l5 level1 lfo10; text-indent: -.25in;"><span style="font-family: 'Courier New';"><br />
</span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.75pt; mso-add-space: auto; mso-list: l5 level1 lfo10; text-indent: -.25in;"><span style="font-family: 'Courier New';"><br />
</span></div>Robert Herrimanhttp://www.blogger.com/profile/16844146002845854017noreply@blogger.com4