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Parasitology-Lec 4 Anisakis (Kat)

Parasitology-Lec 4 Anisakis (Kat)

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Nematodes II
Lecture 4; Dr. Lagamayo
ANISAKIS
DISEASE:Anisakiasis, herring disease
HISTORY:

\ue000 a recently recognized parasitic infection
\ue000 1955- first case was first described from the Netherlands
\ue000 third stage larva is ingested by humans in the flesh of raw fish

\ue000infection is a human zoonosis with people as accidental hosts
\ue000 noted among Dutchmen who eat their herring raw
\ue000 migration of Anisakis larvae from the viscera to the musculature
after death of the fish
\ue000 very common in Japan
LIFE CYCLE
Intermediate Host
for the larvae
marine crustaceans
and Fish (Body cavity,
liver muscles)
Larvae
Eggs

Definitive Host
for adult parasite-
marine mammals;
(Dolphin, whale, porpoise)
Seals \u2013 (Pseudoteranova)

EPIDEMIOLOGY:
\ue000In adult males: raw marine food with alcoholic beverages
\ue000Northern Europe: raw or \u201cgreen\u201d herring marinated with vinegar and
salt or smoked
\ue000Japan: sashimi from squid,cod, salmon,or mackerel
PATHOLOGY AND SYMPTOMATOLOGY:
\ue000 depends on the site of the lesion
\ue000 Pseudoterranova spp.- do not penetrate the stomach or gut wall
and likely to cause throat irritation and coughed out
PATHOLOGY OF ANISAKIS
\ue000Anisakis simplex- ( USA):
-
stomach or upper small intestines with severe inflammatory
reaction surrounding the larva
PATHOLOGY OF ANISAKIASIS:
\ue000local tissue response:
-

granulomatous, foreign-body type reaction or massive
eosinophilic infiltration with hemorrhage, fibrinous exudate,
and edema of intestinal wall that produces intestinal
obstruction

\ue000Eustrongylides spp.
-
causes perforation of large bowel in several cases after
eating raw fish
SYMTOMATOLOGY OF ANISAKIASIS:
\ue000Gastric involvement:
-
epigastric or midabdominal pain, nausea, vomiting
-
acute or chronic over a period of week or months
\ue000 Small bowel:
-
present as partial intestinal tract obstruction within 7 days of
ingestion of raw seafood
DIAGNOSIS OF ANISAKIASIS:

\ue000endoscopy for diagnosis and treatment
\ue000 larvae are removed from the stomach wall by biopsy forceps
\ue000surgical intervention for obstruction and perforation
\ue000 immunologic tests still under study
\ue000 otherwise, managed conservatively

ANGIOSTRONGYLUS NEMATODES:
A. cantonensis
A. costaricensis
DISEASE: ANGIOSTRONGYLIASIS
\ue000A. cantonensis:
-
infective larvae ingested by a person, migrate to the brain
and spinal cord, producing eosinophilic meningoencephalitis
\ue000 A. costaricensis:
-
acute inflammatory lesion of the ileocecal region
LIFECYCLE OF ANGIOSTRONGYLUS:
A. cantonensis (Rat Lung worm)
Eggs into the pulmonary
vessels
RATS
RATS
Smaller blood
vessels
Respiratory
tract(trachea)
larvae
larvae
RAT
FECES
swallowed
Mollusks:interm. host)
Snails: Achantina
Pila
Slugs, Planaria,
Freshwater prawns
Infective 3
Infective 3rd
rdstage larvae
stage larvae
Eaten by Man & Rats
Migrates to the brain
and spinal cord
Remain as larvae
MAN
MAN
ADULT
(lungs)
Cotton rat
(Sigmodon hispidus)
Mollusks(intermediate
host): Snails, slugs
Infective 3
Infective 3rd
rdlarvae stage
larvae stage
Eaten by Man & Rats
Eaten by Man & Rats
MAN
MAN
Mesenteric arterioles of

Ileocecal region; eggs
deposited in the
intestinal wall;

embryonate & hatch
as1
1st
ststage larvae
stage larvae
migrate to the intestinal
lumen (Rat feces)
Gut wall
Do not hatch
Severe
inflammatory rxn
ADULT Parasite
EPIDEMIOLOGY OF ANGIOSTRONGYLUS:
Possible route of infection:
\ue000transfer of infective larvae from snails to paratenic hosts, such
freshwater prawns used in dishes
\ue000 contamination of water or vegetables by infective larvae
\ue000Human eosinophilic meningitis:
-
wide geographic distribution: Taiwan, Thailand, Cambodia,
Vietnam, Indonesia, Hawaii, Tahiti
PATHOLOGY AND SYMPTOMATOLOGY OF ANGIOSTRONGYLUS:
\ue000Acute meningoencephalitis with eosinophils in the CSF
-
acute onset of severe headache, nuchal rigidity, and low-
grade fever; ICP
-
nausea and vomiting are common
-
paresthesias and cranial nerve involvement: diplopia and
strabismus
-
CSF:\u2265500 cells/mm3, with 10-90% eosinophils
\ue000A. costaricensis infection:
-
\u201cacute abdomen\u201d \u2013 abdominal pain and tenderness localized
to the right lower quadrant with low-grade fever
-
2-4 weeks duration with palpable tumorlike mass
-
leukocytosis and eosinophilia
-
terminal ileum, cecum, and ascending colon show edema
and thickening of the bowel wall with mesenteric adenitis
-
histologically: granulomatous, eosinophilic inflammatory
reaction with adult worms and eggs in tissue
DIAGNOSIS OF ANGIOSTRONGYLIASIS:

\ue000 history of travel to or residence in endemic area
\ue000 inquiry into eating habits and food eaten
\ue000 leukocytosis and eosinophilia
\ue000 eosinophilic meningitis, differential dx:

-
cerebral cysticercosis, trichinosis, visceral larva migrans,
schistosomiasis, gnathostomiasis
\ue000Differential dx of abdominal angiostrogyliasis :
-
acute appendicitis
-
granulomatous disease of the bowel
-
tumor
\ue000 Skin test has not been critically evaluated
TREATMENT OF ANGIOSTRONGYLIASIS:
\ue000 No recommended antihelminthics

\ue000 dead parasite could exacerbate tissue reaction
\ue000 anti-inflammatory agents need evaluation
\ue000 surgical intervention if necessary

PREVENTION OF ANGIOSTRONGYLIASIS:
\ue000 Boiling infected snails and prawns for 2 minutes
\ue000 refrigeration at \u2013150C for 24 hrs.
\ue000 careful washing and cooking of vegetables
\ue000 hygienic practices of handwashing
\ue000 drinking of safe water
DRACUNCULUS MEDINENSIS
DISEASES:
-
Dracontiasis, dracunculosis, guinea worm, fiery serpent of
Israelites
LIFE CYCLE:
EPIDEMIOLOGY:

- Central belt of African countries
- Asia, India, Pakistan
- Middle East: Saudi Arabia, Yemen

PATHOLOGY and SYMPTOMATOLOGY:
-
worms in the mesenteric tissues explain pseudoperitonial
syndromes and allergic manifestations
-
liberates toxic substance that produces local inflammatory
reaction in a form of a blister with serous exudation
-
blisters are located in the legs,ankles, and feet, in between
the toes which favors escape of the larvae to the water
-
complication: abscesses, cellulitis, extensive ulceration, and
necrosis
-
symptoms occurs just previous to the local eruption of the
worm:
- urticaria
- erythema
- dyspnea
- vomiting
- pruritus
- giddiness
-
symptoms subside with rupture of the worm
DIAGNOSIS:
- local lesion, worm or larvae
- calcified worms by X-ray
TREATMENT:
- Metronidazole, 250 mgs. TID x 7 days
- Thiabendazole, 25 mgs/kg BW
BID x 2 to 3 days
PREVENTION:
-
Education
-
use of running water supplies
-
boiling water
-
prohibiting bathing and washing on sources of drinking
water
-
treat water supply with chlorine or copper sulfate, or planting
fish destructive to the crustaceans(Cylcops)
THE FILARIAE
Wuchereria bancrofti
Onchocerca volvulus
Brugia malayi
Loa loa
Brugia timori

(Mansonella ozzardi,
O. perstans,
O. streptocercum)

-
live in tissues or body cavities of vertebrate host
-
produce microfilaria sheathed unsheated
-
blood sucking arthropods \u2013 as intermediate host -
mosquitos, black flies,
-
ovoviviparous
WUCHERERIA BANCROFTI (Bancroft\u2019s filarial worm)
1863 \u2013 Demarquay described
microfilaria
1877 \u2013 adult by Bancroft in Australia ;

Lewis in India
- geographic distribution \u2013 practically all warm regions of the world.
Morphology: threadlike

Adult: male 40 mm X 0.1 mm
female 80-100 mm X .25 mm

Microfilariae \u2013 270 X 9 micra
- smooth cuticula
- rounded anterior, blunt tail
- sheathed

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