LIVER FLUKES

Fasciola hepatica Fasciola gigantic Clonorchis sinensis Opisthorchis Opisthorchis viverrini

(Fasciola magna) (The Chinese or felinens
oriental liver fluke) (The cat liver fluke)
Disease Fascioliasis
Geo distributn Cosmopolitan It is a parasite of: Japan, China, South Eastern and Thailand, Laos in SEA
Sheep- and cattle-raising -Cattle, water buffalo, Korea, Formosa, and southestern Europe
countries camels, wild hogs Vietnam Asiatic areas of the
Human infection is -Herbivora and former USSR
common occasionally man in
Africa, Asia and Hawaii

Epidemiology .Primarily an animal d/s .Clonorchis infection may .very prevalent in

.Human infection: predispose to hepatic Thailand
-Ingestion of plants such as watercress and cholangiosarcoma .Association w
-Water containing encysted metacercariae cholangiocarcinoma
.Herbivorous or omnivorous animals .Acquired by eating
-Acquire the infection in the low damp pastures uncooked fish containing
where the vegetation is infested with metacercariae the infective
metacercariae
Habitat Proximal bile passages, gallbladder Mainly distal biliary Distal bile, occasionally
Occasionally ectopic sites passages pancreatic ducts,
May be in the gallbladder sometimes the
Occasionally in the gallbladder
pancreatic duct
DH Sheep, cattle, deer, rabbits Fish eating mammals Cats, dogs, foxes, hogs People
Other herbivorous mammals (reservoir hosts) Man, dog, hog, cat Man (in endemic areas) Civet cats, cats, dogs,
Rarely man other fish-eating animals
Morphology / Leptocercous cercaria The adult worm is The egg: 7 – mm by 1.5 – 3 mm, Egg:
Life cycle distinguished from Light yellowish brown resemble Clonorchis 26 by 13 µ, resemble
Fasciola hepatica by: Size: 29 by 16 µ sinensis Clonorchis sinensis
-Greater length Have a thick shell & a
-Shorter cephalic cone pitcher shape .The ventral sucker is
-Larger ventral sucker At the smaller end, the of the same size as the
-Borders are parallel operculum rests in a rim oral sucker
-Medial branches of w distinct shoulders . 2 lobed testes
intestinal ceca T or Y At the thicker posterior (branched in
shape end is a small Clonorchis sinensis)
-More anterior position protuberances obliquely situated
of the reproductive Content: fully developed .Vitelline glands of
1
 organs miracidium
-Larger egg
-Different snail IH 1st IH: Snail of genera
species Alocima and
parafossarulus which
ingests the eggs
The miracidium hatch
inside the snail t/s &
metamorphose into
sporocyst, rediae and
cercariae
The free swimming
cercariaw w finned tail
(lophocercous) r
liberated
The cercariae:
-penetrate the 2nd IH, a
fish, beneath the scales
-losing its tail, encysts as
an ovoid metacercariae
-Chiefly in m/s and s.c.
t/s
-in 14 species of
freshwater fish of family
cyprinidae
Human gets the infectn
by:
-eating improperly
cooked fish containing
infection metacercariae
-less often by ingestion
of cysts in drinking water
Pathology 1.Liver root .Mechanical irritation of
2
follicles limited to
middle third of the
body on either sides of
intestinal ceca
Eggs:
30 by 12 µ
Contain fully developed
miracidium
Narrower than
C.sinensis &
-hv more tapering
sides,
-pointed terminal knob
-a less conspicuous
opercular rim
1st IH: Snails Bulimus,
infected by feces
deposited on sandy
shores & washed into
stream
2nd IH: cyprinoid fish.
The eggs hatch inside
the digestive gland of
the snail
Miracidium develop
into sporocyst & redia
Cercariae encyst in the
fish & become infective
metacercariae
The infection is
acquired by eating raw
or insufficient cooked
fish
Cats r the most
important reservoir
hosts in highly endemic
areas
Biliary epithelium
 >Mechanical or traumatic lesions: the distal bile ducts – already hyperplastic
-Migration of metacercariae toxic secretions From the presence of
-Toxic effects .Slight leukocytosis & worms,
>Inflammatn, necrosis & fibrosis eosinophilia Stimulated by
.Liver may become nitrosamines in foods or
2.Inflammatory & adenomatous changes enlarged and tender By nitrose compounds
>Mucosa of bile ducts fibrosis & obstruction .The bile ducts: produced by
>Cholecystitis & cholelithiasis -gradually thicken macrophages in
-become dilated & chronically affected
3.Migrating larvae, in ectopic foci: tortuous tissue
>Abscesses or fibrotic lesions -adenomatous proliferatn
>Lung, brain, orbit, and subcutaneous tissues of epithelium
.Fibrosis & destructn of
4.HALZOUN – mechanical suffocation hepatic – liver f(x) is
impaired

Sign/Symptom • Stabbing substernal pain & right upper 1.Mild symptoms w light Similar to Clonorchis
s/ quadrant pains may be the 1st evidence of infection sinensis
Clinical infection 2.Indigestion, epigastric
manifestation • With progression of infection: discomfort unrelated to
o Liver enlarged & tender meals, weakness, and
o Biliary colic, jaundice loss of weight
o Generalised abdominal pain 3.Heavy infections r
complicated by
o Digestive disturbances, diarrhea
cholelithiasis
o Anemia
& bouts of pyogenic
Eosinophilia
cholangitis
4.Signs of liver failure
Diagnosis 1.History 1.Clinical signs in Eggs in stool of Eggs in stool of duodenal
2.Clinical picture & prominent eosinophilia endemic areas w history duodenal drainage drainage
3.Direct methods of eating uncooked fish
-Finding characteristic eggs in stool 2.Eggs in stool or biliary
-False diagnosis. Avoided by liver-free diet for few drainage
days before examination Eggs require differentiatn
4.Indirect methods (immunological) useful in early from those of
infection and ectopic Fascioliasis: opisthorchid heterephyid
-Intradermal (intracutaneous) test flukes
-Complement fixation test
Treatment 1.Dicholorophenol (bithionol) Praziquantel Praziquantel Praziquantel
2.Dehydroemetine
-since both drugs are cardiotoxic the pt should rest
3
 during therapy
3.Metronidazole
4.Praziquantel
Prevention 1.Snail control 1.Good cooking of fish in Proper cooking of dish Eating only cooked fish
2.Treatment of infected sheep and cattle (reservoir endemic areas. Proper sanitary
host) – main source of infection to the snails 2.Refrigeration, salting, disposal of human
3.Avoid eating raw vegetables before proper or the addition of vinegar excreta
washing or sauce does not kill
4.Water from possibly polluted sources should be Metacercariae
boiled 3.Storage or addition of
5.A safe water supply ammonium sulphate may
affect sterilization of
human feces
4.Molluscacides capable
of destroying the snail
may destroy fish and
other aquatic life