26th Intensive Training Course on Diagnostic Parasitology, June 15-19, 2015, Lara Hall, CPH

Food-Borne Helminthes

Lydia R. Leonardo, DrPH

Department of Parasitology
College of Public Health
University of the Philippines Manila
 Food Borne Helminthes
• Capillaria philippinensis
• Paragonimus westermani
• Heterophyids
• Echinostoma ilocanum
 Capillaria philippinensis adult

male worms average 2.6 mm in length;

the female worms are somewhat larger,
averaging 3.6 mm in length
 Life Cycle of Capillaria
philippinensis

IH:small fresh- or
brackish-water fish
("birut," "bagsang", and
"bagsit,“)
DH:fish-eating birds
Eggs are ovoid or peanut-shaped and with flattened bipolar plugs.
Superficially they resemble the eggs of the whipworm, Trichuris
trichiura, but have broader shoulders and a striated shell.
 Epidemiology
• First recorded in Northern Luzon in the
Philippines
• Later reported in Thailand, Iran, Japan, Egypt,
Korea, Taiwan and India
• Nearly 2,000 cases reported from the Northern
Luzon provinces, Zambales and Southern Leyte
• Recently described in Compostela Valley province
and Zamboanga del Norte
 Pathology

•Autopsy on the first victim who died of extreme emaciation

after three weeks of intractable diarrhea
•Intestinal villi become flattened and crypts of Lieberkuhn
atrophy
•Small bowel wall may be thickened and indurated and
bowel distended with gray watery fluid.
•Causes protein-losing enteropathy and malabsorption
•Pathological changes may occur in distant parts of the
body due to malnutrition and electrolyte depletion
Lobar pneumonia, lung abscesses, congested spleen, and
damaged kidneys have been reported.
 Multiple tangential sections of adult worms in the human small
bowel mucosa.
The worms live in the lumen of the glands or crypts and sometimes
the anterior ends of the worms penetrate into the lamina propria,
causing infiltration with lymphocytes and plasma cells.
 Autopsy specimen of human intestine showing
numerous sections of C. philippinensis (arrows) and debris.
Both oviparous and larviparous female parasites have been found at autopsy in the
tissues of humans dying of this disease, which indicates that autoinfection occurs within
the human host. Thus the parasite can carry out its life cycle entirely within the human
intestine.
The specific diagnosis of Capillaria philippinensis infection normally
requires the demonstration of C. philippinensis eggs in the stool of the
patient, or in tissue biopsies taken from the small intestine. Typically
the eggs found in the feces are unembryonated. However, in rare and
serious infections, it is possible to also find embryonated eggs, larvae,
and adult worms in the feces. Such findings are usually indicative of
autoinfection and are often accompanied by considerably greater
numbers of the Capillaria philippinensis parasite.
 Treatment
• Albendazole 400 mg once daily for 10 days
• Mebendazole 200 mg once daily for20 days
 Paragonimus westermani

Lung fluke causing

paragonimiasis,pulmonary
distomiasis, endemic
hemoptysis or parasitic
hemoptysis
Life Cycle of
Paragonimus
westermani
 Epidemiology
• With global distribution in freshwater crabs
• Major endemic areas in Japan, South Korea,
Thailand, Taiwan, China, Philippines
• Leyte, Sorsogon, Mindoro, Camarines,
Samar,Davao, Cotabato and Basilan
 Pathology
• Granulomatous reactionfibrotic encapsulation
• Heavy infections, dry cough ,blood-stained sputum
with foul fish odor,chest pains, dyspnea,
hemoptysis
• Low grade fever, fatigue and generalized myalgia
like TB
• Erratic paragonimiasis – abdominal wall and cavity,
mesenteric lymph nodes, omentum, pericardium,
myocardium and intestinal wall
 Diagnosis
• Definitive diagnosis based on detection of
characteristic eggs in sputum, stool or aspirated
material from abscesses or pleural effusions
• Serological tests like complement fixation, enzyme
immunoassay and immunoblot
• Radiographs difficult to differentiate from PTB
Paragonimus adult
and egg
Lung X –ray of paragonimiasis patient

RNAS+, 2009
Eating raw crab

RNAS+, 2009
Echinostomiasis
Echinostoma revolutum

Tamayo and Trinidad, 2013

Echinostoma revolutum

Tamayo and Trinidad, 2013

Life Cycle of Echinostoma spp.
Snail Intermediate Hosts of
Echinostoma spp

RNAS+, 2009
 Echinostomiasis
• Endemic in Northern Luzon, Leyte, Samar and
the provinces of Mindanao
• Ulceration, diarrhea and abdominal pain
• Eggs should be differentiated from Fasciola
spp.and Fasciolopsis
• Treatment with praziquantel
• Avoid ingestion of raw or improperly cooked
second intermediate host such as Pila
Heterophyid Flukes
 In the Philippines, 21 species of heterophyid
trematodes have been reported (WHO/FAO Workshop on Food-borne
Trematode Infections in Asia, 2002).

 The common species are Heterophyes heterophyes,

Metagonimus yokogawai, Haplorchis taichui and
Haplorchis yokogawai.

Moendeg, 2013
 Prevalence of Heterophyid Infection in Different
Provinces of the Philippines
Southern Leyte 2.21%
0.10%
Northern Samar 0.24%
0.12%
Leyte 0.81%
0.40%
Zamboanga City 0.40%
0.60%
Provinces

Maguindanao 0.79%
0.80%
Gensan City 0.80%
1.40%
Lanao 1.70%
2.20%
S. del Sur 5.50%
7.70%
Davao del Norte 9.60%
21.30%
Davao Del Sur 27.50%
0.08%
Apayao 0.03%
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00%

SOURCE : PREVALENCE SURVEY OF SCHISTOSOMIASIS 2005-2008

Provinces Prevalence

Davao Sur + Digos 27.5%

Compostela Valley 21.3
Davao del Norte 9.6
Agusan del Sur 7.7
Surigao del Sur 5.5
Bukidnon 2.2
Southern Leyte 2.21
Lanao del Sur 1.7
Surigao del Norte 1.4
GenSan City 0.8
Leyte 0.81
Sarangani 0.8
Maguindanao 0.79
Agusan del Norte 0.6
Zamboanga City 0.4
Misamis Oriental 0.4
Northern Samar 0.24
Iloilo 0.1

Ilocos Sur 0.08

Apayao 0.03
 Intermediate Hosts
 The parasite lacks host specificity.

 Snail and fish intermediate hosts involved in the

heterophyid life cycle identified as Thiara tuberculata
and Oreochromis niloticus.

Moendeg, 2013
 First Intermediate Hosts
Members of thiarid or melaniid snails.
Found in fresh to brackish waters especially in
temperate, subtropical and tropical areas
(Kitikoon, 1983).

They thrive best in shallow slow running water

on a substrate consisting of soft mud.

Moendeg, 2013
 Second Intermediate Hosts

 In New Corella , only one species O. niloticus (commonly

known as “tilapia”) was positive for heterophyid
metacercaria out of four species of freshwater fish
(unpublished report, 2009).

Moendeg, 2013
 Some of the Philippine fishes inhabiting brackish to marine
known to harbor metacercariae are:
Scientific name Common Name
Mugil dussumieri Gisaw
Siganus canaliculatus Danggit
Epinephelus corallicola Galut
Scatophagus argus Kitang
Gerres filamentosus Gapas-gapas
Glossogobius giurus Lagnas
Therapon jarbua Bogaong
Chanos chanos Bangus

Moendeg, 2013
 Larval Stages in the Snail

Sporocyst
Redia Redia

Moendeg, 2013
 Encysted
• Caudal fins are
Metacercaria
important sites of
heterophyid infection
in fishes (Vasquez-Colet
and Africa (1940).

• Spherical and double-

walled

• Contained a folded
blackish-yellowish
brown larva.

ENCYSTED METACERCARIA IN THE

Moendeg, 2013 CAUDAL FIN OF Tilapia sp.
Thank you for listening.