Teacher Name: Dr Isma’il Sheikh Adam

Bach
University Name: Job-Key University
Name:
GM06

Lecturer Name: NasruLlaah A/Kadir

Jaziir
Presentation Name: Subject Name:
Attendanc Class No: A7 Paragonimus General Medical
e No: 9 Westermani Parasitology
 History
• Most discovers made between 1874-1918.
• Discovered in Brazil in 1850 by Diesing.
• First described in Bengal tigers housed in
zoos in Hamburg and Amsterdam in 1877.
• Coenraad kerbert named the parasite after
the manager of the zoo G.F westerman.
 Continued
• Sidney Ringer discovered the parasite in a human in a
Portuguese man during an autopsy in 1879.
• Rudolf Luekart found that the parasite found in the Tiger is
the same as the parasite that caused hemoptysis in Formosa
and Japan.
• 1916-1922 Japanese workers discovered the life cycle in the
snail.
• Nine cases of Paragonimiasis have been encountered in Laotian
Hmong immigrants from Camp Ban Vinal in Thailand.
• 12 Human infestations were described later in Asia.
 Geographic Distribution
• P.Westermani infections occur in limited
areas where local people eat improperly
cooked crustacean.
• P.Westermani occurs in the far East specially
in the countries of Korea, Japan, China,
Taiwan, Far-East Russia, Malaysia, India, The
Philippines and Indonesia.
• Other species of Paragonimus are
encountered in Asia, Americas and Africa.
 Introduction
• Agent: P.westermani also known as the oriental lung Fluke.
• Disease: Paragonimiasis
• More than 30 species of trematodes(Flukes) of the genus
paragonimus have been reported to infect animals and
human.
• Among them more than 10 species are reported to infect
humans.
• The most common is P,westermani.
 Transmission

• Eating raw, undercooked or pickled crustaceans

such as: Crab or Crayfish.
• Spitting, a habit in Asian countries.
• Cultures that eat raw Crustaceans.
• Drunken Crab in China, Raw Crab or Crayfish and
Alcohol in the Philippines.
• Gye Muchim Korea.
• Sushi Crab, Ama ebi and odori in Japan.
 Life Cycle
• Infective stage: Meta-cercariae
• Infective Mode: Eating raw fresh water crabs and crayfish with Meta-
cercariae.
• Infective route: By mouth.
• Site of inhabitation: Lungs
• Intermediated Host: 1 int. host is Malaria snail. 2 int. hosts are crab and
crayfish.
• Reservoir hosts: carnivores such as: Tiger, Lion, Wolf, Fox, Dog, Cat and etc.
• Life span: 5-6 Years.
 Morphology
• The living adult worms are a pinkish-brown colour and bean
shaped(7-15mm in Length to 8mm in width, and 3 to 5 mm in
thickness)
• It contains a characteristic ovary in the middle of the worm.
• The golden brown colored immature eggs are approximately
45-60 µm by 80-100 µm.
• The Meta-cercariae in the second intermediate host are spherical in
shape measuring 220-450 µm.
How The Eggs Appear
• The Oval Ova have an
operculum and are 80-100
48-80µm.
• It is golden yellow in color.
• The shell in uneven in
thickness.
• Then content is an ovum and
more than 10 yolk cells.
 Intermediated Host
• The eggs are passed in Sputum of feces.
• The eggs flow downstream and have a small chance of survival but this is offset by
fact that the eggs are produced in large numbers.
• The Miracidium hatches and penetrates its first intermediate host a snail in the
family of Thiaridae.
• In the snail the miracidium forms a sporocyst the produces a radiae, which in turn
develop many cercariae.
• The Cercariae are spined with knoblike tails and minute oral stylets.
• It is capable of creeping over rocks in inchworm fashion.
• It enters its second intermediate host of a crab or crayfish.
• There are at least 11 different species it infects.
• There is some evidence that the crabs can be infected by eating snails.
• Once in the crab, they encyst in the muscles and viscera.
 Definitive Host
• The last stage of the parasite development
is fulfilled when a mammalian host ingests
an infected Crab.
• Specifically humans, Pigs, Dogs and a
variety of feline species.
• Infections of P.Westermani can persist in
humans for up to 20 years.
 Pathophysiology
• When humans ingest raw infected crustaceans ,larval flukes develop in the
small intestine, penetrate the intestinal wall in to the peritoneal cavity 30
minutes to 48 hours after excysting.
• They then migrate into the abdominal wall or liver, where they undergo
further development.
• Approximately 1 week later, adult flukes reenter from the abdominal
cavity and penetrate the diaphragm to reach pleural space and lungs.
• Flukes mature, a fibrous cyst wall develops around them and then egg
deposition starts 5-6 weeks after infections.
• The symptoms of the early stages of this disease appear to be few with
some people being once parasite is in the lung or another organ, the worm
stimulates an inflammatory response that eventually coats tissue.
 Continue
• If worm enter the CSF of the spinal cord it can
result in partial or total paralysis.
• There have also been fetal cases of
Paragonimiasis by infection of the heart.
• Cerebral cases result in cerebral
cysticercosis( condition in which fluid-filled
cyst surrounding the worm are present).
 Diagnosis
Sputum examination:
a. Alkali digestive method (10%NaOH),
b. Direct Sputum smear.
• Stool examination:
a) Alkali digestion,
b) Water sedimentation method,
c) Direct fecal smear.
Biopsy for subcutaneous type.
CT for brain type
Immunological tests for reference.
 Diagnosis( Continue)
• The adult worms can be discovered during surgery or biopsy.
• However it is usually through microscopic examination of the
characteristic eggs present in sputum, aspired pleural fluid,
Feces and matter of ulcer caused by the parasite.
• The eggs may not be present in these sources until 2 to 3
months after infection.
• X-ray examination of a pulmonary infection may be mistaken
for tuberculosis, Pneumonia, Spirochetosis etc.
 Diagnosis ( Continue)
• Cerebral involvement requires differentiation from tumor, cysticercosis,
Cysts, Encephalitis and Others.
• Since egg detection rates are low , it would be useful to utilize
serological techniques to detect paragonimus antibodies.
• ELISA serological tests are highly sensitive at >92% detection.
• Intradermal skin tests performed with an extract of adult paragonimus is
sensitive and has few false positives.
• The results of the skin test may remain positive for up to 20 years after
the infections has been cured.
• An Assay that detect worm antigens with monoclonal antibodies is also
available and can be used in conjunction with the intradermal skin test.
 Treatment
Praziquantel oral
Causes severe spasms and paralysis of the
worms muscles
a. Not for pregnancy women
b. Stomach pains, dizziness, Fever,
Nausea, Vomiting and Headache.
c. Better tolerated than Bithionol.
 Bithionol
• Diarrhea use is limited due to side effects.
 Triclabendazole
• Can cure other drugs failed.
 Treatment
• Extrapulmonary lesions may need to be
surgically excised.
• Intraventricular shunts may also needed to
manage hydrocephalus.
• Therapy may also be required for seizures
caused by an inflammatory reaction to dying
worms in the brain.
 Complications
•Pulmonary complications includes
pneumonia, Bronchitis,
Bronchiectasis( bronchial dilation), Lung
abscess, Pleural effusion and empyema( Pus
in the plural cavity).
•Cerebral complications include: Migratory
allergic skin lesions.
 Prevention
Fully cook shellfish:
.Heat water to 55˚c for 5 minutes.
Freeze Fish:
. -20c for 7 days.
. -35 c for 15 hours.
Make spitting illegal.
Use Molluscicide to control snail population.
 Epidemiology
• It is estimated that 20 million are infected with Paragonimus
Westermani.
• It is endemic in China, Korea, Japan, The Philippines and
Taiwan.
• Japan, Korea, Formosa, China, Manchuria, The Philippine, Island
and India.
• Infection is also found in parts of tropical west Africa, from the
congo and Nigeria, specially from southern Cameron.
• Rare in the US but it is found in Missouri.
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