Flukes

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    Infection/Epidemiology

    Clinical features/Diagnosis

    Treatment

    Lung flukes
    Paragonimus sp
    Distribution: South-East Asia, China, parts of Cameroon, Nigeria, Gabon, Congo, Colombia, Peru
    Transmission: eating raw freshwater crustaceans

    The two most prominent symptoms are prolonged (> 2 weeks) productive cough and intermittent haemoptysis (rusty-brown sputum). In endemic areas, paragonimosis should be considered whenever pulmonary tuberculosis is suspected as the clinical and radiological features overlap. Paragonimosis is confirmed when eggs are detected in sputum (or possibly in stools).

    praziquantel PO
    Children 4 years and over and adults:
    25 mg/kg 3 times daily for 2 days

    Hepatobiliary flukes

    Fasciola hepatica and gigantica
    Distribution
    : worldwide, in areas where sheep and cattle are raised
    Transmission: eating uncooked aquatic plants

     

    During migration phase: asthenia, prolonged fever, myalgia, right upper quadrant pain, mild hepatomegaly; sometimes, allergic signs (e.g. pruritus). At this stage, the diagnosis is rarely considered and can only be confirmed through serology; parasitological examination of stools is always negative.
    Once adult flukes are present in the biliary tract: presentation resembles cholelithiasis: right upper quadrant pain, recurrent episodes of obstructive jaundice/ febrile cholangitis. The diagnosis is confirmed when parasite eggs are detected in stools (or flukes are seen in the biliary tract with sonography).

     

    triclabendazole PO
    Children and adults:
    10 mg/kg single dose
    May repeat in 24 hours in the event of severe infection

    Opisthorchis felineus
    (Asia, Eastern Europe)
    Opisthorchis viverrini
    (Cambodia, Laos, Vietnam, Thailand)
    Clonorchis sinensis
    (China, Koera, Vietnam)
    Transmission: eating raw/undercooked freshwater fish

    Abdominal pain and diarrhoea. With heavy infection, hepatobiliary symptoms: hepatomegaly, right upper quadrant pain, jaundice or episodes of febrile cholangitis. The diagnosis is confirmed when parasite eggs are detected in stools.

    praziquantel PO
    Children 4 years and over and adults:
    25 mg/kg 3 times daily for 2 days

    Intestinal flukes
    Fasciolopsis buski
    (India, Bangladesh, South-East Asia)
    Heterophyes heterophyes
    (South-East Asia, Nile delta)
    Metagonimus yokogawai
    (Siberia, China, Korea)
    Transmission: eating uncooked aquatic plants (F. buski), raw/undercooked fish (other species)

    Symptoms are limited to diarrhoea and epigastric or abdominal pain.
    With massive infection, F. buski can cause oedematous allergic reactions (including ascites, anasarca).
    The diagnosis is confirmed when parasite eggs are detected in stools.

    praziquantel PO
    Children 4 years and over and adults:
    25 mg/kg 3 times daily, 1 day