Flukes

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 > 2 years and adults:
25 mg/kg 3 times daily for 2 to 3 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, mid 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 > 2 years and adults:
25 mg/kg 3 times daily for 1 or 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 > 2 years and adults:
25 mg/kg 3 times daily, 1 day