| Metazoa >trematoda (flukes) |
Fasciola gigantica (liver fluke) |
Fasciola hepatica
(liver fluke) |
Heterophyes
heterophyes (intestinal fluke) |
Schistosoma haematobium (blood fluke) |
schistosoma mansoni (blood fluke) |
|
|
| distribution |
egypt |
europe |
egypt & turkey |
upper egypt |
delta |
|
| morphology |
size |
larger (leaf like) |
smaller |
*pear
shape *3-suckers (oral ,ventral , genital) *genital system: (2-testes
,globular ovary ,vitelline glands) |
larger /fine cuticle |
smaller
/coarse cuticle |
|
|
| LATERAL MARGINS |
parallel |
converging |
long uterus (10-20) /small vetelline |
short (one egg) /big vetelline |
|
| shoulders |
less prominent |
more prominent |
3-5 testes big /posterior ovary |
6-9 small /anterior ovary |
|
| intermediate host |
snail (Lymnaea cailliaudi) 2nd :water plants |
snail (Lymnaea trunctus 2nd >water plant |
1-snail (pirenella conica) 2-fish |
Bulinus truncatus |
Biomphalaria alexandria |
|
| infective stage |
encysted metacercariae |
encysted metacercariae |
cercaria itself (not encysted) |
|
| source |
raw vegetables or water contain encysted metacercarias |
undercooked & undersalted fish (pickled <10 days) of Boury & Bolty fish |
water contaminated e circaria |
|
| disease |
Fascioliasis (liver rot) |
Heterophyiasis |
urinary bilharziasis |
intestinal bilharziasis |
|
| pathogensis |
1-serious liver damage (due to pressure & toxic metabolites and feeding habits )
2-worm in bile duct >inf >fibrotic changes >obstruction >liver cirrosis and general toxemia 3-migrating
worms reach ectopic foci & form worm abscesses in diff parts of body |
1-irritatn of intestinal mucosa 2-eosinophilia , intestinal discomfort ,pain & diarrhea 2-eggs may enter circulatn
>as emboli >lesions in diff parts eg myocarditis or H. failure ,brain hemorrhage |
1-stage of invasion :irritatn
+dermatitis 2-stg of migration :cercaria to lungs >he ,pneumonitis ,eosinophilia
,leucocytosis ,fever ,cough 3-stg of oviposition
& tissue reaction :eggs in * tissue
>pseudo-tubercle or bilharzial granuloma >fibrosis or calcificatn
*other washed back >blood stream >ectopic lesions in diff parts of body
*urinary bladder :(eggs) >hyperemia ,papular formn ,ulceratn ,thickened
wall *urethra >obstructn *other pelvic organs >deposition of eggs
(details) |
eggs deposit in mesentric plexus through wall
of intestine to feces *eggs trapped in intestine wall >inf reaction
>congestion ,ulceration ,sandy patches >wall thickened *dysentry e
blood & mucous in feces *periportal fibrosis >portal hypertension
(details) |
|
| diagnosis |
1- characteristic egg in feces { diagnostic stage} >oval ,operculated ,thin shelled
,yellow ,contain immature
larva 2-indirect
(ultrasonography : IHA , ,ELISA , CFT 3-by symptoms :fever ,chills ,vomiting
,dyspnea ,oesinophilia ,jaundice |
stool analysis
>characteristic eggs
(oval ,operculated ,thick shelled ,yellow in col (contain mature
micacidium) |
1-direct a:presence of egg in urine by sedimentatn in conical glass (oval ,thin shelled with terminal spine ,translucent and contain miracidium) b:-Biopsy from blader mucosa using cystoscope 2-indirect a: IHA test for ab (titer =250) b:for ag :scistofast test (see details) |
not easy to diagnose 1-stool exam 2-rectal swap
3-rectal Biopsy (swap or bioxy test for ova) indirect :IHA test |
|
| treatment |
1-Dichlorophenol
(Bithionol) 30-50mg/kg for 10-15 doses 2-Triclabendazole "single dose" 3-surgical
removal of ectopic flukes 4-dehydroemetine HCL |
1- Bephenium bromide 2- Thiabendazole 3-praziquantel (Biltracide) 25mg/kg twice daily for one day |
praziquantel (Biltracide) >40mg/kg body wt as single oral dose
2-oxaminquine (for
s.mansoni) >single oral dose
of 50 mg/kg ** Trinidazole is contraindicated for s.mansoni esp if liver fibrosis & portal hypertension |
|
| life cycle |
adult (in bile duct) >lie immature eggs in feces >in water miracidium develop w swim to snail (24h') >change to sporocyst >rediae >cercarias
(30days) >cercaria leave snail >encyst (infective stg) >intestine
>peritonium >liver >bile duct (8 weeks) |
adult (in small intestine of man & fish) >egg in feces >water >ingested by snail (not hatch in water) >sporocyst >rediae >cercariae (30days) >leave snail >attack fish >encysted metacercariae (infective stg) >man
>intestine |
adult (in pelvic and vesical
plexus of veins) >immqture egg appear after 8 weeks of infectn >miracidium >snail >sporocyst (norediae) after 12
months >cercariae
{infective stg} >max 48h in water >penetrate skin by contact e water or drinking through mucous membrane (e
proteolytic enz) >venous circulatn >right
heart and lung to systemic circulatn >adulted
>paired >migrate to pelvic & vesical plexus (s.haematobium) |
|
| notes |
*hermaphrodite *2-hosts *falt unsegmented body ,bilaterally
symmetric ** it cause increase in
oesinophils n. (oesinophilia) is not diagnostic tool as parasite
may occur e normal oesinophils ** False
Fascioliasis (spurious infectn) (presence of Fasc
eggs in feces of uninfected person due to ingestion of meat or liver of
infected animal >to confirm
:patient not eat meat or liver for 3 days then repeat test |
mass control :1-avoid
defecation in water 2-control of snails 3-examination of fishermen 4-proper
cooking and salting of fish |
habitat :vesical and pelvic
plexus ** host
:exprimentally monkeys and rodents ** control :1-mass ttt 2-avoid defecatn in
water 3-snail control by a-drynessb-periodic cleaning c-beatching canal banks
e concrete or cuso4 |
habitat : mesentric venous
plexus ( large intestine)** host :monkeys and rodents ** control as s.haemat. |
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