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Chapter 16 : Liver and Lung Trematodes

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Abstract:

spp., also known as lung flukes, cause paragonimiasis in humans. The infections caused by the liver and lung trematodes are food borne and have considerable economic and public health impact. Of great public health concern is cholangiocarcinoma associated with and infections, severe liver disease associated with infections, and the misdiagnosis of tuberculosis in those infected with spp. In the Far East, forms of chronic inflammation associated with cholangiocarcinoma include infestation with either of the liver flukes, or . Cholangiography, ultrasonography, and liver scans may reveal lesions consistent with liver fluke infection. Like infections with other liver flukes, the degree of clinical involvement depends on the extent and duration of the infection. Abscess or tumorlike reactions have also been reported to occur in subcutaneous tissues or in the liver. Symptoms of paragonimiasis depend largely on the worm burden of the host and are usually insidious in onset and mild in patients with chronic infections. The patient may experience increasing dyspnea with chronic bronchitis and be misdiagnosed as having tuberculosis or bronchial asthma. The most serious consequences of paragonimiasis are the cerebral complications, which are commonly found in younger age groups. Unlike adult flukes in other extrapulmonary sites, worms found in the brain usually contain eggs. Pulmonary paragonimiasis is rarely fatal; however, cerebral disease is characterized by chronic morbidity and symptoms including epilepsy, dementia, and other neurologic sequelae.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16

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Figures

Image of Figure 16.1
Figure 16.1

Life cycle of the liver and lung trematodes.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.2
Figure 16.2

Eggs of Note the range of sizes and shapes.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.3
Figure 16.3

adult (10 to 25 mm long by 3 to 5 mm wide). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.4
Figure 16.4

Adult liver and lung trematodes. (A) ; (B) ; (C) ; (D) and .

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Algorithm 16.1
Algorithm 16.1

Trematode infection.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.5
Figure 16.5

adult in a biliary duct (cross section). (Panel A, Armed Forces Institute of Pathology photograph; panel B, from A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.6
Figure 16.6

adult trematode.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.7
Figure 16.7

adult trematode.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.8
Figure 16.8

adult worm (upper left), egg (upper right), and living worm (lower). The operculum can be difficult to see; this egg resembles that of (intestinal trematodes) and (liver trematodes), although the egg of is larger. The adult worm is 20 to 30 mm long by 8 to 13 mm wide.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.9
Figure 16.9

adult worm in a bile duct; note the U-shaped worm within the bile duct with surrounding tissues.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.10
Figure 16.10

adult worm in the liver; note the U-shaped worm with surrounding hepatic tissue, with a cellular response seen around the worm.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.11
Figure 16.11

adult worm (left) and egg (right). The operculum can be difficult to see; this egg resembles that of (intestinal trematodes) and (liver trematodes), although the egg of is larger (160 to 190 μm by 70 to 90 μm). The adult worm is 25 to 75 mm long by 12 mm wide. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.12
Figure 16.12

adult worm (left) and egg (right). Adapted from reference .

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.13
Figure 16.13

adult worm (left) and egg (right). Adapted from reference .

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.14
Figure 16.14

adult worm (left) and egg (right). The opercular shoulders are clearly visible at the top of the egg, as is the thickened abopercular end.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.15
Figure 16.15

Photographs (top) and drawings (bottom) of egg (A) and egg (B). (Illustration by Nobuko Kitamura.)

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.16
Figure 16.16

Crab second intermediate host for spp.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.17
Figure 16.17

egg in the lung (cross section). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Image of Figure 16.18
Figure 16.18

(Upper) egg in brain granuloma (cross section). (Armed Forces Institute of Pathology photograph.) (Lower) eggs in brain tissue. (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
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Tables

Generic image for table
Table 16.1

Characteristics of liver and lung trematodes

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
Generic image for table
Table 16.2

Human paragonimiasis

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16
Generic image for table
Table 16.3

Possible means of acquiring infection with spp.

Citation: Garcia L. 2007. Liver and Lung Trematodes, p 423-444. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch16

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