Paragonimus

wetermani

Paragonimus westermani
Disease :-Paragonimiasis
-Pulmonary distomiasis
D H : Any animal that eats crustaceans
I H ;1st = Snail ( freshwater snail )
Melania sp., Semisulcospira, ,Thiara sp.

2nd = Crustaceans (ex. Freshwater

crabs)
Potamon sp, Eriocheir sp, Cambarus
virilis

Epidemiology & Risk Factors

Human lung fluke, Paragonimus westermani,
infects 22 million people in Africa, Asia ,South
and Central America. Southeast Asia in
particular is affected because raw seafood is
very popular there. Humans get infected with
the disease, paragonimiasis, by eating raw
crabs or fish that are carrying the parasite.
In Asia about 80 % of freshwater crabs are
infected with the lung fluke.
Asia including China, the Philippines, Japan,
Vietnam, South Korea, Taiwan, and Thailand
Infections more frequent in males than female

MORPHOLOGY
adult
Fresh-reddish brown fluke
Small size : 8-16 x 4-8 mm
Shape :
a. When active: resembling a spoon
with one end contracted and other
elongated.
b. When contracted: preserved oval,
flattened coffee bean

Spinous cuticle
Suckers of equal site, ventral just
anterior to equatorial plane
Iregularly lobed testes, oblique to
each other, in posterive 3rd worm
Lobed ovary anterior to testes on
right side opposite closely coiled
uterus
Vitellaria in extreme lateral fields
for entire length of body

are 80 to 125 x 45 to 65 microns, yellowish

brown opercular end is broader than the other
end , abopercular end often has marked
thickening of egg shell.

Eggs

The

eggs are excreted unembryonated

in the sputum, or alternately they are
swallowed and passed with stool . In
the external environment, the eggs
become embryonated , and miracidia
hatch and seek the first intermediate
host, a snail, and penetrate its soft
tissues . Miracidia go through several
developmental stages inside the snail :
sporocysts , rediae , with the latter
giving rise to many cercariae , which
emerge from the snail.

The

cercariae invade the second

intermediate host, a crustacean such
as a crab or crayfish, where they
encyst and become metacercariae.
This is the infective stage for the
mammalian host . Human infection
with P. westermani occurs by eating
inadequately cooked or pickled crab or
crayfish that harbor metacercariae of
the parasite .

The

metacercariae excyst in the

duodenum , penetrate through the intestinal
wall into the peritoneal cavity, then through
the abdominal wall and diaphragm into the
lungs, where they become encapsulated
and develop into adults (7.5 to 12 mm by 4
to 6 mm). The worms can also reach other
organs and tissues, such as the brain and
striated muscles, respectively. However,
when this takes place completion of the life
cycles is not achieved, because the eggs
laid cannot exit these sites. Time from
infection to oviposition is 65 to 90 days.

Disease

Paragonimiasis is an acute infection

with cough, abdominal pain,
discomfort, and low-grade fever that
may occur 2 to15 days after infection.
Persons with light infections may
have no symptoms. Symptoms of
long-term infection may mimic
bronchitis or tuberculosis, with
coughing up of blood-tinged sputum.

The worm produces neutrophilic and

eosinophilic reactism in the tissues with
the formalism of a thick fibrous capsule
4 Types of fibrous Lessim :
- non suppuratif
- tuberculoid with caseation
- supurative with abscess
formation
- ulcerative

Diagnosis

Pulmonary symptoms, bloodtinged sputum,

eosinophilia in endemic region
Diagnosis by finding ova in the reddishbrown via sputum
Ova usually present in sputum, but can be
found in feces when the sputum is negative
A tissue biopsy is sometimes performed to
look for eggs in a tissue specimen.
Specific and sensitive antibody tests based
on P. westermani antigens and serologic
tests using a variety of techniques are
available through commercial laboratories.

Treatment

Praziquantel is the drug of choice:

adult or pediatric dosage, 25 mg/kg
given orally three times per day for 2
consecutive days.
Alternative: Triclabendazole, adult or
pediatric dosage, 10 mg/kg orally once
or twice. For cerebral disease, a short
course of corticosteroids may be given
with the praziquantel to help reduce
the inflammatory response around
dying flukes