Fasciola Parasitology PDF

Infectious 2 parasitology Dr. Shrouk Fasciola hepatica and gigantica liver flukes (fascioliasis) DR: shorouk  Fascio H H 1M e flat dorson hr shape...

Infectious 2 parasitology Dr. Shrouk Fasciola hepatica and gigantica liver flukes (fascioliasis) DR: shorouk  Fascio H H 1M e flat dorson hr shape S dong ex S Cuticle spiny tuberal Org ofAH suckers except HH 358 a GIT Rudiments 2 Blind Blind Anus x S Reunion Genital Hermaph ex S separate testis 5 2  utn Items discussed: 1.Occurance 2.Morphology 3.Life cycle 4.Pathology and pathogenesis 5.Clinical presentation 6.Diagnosis 7.Differential diagnosis 8.Treatment 9.Prevention and control 1. Occurrence: - belongs to phylum: platy-helminths, class: Trematoda, genus: Fasciola - zoonotic disease (parasite of sheep, cattle and related animals worldwide and transmitted to man.) - foodborne trematode infections (from infected plants) - global disease, in Egypt (Delta region, in Alexandria city, in some governorates of Upper Egypt) , endemic - fascioliasis affects people from all age groups, and there is no specific risk group - infection tend to peak in school age children , common in people living in rural areas. 2. morphology: üFasciola hepatica and gigantica differ from each other only in morphology (mainly size), Fasciola large parasite Fasciola hepatica Fasciola gigantica size Small (2.5-3 cm) Large (7 cm) Cephalic cone Prominent, large Less prominent + shoulder Suckers Nearly equal Ventral > oral veto Lateral side Intestinal ceca Converging Poor developed I Parallel Highly developed Median branches Median branches Snail Lymnaea truncatule Lymnaea natalesis 0 Eggs Smaller Larger Metacercaria Less liable to desiccation More liable 3. Life cycle: encyst  DH: herbivourus animal , infrequently man (accidentally) TespeTyBi FH: hepatobiliary na.se Diagnostic stage: immature operculated egg in stool IH: snail (lymnae) e 0 Infective stage: encysted metacercaria (appear white spherical) Mode of infection: encysted metacercaria in aquatic plants food plant water conton lingestion - Eggs pass in stool immature------reach fresh water to maturate -------then miracidium hatch -----enter snail. - In lymph space of snail (miracidium----sporocyst-----redia----cercaria) 8 - Cercaria here with simple tail (called leptocercous)------that leave water to encyst on vegetation after loosing its tail - Now we named it encysted metacercaria which is the infective stage (microscopically----- appear round with a cyst wall, rudimentry gut and suckers) 3.Pathogenesis and pathology: after ingestion of infective stage (encysted meta-cercaria) in unwashed vegetable it pass to the stomach cercaria (juvenile fluke) escape. m es üThen migrate to small intestine (duodenum) where ex-cystation happen , then the meta- o o üIn the small intestine it start to penetrate the intestinal wall to the peritoneal cavity then to the liver (sometimes enter the systemic circulation where they are distributed in abnormal site) ecopian üAt the liver it penetrate the Glisson capsule and start to reach liver and gall bladder üThere the meta-cercaria start to maturate and converted to mature Fasciola and fertilization happen to produce eggs Bile duct Pentff On vPathology: Liver gall bladder 1. pressure atrophy 1. inflammation 2. Cell damage Mechanical 2. adenomatous 3. Cell necrosis changes TIE  4. Clinical picture: (IP=3-4month) Migration phase (acute) Juvenil maturation phase (chronic) Metaarcare p caused by migration of immature flukes through hepatic parenchyma. 0_ presence of adult flukes in the bile ducts causing biliary obstruction and inflammation. - Main symptoms: Jaws Main symptoms: I L - Upper right abdominal pain, cough, dyspepsia, - nausea, vomiting, fatty food intolerance, upper pi anorexia, vomiting, diarrhea, weight loss, right abdominal pain and pruritus. urticaria and headache - Main signs: E.at timngMain E sign: - cholestatic jaundice with hepatomegaly, and - Fever, tender hepatomegaly, +/- splenomegaly , fever with cholangitis, calcular or acalcular jaundice trat0eT - High eosinophilia up to 80% cholecystitis. (eosinophilia 40%) Foregg tthftion  N.B: town - Fascioliasis causing anemia ??? Yes ,type of it? ( normocytic normochromic anemia changed to microcytic hypochromic) anemia - cause? - Blood sucking activity of adult - Migration through bile duct causing bleeding - Toxic substance from the worm - (haemobilia)= very rare complication associated with chronic fascioliasis due to arterial bleeding associated with ulcer caused by a dead parasite in the common bile duct. - Hemobilia Presented in the form of anemia, melena, hematemesis, fatigue  ØOther forms of fascioliasis: a C make 1. True fascioliasis (classic) 3. halzoun fascioliasis ( pharyngeal) 2. False fascioliasis ( spurious) Infective stage True O Encysted metacercaria 0 False 4. ectopic fascioliasis Halzoun Adult and egg of fasciola Adult in raw liver WE ectopic Encysted metacercaria in pagno And source of in unwashed vegetables in cooked liver unwashed vegetable infection I grand Clinical piscture As said befor Subclinical Suffocation due to According to organ 0 attachment of suckers - Pleuropericarditis in mucosa of - Meningitis laryn.tw_ oesphageous - Lymphadenopathy - Panniculitis (SC) Diagnosis Stool analysis to detect History mainly ( Diagnosed clinically a Immunological test eggs differentiated from true ….treatetd by gargling O by stop eating liver for 3 with alcohol days then repeat stool test …free) Feat 5. diagnosis: Clinical lab 1. History (endemic area, eating raw vegetables) a. direct 2. Symptoms b. indirect 3. Signs - immunological Ag Ab - CBC - liver function Tetrad key words: - Abdominal pain - radiological test Migratory - Fever - Hepatomegaly - High oesinophilia a. Direct lab diagnosis: (to find egg) - Stool analysis (in chronic phase) ration - Duodenal aspiration (entero-test capsule) 0 Size Largest egg Shape Oval, operculated Color Yellowish content Immature b. In-direct 1 Immunological test: ( early stage, ectopic, false rule out, chronic with low level) - IHAT (test of choice) Fatter - IFAT, ELISA, gel electrophoresis, counter immuno-electrophoresis, metacercaria precipitin test. - ELISA for (copro-antigen) in stool.------detecting patient with very low level of egg CBC: ok metacercana Q - Oeisinophilia (40-80%) , leukocytosis, anemia Tavasi MEET That  P Liver function test: J 00 - ALT, AST, GGT (gamma glutamyl transferase), alkaline phosphatase, bilirubin Radiological : 000 C - U/S, CT. MRI ----- show hypodense area in liver and abnormalities in bile tract. 0 - ERCP (endoscopic retrograde cholangio-pancreatography) = diagnostic , therapeutic EEO - MRCP (magnetic resonance cholangio-pancreatography)= diagnostic only 6. Differential diagnosis: I - Causes of hepatomegaly. ( schistosomiasis, hydatid cyst, VLM, viral hepatitis, amoebic hepatitis) I - Causes of cholangitis , recurrent jaundice ( gall bladder stone, Gilbert disease) 7. treatment: a. Medical E G O - Triclabendazole (10 mg/kg ---single dose after meal, in heavy infection 20mg/kg ---in 2 divided dose) - Merazide (2 tablet daily before breakfast by 1 hr -----for 6 days) - Nitazoxanide (replace triclabendazole) ----500mg twice daily -----7days Triclabendazole used to treat or prevent b. surgical: cholecystectomy no 0 c. Endoscopic therapy----- by ERCP open sphincter and extract worm., followed by medical treatment 8. Prevention and control: 1. Health education 80s 2. Good washing of vegetable (vinger, potassium permengnate 5-10 min) 3. Control of snail (by molluscicide) 4. Treatment of cases and animals intestine  If 0 E I ease gigantica egg inmate hepatica Digge  1,6m TE scy ectopic encyst 1 mig y. maturat clinically app T.se598 Indirect 4 Tlimee relax dinical I 6 Direct 1 Shot egg II me 2 Dudentrotes fse lIndieII immlogicalvcoprLISA t CBGOesinoph.E L r arena  Ra niag smeYp ED fibosis fasciola Triclabenda R Prophy Nitron tend Choleshond Ep