Paragonimus

westermani

BY- ADARSH ARUN 8B

 PARAGONIMUS WESTERMANI

• Diagenetic Trematode
• Infects the lungs of definitive host (humans)
• Discovered in 1877
• Found mainly in Asia
• Life span usually 6 years but can live up to 20 years
• Most common oriental lung fluke to infect humans
• Genus includes 45 species of lung fluke
• Only 12 species infect man
– Paragonimus africanus (West Africa)
– Paragonimus mexicanus (Central America)
 Morphology

Trematode (fluke) means pierced with holes

1) Characterized by oral and ventral suckers
2) Oval shape 8-16mm by 4-8mm
3) Bodies unsegmented
4) Alimentary canal incomplete QuickTime™ and a
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5) Excretory system is bilaterally symmetric

6) Reciprocally inseminating simultaneous
hermaphrodite
 Life Cycle
Diagenetic means alterations of generations
1) Two intermediate hosts and one human definitive host
2) Polyembryony

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First intermediate host Sporocyst

Eggs Miracidia Redia
(Melania snail)
Daughter Redia

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Raw crab Metacercaria Crustacean Cercaria

Paragonimiasis: Life
Cycle
Paragonimiasis
Infectious agent: Paragonimus species
aka "the lung fluke“
most common is Paragonimus westermani
aka “the oriental lung fluke”

Geographical distribution:
Paragonimus spp. are distributed throughout the Americas, Africa and southeast
Asia
Paragonimus westermani is distributed in southeast Asia and Japan
Paragonimus kellicotti is endemic to North America
 Transmission
By eating inadequately cooked or pickled food
Crustaceans (crabs and crayfish) containing
metacercaria

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Wild boar (paratenic host) harboring juvenile

P. westermani
 Factors that facilitate transmission
I. Behavior spitting and using human feces as fertilizer

II. Wetland environments

Paragonimiasis
Transmission:
Primarily through consumption of raw,
salted, pickled, or partially cooked
freshwater crabs or crayfish (crawfish)
containing infected larvae
(metacercariae) :
not transmitted directly from person to
person
Incubation Period:
Variable; approximately 7-12 weeks
after ingestion of the infectious larvae
 ParagonimiasisP

Clinical Illness
Acute phase
diarrhea, abdominal pain, fever, cough, urticaria,
hepatosplenomegaly, pulmonary abnormalities, and eosinophilia
Chronic phase,
pulmonary manifestations include dry cough, rusty-colored or
blood-tinged sputum on exertion, and pleuritic chest pain
extrapulmonary disease is not uncommon, with flukes found in
such sites as the CNS, subcutaneous tissues, intestinal wall,
peritoneal cavity, liver, lymph nodes and genitourinary tract
Paragonimiasis
Laboratory diagnosis:
Microscopic exam- identification of Paragonimus
eggs in stool or sputum
Detection of Paragonimus antibodies

Treatment:
Praziquantel is the drug of choice for treatment
of paragonimiasis
III. Culinary habits of culture
- China and Philippines “Drunken crab”
1. marinated raw crab in rice wine,
soy sauce, and spring onions
2. Leave over night and enjoy the
next day
- Korea “Gye muchim” (seasoned raw crab)
- Japan “Ama ebi” (sushi crab)

Drunken crab
 Pathogenic Effects
• Zoonotic disease
• Infection route by mouth
• Invading and migration stage
– Excystation then adolescents penetrate intestinal
wall and migrate to lungs
• Suppurative stage
– Neutrophils and eosinophils surround worms and
form abscess
• Cystic stage
– Cyst wall is formed and hemoptysis results (the
coughing up of rusty sputum containing blood
and eggs)
• Fibrous-scar stage
– Worm dead and pus is expelled leaving fibrous-
scar tissue
 Clinical Manifestation
• Two phases of paragonimiasis
• Acute phase
• Abdominal type
– Abdominal pain, diarrhea, and mucus of ova in feces
• Subcutaneous type
– Painless subcutaneous nodules
• Chronic phase
• Pulmonary type
– Resemble tuberculosis,low fever, hemoptysis, and chest pain
– Rarely fatal even without treatment flukes eventually die in 10 to 20 years
• Brain type
– Epilepsy, visual disturbance, aphasia
– 5% die form hemorrhage
 Diagnosis
1) Sputum or stool examination for ova, eggs may not
be present for 2-3 months
2) CT of brain
3) X-ray of the lungs
4) Blood tests for neutrophils and eosinophils

Treatment
Praziquantel
1) Increase cell membrane permeability in fluke
2) Results in loss of calcium, massive contractions, and paralysis
3) Attachment of phagocytes to fluke
4) Side effects are mild drowsiness and headache
5) Eggs clear from sputum in a few weeks
6) Cure almost 100% except in case of cerebral damage
X-ray of infected lung
 Prevention

1) Properly cook crab and crayfish

2) Avoid sputum and feces getting into water

3) Molluscicides at present are impractical

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 Incidence and Distribution
Geographic distribution
1) Endemic in Japan, Taiwan, central China, India, Philippines, and Korea

2) Found in Malaysia, Indonesia, and Thailand

Incidence
1) In endemic areas infection ranges form 1 in 1000 to 1 in 4
a. Manipar India 8% infection in people who eat raw crab
b. Ulchin Korea 13.9% of school children positive reaction

2) 21 million people infected

3) 200 million at risk