HETEROPHYID FLUKES

heterophyids live in the intestines of fish-eating hosts

major species are Heterophyes heterophyes,
Metagonimus yokogawai, Haplorchis taichui and
Haplorchis yokogawai
mode of transmission is via ingestion of metacercariae
encysted in fish
DISEASE
intestinal heterophyidiasis
Adult
elongated, oval or pyriform
Dimensions: 2mm in length
Integument: fine, scale-like spines
Some species have gonotyl or a genital sucker located near the left posterior bo
rder of the ventral sucker
Reproductive organs:
testes â variously arranged; in the posterior part of body
ovary â globular or slightly lobed; located submedian, pre- or post-testicular
Miracidium
fully developed, symmetrical miracidium is already present w/in the egg when it
is deposited by the adult worm
Egg
color: light brown
shape: ovoid
operculated; operculum fits into eggshell smoothly
does not have abopercular protuberance
dimensions: 20-30 um x 15-17 um
Adult
larva develops into a sexually mature adult that has a typically short life span
of less than one year
adult worm inhabits the small intestines of the definitive host
Eggs
large numbers of eggs are produced and passed out with the feces
eggs are ingested by 1st intermediate host
1st intermediate host: snails (freshwater, brackish
water or marine)
Miracidium
hatches from the egg inside the snail
transforms into a sporocyst
Sporocyst and Redia
sporocyst develops into one or two generations of redia that give rise to cercar
ia
Cercaria
liberated form the snail and encyst as metacercaria on or under the scales in th
e muscles, fins, tails or gills of fish
Metacercaria
often found in the muscles at the base of the fin
reaches duodenum and excysts liberating a young larva that attaches to intestina
l wall
2nd intermediate hosts: In the Philippines there are 30 species of fish harborin
g metacercaria life cycle of Metagonimus yokogawai
PATHOGENESIS AND CLINICAL MANIFESTATION
inflammation at the sites where the worm is attached to or burrowed in the mucos
a
excessive mucus production and sloughing off of the superficial layers may occur
most common manifestions were consistent with peptic ulcer disease (PUD) or acid
peptic disease (APD)
symptoms:
- upper abdominal discomfort/pain
- gurgling abdomen
- colicky abdominal pain
- mucoid diarrhea
In Africa, worms were shown to burrow deep into the intestinal walls and eventua
lly die
Eggs of degenerating worms may be filtered through the intestinal lymphatics and
blood vessels and deposited in various tissues
Eggs and adults of heterophyids have been observed in the heart and brain of Fil
ipino patients who died of heart failure and intracerebral hemorrhage
Eggs can be lodged in the spinal cord and may result in sensory and motor losses

DIAGNOSIS and TREATMENT

Important to consider intestinal fluke infection when dealing with bowel disturb
ance and a history of consumption of raw fish in cases with same presentation as
APD
definitive diagnosis: detection of eggs in stool using the Kato-Katz method
hard to distinguish between eggs of heterophyid species
· Praziquantel
EPIDEMIOLOGY
· Egypt, Greece, Israel, western India, Central and South China, Japan, Korea,
Taiwan and the Philippines
· worldwide distribution due to the fact that they have adapted to snails belon
ging to various families and are not very specific with respect to 2nd intermedi
ate hosts
both intermediate hosts may be found in different habitats (fresh, brackish and
salt waters) and climates
Reservoir hosts: dogs, cats and birds

PREVENTION AND CONTROL

avoid ingestion of raw or improperly cooked fish