PARAGONIMUS

WESTERMANI
• Kingdom: Animalia
• Phylum: Platyhelminthes

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• Class: Trematoda
• Family: Paragonimidae
• Genus: Paragonimus
• Species: P. westermani

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HISTORY
•  P. westermani was discovered in the lungs of a
human by Ringer in 1879 and eggs in the sputum
were recognized independently by Manson and
Erwin von Baelz in 1880.

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• Manson proposed the snail as an intermediate host
and various  Japanese workers detailed the whole
life cycle in the snail between 1916 and 1922.

• The species name P. westermani was named after a

zookeeper, Mr. P. Westermani, who noted the
trematode in a Bengal tiger in an Amsterdam Zoo. 4
INTRODUCTION

Disease: Paragonimiasis

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- is a food-borne parasitic
infection caused by the lung
fluke, most commonly
Paragonimus westermani. It
infects an estimated 22 million
people yearly worldwide. It is
particularly common in East
Asia.
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• More than 30 species of
trematodes (flukes) of
the genus Paragonimus

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have been reported to
infect animals and
humans. Among them,
more than 10 species are
reported to infect
humans, the most
common is P. westermani
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GEOGRAPHIC DISTRIBUTION

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• P. westermani infections occur in limited areas
where local people eat improperly cooked
crustaceans.

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• P. westermani occurs in the Far East specifically
in the countries of Korea, Japan, China, Taiwan,
far-east Russia, Malaysia, India, the Philippines,
and Indonesia.

• Other species of Paragonimus are encountered

in Asia, the Americas, and Africa.
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 TRANSMISSION

• Eating raw, undercooked or

pickled crustaceans such as

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crab or crayfish
• Spitting, a habit in asian
countries
• Cultures that eat raw
crustaceans
• Drunken Crab in China
• Raw Crab or Crayfish and
alcohol in The Philippines
• Gye Muchim in Korea 9

• Sushi crab, ama ebi and odori

 MORPHOLOGY

• The living adult worms are

a pinkish-brown colour and
bean shaped (7 to 15 mm

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in length to 8 mm in width,
and 3 to 5 mm in
thickness). It contains a
characteristic ovary in the
middle of the worm.

The adult fluke is found in

mammalian host.
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• Eggs range from 80-120 µm
long by 45-70 µm wide. They
are yellow-brown, ovoid or
elongate, with a thick shell,
and often asymmetrical with

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one end slightly flattened. At
the large end, the operculum
is clearly visible. The
opposite (abopercular) end is
thickened. The eggs are
unembryonated when passed
in sputum or feces.
• The egg form, leaves the
definitive host and hatches in 11
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The metacercaria is The cercaria is the
the form ingested by form that penetrates
humans. the crab.
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LIFE CYCLE
• Infective stage: Metacercariae
• Infective mode: eating raw fresh water crabs
and crayfish with metacercariae

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• Infective route: by mouth
• Site of inhabitation: lungs
• Intermediate hosts: 1st int. host is melania
snail. 2nd int. hosts are crab and crayfish.
• Life span: 5-6 years

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 INTERMEDIATE HOSTS

• The eggs are passed in sputum

or feces.
• The eggs flow downstream and

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have a small chance of survival
but this is offset by the fact
that the eggs are produced in
large numbers.
• The miracidium hatches and
penetrates its first
intermediate host a snail in the
family of Thieridae.
• In the snail, the miracidium
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• The cercariae are spined
with knoblike tails and
minute oral stylets. It is
capable of creeping over
rocks in inchworm fashion.

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• It enters its second
intermediate host of a crab
or crayfish. There are at
least 11 different species it
infects. Also, there is some
evidence that the crabs can
be infected by eating snails.
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• Once in the crab, they

 DEFINITIVE HOST

• The last stage of the

parasites development is
fulfilled when a

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mammalian host ingests
an infected crab.
• Specifically humans,
pigs, dogs, and a variety
of feline species.
• Infections of P.
westermani can persist
in humans for up to 20 17

years
PATHOPHYSIOLOGY

• When humans ingest raw infected crustaceans,

larval flukes develop in the small intestine,
penetrate the intestinal wall into the peritoneal

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cavity 30 minutes to 48 hours after excysting.
They then migrate into the abdominal wall or
liver, where they undergo further development.

• Approximately 1 week later, adult flukes reenter

from the abdominal cavity and penetrate the
diaphragm to reach the pleural space and lungs.
Flukes mature, a fibrous cyst wall develops 18

around them, and then egg deposition starts 5-6

The symptoms of the early stages of this disease appear
to be few with some people being. In the first month or
so after someone is infected, paragonimiasis worms
spread through the abdomen, sometimes causing

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symptoms that can include:
• Fever
• Ill-feeling (malaise)
• Diarrhea
• Belly pain
• Itching and hives
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Worms then travel from the belly into the
chest. There they can cause respiratory
symptoms, such as:

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• Cough
• Shortness of breath
• Chest pain (made worse by deep
breathing or coughing)

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The most common long-term paragonimiasis
symptom is a cough with bloody sputum (
hemoptysis) that comes and goes. Other chronic
paragonimiasis symptoms may include:

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• Belly pain
• Nausea
• Vomiting
• Bloody diarrhea
• Lumps or bumps on the skin of the belly or legs
that come and go over time
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In up to 25% of people hospitalized with
paragonimiasis, the worms infect the brain.
Symptoms can include:

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• Headache
• Fever
• Vomiting
• Double vision
• Seizures

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• Once the parasite is in the lung
or another organ, the worm
stimulates an inflammatory
response that eventually coats

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tissue. If worms enter the CSF
of the spinal cord, it can result
in partial or total paralysis.
There have also been fatal
cases of Paragonimiasis by
infection of the heart. Cerebral
cases result in cerebral
cysticercosis (condition in 23

which fluid-filled cysts

DIAGNOSIS

• Physical examination. Abnormal breath sounds or

belly tenderness observed with a doctor’s examination

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of the chest or belly can suggest a problem and direct
further testing.

• Blood tests. A high number of a specific type of white 

blood cells can suggest parasitic infection. Antibodies
against flukes may be present in the blood.

• Sputum microscopy. Fluke eggs may be detected

during examination of coughed-up sputum under a 24

microscope.
• Chest X-ray. Nodules (spots) in the lungs, hollowed-out
areas (cysts or cavities), or fluid around the lungs (pleural
effusions) may be present.

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• CT scan. High-resolution images of the lungs may show
more detailed information than a chest X-ray. Also, CT of
the head or abdomen may be abnormal if paragonimiasis
involves the brain or liver.

• MRI. Very high-definition images of the brain can identify

cysts or brain swelling caused by paragonimiasis. 25
TREATMENT

Praziquantel (Drug of choice)

• adult or pediatric dosage, 25 mg/kg given orally three times

per day for 2 consecutive days.

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• For cerebral disease, a short course of corticosteroids may
be given with the praziquantel to help reduce the
inflammatory response around dying flukes.

 Pregnant mothers (any stage of pregnancy)

 Lactating mothers
 Pediatric

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Triclabendazole
• adult or pediatric dosage, 10 mg/kg orally
once or twice a day, 12 hours apart.

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 Pregnant mothers
 Lactating mothers
 Pediatric patients aged 6 years old and
older

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PREVENTION

• Fully cook shellfish

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Heat water to 55oC for 5 minutes

• Freeze Fish –
-20 C for 7 days
-35 C for 15 hours

• Make spitting illegal

• Use Moluskicide to control snail population
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ROLE OF THE MIDWIFE

• Triclabendazole or Praziquantel available at

peripheral health centers in all endemic
areas.

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• Mass drug administration with
triclabendazole.

• Information, Education and Communication

on safe food practices.

• Sanitation 29
REFERENCES:

https://www.webmd.com/a-to-z-guides/paragonimiasis#2

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https://www.cdc.gov/parasites/paragonimus/biology.html
https://www.msdmanuals.com/professional/infectious-diseases/tremato
des-flukes/paragonimiasis
https://www.who.int/foodborne_trematode_infections/paragonimiasis/e
n/

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Than
k You
Shaira Jaudian
sjaudian@up.edu.ph