Heterophyiasis - Clinicals, Diagnosis, and Management

Infectious diseases

Clinicals - History

Fact Explanation
Abdominal pain Heterophyiasis is a parasitic infection caused by intestinal flukes ( trematoda) called Heterophyes. Human becomes infected by ingesting undercooked or salted fish containing metacercariae. The metacercariae becomes an adult and get attached to the intestine. Each worm causes a mild inflammatory reaction at its site of contact with the intestine. In heavy infections which are common cause damage to the mucosa and produce abdominal pain. It is a severe and fluctuating abdominal pain that usually not localized. Abdominal pain
Heterophyiasis is a parasitic infection caused by intestinal flukes ( trematoda) called Heterophyes. Human becomes infected by ingesting undercooked or salted fish containing metacercariae. The metacercariae becomes an adult and get attached to the intestine. Each worm causes a mild inflammatory reaction at its site of contact with the intestine. In heavy infections which are common cause damage to the mucosa and produce abdominal pain. It is a severe and fluctuating abdominal pain that usually not localized.
Diarrhea If the parasitic load is very high, the severe inflammation of the mucosa causes watery diarrhea. Nausea and vomiting are also accompanied. Diarrhea
If the parasitic load is very high, the severe inflammation of the mucosa causes watery diarrhea. Nausea and vomiting are also accompanied.
Chest pain Sometimes eggs can enter the blood and lymph vascular systems through mucosa go into the ectopic sites in the body. Rarely, when the eggs of the flukes move into the heart, fatal valvular and myocardial damage may occur. The resultant arrhythmias may manifest as a chest pain. Ultimately, myocarditis may lead to chronic heart failure. Chest pain
Sometimes eggs can enter the blood and lymph vascular systems through mucosa go into the ectopic sites in the body. Rarely, when the eggs of the flukes move into the heart, fatal valvular and myocardial damage may occur. The resultant arrhythmias may manifest as a chest pain. Ultimately, myocarditis may lead to chronic heart failure.
Neurological manifestations Very rarely, the eggs may cause cerebral embolism. In such instances, patents may present with various neurological symptoms from headache to paresis. Neurological manifestations
Very rarely, the eggs may cause cerebral embolism. In such instances, patents may present with various neurological symptoms from headache to paresis.
At risk population ` The disease is endemic to some regions like Egypt, the Middle East, and Far East where the population lives near the river banks and those societies where fish plays a main role of their meal. Eating fish either undercooked, raw, or pickled carries a higher risk. At risk population `
The disease is endemic to some regions like Egypt, the Middle East, and Far East where the population lives near the river banks and those societies where fish plays a main role of their meal. Eating fish either undercooked, raw, or pickled carries a higher risk.

Clinicals - Examination

Fact Explanation
Fever Fever is not common among the patients as the pathology is usually limited to a local inflammatory response off the intestine. Fever
Fever is not common among the patients as the pathology is usually limited to a local inflammatory response off the intestine.
Abdominal tenderness Mild abdominal tenderness is possible due to the inflammation of the bowel mucosa. Abdominal tenderness
Mild abdominal tenderness is possible due to the inflammation of the bowel mucosa.
Cardiac murmers Very rarely cardiac murmurs may be auscultated owing to the myocarditis and eventual heart failure. Cardiac murmers
Very rarely cardiac murmurs may be auscultated owing to the myocarditis and eventual heart failure.
Neurological signs In rare instances, neurological signs such as paresis can be found, depending on the extent that the cerebral emboli is affected. Neurological signs
In rare instances, neurological signs such as paresis can be found, depending on the extent that the cerebral emboli is affected.

Investigations - Diagnosis

Fact Explanation
Full blood count Parasitic infestation is characterized by high degree of eosinophilia. Leukocytosis and anemia (rarely) may also occur. Full blood count
Parasitic infestation is characterized by high degree of eosinophilia. Leukocytosis and anemia (rarely) may also occur.
Stool examination The diagnosis depends on the demonstration of eggs in stool specimens. Concentration techniques and repeated examinations will increase the likelihood of detecting light infections. However, the eggs are indistinguishable from those of Metagonimus yokogawai and resemble those of Clonorchis and Opisthorchis. he eggs from Heterophyes are small, oval and brown, with embryo and operculum / lid. They are 28 to 30 microns long and 15 to 17 microns wide. Stool examination
The diagnosis depends on the demonstration of eggs in stool specimens. Concentration techniques and repeated examinations will increase the likelihood of detecting light infections. However, the eggs are indistinguishable from those of Metagonimus yokogawai and resemble those of Clonorchis and Opisthorchis. he eggs from Heterophyes are small, oval and brown, with embryo and operculum / lid. They are 28 to 30 microns long and 15 to 17 microns wide.

Management - Supportive

Fact Explanation
Prevention Avoidance from having raw, undercooked or pickled wish is the best preventive method. Using molluscicides for snail (a host) control have been successful. Prevention
Avoidance from having raw, undercooked or pickled wish is the best preventive method. Using molluscicides for snail (a host) control have been successful.

Management - Specific

Fact Explanation
Praziquantel Praziquantel as a single dose (25 mg/kg or less) is the current treatment of choice. Frequently occurring side effects are dizziness, headache, and malaise. Approximately 90% of all patients have abdominal pain or cramps with or without nausea and vomiting. Praziquantel
Praziquantel as a single dose (25 mg/kg or less) is the current treatment of choice. Frequently occurring side effects are dizziness, headache, and malaise. Approximately 90% of all patients have abdominal pain or cramps with or without nausea and vomiting.

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  2. CHAI JY, KIM JL, SEO M. Four Human Cases of Acanthotrema felis (Digenea: Heterophyidae) Infection in Korea. Korean J Parasitol [online] 2014 Jun, 52(3):291-4 [viewed 09 August 2014] Available from: doi:10.3347/kjp.2014.52.3.291
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