Resources Causal Agents The trematode family Echinostomatidae includes numerous spiny-collared intestinal flukes known to infect humans. Infections are documented mostly from members of the genera Echinostoma E. Sporadic infections with members of other echinostomid genera including Echinoparyphium, Acanthoparyphium, Artyfechinostomum, Episthmium, Himasthla, Hypoderaeum, and Isthmiophora are known. Life Cycle Like many trematodes, echinostomid flukes undergo a multi-host indirect life cycle. Unembryonated eggs are passed in feces of infected definitive hosts and develop in water. Miracidia usually take about 3 weeks to mature before hatching , after which they swim freely and penetrate the first intermediate host, a snail.
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Received Aug 31; Accepted Jan 6. This article has been cited by other articles in PMC. Associated Data Data generated or analyzed during this study are included in this published article and remaining are available from the corresponding author on reasonable request.
Abstract Background Echinostomiasis is a food-borne infection caused by an intestinal trematodes belonging to the family Echinostomatidae. They infect the gastrointestinal tract of humans.
Patients are usually asymptomatic. However, with heavy infections, the worms can produce catarrhal inflammation with mild ulceration and the patient may experience abdominal pain, anorexia, nausea, vomiting, diarrhea and weight loss. Infection are associated with common sociocultural practices of eating raw or insufficiently cooked mollusks and fish. He had history of consumption of insufficiently cooked fish and snail with alcohol.
The adult worm was identified as Echinostoma species based on its morphology and characteristic ova found on stool routine microscopic examination of the patient.
Conclusions The patients having history of consumption of insufficiently cooked snail and fish with suggestive clinical features of echinostomiasis should be suspected by physicians and ova of Echinostoma species should be searched by trained microscopists. An epidemiological survey is required to know the exact burden of Echinostoma species infection in the place where people have habit of eating insufficiently cooked fish and snails, as it can be endemic in that community or geographical area.
Keywords: Echinostomiasis, Echinostoma species, Food-borne disease, Abdominal pain, Insufficiently cooked fish and snail, Nepal Background Echinostomiasis is a food-borne parasitic disease caused by an intestinal trematodes belonging to the family Echinostomatidae [ 1 ].
It can infect both humans and animals. These intestinal trematodes have a three-host life cycle with aquatic snails as first intermediate hosts in which a sporocyst, two generations of rediae and cercaria develop. Emerged cercariae freely swim and infect the second intermediate hosts, which may be several species of aquatic organisms such as snails, frogs, clams and fishes. However, with heavy infections, the worms can produce catarrhal inflammation with mild ulceration and the patient may experience abdominal pain, anorexia, nausea, vomiting, diarrhea and weight loss [ 2 , 3 ].
Infection are associated with common sociocultural practices of eating raw or insufficiently cooked mollusks, fish, crustaceans, and amphibians, promiscuous defecation, and use of night soil human excrement collected from latrines for fertilization of fish ponds [ 2 , 4 ]. Anamnesis The patient had past history of repeated admission for jaundice and abdominal distension probably due to alcoholic liver cirrhosis with decompensation ascites in local and regional hospital.
He moreover had a history of consumption of insufficiently cooked fish and snail with alcohol and water cress aquatic plants from riverside as the part of his daily meal. Clinical picture In the local government hospital, his abdominal pain was managed with antacids, proton pump inhibitors PPI , antispasmodic and albendazole but his pain was not relieved.
So, he was referred to Tribhuvan University Teaching Hospital where intravenous pantoprazole and hyoscine butylbromide was given which caused only mild relief of pain. Since, his pain was not resolving an ultrasound analysis was performed on 17th July which showed cirrhotic liver changes with ascites. For further evaluation endoscopy was planned for next day. On 18th July endoscopy was performed.
On macroscopic examination of stool, it was yellowish—brown with soft consistency. Oral sucker, ventral sucker, uterus and testes were clearly observed in the adult worm Figs. The adult worm resembled to the Echinostoma species, Clonorchis sinensis and Opisthorchis felineus.
Human echinostomiasis: a case report