People are infected when they swallow cysts containing fluke larvae in raw, undercooked, or pickled freshwater crabs or crayfish.
Most infected people do not have symptoms, but those who do may have diarrhea, abdominal pain, fever, cough, itching, and later, symptoms due to damage to the lungs and other organs.
Doctors diagnose the infection when they see eggs in a person's sputum or eggs from swallowed sputum in stool.
Praziquantel or another drug is given to eliminate the flukes from the body.
Flukes Overview of Fluke Infections Flukes are parasitic flatworms. There are many species of fluke. Different species tend to infect different parts of the body. Flukes may infect Blood vessels of digestive or urinary system... read more are parasitic flatworms. There are many species of flukes. Different species tend to infect different parts of the body. There are more than 30 species of Paragonimus, and 10 species can infect people, causing paragonimiasis. However, most cases of paragonimiasis are caused by
People get lung fluke infections when they swallow cysts containing immature flukes (larvae) in raw, undercooked, or pickled freshwater crabs or crayfish. These infections occur most often in Asia. (See also Overview of Parasitic Infections Overview of Parasitic Infections A parasite is an organism that lives on or inside another organism (the host) and benefits (for example, by getting nutrients) from the host at the host's expense. Although this definition actually... read more .) Other Paragonimus species cause paragonimiasis in Africa, Central and South America, and rarely in North America.
After the cysts are swallowed, the larvae leave the cyst, penetrate the wall of the intestine and enter the abdominal cavity. Then they pass through the diaphragm, and invade the lungs. There, they develop into adults and produce eggs. Adults can live 20 years if not treated.
The flukes may also go to the brain, liver, lymph nodes, skin, or spinal cord where they form cysts and produce eggs. However, the life cycle cannot be completed in these organs because the eggs have no way to exit the body.
From the lungs, eggs are passed in the sputum that is coughed up and spit out or swallowed and passed in stool. If the eggs enter fresh water, they hatch into larvae that are ingested by snails. Inside the snail, the larvae develop into a form (called cercariae) that can swim. Cercariae released from infected snails then infect crabs or crayfish and form cysts (called metacercariae).
Symptoms of Fluke Lung Infections
Most people with fluke lung infections do not develop symptoms. However, soon after getting a lung fluke infection, people may have diarrhea, abdominal pain, fever, cough, and itching.
Later, the infection damages the lungs the most but may affect other organs, including the skin. People slowly develop symptoms such as a chronic cough, chest pain, and difficulty breathing. They may cough up blood. Bumps may form on the skin.
If the brain is affected, people may have seizures, difficulty using or understanding language, or problems seeing. They may be paralyzed.
Diagnosis of Fluke Lung Infections
Examination of a sputum or stool sample
Sometimes blood tests to detect antibodies to the parasite
Imaging tests of the lungs
Doctors diagnose lung fluke infections when they see eggs in a person's sputum or stool. Sometimes a sample of fluid is removed from the lungs and checked for eggs. Eggs may be difficult to find because only a few are released at time and they are not released regularly. Laboratories may use special concentration techniques to help them identify the eggs.
Blood tests to detect antibodies to the parasite may be useful. (Antibodies Antibodies One of the body's lines of defense (immune system) involves white blood cells (leukocytes) that travel through the bloodstream and into tissues, searching for and attacking microorganisms and... read more are proteins produced by the immune system to help defend the body against attack, including that by parasites.)
Other tests, such as an x-ray Plain X-Rays X-rays are high-energy radiation waves that can penetrate most substances (to varying degrees). In very low doses, x-rays are used to produce images that help doctors diagnose disease. In high... read more or computed tomography (CT) Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more of the chest, may be done to check for damage to the lungs or other organs.
Prevention of Fluke Lung Infections
For travelers to areas where lung fluke infections occur, prevention involves not eating raw or undercooked freshwater crabs and crayfish.
Treatment of Fluke Lung Infections
A drug to eliminate the flukes from the body
Lung fluke infections are treated with praziquantel, a drug used to eliminate flukes from the body (called an anthelmintic drug). An alternative is triclabendazole.
If the brain is infected, corticosteroids may also be given. They help control the inflammation that develops when the drug kills the flukes. Antiseizure drugs are used to control seizures.
Sometimes surgery is needed to remove bumps on the skin or rarely cysts in the brain.