Cause:
Fasciolopsiasis:Fasciola hepatica(sheep liver fluke)
Paragonimiasis:Paragonimus westermani
Pathophys:
Fasciolopsiasis: in adult, "snowplows" through liver to reach biliary system
Paragonimiasis: hypersensitivity response to encysted adults
Similar to clonorchis except metacercaria encysts on water plants (fasciolopsiasis) or crustaceans (paragonimiasis)
Fasciolopsiasis: worldwide wherever sheep raised and human manure used to fertilize salad foods
Paragonimiasis: mink farms in US; Southeast Asia
Sx:
Fasciolopsiasis: fever, urticaria
Paragonimiasis: hemoptysis, seizures (brain cysts)
Si:Fasciolopsiasis: fever, hepatosplenomegaly
Lab: Bact: Stool, sputum, urine show operculated eggs
Xray:Pleural effusions w eosinophils
Hem:Eosinophilia
Serol:Immunoblot assay for paragonimiasis (96% sens, 99% specif)
Rx:
Fasciolopsiasis: bithionol (Nejm 1972;287:995) (adverse effects: pneumonias as organisms killed); or praziquantel
Paragonimiasis: praziquantel 25 mg/kg tid × 1 d (Ann IM 1989;110:290)