Vicente Y. Belizario, Jr., MD, MTM&H University of the ... · o Dracunculiasis o Echinococcosis o...
29
Vicente Y. Belizario, Jr., MD, MTM&H University of the Philippines Manila
Transcript of Vicente Y. Belizario, Jr., MD, MTM&H University of the ... · o Dracunculiasis o Echinococcosis o...
Vicente Y Belizario Jr MD MTMampH
University of the Philippines Manila
o Group of parasitic and bacterial diseases that cause significant impairment of physical and cognitive development (CDC 2011)
o Has plagued humanity for centuries
o Affect an estimated two billion people in tropical and subtropical countries (WHO 2013)
o All low-income countries are affected by at least five NTDs (CDC 2011)
o Related to unsafe water poor sanitation and impoverished living conditions
oViruso DengueSevere dengueo Rabies
oProtozoao Chagas diseaseo Human African trypanosomiasiso Leishmaniases
oHelmintho CysticercosisTaeniasiso Dracunculiasiso Echinococcosiso Foodborne trematodiaseso Lymphatic filariasis
o Onchocerciasis (river blindness)o Schistosomiasiso Soil-transmitted helminthiases
oBacteriao Buruli ulcero Leprosy (Hansen disease)o Trachomao Yaws
(WHO 2014)
(United to Combated NTD 2014)
o In Southeast Asia and Western Pacifico Soil-transmitted helminthiases (STH)
o Schistosomiasis (SCH)
o Lymphatic filariasis (LF)
o Food-borne trematodiases (FBT)
o Morbidities includeo Anemia malnutrition poor mental
and physical development (STH and SCH)
o Chronic liver and pulmonary disease (SCH)
o Physical disfigurement and disability (LF)
o Diarrhea anorexia weight loss peptic ulcer disease-like symptoms and chronic cough (FBT)
A case of elephantiasis due
to filariasis
Child with hepatosplenomegaly
due to SCH
o Not uncommon in tropical countries especially in Southeast Asia
o Manner of presentation
oFocal lesions
ocystic lung lesions
ocoin lesions
oconsolidationpleural effusion
oDiffuse lung disease
o transient pulmonary infiltrates
oalveolarinterstitial lung changes(Kunst et al 2010)
Diseases Parasites
Nematodes
Pulmonary ascariasis Ascaris lumbricoides
Pulmonary ancylostomiasis Ancylostoma duodenale
Necator americanus
Pulmonary strongyloidiasis Strongyloides stercoralis
Tropical pulmonary eosinophilia Wuchereria bancrofti
Trematodes
Pulmonary schistosomiasis Schistosoma haematobium
Schistosoma japonicum
Pulmonary paragonimiasis Paragonimus westermani
Cestodes
Pulmonary hydatid cyst Echinococcus granulosus
Echinococcus multilocularis
(Kunst et al 2010)
Diseases Parasites
Protozoa
Pulmonary amoebiasis Entamoeba histolytica
Pulmonary leishmaniasis (ibaba) Leishmania donovani
Pulmonary malaria Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi
Pulmonary toxoplasmosis Toxoplasma gondii
Pulmonary babesiosis Babesia microti
(Kunst et al 2010)
o Hypersensitivity response leading to respiratory symptoms including cough wheezing dyspnea chest pain fever and hemoptysis
o Characterized by transient pulmonary infiltrates associated with peripheral eosinophilia
(Kunst et al 2010)
o Pathophysiologyo Damage to the respiratory epithelium ciliastasis and mucus production
o Release of platelet activating factor and leukotrienes contributing to bronchospasm
o Ascaris lumbricoides and hookworms
o Other parasites such as Strongyloides stercoralis
o Can also be caused by nonsteroidal anti-inflammatory drug (NSAID) or infection with fungi (Aspergillus fumigatus or Pneumocystis jirovecii) (Sharma et al 2014 NLM 2013)
o Causative agentso Ascaris lumbricoides (round
worm)
o Ancylostoma duodenale or Necator americanus
o Transmission o Ingestion of eggs (Ascaris) or
skin penetration by larvae from soil (hookworms)
o Lung migration phase
(CDC 2011)
Life cycle of Ascaris lumbricoides
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Group of parasitic and bacterial diseases that cause significant impairment of physical and cognitive development (CDC 2011)
o Has plagued humanity for centuries
o Affect an estimated two billion people in tropical and subtropical countries (WHO 2013)
o All low-income countries are affected by at least five NTDs (CDC 2011)
o Related to unsafe water poor sanitation and impoverished living conditions
oViruso DengueSevere dengueo Rabies
oProtozoao Chagas diseaseo Human African trypanosomiasiso Leishmaniases
oHelmintho CysticercosisTaeniasiso Dracunculiasiso Echinococcosiso Foodborne trematodiaseso Lymphatic filariasis
o Onchocerciasis (river blindness)o Schistosomiasiso Soil-transmitted helminthiases
oBacteriao Buruli ulcero Leprosy (Hansen disease)o Trachomao Yaws
(WHO 2014)
(United to Combated NTD 2014)
o In Southeast Asia and Western Pacifico Soil-transmitted helminthiases (STH)
o Schistosomiasis (SCH)
o Lymphatic filariasis (LF)
o Food-borne trematodiases (FBT)
o Morbidities includeo Anemia malnutrition poor mental
and physical development (STH and SCH)
o Chronic liver and pulmonary disease (SCH)
o Physical disfigurement and disability (LF)
o Diarrhea anorexia weight loss peptic ulcer disease-like symptoms and chronic cough (FBT)
A case of elephantiasis due
to filariasis
Child with hepatosplenomegaly
due to SCH
o Not uncommon in tropical countries especially in Southeast Asia
o Manner of presentation
oFocal lesions
ocystic lung lesions
ocoin lesions
oconsolidationpleural effusion
oDiffuse lung disease
o transient pulmonary infiltrates
oalveolarinterstitial lung changes(Kunst et al 2010)
Diseases Parasites
Nematodes
Pulmonary ascariasis Ascaris lumbricoides
Pulmonary ancylostomiasis Ancylostoma duodenale
Necator americanus
Pulmonary strongyloidiasis Strongyloides stercoralis
Tropical pulmonary eosinophilia Wuchereria bancrofti
Trematodes
Pulmonary schistosomiasis Schistosoma haematobium
Schistosoma japonicum
Pulmonary paragonimiasis Paragonimus westermani
Cestodes
Pulmonary hydatid cyst Echinococcus granulosus
Echinococcus multilocularis
(Kunst et al 2010)
Diseases Parasites
Protozoa
Pulmonary amoebiasis Entamoeba histolytica
Pulmonary leishmaniasis (ibaba) Leishmania donovani
Pulmonary malaria Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi
Pulmonary toxoplasmosis Toxoplasma gondii
Pulmonary babesiosis Babesia microti
(Kunst et al 2010)
o Hypersensitivity response leading to respiratory symptoms including cough wheezing dyspnea chest pain fever and hemoptysis
o Characterized by transient pulmonary infiltrates associated with peripheral eosinophilia
(Kunst et al 2010)
o Pathophysiologyo Damage to the respiratory epithelium ciliastasis and mucus production
o Release of platelet activating factor and leukotrienes contributing to bronchospasm
o Ascaris lumbricoides and hookworms
o Other parasites such as Strongyloides stercoralis
o Can also be caused by nonsteroidal anti-inflammatory drug (NSAID) or infection with fungi (Aspergillus fumigatus or Pneumocystis jirovecii) (Sharma et al 2014 NLM 2013)
o Causative agentso Ascaris lumbricoides (round
worm)
o Ancylostoma duodenale or Necator americanus
o Transmission o Ingestion of eggs (Ascaris) or
skin penetration by larvae from soil (hookworms)
o Lung migration phase
(CDC 2011)
Life cycle of Ascaris lumbricoides
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
oViruso DengueSevere dengueo Rabies
oProtozoao Chagas diseaseo Human African trypanosomiasiso Leishmaniases
oHelmintho CysticercosisTaeniasiso Dracunculiasiso Echinococcosiso Foodborne trematodiaseso Lymphatic filariasis
o Onchocerciasis (river blindness)o Schistosomiasiso Soil-transmitted helminthiases
oBacteriao Buruli ulcero Leprosy (Hansen disease)o Trachomao Yaws
(WHO 2014)
(United to Combated NTD 2014)
o In Southeast Asia and Western Pacifico Soil-transmitted helminthiases (STH)
o Schistosomiasis (SCH)
o Lymphatic filariasis (LF)
o Food-borne trematodiases (FBT)
o Morbidities includeo Anemia malnutrition poor mental
and physical development (STH and SCH)
o Chronic liver and pulmonary disease (SCH)
o Physical disfigurement and disability (LF)
o Diarrhea anorexia weight loss peptic ulcer disease-like symptoms and chronic cough (FBT)
A case of elephantiasis due
to filariasis
Child with hepatosplenomegaly
due to SCH
o Not uncommon in tropical countries especially in Southeast Asia
o Manner of presentation
oFocal lesions
ocystic lung lesions
ocoin lesions
oconsolidationpleural effusion
oDiffuse lung disease
o transient pulmonary infiltrates
oalveolarinterstitial lung changes(Kunst et al 2010)
Diseases Parasites
Nematodes
Pulmonary ascariasis Ascaris lumbricoides
Pulmonary ancylostomiasis Ancylostoma duodenale
Necator americanus
Pulmonary strongyloidiasis Strongyloides stercoralis
Tropical pulmonary eosinophilia Wuchereria bancrofti
Trematodes
Pulmonary schistosomiasis Schistosoma haematobium
Schistosoma japonicum
Pulmonary paragonimiasis Paragonimus westermani
Cestodes
Pulmonary hydatid cyst Echinococcus granulosus
Echinococcus multilocularis
(Kunst et al 2010)
Diseases Parasites
Protozoa
Pulmonary amoebiasis Entamoeba histolytica
Pulmonary leishmaniasis (ibaba) Leishmania donovani
Pulmonary malaria Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi
Pulmonary toxoplasmosis Toxoplasma gondii
Pulmonary babesiosis Babesia microti
(Kunst et al 2010)
o Hypersensitivity response leading to respiratory symptoms including cough wheezing dyspnea chest pain fever and hemoptysis
o Characterized by transient pulmonary infiltrates associated with peripheral eosinophilia
(Kunst et al 2010)
o Pathophysiologyo Damage to the respiratory epithelium ciliastasis and mucus production
o Release of platelet activating factor and leukotrienes contributing to bronchospasm
o Ascaris lumbricoides and hookworms
o Other parasites such as Strongyloides stercoralis
o Can also be caused by nonsteroidal anti-inflammatory drug (NSAID) or infection with fungi (Aspergillus fumigatus or Pneumocystis jirovecii) (Sharma et al 2014 NLM 2013)
o Causative agentso Ascaris lumbricoides (round
worm)
o Ancylostoma duodenale or Necator americanus
o Transmission o Ingestion of eggs (Ascaris) or
skin penetration by larvae from soil (hookworms)
o Lung migration phase
(CDC 2011)
Life cycle of Ascaris lumbricoides
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
(United to Combated NTD 2014)
o In Southeast Asia and Western Pacifico Soil-transmitted helminthiases (STH)
o Schistosomiasis (SCH)
o Lymphatic filariasis (LF)
o Food-borne trematodiases (FBT)
o Morbidities includeo Anemia malnutrition poor mental
and physical development (STH and SCH)
o Chronic liver and pulmonary disease (SCH)
o Physical disfigurement and disability (LF)
o Diarrhea anorexia weight loss peptic ulcer disease-like symptoms and chronic cough (FBT)
A case of elephantiasis due
to filariasis
Child with hepatosplenomegaly
due to SCH
o Not uncommon in tropical countries especially in Southeast Asia
o Manner of presentation
oFocal lesions
ocystic lung lesions
ocoin lesions
oconsolidationpleural effusion
oDiffuse lung disease
o transient pulmonary infiltrates
oalveolarinterstitial lung changes(Kunst et al 2010)
Diseases Parasites
Nematodes
Pulmonary ascariasis Ascaris lumbricoides
Pulmonary ancylostomiasis Ancylostoma duodenale
Necator americanus
Pulmonary strongyloidiasis Strongyloides stercoralis
Tropical pulmonary eosinophilia Wuchereria bancrofti
Trematodes
Pulmonary schistosomiasis Schistosoma haematobium
Schistosoma japonicum
Pulmonary paragonimiasis Paragonimus westermani
Cestodes
Pulmonary hydatid cyst Echinococcus granulosus
Echinococcus multilocularis
(Kunst et al 2010)
Diseases Parasites
Protozoa
Pulmonary amoebiasis Entamoeba histolytica
Pulmonary leishmaniasis (ibaba) Leishmania donovani
Pulmonary malaria Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi
Pulmonary toxoplasmosis Toxoplasma gondii
Pulmonary babesiosis Babesia microti
(Kunst et al 2010)
o Hypersensitivity response leading to respiratory symptoms including cough wheezing dyspnea chest pain fever and hemoptysis
o Characterized by transient pulmonary infiltrates associated with peripheral eosinophilia
(Kunst et al 2010)
o Pathophysiologyo Damage to the respiratory epithelium ciliastasis and mucus production
o Release of platelet activating factor and leukotrienes contributing to bronchospasm
o Ascaris lumbricoides and hookworms
o Other parasites such as Strongyloides stercoralis
o Can also be caused by nonsteroidal anti-inflammatory drug (NSAID) or infection with fungi (Aspergillus fumigatus or Pneumocystis jirovecii) (Sharma et al 2014 NLM 2013)
o Causative agentso Ascaris lumbricoides (round
worm)
o Ancylostoma duodenale or Necator americanus
o Transmission o Ingestion of eggs (Ascaris) or
skin penetration by larvae from soil (hookworms)
o Lung migration phase
(CDC 2011)
Life cycle of Ascaris lumbricoides
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o In Southeast Asia and Western Pacifico Soil-transmitted helminthiases (STH)
o Schistosomiasis (SCH)
o Lymphatic filariasis (LF)
o Food-borne trematodiases (FBT)
o Morbidities includeo Anemia malnutrition poor mental
and physical development (STH and SCH)
o Chronic liver and pulmonary disease (SCH)
o Physical disfigurement and disability (LF)
o Diarrhea anorexia weight loss peptic ulcer disease-like symptoms and chronic cough (FBT)
A case of elephantiasis due
to filariasis
Child with hepatosplenomegaly
due to SCH
o Not uncommon in tropical countries especially in Southeast Asia
o Manner of presentation
oFocal lesions
ocystic lung lesions
ocoin lesions
oconsolidationpleural effusion
oDiffuse lung disease
o transient pulmonary infiltrates
oalveolarinterstitial lung changes(Kunst et al 2010)
Diseases Parasites
Nematodes
Pulmonary ascariasis Ascaris lumbricoides
Pulmonary ancylostomiasis Ancylostoma duodenale
Necator americanus
Pulmonary strongyloidiasis Strongyloides stercoralis
Tropical pulmonary eosinophilia Wuchereria bancrofti
Trematodes
Pulmonary schistosomiasis Schistosoma haematobium
Schistosoma japonicum
Pulmonary paragonimiasis Paragonimus westermani
Cestodes
Pulmonary hydatid cyst Echinococcus granulosus
Echinococcus multilocularis
(Kunst et al 2010)
Diseases Parasites
Protozoa
Pulmonary amoebiasis Entamoeba histolytica
Pulmonary leishmaniasis (ibaba) Leishmania donovani
Pulmonary malaria Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi
Pulmonary toxoplasmosis Toxoplasma gondii
Pulmonary babesiosis Babesia microti
(Kunst et al 2010)
o Hypersensitivity response leading to respiratory symptoms including cough wheezing dyspnea chest pain fever and hemoptysis
o Characterized by transient pulmonary infiltrates associated with peripheral eosinophilia
(Kunst et al 2010)
o Pathophysiologyo Damage to the respiratory epithelium ciliastasis and mucus production
o Release of platelet activating factor and leukotrienes contributing to bronchospasm
o Ascaris lumbricoides and hookworms
o Other parasites such as Strongyloides stercoralis
o Can also be caused by nonsteroidal anti-inflammatory drug (NSAID) or infection with fungi (Aspergillus fumigatus or Pneumocystis jirovecii) (Sharma et al 2014 NLM 2013)
o Causative agentso Ascaris lumbricoides (round
worm)
o Ancylostoma duodenale or Necator americanus
o Transmission o Ingestion of eggs (Ascaris) or
skin penetration by larvae from soil (hookworms)
o Lung migration phase
(CDC 2011)
Life cycle of Ascaris lumbricoides
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Not uncommon in tropical countries especially in Southeast Asia
o Manner of presentation
oFocal lesions
ocystic lung lesions
ocoin lesions
oconsolidationpleural effusion
oDiffuse lung disease
o transient pulmonary infiltrates
oalveolarinterstitial lung changes(Kunst et al 2010)
Diseases Parasites
Nematodes
Pulmonary ascariasis Ascaris lumbricoides
Pulmonary ancylostomiasis Ancylostoma duodenale
Necator americanus
Pulmonary strongyloidiasis Strongyloides stercoralis
Tropical pulmonary eosinophilia Wuchereria bancrofti
Trematodes
Pulmonary schistosomiasis Schistosoma haematobium
Schistosoma japonicum
Pulmonary paragonimiasis Paragonimus westermani
Cestodes
Pulmonary hydatid cyst Echinococcus granulosus
Echinococcus multilocularis
(Kunst et al 2010)
Diseases Parasites
Protozoa
Pulmonary amoebiasis Entamoeba histolytica
Pulmonary leishmaniasis (ibaba) Leishmania donovani
Pulmonary malaria Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi
Pulmonary toxoplasmosis Toxoplasma gondii
Pulmonary babesiosis Babesia microti
(Kunst et al 2010)
o Hypersensitivity response leading to respiratory symptoms including cough wheezing dyspnea chest pain fever and hemoptysis
o Characterized by transient pulmonary infiltrates associated with peripheral eosinophilia
(Kunst et al 2010)
o Pathophysiologyo Damage to the respiratory epithelium ciliastasis and mucus production
o Release of platelet activating factor and leukotrienes contributing to bronchospasm
o Ascaris lumbricoides and hookworms
o Other parasites such as Strongyloides stercoralis
o Can also be caused by nonsteroidal anti-inflammatory drug (NSAID) or infection with fungi (Aspergillus fumigatus or Pneumocystis jirovecii) (Sharma et al 2014 NLM 2013)
o Causative agentso Ascaris lumbricoides (round
worm)
o Ancylostoma duodenale or Necator americanus
o Transmission o Ingestion of eggs (Ascaris) or
skin penetration by larvae from soil (hookworms)
o Lung migration phase
(CDC 2011)
Life cycle of Ascaris lumbricoides
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
Diseases Parasites
Nematodes
Pulmonary ascariasis Ascaris lumbricoides
Pulmonary ancylostomiasis Ancylostoma duodenale
Necator americanus
Pulmonary strongyloidiasis Strongyloides stercoralis
Tropical pulmonary eosinophilia Wuchereria bancrofti
Trematodes
Pulmonary schistosomiasis Schistosoma haematobium
Schistosoma japonicum
Pulmonary paragonimiasis Paragonimus westermani
Cestodes
Pulmonary hydatid cyst Echinococcus granulosus
Echinococcus multilocularis
(Kunst et al 2010)
Diseases Parasites
Protozoa
Pulmonary amoebiasis Entamoeba histolytica
Pulmonary leishmaniasis (ibaba) Leishmania donovani
Pulmonary malaria Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi
Pulmonary toxoplasmosis Toxoplasma gondii
Pulmonary babesiosis Babesia microti
(Kunst et al 2010)
o Hypersensitivity response leading to respiratory symptoms including cough wheezing dyspnea chest pain fever and hemoptysis
o Characterized by transient pulmonary infiltrates associated with peripheral eosinophilia
(Kunst et al 2010)
o Pathophysiologyo Damage to the respiratory epithelium ciliastasis and mucus production
o Release of platelet activating factor and leukotrienes contributing to bronchospasm
o Ascaris lumbricoides and hookworms
o Other parasites such as Strongyloides stercoralis
o Can also be caused by nonsteroidal anti-inflammatory drug (NSAID) or infection with fungi (Aspergillus fumigatus or Pneumocystis jirovecii) (Sharma et al 2014 NLM 2013)
o Causative agentso Ascaris lumbricoides (round
worm)
o Ancylostoma duodenale or Necator americanus
o Transmission o Ingestion of eggs (Ascaris) or
skin penetration by larvae from soil (hookworms)
o Lung migration phase
(CDC 2011)
Life cycle of Ascaris lumbricoides
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
Diseases Parasites
Protozoa
Pulmonary amoebiasis Entamoeba histolytica
Pulmonary leishmaniasis (ibaba) Leishmania donovani
Pulmonary malaria Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi
Pulmonary toxoplasmosis Toxoplasma gondii
Pulmonary babesiosis Babesia microti
(Kunst et al 2010)
o Hypersensitivity response leading to respiratory symptoms including cough wheezing dyspnea chest pain fever and hemoptysis
o Characterized by transient pulmonary infiltrates associated with peripheral eosinophilia
(Kunst et al 2010)
o Pathophysiologyo Damage to the respiratory epithelium ciliastasis and mucus production
o Release of platelet activating factor and leukotrienes contributing to bronchospasm
o Ascaris lumbricoides and hookworms
o Other parasites such as Strongyloides stercoralis
o Can also be caused by nonsteroidal anti-inflammatory drug (NSAID) or infection with fungi (Aspergillus fumigatus or Pneumocystis jirovecii) (Sharma et al 2014 NLM 2013)
o Causative agentso Ascaris lumbricoides (round
worm)
o Ancylostoma duodenale or Necator americanus
o Transmission o Ingestion of eggs (Ascaris) or
skin penetration by larvae from soil (hookworms)
o Lung migration phase
(CDC 2011)
Life cycle of Ascaris lumbricoides
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Hypersensitivity response leading to respiratory symptoms including cough wheezing dyspnea chest pain fever and hemoptysis
o Characterized by transient pulmonary infiltrates associated with peripheral eosinophilia
(Kunst et al 2010)
o Pathophysiologyo Damage to the respiratory epithelium ciliastasis and mucus production
o Release of platelet activating factor and leukotrienes contributing to bronchospasm
o Ascaris lumbricoides and hookworms
o Other parasites such as Strongyloides stercoralis
o Can also be caused by nonsteroidal anti-inflammatory drug (NSAID) or infection with fungi (Aspergillus fumigatus or Pneumocystis jirovecii) (Sharma et al 2014 NLM 2013)
o Causative agentso Ascaris lumbricoides (round
worm)
o Ancylostoma duodenale or Necator americanus
o Transmission o Ingestion of eggs (Ascaris) or
skin penetration by larvae from soil (hookworms)
o Lung migration phase
(CDC 2011)
Life cycle of Ascaris lumbricoides
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Causative agentso Ascaris lumbricoides (round
worm)
o Ancylostoma duodenale or Necator americanus
o Transmission o Ingestion of eggs (Ascaris) or
skin penetration by larvae from soil (hookworms)
o Lung migration phase
(CDC 2011)
Life cycle of Ascaris lumbricoides
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Major factors for exposure poor environmental sanitation and poor personal hygiene
o Common worldwide in areas with poor sanitation
o Prevalence of STH in Southeast Asiao 597 in a rural community in Malaysia (Hakim et al 2007)
o 437 among PSAC and 447 among SAC in the Philippines based from a sentinel surveillance in 2009 (Belizario et al 2013)
o Definitive diagnosis Microscopic examination of stool
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Albendazole or Mebendazole
o WHO recommends preventive chemotherapy for morbidity controlo Use of anthelminthic drugs either alone or
in combination as a public health tool against helminth infections
(WHO 2006)
o Major mass drug administration (MDA) efforts ongoing in developing countries
o In the Philippines MDA coverage rates generally very low at 15 (WHO 2012)
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Strongyloides stercoralis
o Infection rates in Southeast Asia
o 175 in Cambodia
o 237 in Thailand
o 262 in Lao PDR (Schar et al 2013)
o 447 infection rate in a province in Northern Cambodia
(Khieu et al 2014)
o Skin penetration of filariform larvae gt entry to blood vessels gt heart and lung migration gt migration to alveoli (Kunst et al 2010)
o Autoinfection leading to hyperinfection
o Disseminated strongyloidiasis - case-fatality rates near 90
(CDC 2013)
Filariform larva of Strongyloidesstercoralis (CDC 2012)
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Clinical Manifestations
o Generally asymptomatic (latent phase)
o Mild symptoms during lung migration
o Respiratory symptoms may be non-specific
o Asthma-like symptoms
o In hyperinfection pulmonary infiltrates are commonly seen on chest radiographs
o Eosinophilia in 75 of the cases
o Definitive diagnosis demonstration of rhabditiformlarvae in stool sputum or duodenal aspirates
(Kunst et al 2010)
o Use of culture techniques such as Harada-Mori technique
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Ivermectin (first line therapy)
single dose 200 microgkg orally
for 1-2 days
oAlbendazole (alternative)
400 mg orally two times a day for 7 days
(CDC 2013)Ivermectin tablets
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Syndrome resulting from hypersensitivity reaction to Wuchereriabancrofti and Brugia malayi
o Occurs in Southeast Asia China India and Africa
o Slow onset (over several months)
o Respiratory symptoms cough dyspneaand wheezing
o Systemic symptoms fever malaise and weight loss
o Seen in only lt1 of filarial infection
(Kunst et al 2010 Vijayan 2008)
Wuchereria bancrofti adult
Brugia malayi adult
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Diagnosis
oDemonstration of filarial parasite through microscopy
oHigh titres of antifilarial antibodies
oPeripheral blood eosinophilia
oElevated total serum IgE
o Treatment
oDiethylcarbamazine (may be combined with albendazole to improve efficacy)
(Kunst et al 2010 Vijayan 2008)
Diethylcarbamazinetablet
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Paragonimus westermaniKorea Japan China Taiwan Malaysia Indonesia
Philippines and India
o Paragonimus heterotremusSoutheast Asia and Southern China
(WHO 2014)
o 20 million people with paragonimiasis in Asia (90 of all cases) (Vijayan 2008)
o 209 prevalence in children and 41 in adults in Arunachal Pradesh in India (Devi et al 2007)
o 02ndash113 prevalence in Vietnam majority of whom are children (Doanh et al 2013)
o 15-25 prevalence in Zamboanga del Norte and Sorsogon (Belizario et al 2000 2007)
Paragonimuswestermani adult
Paragonimus egg
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
Occidental Mindoro
Oriental Mindoro
Camarines Sur
Sorsogon
Samar
Leyte
Zamboanga del Norte
Compostela Valley
Davao del Norte
Davao Oriental
Cotabato
Basilan
(Cabrera 1979 Belizario and Malte 2004)
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Major clinical manifestations
o Manifestations and X-ray findings mimic pulmonary tuberculosis (Singh et al 1986 2005 Belizario et al 1997 Nagakura et al 2002 Narain et al 2004 Tay et al 2005)
o30 with TB as co-mobidityoNo significant different between males and females(Belizario et al 1997)
Persistent coughHemoptysisChest painBack Pain
DyspneaWeight lossAnorexiaFever
48 year old female from ZDN with Paragonimiasismisdiagnosed to have PTB
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
oDiagnosisoSputum examination (3 NaOHconcentration technique)oImmunological techniques and PCR not readily available (WHO 2014)
oTreatmentoTriclabendazole
20 mgkg in two divided doses on the same day
oPraziquantel25 mgkg three times a day
for three days(WHO 2014)
Triclabendazole tablet
Praziquantel tablets
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Schistosomajaponicum in China Philippines Indonesia
o Schistosoma mekongiin Cambodia Lao PDR
(WHO 2014)
o Prevalent in Southeast Asia
o Cambodia lt1
o Lao PDR lt1
o Philippines 3(Zhou et al 2010 DOH 2013)
Schistosoma adult Freshwater snails
wwwcdcgovparasites
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Endemic in 12 regions covering 28 provinces with focal distribution
(DOH 2007 Belizario et al 2005)
o Prevalence of schistosomiasis in school-age children
o Negros Occidental ndash 68
o Davao del Norte - 31
o Surigao del Norte ndash 48
o Agusan del Sur - 318 (5-70)(Belizario et al 2007 2012 2013)
o Major challenges with lab diagnostics (Belizario et al 2004)
WHODOH Target
Prevalence lt1
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Schistosomiasis ndash maybe one of the most common causes of pulmonary hypertension
o Lack of data on disease burden (Butrous et al 2008
Kolosionek et al 2010)
o Acute pulmonary schistosomiasis (Katayama syndrome)
oDevelop three to eight weeks after skin penetration
oFever chills weight loss diarrhea abdominal pain myalgia shortness of breath wheezing urticariaand dry cough
oSmall pulmonary nodules in CT
(Kunst et al 2010 Vijayan 2008)
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Chronic pulmonary schistosomiasis
o Features of pulmonary hypertension and cor pulmonale
oMassive hemoptysis
o Lobar consolidation and collapse(Kunst et al 2010 Vijayan 2008)
o Pulmonary granulomas and fibrosis in S japnicum infections resported in 80 of autopsied cases of advanced disease in China (Zheng et al 1981)
oOnly 1 case of cor pulmonale in 65 patients with S japonicum infections in Philippines (Watt et al 1986)
Schistosoma japonicum egg
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
oDiagnosis
oMicroscopy
oKato Katz Technique
oFormalin Ether Concentration Technique
oImmunodiagnostic Tests
o Circumoval Precipitin Test (COPT)
o Enzyme-Linked Immunosorbent Assay
o Rectal imprint
o Treatment Praziquantel
(Kunst et al 2010 Vijayan 2008)
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
o Neglected diseases infectious diseases of poverty
o Parasitic infections affecting the lungs not uncommon in Southeast Asia
o Pulmonary manifestations coupled with evidence of parasitic infections provide basis for clinical diagnosis
o Treatment will include provision of appropriate anti-parasite drugs
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
Belizario VY De Leon WU Ortega AR Macatangay BC BugaoisanVM Hipolito RH Malte BI Ting TM Philippine Textbook of Medical Parasitology 2nd Edition 2004 Manila
Center for Disease Control Resources for Health Professionals Strongyloides Available from httpwwwcdcgovparasitesstrongyloideshealth_professionals
Kunst H Mack D Kon OM Banerjee AK Chiodini P Grant A Parasitic infections of the lung A guide for the respiratory physician Thorax 2010 Sep Available from httpthoraxbmjcomcontentearly20100929thx2009132217fullref-8
Schaumlr F Trostdorf U Giardina F Khieu V Muth S et al (2013) Strongyloides stercoralis Global Distribution and Risk Factors PLoS Negl Trop Dis 7(7) e2288 doi101371journalpntd0002288
Stamatakos M1 Sargedi C Stefanaki Ch Safioleas C MatthaiopoulouI Safioleas M Anthelminthic treatment an adjuvant therapeutic strategy against Echinococcus granulosus Parasitology International 2009 Jun 58(2
Vijayan VK Tropical Parasitic Lung Diseases The Indian Journal of Chest Diseases and Allied Sciences 2008 Vol 50 Available from httpmedindniciniaet08i1iaet08i1p49pdf
