Human echinostomiasis: a case report

Abstract

BackgroundEchinostomiasis is a food-borne infection caused by an intestinal trematodes belonging to the family Echinostomatidae. They infect the gastrointestinal tract of humans. Patients are usually asymptomatic. However, with heavy infections, the worms can produce catarrhal inflammation with mild ulceration and the patient may experience abdominal pain, anorexia, nausea, vomiting, diarrhea and weight loss. Infection are associated with common sociocultural practices of eating raw or insufficiently cooked mollusks and fish.Case presentationWe report a first case of echinostomiasis from Nepal in a 62 years old, hindu male who presented to Tribhuvan University Teaching Hospital, Kathmandu with a complaint of abdominal pain and distension with vomiting on and off for 3–4 months. He had history of consumption of insufficiently cooked fish and snail with alcohol. During endoscopy, an adult flat worm was seen with mild portal hypertensive gastropathy (McCormack’s classification) and erosive duodenopathy. The adult worm was identified as Echinostoma species based on its morphology and characteristic ova found on stool routine microscopic examination of the patient. Patient was treated with praziquantel 40 mg/kg (single dose) which is the drug of choice for Echinostoma species infection by which he got improved and on follow up stool examination after 2 weeks revealed no ova of Echinostoma species.ConclusionsThe patients having history of consumption of insufficiently cooked snail and fish with suggestive clinical features of echinostomiasis should be suspected by physicians and ova of Echinostoma species should be searched by trained microscopists. An epidemiological survey is required to know the exact burden of Echinostoma species infection in the place where people have habit of eating insufficiently cooked fish and snails, as it can be endemic in that community or geographical area.

Intestinal parasites at the Late Bronze Age settlement of Must Farm, in the fens of East Anglia, UK (9th century B.C.E.)

“…The eggs had small opercula with barely visible shoulders and a thickened wall at the abopercular end (Fig. 11) consistent with eggs recovered from modern echinostomiasis infections (Toledo and Estaban, 2016; Sah et al ., 2018). There are many species of Echinostoma that we cannot differentiate based on the morphology of the eggs.…”

“…Most cases of echinostomiasis are caused by ingestion of molluscs. However, reports of human infections have cited freshwater fish, snails, frogs and tadpoles as potential intermediate hosts that if ingested can lead to the development of the adult worm in the intestines (Toledo and Esteban, 2016; Chunge and Chunge, 2017; Sah et al ., 2018).…”

The study of Cytochrome B (CYTB): species-specific detection and phylogenetic relationship of Echinostoma revolutum, (Froelich, 1802)

“…The speciesspecific primer of E. revolutum obtained from this study can detected a single egg in the specimen with no crossreaction to other related trematode species or their intermediate and definitive hosts. Therefore, the successful development of a high-performance species-specific primer is helpful for discriminating between E. revolutum eggs and other trematode eggs that are similar in color and morphological appearance, such as Echinostoma eggs, Fasciola eggs, Fasciolopsis eggs and Gastrodiscoides eggs (Qureshi et al 2016;Sah et al 2018). The findings of this study can be applied for use in the development of detection tools for fecal examination in Echinostomiasis patients due to the fact that it would take considerably less time than the conventional method.…”

An Autochthonous Human Case of Fasciolopsiasis in Nepal

“…The diagnosis is usually suggested by the clinical presentations in endemic areas and confirmed by detecting the ellipsoidal, yellowish-brown, large (130–140×85 μm), thin shell, operculated eggs in the stool [2,3]. It should be noted that the eggs of F. buski are almost indistinguishable from those of Fasciola species ( F. hepatica and F. gigantica ) [5,12,13], and those of other lesser common intestinal trematode such as Echinostoma ilocanum [14], making necessary further investigations in areas where these parasites overlaps. In our case, identification of the adult worm was made on the basis of morphological keys and its differences with F. hepatica are evident, specifically, F. buski lacks the cephalic cone and is usually longer [3].…”