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Mugil cephalzs) and minnow (Gambusia species)

-,..rophyes species, and carp (e.g. Carassius carrasius) and

:h Plecoglossus altiyelis in the case of Metagonimas species.

::s are infected after ingestion of inadequately cooked fish

-..'rng metacercariae, which mature in the flesh or scales of

..-'

. :du1t worms attach to or invade the mucosa of the upper

:orvel where they may cause granulomatous inflammation

!.'i.3 Famtlies of intestinal trematodes containing species that are


uncommon human pathogens

i:ig":-.!1"+.i+ EggotMetagonimusyokogawai.A[L
heterophyideggslooksimilar,as

do those of Clonorchis stnensis and Optsthorchts vtverrint.

(Courtesy of P Radomyos.)

and erosion. Light infections are generaliy asymptomatic but

hear,7 worm burdens may be associated with anorexia, nausea,

abdominal discomfort and mucous diarrhoea. Occasionally ova

deposited in the bowel wa11 enter blood vessels and embolize

to other tissues. Eggs have been found in the heart and central

nervous system and rarely in the b1ood. In cases of heterophyiasis

described in the Philippines, cardiac failure was associated

with subepicardial haemorrhages, myocardial damage caused by

occlusion of vessels by ova, and eggs stuck to a thickened, calcified

mitral valve. Neurological features include focal cerebral disturbances

and transverse myelitis.

Eggs (20-40 x 10-20pm in size) are passed in the stools (!,i;,:.

,:. I i. 1..;). They are yeliow-brown, elongated, operculate, and contain

a miracidium. Eggs of members of the family Heterophyidae

cannot be reliably differentiated from each other. Furthermore,

they are extremely difficult to differentiate from eggs of Clonorchis

sinensis and Opisthorcftls species although heterophyids tend to

have a smoother egg shell and a less prominent shoulder at the

operculum, and the abopercular knob may be absent.

7"1-1.4 INTESTINAL TREMATODE INFECTIONS 1223

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luq: :S Geographical