FISH–BORNE

PARASITIC
ZOONOSES

Source Collected By
Mushfiqur Rahman
 ZOONOSES

Zoonoses are diseases and infections

that are naturally transmitted between vertebrate
animals and man.

Zoonose –Greek word, “zoon + noses”

(zoon-animal) (noses-disease)
 Importance
 Public health significance
 Classification is necessary
 Causative agent-Bacterial, Viral,
Parasitic,Fungal
 Reservoir host- Anthroponoses,
Zooanthroponoses, Amphixenosis
 Mode of transmission-Direct zoonoses,
Cyclozoonoses, Metazoonoses, Saprozoonoses
 Related animals-Domesticated animal
zoonoses, Wild animal zoonoses
Epidemiolgy of Parasitic zoonoses

♦ The importance of emerging zoonotic parasitoses

examine the intimate relationship between humans,the
parasites and environment including other hosts.

♦ Such studies includes

Macroepidemiological
Microepidemiological levels.
 Cont..
 Macroepidemiological studies involves –broad
pattern of distribution,prevelance and incidence
of infection by age and sex,estimates of
morbidity and mortality,economic impacts etc

 Microepidemiological studies involves- the

variability of organisms themselves and
relationship between parasite and the host, both
in internal and external environment.
(Nelson1990)
 Types of parasitic zoonoses
1. Water borne parasitic zoonoses
Protozoan parasites such as Giardia,
Cryptosporidium causes diarrhoea in a
number of animals and humans, an estimated
2.8 billion people per year (Lane and Loyel
2002)
2. Plant borne parasitic zoonoses
Freshwater raised plants such as
watercress, is the route of transmission of
Fasiola hepatica. An estimated 2.4 million
people infected by fascioliasis (WHO-1995)
 Cont..
3. Meat borne parasitic zoonoses
By eating raw or undercooked food
including crustaceans, fishes, pigs, etc

Cysticercosis - Taenia solium

Trichinellosis-Trichinella spiralis
(consumption of undercooked pork)
Paragonimosis- Paragonimus westermani
(undercooked crabs, cray fish or shrimp)
Parastrongylosis - Parastrongylus cantonensis
(consumption of mollusks)
 Fish borne parasitic zoonoses
 Mainly caused by Helminths.

 Both marine and freshwater fishes serve as source of

parasites.

 Mainly acquired through eating raw or undercooked fish

 By the use of ‘sushi’, ’sashimi’ and similar food fishes the
probability of disease transmission increased.

 Fish can either be intermediate host of parasites

involving man as the definitive host,or harbour larval
parasites of which definitive hosts are other animals.
 Cont..
 List of potential fish borne parasitic zoonoses is
quite large, some are described below.

 Liver fluke diseases- Clonorchiasis,

Opisthorchiasis
 Intestinal trematodiasis -
Heterophyds,Echinostomes
 Anisakiasis - Anisakis simplex larvae
 Diphyllobothriasis-Diphyllobothrium latum
 Trematodiasis

 Food borne trematodes contribute parasitic

zoonoses such as liver,lung and intestinal flukes
of humans
 It has been recognised as an important health
problem in Asia(WHO,1995,2004)
 Important in South east Asia and Far East
where people are dependent on fresh water fish
as a source of protein
 Residents living near freshwater bodies have a
2.15 fold higher risk for infections
 Cont..
 Route of infection by metacercaria of parasites
through fishes
 Cause morbidity and serious complications in
humans

 WHO (1995) estimated that the number of

people infected with fish borne trematodes
exceeds 18 million
 Liver flukes
 Clonorchis sinensis –(Chinese liver fluke)
 Opisthorchis viverrini-(South east Asian liver
fluke)
 O.felinus-(Cat liver fluke)
 Infection by the consumption of raw, dried,
salted or pickled fish from areas where the worm
breeds
 Epedemiology
 C.sinensis is endemic in Far East, especially in
Korea, Japan, Taiwan and Southern China.

 It has been reported in non-endemic areas

including the United States.
In such cases the infection is found in
Asian immigrants or following ingestion of
imported, undercooked or pickled freshwater fish
containing metacercaria.
Up to 26% of immigrants from China to the
United States have been found to be infected
with this parasite.
 Cont..
 The geographical pattern of liver flukes is not
uniform
 In Thailand O.viverrrini shows marked regional
variation
(highly prevalent in North east compared to
other regions of the country)
 A similar uneven distribution is true for
C.sinensis in China.
 Biology
 Liver flukes are hermaphroditic trematodes
 Dorsoventrally flattened body with two muscular
structures

 Differentiation of the species mainly in the shape and

position of the testes and the arrangement of vitellerian
glands
 C.sinensis seperated from the other two species by the
presence of branched testes and continuosly distributed
vitelline glands.
 O.viverrini is similar to O.felinus in lobed testes and
cluster vitelline gland.
C.sinensis O.viverrini
 Life cycle..
 Digenetic trematodes having more than one
intermediate host in life cycle.

 In the definitive host (in the biliary passage) the

adult worms cross -fertilize and produce yellow
brown eggs

 Each ovum is characterised by a protruberance

posteriorly
 Cont..

Egg

Miracidia

Cercaria
 Intermediate hosts
 The first intermediate host are Parafossarulus
manchouricus,Bithynia and Bulimus

 About 71 species in the family Cyprinidae,2 species in

Ophiocephalidae and Eleotridae, and one species each
in the Bagridae, Cypinodontidae,
Clupeidae,Osmeridae,Cichlidae and Gobidae are
susceptable to this parasite.

 Among these the most widely distributed species are

Pseudorasbora parva and Rhodeus ocellatus
 Cont..

Bithynia funiculata B.goniomphalus

B..siamensis Parafossarulus manchaorichus

 Pathogenesis
 Humans become infected after ingesting
metacercaria in poorly cooked fish.

 The metacercaria exist in small intestine and

migrate through the Ampulla of vater into the
biliary ducts,where they mature in 3-4 weeks
and subsequently release eggs.

 Adult flukes can survive for 20-25 years.

 Signs and Symptoms
 Acute cases lesions in the distal biliary passage

 The latter complication leads to biliary

obstruction as a result of extensive
adenomatous proliferation and cholangitis.

 Atrophy of the biliary epithelium and underlying

hepatic cells may also develop.

 Chlonorchias may also cause

pancreatitis(Hou,1995)
 Cont..
 In chronic infections, chronic cholangitis may progress to
portal fibrosis ,cirrhosis and atrophy of liver parenchyma.

 Jaundice is caused by biliary obstuction due to mass of

flukes.

 In moderate and heavy infections –fever, chills,anorexia,

diarrhoea and epigastric pain, hot sensation over the
liver which can be slightly enlarged , begin 10 to 26 days
after infection.

 In chronic heavy infections ,symptoms of gastroenteritis

may occur together with cachexia, oedema and
malnutrition.
Clonorchis sinensis in liver cells
Bile duct with Clonorchis sinensis
Cholangiocarcinoma of liver cells
 Treatment
 Oral praziquantel taken after each meal in one
day.

 Albendazole can also be used,but a 7 day

treatment course is required.
 Opisthorchiasis
 Opisthorchis  O. felinus
viverrini
 Cats, Dogs,Foxes
 Civette cat and Pigs are the
( Felis viverrini )is common hosts.
the definitive host.
 Opisthorchis viverrini
 Southeast Asian liverfluke

 The adult worms seen in

the biliary passage.

 The species is
distinguished from
C.sinensis having lobed
testes and a different
patterns of flame cells in
the cercaria and
metacercaria.
 Epedemiology
 Endemic throughout Thailand, Vietnam and
Combodia.

 The disease can be acquired by eating a local

dish called ‘Koi-pla’ which contains infected raw
fish.

 The high prevalence of this infection is related

to the eating and defaecation habits of local
inhabitance as well as the common occurrence
of snail intermediate hosts.
 Opisthorchis felinus
 Cat liver fluke

 Morphologically
resembles O.viverrini
except less lobate
testes and situated
further from the ovary.
 Cont..
Epedemiology
The disease usually occurs in villages
and reservoirs in Siberia and Central Europe
where fish eaten are raw.
Biology
The first intermediate hosts are the
freshwater snails like Bithynia inflata,Bithynia
leachii etc
The metacercaria are located in the
muscles of freshwater fishes which are the second
intermediate hosts
 Pathogenesis
 The presence of large number of worms in the
bile duct and its canaliculi,the gall bladder and
the hepaic ducts can elicit adenomatous
hyperplasia of the biliary epithelium.

 Heavy infection leads to cirrhosis of liver,

cholangiocarcinoma or liver carcinoma and
hepatic cyst formation.

 Treatment of Opisthorchiasis is generally with a

single doze of praziquantel.
Adult worms in bile duct of liver
 Intestinal Trematodiasis
 Caused by small trematodes (0.5-3 mm)

 Members of Heterophydae and Echionostomidae.

 The important species are

Heterophys nocens,H.continua,H.heterophys,H.dispar,
H.pumilo, Metagonimus yokogawai,Centrocestus
armatus,Echionostoma hortensi,
 Cont..
 Common in Southeast Asia and Far East (northern
Thailand, Cambodia, Vietnam, Indonesia ,Philippines
and South Korea)

 Heterophys heterophys infection is common in Egypt

where the pickled mullet is traditionally eaten at the time
of feast.

 Transmission is by eating raw or recently salted or

pickled fish and the metaceraria will develop into adults
in the intestine.
 Cont..
 The parasites only causes mild intestinal
symptoms such as tenderness, chronic bloody
diarrhoea, vomitting etc.

 Treatment similar to that given for

Opisthorchiasis.
 Nematodiasis
 Generally caused by the incidental infection of
man with nematodes.

 Natural definitive hosts are marine

mammals,birds,pigs or other animals.

 Freshwater, brackish or marine fishes are the

second intermediate hosts.

 Nematodes like Capillaria,Anisakis,Gnathostoma

causes disease to human beings.
 Capillariasis
 Capillaria philippensis

 A trichuirid nematode
with a narrow and
filiform anterior region
 1.5-3.9 mm (males)
2.5-5.3mm (females)
 Cont..
 An indigeneous disease of the Philippines where
an epidemic was first recorded in 1967

 Capillaria philippensis is the only known

capillarid which is transmitted to man via fish

 Only small fish(6-7 cm in length) are eaten raw,

like bagsit (Hypesleotris bipartita), bagsan
(Ambassis miops) and bacto (Eleotris
melanosoma)
 Life cycle
 Fish eating birds are the natural definitive host

 Adult worms are located in the lumen of small

inestine and produce eggs.

 The eggs are passed out with the faeces

 Embryonation of eggs occurs in the water,upon

ingestion by fresh water or brackishwater
fish,larvae hatch in the intestine.
 Pathogenesis
 Basically an intestinal disease

 Large number of parasites disturb the normal

gastrointestinal functions,results in extensive
pathophysiological lesions.

 Atrophy of the crypts of Lieber kuhn occurs and

the villi are flattened.
 Responsible for diarrhoea and deficiencies in
digestion and absorption.
 Cont..

Autopsy specimen of the human intestine showing adult worms of

C.philippensis
 Diagnosis and Treatment

 The standard laboratory diagnostic method by

stool examination to search for the eggs,larvae
and adults.

 Mebendazole is the current drug of choice.

 Anisakiasis
 Refers to an infection by larval ascaridoid nematodes
whose normal definitive hosts are marine mammals

 The genera involved are Anisakis, Pseudoterranova and

Contrecaecum.

 It has been referred to as ‘herring worm’ disease

 The first documented human infection was in the
Netherlands in 1955

 More than 2000 cases have been noted in Japan and

sporadic cases are known to occur in North America and
other parts of the world.
 Japanese dishes include raw sea food; ’sashimi ’is raw
fish or squid fillet ,’isushi’ is pickled rice with raw fillet of
chum salmon.

 Theragra chalcogramma ( Pacific pollack )

Onchorhyncus masou (masu salmon) Todarodes
pacificus (squid) are the most common species eaten by
raw.

 In Hokkaido, the incidence of regional enteritis has been

observed to increase from October to March and
decrease during summer (Ishikura,1968).This is
coincides with the fishing of Pacific pollack.
 Cont..
 The major aetiological agents of anisakiasis are
the larvae of
A.simplex,A.typica,A.physteris,P.decipiens
and
C.osculutum
 The worms are characterised by three lips and a
tooth at the anterior extremity.
 Pathogenesis and Symptoms
 In humans, causes both gastric and intestinal infections.

 Gastric Anisakiasis-Larva penetrate gastric wall causing

acute abdominal pain,nausea and vomitting within a few
minutes to several hours

 Intestinal Anisakiasis-Larva invade intestinal mucosa.

Severe local pain and intestinal obstruction

 Extragastrointestinal Anisakiasis-Larva penetrate into the

peritoneal cavity or other visceral organs cause
eosinophilic granuloma which is often suspected of being
neoplasia.
 Diagnosis and treatment
 Fibre optic gastroscopy is the most useful
method to diagnose gastric anisakiasis

 The appropriate drug treatment for anisakiasis

has not been established.However albendazole
was shown to be effective.
 Gnathostomiasis
 Also known as ‘larvalmigrans profundus’

 Four species have been found in man

Gnathostoma hispidum ,G.spinigerum , G.
doloresi and G.nipponicum.

 Gnathostomiasis is transmitted by the ingestion of

insufficiently cooked definitive host such as fish, frogs or
poultry

 These nematodes are characterised by a head bulb and a fluid filled

cephalic –cervical system.
 Cont..
 Reported in Southeast
Asia,China,Japan,Korea,the Indian subcontinent
and Middle-East.
 Freshwater eel (Fluta alba), freshwater cat
fish(Clarius fuscus),C.batrachus,Ophiocephalus
spp,frogs and snakes are infected with larvae.
 If man ingesting the third stage larvae
from,fish,frog or snake,the worm undergoes
visceral migration.
 Pathogenesis
 Pathology mainly caused by toxins secreted by the
migrating larvae.

 Cause creeping eruptions in the subcutaneous tissue

 Disturb the normal function of the liver.
 Invasion of eye, bladder or uterus cause permanent
impairment of vision, haemorrages, haematuria,
leukorrhea etc
 If the larvae enters the brain and spinal cord,eosinophilic
encephalomyletis will occur.
 Cont..
 Laboratory diagnosis by the identification of the
worm and therapeutical measures includes
surgical removal or treatment with albendazole
or ivermectin
 Diphyllobothriasis
 A fish-borne cestode infection

 Disease is caused by pseudophyllid cestodes belonging

to the genus Diphyllobothrium

 Diphyllobothrium latum (Human fish tapeworm)

 Most human infections are accidental as the natural

definitive hosts of the genus include birds, bears,seals,
dogs, walruses, etc.

 The method of infection by ingesting raw or smoked fish

which harbours the plerocercoid larva.
 Cont..
 Sporadic occurrence of Diphyllobothriasis known to
occur in many parts of the world and several cases were
reported in Japan.

 Salmon is the main source of infection

 Japanese eat raw cherry salmon fillet as ‘sushi’ or

‘sashimi’

 In Peru,the infection is commonly acquired by eating a

popular local dish called ‘ceviche’which consist of raw
marine fish marinated with lime juice.
 Pathogenesis
 The adult worm attaches to the mucosa of the
ilium and occasionally the jejunum

 Gastrointestinal disorders like diarrhoa,

abdominal cramps, flatulence ,polyphagia etc.

 The worm depletes vitamin B12 from its

definitive host for its own extensive growth and
development.
 The drugs of choice are nicolsamide, bithionol,
and paramomycin sulphate.
 Status of Zoonoses

. Changes in the environment ,climate,

technology, land use, human
behaviour and demographic converge
favour the emergence of infectious
disease caused by a broad range of
organisms (Wilson,1995)
 Perspectives….
 Improved diagnostic tools
 Epidemiological studies
 Improved aquaculture systems
 Effective policy making
 References..
 Woo PTK, Fish Diseases and Disorders, Vol1 Protozoan and
metazoan infections, 2nd edition, CAB International,2006 Pg:631-671
 Ronald J.Roberts,Fish Pathology,Third edition,Pg-295-296
 Jennifer Keiser and Jurg Utzinger,Emerging food borne
Trematodiasis,VOL 11,no 10,October 2005
 Yong –Yil Chai, K Darwin ,Alan.J.Lymbery,Fish borne parasitic
zoonoses-Status and Issues,International Journal for
Parasitology(2005) 1233-1254
 Gadadhar Dash,Debolina Majumder,Perisetti Bhargabi and Ritu
Ranjan,Zoonotic potentiality of parasites in Cultivable food
fishes,Aqua international-May-2010