Trematode Infection Follow-up

Updated: Nov 23, 2015
  • Author: Subhash Chandra Parija, MD, MBBS, PhD, DSc, FRCPath; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Follow-up

Further Outpatient Care

Further outpatient care includes health education. Thorough cooking of fish and aquatic vegetables, fruits, and plants is necessary to prevent ingestion of infective forms of the parasite.

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Further Inpatient Care

Anemia may be treated with iron supplements and vitamins, which may be administered orally to facilitate iron absorption.

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Transfer

Transfer if access to specialized health care services is lacking.

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Deterrence/Prevention

Note the following practices for deterrence and prevention of trematode infection:

  • Elimination of molluscan hosts using molluscicides, such as metal salts, and organophosphates or carbamates to control infection with schistosomes and intestinal, liver, and lung flukes

  • Proper sanitary disposal of human and pig excreta to avoid water contamination

  • Chemotherapy of infected persons

  • Avoidance of consumption of contaminated water, water plants, fruits, fish, crab, and raw liver

  • Thorough cleaning and washing of raw vegetables and aquatic fruits to prevent infection with intestinal flukes

  • Thorough cooking of water-grown vegetables before eating

  • Cooking of crab and crayfish before eating to prevent infection with lung flukes

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Complications

Schistosomiasis complications can include the following:

  • Cor pulmonale

  • Portal hypertension

  • Urinary bladder carcinoma

  • Neurological complications: Cerebral and cerebellar tumour–like neuroschistosomiasis can present with increased intracranial pressure, headache, nausea and vomiting, and seizures. Myelopathy (acute transverse myelitis and subacute myeloradiculopathy) is the most common neurological complication of S mansoni infection. Schistosomal myelopathy tends to occur early after infection and is more likely to be symptomatic than cerebral schistosomiasis. The conus medullaris and cauda equina are the most common sites of involvement. Severe schistosomal myelopathy can provoke a complete flaccid paraplegia with areflexia, sphincter dysfunction, and sensory disturbances. [18]

Lung fluke complications can include the following:

  • Lung abscess

  • Pleural effusion

  • Ectopic lesions in the brain

Liver fluke complications can include the following:

  • Intercurrent bacterial infections

  • Less commonly, pancreatitis in fascioliasis [43]

  • Anemia

  • Recurrent pyogenic cholangitis and cholangiocarcinoma in clonorchiasis

Intestinal fluke complications can include asthenia with ascites in fasciolopsiasis.

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Prognosis

Prognosis is excellent in patients with mild-to-moderate trematode infection, with early disease, and/or without severe complications.

Patients with heavier worm infection are less likely to improve, and the outcome in such infections may be serious and fatal.

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Patient Education

Avoid high-risk food habits. Inform patients about the danger of eating raw or undercooked vegetables and fish and the importance of cleaning, washing, and adequately cooking vegetables and fish or raw liver. [2]

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