Trematode Infection Treatment & Management

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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Medical Care

Causes of mortality include recurrent pyogenic cholangitis in persons with schistosomiasis; hemiplegia, cephalgia, and paresis in those with cerebral paragonimiasis; cholangiocarcinoma in those with clonorchiasis; and intercurrent bacterial infections in those with fascioliasis and/or intestinal fluke infections.

Praziquantel remains the drug of choice for all trematode infections except fascioliasis, for which bithionol is the drug of choice. Praziquantel is recommended when bithionol is not available.

Bithionol is the drug of choice for Fasciola infections. The drug of choice in the treatment of fascioliasis is triclabendazole, a member of the benzimidazole family of anthelmintics. The drug works by preventing the polymerization of the molecule tubulin into the cytoskeletal structures and microtubules. However, resistance of F hepatica to triclabendazole has already been recorded in Australia and Ireland. Artemether has been shown to be effective in a rat model of fascioliasis.

Emetine, dehydroemetine, chloroquine, albendazole, and mebendazole were once used in many trematode infections; however, this practice is now discontinued because these drugs are associated with toxicity and their efficacy is in doubt.

When trematode infections are complicated by intercurrent bacterial infections, institute antibiotic therapy.


Surgical Care

Surgical management may be needed for complications of trematode infection, which include bladder carcinoma in patients with urinary schistosomiasis, fibrosis and thickening of the intestinal wall in those with intestinal schistosomiasis, ascending cholangitis in those with fascioliasis, and cholangiocarcinoma in those with clonorchiasis.

Schistosomicidal drugs, steroids, and surgery are the currently available treatments for neuroschistosomiasis. [18] A multidisciplinary approach is warranted for effective treatment of schistosomiasis. [42]



The following consultations may be necessary:

  • Intestinal and liver trematode infections - Infectious diseases specialist

  • Urinary schistosomiasis - Infectious diseases specialist, gastroenterologist, and urologist

  • Pulmonary paragonimiasis - Chest disease specialist

  • Ectopic fluke infections (eg, abdominal and cerebral paragonimiasis; ectopic schistosomiasis in intestine, lung, brain, or spinal cord; ectopic clonorchiasis) - Consultations with appropriate specialists as required per particular manifestations



To prevent paragonimiasis and clonorchiasis, avoid eating raw or undercooked fish.

To prevent infection with intestinal flukes and fascioliasis, properly clean and thoroughly wash raw vegetables, watercress, and other water-grown vegetables before eating.

Cook water-grown vegetables thoroughly before eating.



The patient should be given adequate bed rest supplemented with an adequate protein-rich diet.