Parasitic Diseases of The Lung

Parasitic Diseases of the Lung
Pulmonary Amebiasis
- Entamoeba histolytica amebiasis occurs worldwide.
- Human becomes infected via feco-oral route (ingestion of

mature E. histolytica cyst).
- Trophozoites invade the intestinal mucosa and enter the
bloodstream.

- Pleuropulmonary amebiasis occurs by local extension
from the amoebic liver abscess.
- Patients usually present with fever, right upper quadrant

abdominal pain, chest pain, and cough.
- Lung abscess.
- The radiographic findings are elevated right
hemidiaphragm, hepatomegaly, and pleural effusion (water
on the lungs).
- Live trophozoites of E. histolytica can be found in sputum,

pleural fluid, or lung biopsy.
- The presence of amoeba in the stool does not indicate

active E. histolytica infection.
- Serologic tests / antigen detection and (PCR) is the most

preferred approach to diagnosis
Nematodes (Roundworms)
Ascariasis
- Ascaris lumbricoides is one of the most common

parasitic infestations. affecting over a billion of the
world’s population.
- Ascaris larvae migrate to the lungs via either the

venules of the portal system or the lymphatic drainage.
- Larval ascariasis causes Löffler’s syndrome, consisting

of wheezing, pulmonary infiltrations, and a moderate
eosinophilia.
- The larvae can cause alveolar inflammation, necrosis,

and hemorrhage.
- Difficult to diagnose ascariasis larvae phase.
- The sputum may show numerous eosinophils.
- Diagnosis can be confirmed by identifying larvae in the

sputum.
- Solitary pulmonary nodules (SPN) can also develop if

the larva dies and evokes a granulomatous reaction.
- Adult ascaris has been reported to cause airway

obstruction in a child

- Mebendazole and albendazole are the most effective
treatmnets
Ancylostomiasis (Hookworm Disease)
Ancylostoma duodenale
Necator americanus.
- Involves larval migration through the lungs via the

bloodstream resulting in a hypersensitivity reaction.
- Patients usually present with transient eosinophilic

pneumonia (Löffler’s syndrome).
- It is characterized by nausea, vomiting, dyspnea, cough,

throat irritation, hoarseness, and eosinophilia.
Diagnosis at larval phase is difficult.

Sputum: occult blood, eosinophils, and, migrating larvae.
Treatment: mebendazole and albendazole
Strongyloidiasis:
Strongyloides stercoralis
Strongyloides larvae from BAL

Tropical Pulmonary Eosinophilia (TPE)
- Is a syndrome of immunologic reaction to microfilaria of the
lymphatic-dwelling organisms
Brugia malayi
Wuchereria bancrofti.
- It is a mosquito-borne infestation.
- Travelers from non-endemic areas are at risk of developing

TPE.
- The microfilariae are released into the circulation and may
be trapped in the pulmonary circulation.
- This presents strong immunogenicity and trigger anti-

microfilarial antibodies, resulting in asthma-like symptoms.
The hallmark of TPE is a high absolute eosinophil count
(5000–80,000/mm3)
- The radiologic features include reticulonodular opacities

predominantly in the middle and the lower lung zones
- Chest CT may demonstrate bronchiectasis (widened

airways), air trapping, calcification, and mediastinal
lymphadenopathy.
- BAL fluid may contain numerous eosinophils.

- The chronic phase of TPE may lead to progressive and
irreversible pulmonary fibrosis.
- The standard treatment for TPE is diethylcarbamazine
(DEC).
Pulmonary flukes:
Paragonimus westermani:
- Common name: The oriental lung fluke.
- in Southeast Asia, African, and South America.
- The worm was discovered in the lungs of person after he was

died (Autopsy), also the eggs of the parasites were found in
rusty-brown sputum of Chinese patients.
- Infection via eating (infective) undercooked crustaceans.
- The larvae penetrate the intestinal wall, migrating

through the diaphragm and the pleura, into the
bronchioles.
- The eggs are produced by the mature adult worms which

are expelled in the sputum.
- The fluke present in the lung (in fibrous capsules and in

pairs)
- Typically acute symptoms include fever, chest pain, and

chronic cough with hemoptysis.
- Chest X-ray demonstrates patchy infiltrates, nodular
opacities, pleural effusion, and fluid-filled cysts

- Lung biopsy may show chronic eosinophilic inflammation.
- The diagnosis is confirmed by the presence of eggs or

larvae in the sputum sample or BALF.
- Eosinophilia and elevated serum IgE levels are observed in

more than 80 % of infected patients.
- Serological tests are highly sensitive and specific.
- Praziquantel and triclabendazole (high cure rate more

than 90 %)
Pathogenesis:
- (Pseudo tuberculosis), that characterized by eosinophilic and
neutrophilic infiltration around the worm, followed by
development of thick envelop (capsule).
- Discharging of eggs and fluke metabolites into the bronchiole

causes paroxysmal coughing that result in hemorrhage with
blood in sputum.
Echinococcosis / cause hydatid disease

- Echinococcus granulosus causes cystic hydatidosis
- E. multilocularis causes alveolar echinococcosis
E. granulosus is endemic in sheep-herding areas of the

Mediterranean, Eastern Europe, the Middle East, and
Australia.
- Humans become accidental hosts by ingestion of food

contaminated with feces containing parasite eggs.
- An echinococcal infection becomes symptomatic after

5–15 years (dysfunction of the affected organ).
Pathogenesis and clinical symptoms
- Echinococcus granulosus usually forms one large fluid-
filled cyst (unilocular).
- The cyst acts as a space-occupying (pressure on adjacent

tissue).
- The outer layer of the cyst is thick, fibrous tissue produced

by the host.
- The cyst fluid contains parasite antigens, which can

sensitize the host.
- Pulmonary cysts expand by 1–5 cm per year.
- Pulmonary symptoms from the intact cyst include cough,
fever, dyspnea, and chest pain.

- The cyst may rupture into a bronchus and cause
hemoptysis and/or (hydatoptysis).

- Cystic hydatidosis is diagnosed by chest radiography
which demonstrates a well-defined homogenous fluid-filled
round opacity.
-Ruptured cysts may demonstrate an empty cavity,

- Floating membrane (“water lily sign”) Ultrasound .
- Serological tests can be used for diagnosis.
- Surgical resection of the cysts is the main treatment of
pulmonary hydatidosis
Pulmonary cystic echinococcosis
Hepatic Hydatid cyst
A well-defined cystic lesion measuring 8.0 cm x 6.5 cm x 7.4 cm in
the right lobe of the liver. The cyst shows a detached, irregular
laminated membrane inside it which appears to float within the
contents of the cyst.
The findings are suggestive of a hepatic hydatid cyst with ultrasound
"water lily sign"
Water lily sign (CT scan obtained at level of right middle lobe shows ruptured
hydatid cyst. After rupture and discharge of cyst fluid into pleural cavity, endocyst
collapses, sediments, and floats in remaining fluid at bottom of original cyst)

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Parasitic Diseases of the Lung

- Human becomes infected via feco-oral route (ingestion of

- Patients usually present with fever, right upper quadrant

- Live trophozoites of E. histolytica can be found in sputum,

- The presence of amoeba in the stool does not indicate

- Serologic tests / antigen detection and (PCR) is the most

- Ascaris lumbricoides is one of the most common

- Ascaris larvae migrate to the lungs via either the

- Larval ascariasis causes Löffler’s syndrome, consisting

- The larvae can cause alveolar inflammation, necrosis,

- The sputum may show numerous eosinophils.

- Diagnosis can be confirmed by identifying larvae in the

- Solitary pulmonary nodules (SPN) can also develop if

- Adult ascaris has been reported to cause airway

- Involves larval migration through the lungs via the

- Patients usually present with transient eosinophilic

- It is characterized by nausea, vomiting, dyspnea, cough,

Diagnosis at larval phase is difficult.

Strongyloides larvae from BAL

- Travelers from non-endemic areas are at risk of developing

- This presents strong immunogenicity and trigger anti-

- The radiologic features include reticulonodular opacities

- Chest CT may demonstrate bronchiectasis (widened

- BAL fluid may contain numerous eosinophils.

- The worm was discovered in the lungs of person after he was

- The larvae penetrate the intestinal wall, migrating

- The eggs are produced by the mature adult worms which

- The fluke present in the lung (in fibrous capsules and in

- Typically acute symptoms include fever, chest pain, and

- The diagnosis is confirmed by the presence of eggs or

- Eosinophilia and elevated serum IgE levels are observed in

- Serological tests are highly sensitive and specific.

- Praziquantel and triclabendazole (high cure rate more

- Discharging of eggs and fluke metabolites into the bronchiole

E. granulosus is endemic in sheep-herding areas of the

- Humans become accidental hosts by ingestion of food

- An echinococcal infection becomes symptomatic after

- The cyst acts as a space-occupying (pressure on adjacent

- The outer layer of the cyst is thick, fibrous tissue produced

- The cyst fluid contains parasite antigens, which can

-Ruptured cysts may demonstrate an empty cavity,

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