Identification of Stictodora lari (Heterophyidae) metacercariae encysted in the brackish water fish, Acanthogobius flavimanus

Epidemiology and Geographical Distribution of Human Trematode Infections

Digenetic trematodes infecting humans are more than 109 species that belong to 49 genera all over the world. According to their habitat in the definitive hosts, they are classified as 6 blood flukes (Schistosoma japonicum. S. mekongi, S. malayensis, S. mansoni, S. intercalatum, and S. haematobium), 15 liver flukes (Fasciola hepatica, F. gigantica, Clonorchis sinensis, Opisthorchis viverrini, O. felineus, Dicrocoelium dendriticum, D. hospes, Metorchis bilis, M. conjunctus, M. orientalis, Amphimerus sp., A. noverca, A. pseudofelineus, Pseudamphistomum truncatum, and P. aethiopicum), nine lung flukes (Paragonimus westermani, P. heterotremus, P. skrjabini, P. skrjabini miyazakii, P. kellicotti, P. mexicanus, P. africanus, P. uterobilateralis, and P. gondwanensis), 30 heterophyid intestinal flukes (Metagonimus yokogawai, M. takahashii, M. miyatai, M. suifunensis, M. katsuradai, M. pusillus, M. minutus, Heterophyes heterophyes, H. nocens, H. dispar, Haplorchis taichui, H. pumilio, H. yokogawai, H. vanissinus, Centrocestus formosanus, C. armatus, C. cuspidatus, C. kurokawai, Procerovum calderoni, P. varium, Pygidiopsis genata, P. summa, Stictodora fuscata, S. lari, Stellantchasmus falcatus, Heterophyopsis continua, Acanthotrema felis, Apophallus donicus, Ascocotyle longa, and Cryptocotyle lingua), 24 echinostome intestinal flukes (Echinostoma revolutum, E. cinetorchis, E. mekongi, E. paraensei, E. ilocanum, E. lindoense, E. macrorchis, E. angustitestis, E. aegyptica, Isthmiophora hortensis, I. melis, Echinochasmus japonicus, E. perfoliatus, E. lilliputanus, E. caninus, E. jiufoensis, E. fujianensis, Artyfechinostomum malayanum, A. sufrartyfex, A. oraoni, Acanthoparyphium tyosenense, Echinoparymphium recurvatum, Himasthla muehlensi, and Hypoderaeum conoideum), 23 miscellaneous intestinal flukes (Brachylaima cribbi, Caprimolgorchis molenkampi, Phaneropsolus bonnei, P. spinicirrus, Cotylurus japonicus, Fasciolopsis buski, Gastrodiscoides hominis, Fischoederius elongatus, Watsonius watsoni, Gymnophalloides seoi, Gynaecotyla squatarolae, Microphallus brevicaeca, Isoparorchis hypselobagri, Nanophyetus salmincola, N. schikobalowi, Neodiplostomum seoulense, Fibricola cratera, Plagiorchis muris, P. vespertilionis, P. harinasutai, P. javensis, P. philippinensis, and Prohemistomum vivax), one throat fluke (Clinostomum complanatum), and one pancreatic fluke (Eurytrema pancreaticum). The mode of transmission to humans includes contact with cercariae contaminated in water (schistosomes) or ingestion of raw or improperly cooked food, including fish (liver flukes, heterophyid flukes, echinostomes, and throat flukes), snails (echinostomes, brachylaimids, and gymnophallid flukes), amphibia, reptiles (neodiplostomes), aquatic vegetables (fasciolids and amphistomes), and insect larvae or adults (lecithodendriids, plagiorchiids, and pancreatic flukes). Praziquantel has been proven to be highly effective against almost all kinds of trematode infections except Fasciola spp. Epidemiological surveys and detection of human infections are required for a better understanding of the prevalence, intensity of infection, and geographical distribution of each trematode species.

Foodborne intestinal flukes: A brief review of epidemiology and geographical distribution

Foodborne intestinal flukes are highly diverse consisting of at least 74 species with a diverse global distribution. Taxonomically they include 28 species of heterophyids, 23 species of echinostomes, and 23 species of miscellaneous groups (amphistomes, brachylaimids, cyathocotylids, diplostomes, fasciolids, gymnophallids, isoparorchiids, lecithodendriid-like group, microphallids, nanophyetids, plagiorchiids, and strigeids). The important heterophyid species (15 species) include Metagonimus yokogawai, M. takahashii, M. miyatai, Heterophyes heterophyes, H. nocens, Haplorchis taichui, H. pumilio, H. yokogawai, Heterophyopsis continua, Centrocestus formosanus, Pygidiopsis genata, P. summa, Stellantchasmus falcatus, Stictodora fuscata, and S. lari. The echinostome species of public health significance (15 species) include Echinostoma revolutum, E. cinetorchis, E. lindoense, E. ilocanum, Isthmiophora hortensis, Echinochasmus japonicus, E. perfoliatus, E. liliputanus, E. fujianensis, E. caninus, Acanthoparyphium tyosenense, Artyfechinostomum malayanum, A. sufrartyfex, A. oraoni, and Hypoderaeum conoideum. Among the other zoonotic intestinal flukes, Gastrodiscoides hominis, Brachylaima cribbi, Neodiplostomum seoulense, Fasciolopsis buski, Gymnophalloides seoi, Caprimolgorchis molenkampi, Phaneropsolus bonnei, Microphallus brevicaeca, Nanophyetus salmincola, and N. schikhobalowi (10 species) have drawn considerable medical attention causing quite a fair number of human infection cases. The principal mode of human infections include ingestion of raw or improperly cooked fish (heterophyids and echinostomes), snails including oysters (echinostomes and G. seoi), amphibians and reptiles (N. seoulense), aquatic vegetables (amphistomes and F. buski), and insect larvae or adults (C. molenkampi and P. bonnei). Epidemiological characteristics such as the prevalence, geographical distribution, and clinical and public health significance are poorly known in many of these species. Praziquantel has been proved to be highly effective against most species of intestinal fluke infections. Surveys and detection of human infection cases are urgently required for better understanding of the global status and public health significance of each species.

Infection Status with Digenetic Trematode Metacercariae in Fishes from Coastal Lakes in Gangwon-do, Republic of Korea

The infection status of digenetic trematode metacercariae (DTM) was investigated in fishes from coastal lakes in Gangwon-do, the Republic of Korea (Korea). All fishes collected in 5 lakes were examined with the artificial digestion method. More than 10 species, i.e., Metagonimus spp., Pygidiopsis summa, Centrocestus armatus, Metorchis orientalis, M. taiwanensis, Clinostomum complanatum, Echinostoma spp., Stictodora spp., Diplostomum sp. and Diplostomid No. 1. by Morita (1960), of DTM were detected in fishes from 5 coastal lakes in Gangwon-do. Metagonimus spp. metacercariae were found in 52 (41.3%) out of 126 sea rundace, Tribolodon hakonensis, from 5 lakes, and their density was 14.6 per fish infected. P. summa metacercariae were detected in 48 (84.2%) out of 57 mullets from 5 lakes, and their density was 316 per fish infected. C. armatus metacercariae were detected in 7 (14.6%) T. hakonensis and 3 (15.0%) Tridentiger brevispinis from Hyang-ho, and 5 (19.2%) Acanthogobius flavimanus from Gyeongpo-ho. Stictodora spp. metacercariae were found in 4 fish species, i.e., Tridentiger obscurus, Tridentiger trigonocephalus, Chelon haematocheilus, and Acanthogobius lactipes, from Gyeongpo-ho. Total 15 C. complanatum metacercariae were detected in 2 (9.1%) crucian carp, Carassius auratus, from Songji-ho. M. taiwanensis metacercariae were found in T. hakonensis from Hyang-ho and Gyeongpo-ho and in Pseudorasbora parva from Gyeongpo-ho. Total 11 M. orientalis metacercariae were detected in 3 (6.3%) T. hakonensis from Hyang-ho. From the above results, it was confirmed that various species of DTM are infected in fishes from coastal lakes in Gangwon-do, Korea.

Epidemiology of Trematode Infections: An Update

Digenetic trematodes infecting humans are more than 91 species which belong to 46 genera all over the world. According to their habitat in definitive hosts, they are classified as blood flukes (Schistosoma japonicum. S. mekongi, S. mansoni, S. haematobium, and S. intercalatum), liver flukes (Clonorchis sinensis, Opisthorchis viverrini, O. felineus, Metorchis conjunctus, M. bilis, M. orientalis, Fasciola hepatica, F. gigantica, Dicrocoelium dendriticum, and D. hospes), lung flukes (Paragonimus westermani, P. heterotremus, P. skrjabini, P. miyazakii, P. kellicoti, P. mexicanus, P. africanus, and P. uterobilateralis), throat fluke (Clinostomum complanatum), pancreatic fluke (Eurytrema pancreaticum), and intestinal flukes (Metagonimus yokogawai, M. miyatai, M. takahashii, Heterophyes nocens, H. heterophyes, Haplorchis taichui, H. pumilio, H. yokogawai, Centrocestus formosanus, Echinostoma revolutum, E. ilocanum, Isthmiophora hortensis, Echinochasmus japonicus, E. lilliputanus, Artyfechinostomum malayanum, A. sufrartyfex, A. oraoni, Fasciolopsis buski, Gymnophalloides seoi, Neodiplostomum seoulense, Caprimolgorchis molenkampi, Phaneropsolus bonnei, and Plagiorchis muris). The mode of transmission to humans includes contact with cercariae contaminated in water (schistosomes) and ingestion of raw or improperly cooked fish (liver and throat flukes, heterophyids, and echinostomes), snails (echinostomes and gymnophallids), amphibia, reptiles (neodiplostomes), aquatic vegetables (amphistomes), or insect larvae or adults (plagiorchiids, lecithodendriids, and pancreatic fluke). Praziquantel has been proved to be highly effective against most species of trematode infections except fascioliasis. Epidemiological surveys and detection of human infections are required for better understanding of the geographical distribution and endemicity of each trematode species.

Infections with Zoonotic Trematode Metacercariae in Yellowfin Goby, Acanthogobius flavimanus, from Coastal Areas of Republic of Korea

To investigate the infection status of zoonotic trematode metacercariae in yellowfin goby, Acanthogobius flavimanus, from coastal areas of the Republic of Korea (Korea), we examined total 344 gobies from 21 localities with an artificial digestion method from 2013 to 2017. The metacercariae of Stictodora lari were most frequently detected in 45.3% goby from 7 localities, i.e., Taean-gun (Chungcheongnam-do), Gochang-gun (Jeollabuk-do), Muan-gun, Shinan-gun, Haenam-gun (Jeollanam-do), Hadong-gun and Goseong-gun (Gyeongsangnam-do). Their infection rates were 90.0%, 66.7%, 46.7%, 8.0%, 3.3%, 26.7%, and 86.7% and intensities were 1,090, 6.2, 1.6 1.0, 2.0, 2.0, and 7.2 metacercariae per fish infected respectively. Heterophyopsis continua metacercariae were found in 38.2% goby from 6 localities, i.e., Gochang-gun, Muan-gun, Shinan-gun, Gangjin-gun, Boseong-gun (Jeollanam-do) and Goseong-gun, and their intensities were relatively low, 1–21 metacercariae. Stictodora fuscata metacercariae were detected in 61.3% goby from 4 localities, i.e., Taean-gun, Gochang-gun, Hadong-gun and Goseong-gun. Their infection rates were 90.0%, 53.3%, 5.9%, and 73.3% and intensities were 1,081, 3.1, 3.0, and 10.2 metacercariae per fish infected respectively. Heterophyes nocens metacercariae were found in 55.0% goby from Muan-gun and Shinan-gun. Total 3 metacercariae of Isthmiophora hortensis were detected in 2 (8.0%) gobies from Shinan-gun. Total 15 metacercariae of Centrocestus armatus were detected in 5 gobies (33.3%) from Gyeongpo-ho (ho means lake) in Gangneung-si, Gangwon-do. The present study suggests that yellowfin goby, A. flavimanus, acts as the infection sources of zoonotic intestinal flukes in western and southern coastal areas than in eastern coastal areas of Korea.

Fishborne zoonotic heterophyid infections: An update

Fishborne heterophyid trematodes infecting humans are at least 29 species worldwide and belong to 13 genera. Its global burden is much more than 7 million infected people. They include Metagonimus (M. yokogawai, M. takahashii, M. miyatai, M. minutus, and M. katsuradai), Heterophyes (H. heterophyes, H. nocens, H. dispar, and H. aequalis), Haplorchis (H. taichui, H. pumilio, H. yokogawai, and H. vanissimus), Pygidiopsis (P. summa and P. genata), Heterophyopsis (H. continua), Stellantchasmus (S. falcatus), Centrocestus (C. formosanus, C. armatus, C. cuspidatus, and C. kurokawai), Stictodora (S. fuscata and S. lari), Procerovum (P. varium and P. calderoni), Acanthotrema (A. felis), Apophallus (A. donicus), Ascocotyle (A. longa), and Cryptocotyle (C. lingua). Human infections are scattered around the world but the major endemic areas are located in Southeast Asia. The source of human infection is ingestion of raw or improperly cooked fish. The pathogenicity, host-parasite relationships, and clinical manifestations in each species infection are poorly understood; these should be elucidated particularly in immunocompromised hosts. Problems exist in the differential diagnosis of these parasitic infections because of close morphological similarity of eggs in feces and unavailability of alternative methods such as serology. Molecular diagnostic techniques are promising but they are still at an infant stage. Praziquantel has been proved to be highly effective against most of the patients infected with heterophyid flukes. Epidemiological surveys and detection of human infections are required for better understanding of the geographical distribution and global burden of each heterophyid species. In this review, the most updated knowledge on the morphology, biology, epidemiology, pathogenesis and pathology, immunology, clinical manifestations, diagnosis and treatment, and prevention and control of fishborne zoonotic heterophyid infections is provided.

Infection status of estuarine fish and oysters with intestinal fluke metacercariae in Muan-gun, Jeollanam-do, Korea

The source of human infection with intestinal flukes was surveyed in estuarine fishes, including the dotted gizzard shad, common sea bass, common blackish goby, redlip mullet, black sea bream, and oyster collected from Muan-gun, Jeollanam-do, Korea during August and September 2007. Collected fishes and oysters were artificially digested in pepsin-HCl solution and examined under a stereomicroscope. In 36 shads (Konosirus punctatus) and 20 basses (Lateolabrax japonicus) examined, Heterophyopsis continua metacercariae were found in 58.3% and 100%, and their average numbers were 12.0 and 6.3 per infected fish, respectively. In 34 gobies (Acanthogobius flavimanus) examined, metacercariae of H. continua were detected in 79.4%, Stictodora lari in 97.1%, and Acanthotrema felis in 92.1%, and their average numbers were 45.8, 189.3, and 235.3 per infected fish, respectively. In 37 redlip mullets (Chelon haematocheilus), Heterophyes nocens metacercariae were found in 56.8%, Pygidiopsis summa in 94.6%, and Stictodora fuscata in 45.9%, and the average metacercarial densities were 17.4, 31.3, and 35.1 per infected fish, respectively. In 30 black sea breams (Acanthopagrus schlegeli) and 45 oysters (Crassostrea gigas) examined, no metacercariae were detected. From the above results, it has been confirmed that the dotted gizzard shad, common sea bass, common blackish goby, and redlip mullet from Muan-gun, Jeollanam-do, Korea are infected with the metacercariae of heterophyid flukes.

Epidemiological survey on the infection of intestinal flukes in residents of Muan-gun, Jeollanam-do, the Republic of Korea

Infection status of intestinal flukes was investigated in residents of Muan-gun, Jeollanam-do, the Republic of Korea. Total 1,257 fecal samples of residents were examined by formalin-ether sedimentation technique and Kato-Katz thick smear method. Helminth eggs were detected from 95 (7.6%) residents, and eggs of heterophyid flukes and Clonorchis sinensis were found from 62 (4.9%) and 40 (3.2%) cases, respectively. The larger heterophyid eggs, somewhat dark-brown in color and 37.7 x 21.5 microm in average size, and found in 32 (2.6%) out of 62 egg positive cases of heterophyid flukes. To confirm the adult flukes, we performed worm recovery from 12 cases after praziquantel treatment and purgation with MgSO(4). A total of 1,281 adult flukes, assigned to 7 species, were recovered from 9 cooperative cases. Heterophyes nocens (total 981 specimens) was collected from 9 cases, Stictodora fuscata (80) from 7, Gymnophalloides seoi (75) from 5, Pygidiopsis summa (140) from 3, Stellantchasmus falcatus (3) from 2, and Stictodora lari and Acanthotrema felis (each 1 worm) from 1 case each. The intrauterine eggs of S. fuscata collected from the recovered worm were identical with the larger heterophyid eggs detected in the stool examination. By the present study, it was confirmed that A. felis is a new intestinal fluke infecting humans, and residents in Muan-gun, Jeollanam-do are infected with variable species of intestinal trematodes.

Fish-borne zoonotic trematode metacercariae in the Republic of Korea

The prevalence of fish-borne trematodes (FBT), including Clonorchis sinensis, is still high in riverside areas of the Republic of Korea. The author reviewed the detection and identification methods, differential keys, fish intermediate hosts, and morphological characteristics of FBT metacercariae. FBT metacercariae found in freshwater fish are classified mainly into 4 families, i.e., Opisthorchiidae, Heterophyidae, Echinostomatidae, and Clinostomidae. The metacercariae of C. sinensis, found in 40 species of freshwater fish, are elliptical and 0.15-0.17 x 0.13-0.15 mm in size, have nearly equal sized oral and ventral suckers, brownish pigment granules, and an O-shaped excretory bladder. Their general morphologies are similar to those of Metorchis orientalis (except in the thickness of the cyst wall). Metagonimus spp. (M. yokogawai, M. takahashii, and M. miyatai) metacercariae are subglobular or disc-shaped, and 0.14-0.16 mm in diameter. They have yellow-brownish pigment granules, a ventral sucker deflectively located from median, and a V-shaped excretory bladder. The metacercariae and fish intermediate hosts of Centrocestus armatus, Clinostomum complanatum, and 3 echinostomatid flukes (Echinostoma hortense, E. cinetorchis, and Echinochasmus japonicus) were summarized. FBT metacercariae detected in brackish water fish are mainly members of the Heterophyidae. The morphological characters, identification keys, and fish intermediate hosts of 7 species (Heterophyes nocens, Heterophyopsis continua, Pygidiopsis summa, Stellantchasmus falcatus, Stictodora fuscata, Stictodora lari, and Acanthotrema felis) were also reviewed. The contents treated in this study will provide assistance at the laboratory bench level to those working on recovery of metacercariae from fish hosts and identifying them.

Foodborne intestinal flukes in Southeast Asia

In Southeast Asia, a total of 59 species of foodborne intestinal flukes have been known to occur in humans. The largest group is the family Heterophyidae, which constitutes 22 species belonging to 9 genera (Centrocestus, Haplorchis, Heterophyes, Heterophyopsis, Metagonimus, Procerovum, Pygidiopsis, Stellantchasmus, and Stictodora). The next is the family Echinostomatidae, which includes 20 species in 8 genera (Artyfechinostomum, Acanthoparyphium, Echinochasmus, Echinoparyphium, Echinostoma, Episthmium, Euparyphium, and Hypoderaeum). The family Plagiorchiidae follows the next containing 5 species in 1 genus (Plagiorchis). The family Lecithodendriidae includes 3 species in 2 genera (Phaneropsolus and Prosthodendrium). In 9 other families, 1 species in 1 genus each is involved; Cathaemaciidae (Cathaemacia), Fasciolidae (Fasciolopsis), Gastrodiscidae (Gastrodiscoides), Gymnophallidae (Gymnophalloides), Microphallidae (Spelotrema), Neodiplostomidae (Neodiplostomum), Paramphistomatidae (Fischoederius), Psilostomidae (Psilorchis), and Strigeidae (Cotylurus). Various types of foods are sources of human infections. They include freshwater fish, brackish water fish, fresh water snails, brackish water snails (including the oyster), amphibians, terrestrial snakes, aquatic insects, and aquatic plants. The reservoir hosts include various species of mammals or birds.The host-parasite relationships have been studied in Metagonimus yokogawai, Echinostoma hortense, Fasciolopsis buski, Neodiplostomum seoulense, and Gymnophalloides seoi; however, the pathogenicity of each parasite species and host mucosal defense mechanisms are yet poorly understood. Clinical aspects of each parasite infection need more clarification. Differential diagnosis by fecal examination is difficult because of morphological similarity of eggs. Praziquantel is effective for most intestinal fluke infections. Continued efforts to understand epidemiological significance of intestinal fluke infections, with detection of further human cases, are required.

Echinostoma hortense and heterophyid metacercariae encysted in yellowfin goby, Acanthogobius flavimanus, from Shinan-gun and Muan-gun (Jeollanam-do), Korea

Fishborne trematode (FBT) metacercariae were investigated in yellowfin goby, Acanthogobius flavimanus, collected from Shinan-gun and Muan-gun, Jeollanam-do (province), Korea. All collected fishes were examined using the artificial digestion method. In all of 15 gobies from Aphae-myeon in Shinan-gun, metacercariae of Stictodora spp. (334 metacercariae/fish), Heterophyes nocens (153/fish), and Heterophyopsis continua (20/fish) were detected. In 2 of 14 gobies from Jido-myeon in Shinan-gun, 8 Echinostoma hortense metacercariae in total were detected. In 15 gobies from Haeje-myeon in Muan-gun, the metacercariae of H. continua were found in 100%, Stictodora spp. in 86.7%, and H. nocens in 6.7% of fish examined. The average numbers of metacercariae per infected fish were 23.3 (H. continua), 416.0 (Stictodora spp.), and 2.0 (H. nocens), respectively. The metacercariae of E. hortense found in gobies were elliptical, with 150 x 138 microm in average size, and had 27 collar spines on the head crown. The above results suggest that yellowfin gobies from 2 localities may be the potential infection sources of FBT. Moreover, it is proved for the first time that the yellowfin goby, A. flavimanus, acts as a second intermediate host for E. hortense.

Heterophyid metacercarial infections in brackish water fishes from Jinju-man (Bay), Kyongsangnam-do, Korea

Heterophyid metacercarial infections in brackish water fishes, i.e., perch, shad, mullet, redlip mullet, and goby, of Jinju-man (Bay), Kyongsangnam-do, Korea, were investigated using a digestion technique. Among 45 perch (Lateolabrax japonicus), the metacercariae of Heterophyopsis continua were found in 55.6% (18.5 metacercariae per fish), Stictodora spp. in 28.9% (3.6), and Metagonimus takahashii in 6.7% (17.0). The metacercariae of H. continua were detected in 23 (65.7%) of 35 shad (Konosirus punctatus). Among 15 mullet (Mugil cephalus), the metacercariae of Pygidiopsis summa were found in 100% (105.9 metacercariae per fish), Heterophyes nocens in 40.0% (8.5), H. continua in 13.3%, and Stictodora spp. in 6.7%. Among 12 redlip mullet (Chelon haematocheilus), the metacercariae of P. summa were detected in 91.7% (1,299 metacercariae per fish), H. nocens in 16.7%, and Stictodora spp. in 16.7%. Among 35 gobies (Acanthogobius flavimanus), the metacercariae of Stictodora spp. were found in 82.9% (44.5 metacercariae per fish), and H. continua in 25.7% (2.8). The adult flukes recovered from a cat experimentally infected with metacercariae from perches were compatible with M. takahashii. The results confirm that the estuarine fish in Jinju-man (Bay) are heavily infected with heterophyid metacercariae. Furthermore, it was found for the first time that the perch acts as a second intermediate host for M. takahashii.

Two species of goby, Boleophthalmus pectinirostris and Scartelaos sp., as the new second intermediate hosts of heterophyid fluke in Korea

A survey was performed in order to determine the infection status of the metacercariae of heterophyid fluke in two goby species, Boleophthalmus pectinirostris and Scartelaos sp., collected from Gangjin-gun, and Shinangun, Sooncheon-shi, Jeollanam-do, Republic of Korea. A total of three metacercariae of Heterophyopsis continua was found in only one B. pectinirostris (10.0%) from Gangjin-gun. Heterophyes nocens metacercariae were detected in 24 B. pectinirostris (96.0%) and 14 Scartelaos sp. (63.6%) from Shinan-gun. Heterophyopsis continua metacercariae were found in 11 B. pectinirostris (44.0%) and 21 Scartelaos sp. (95.5%) from Shinan-gun. Stictodora fuscata metacercariae were detected in 18 B. pectinirostris (72.0%) from Shinan-gun. No metacercariae were detected in 20 B. pectinirostris from Sooncheon-shi. From the above results, this study is the first to prove that B. pectinirostris and Scartelaos sp. serve as the second intermediate hosts of some heterophyid flukes in Korea.

Food-borne intestinal trematode infections in the Republic of Korea

A total of 19 species of food-borne intestinal trematodes have been reported in humans in the Republic of Korea. They include 12 species of the Heterophyidae, Metagonimus yokogawai, M. takahashii, M. miyatai, Heterophyes nocens, H. heterophyes (imported), H. dispar (imported), Heterophyopsis continua, Pygidiopsis summa, Stellantchasmus falcatus, Centrocestus armatus, Stictodora fuscata, and S. lari; four species of the Echinostomatidae, Echinostoma hortense, E. cinetorchis, Echinochasmus japonicus, and Acanthoparyphium tyosenense; and one species each of the Neodiplostomidae, Neodiplostomum seoulense, Plagiorchiidae, Plagiorchis muris, and Gymnophallidae, Gymnophalloides seoi. Fresh water fish harbor the metacercarial stage of M. yokogawai, M. takahashii, M. miyatai, C. armatus, E. hortense, E. cinetorchis, E. japonicus, or P. muris. Brackish water fish serve as the second intermediate hosts for H. nocens, H. continua, P. summa, S. falcatus, S. fuscata, and S. lari. Brackish water bivalves are the source of infection with A. tyosenense. Tadpoles and frogs are the second intermediate hosts for N. seoulense, but the major source of human infection is the grass snake Rhabdophis tigrina, a paratenic host. The metacercariae of G. seoi are observed in oysters. The natural definitive hosts are, in most cases, mammals such as rats, cats and dogs. However, several species (C. armatus, S. lari, E. japonicus, A. tyosenense, and G. seoi) have birds as natural definitive hosts. Host-parasite relationships, pathogenesis and pathology, immunity, clinical aspects, differential diagnosis, treatment, prevention and control of these intestinal trematodes are briefly discussed.

Stictodora lari (Digenea: Heterophyidae): the discovery of the first human infections

Stictodora lari Yamaguti, 1939 (Digenea: Heterophyidae) was originally reported as an avian intestinal parasite and is here reported in humans. The patients were adults, aged 46-69 (2 men and 4 women), who resided in coastal villages in Sachon-gun, Kyongsangnam-do, or Shinan-gun, Chollanam-do. in the Republic of Korea. The worms were recovered after praziquantel treatment and purgation with magnesium salts. A total of 15 S. lari specimens (1-10 per individual) was collected, together with 5 other species of intestinal flukes. The flukes were morphologically characterized by a small body size (0.70-0.86 mm long and 0.27-0.36 mm wide), a ventrogenital sac, and a gonotyl armed with 70-80 spines in the form of a comma or reversed comma lying along their lateral margin. The patients had eaten the raw flesh of mullets and gobies that had been caught in an estuary near their villages. To the best of our knowledge, this is the first record of a human S. lari infection.

Surface ultrastructure of Stictodora tridactyla (Trematoda: Heterophyidae) from Kuwait Bay

The surface morphology of Stictodora tridactyla recovered from a kitten that was fed the killifish, Aphanius dispar, naturally infected with the metacercariae was studied using scanning electron microscopy. The body comprised a rounded head, elongate neck, and widely pyriform hind-body. The head bore a circular oral sucker on the ventral side, and concentric rows of peg-like cephalic spines on the dorsal side. The oral sucker was armed with pre-oral spines similar in shape and size to the cephalic spines. The neck and hind-body were densely covered with scale-like multipointed spines, the size and density of which decreased from anterior to posterior parts of the body. Ciliated dome-shaped papillae were found solitarily or as conjugated groups on the head apex and lips of the oral sucker. Non-ciliated dome-shaped papillae were restricted to the lower lip of the oral sucker. The body was devoid of a ventral sucker. The genital opening appeared as a round depression of the tegument at about the anterior third of the body. This is the first record of the occurrence of S. tridactyla in the Arabian Gulf region and A. dispar is a new second intermediate host.

Two endemic foci of heterophyids and other intestinal fluke infections in southern and western coastal areas in Korea

Two endemic foci of heterophyid infections were discovered in coastal villages of Puan-gun, Chollabuk-do, and Sachon-gun. Kyongsangnam-do, Korea. Fecal examinations were performed on 153 inhabitants of Puan-gun and 138 of Sachon-gun, using cellophane thick smear and formalin-ether sedimentation technique. The helminth egg and/or protozoan cyst positive rate was 21.5% (33/153) in Puan-gun and 39.1% (54/138) in Sachon-gun. In Puan-gun, the egg positive rate of heterophyids was the highest, 17.6%, and that of other parasites was 0.7-2.6% by parasite species. In Sachon-gun, that of heterophyids was 18.8%, followed by Clonorchis sinensis (12.3%), and other parasites (0.7-5.0%). Twenth-two (Puan-gun) and six (Sachon-gun) heterophyid egg positive cases were treated with praziquantel, and adult flukes were collected from their diarrheic stools. A total of 3,284 adult flukes of Heterophyes nocens was collected from all of the 22 patients treated in Puan-gun (3-778 individually), and other trematodes were also collected from 2-15 patients: Pygidiopsis summa, Stellantchasmus falcalus. Metagonimus yokogawai, M. miyatai, Stictodora fuscata. Heterophyopsis continua, Acanthoparyphium kurogamo, and Gymnophalloides seoi. In Sachon-gun, M. yokogawai (3,007 specimens), H. nocens (120), and S. falcatus (46) were collected from 5 of 6 treated patients, and H. continua and S. lari each from one patient. The present study revealed that heterophyid flukes, especially H. nocens and M. yokogawai, are prevalent in the southern and western coastal areas of Korea where fresh and/or brackish water fishes are popularly eaten raw.

Stictodora fuscatum (Heterophyidae) metacercariae encysted in gobies, Acanthogobius flavimanus

The metacercariae of the genus Stictodora encysted in gobies, Acanthogobius flavimanus, purchased from a local market of Haenam-gun, Chollanam-do, were identified as those of S. fuscatum. A total of 1,437 metacercariae were collected from 30 gobies and some of them were orally fed to cats in order to obtain the adult worms. The metacercariae were 0.194-0.301 mm by 0.168-0.270 mm in size, yellowish brown, round to elliptical, and with a thin and transparent cyst wall. The excysted larvae were 0.280-0.423 mm long and 0.150-0.184 mm wide, beset with numerous tegumental spines on the anterior half of the body, and equipped with a characteristic ventrogenital sac. Total 21 adult worms were recovered from 2 cats 7 days after infection. The adult worms were small, leaf-like, 0.514-0.918 mm long and 0.235-0.377 mm wide. The ventrogenital sac was elliptical and its gonotyl was armed with 13-18 spines which were radially arranged and appeared as fan-shape. It has been confirmed that A. flavimanus is a second intermediate host of S. fuscatum in Korea.