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Fasciolopsis Buski
Fasciolopsis buski, the largest intestinal fluke infecting humans, can
produce an intestinal disorder characterized by diarrhea, abdominal
pain, fever, ascites, and intestinal obstruction.
From: xPharm: The Comprehensive Pharmacology Reference, 2007

Related terms:
Fasciola Hepatica, Helminths, Intermediate Host, Trematoda, Ingestion, Parasite,
Cercaria, Metacercaria, Snail, Clonorchis sinensis

Trematodes
Patrick R. Murray PhD, F(AAM), F(IDSA), in Medical Microbiology, 2021

Fasciolopsis buski
A number of intestinal flukes are recognized, includingFasciolopsis buski (seeFig.
75.1),Heterophyes heterophyes, Metagonimus yokogawai, Echinostoma ilocanum,
andGastrodiscoides hominis.F. buski is the largest, most prevalent, and most
important intestinal fluke. The other flukes are similar toF. buski in many respects
(epidemiology, clinical syndromes, treatment) and are not discussed further. It is
important only that physicians recognize the relationship among these different
flukes.
Physiology and Structure
This large intestinal fluke has a typical life cycle (Fig. 75.2). Humans ingest the
encysted larval stage(metacercaria) when they peel the husks from aquatic
vegetation (e.g., water chestnuts) with their teeth. The metacercariae are scraped
from the husk, swallowed, and develop into immature flukes in the duodenum.
The fluke attaches to the mucosa of the small intestine with two muscular suckers,

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develops into an adult form, and undergoes self-fertilization. Egg production is
initiated 3 months after the initial infection with the metacercariae. The
operculated eggs pass in feces to water, in which the operculum at the top of the
eggshell pops open, liberating a free-swimming larval stage(miracidium). Glands at
the pointed anterior end of the miracidium produce lytic substances that allow the
penetration of the soft tissues of snails. In the snail tissue, the miracidium
develops through a series of stages by asexual germ cell propagation. The final
stage(cercaria) in the snail is a free-swimming form that, after release from the
snail, encysts on the aquatic vegetation, becoming the metacercariae, or infective
stage.
Epidemiology
Because it depends on the distribution of its appropriate snail host,F. buski is found
only in China, Vietnam, Thailand, parts of Indonesia, Malaysia, and India. Pigs,
dogs, and rabbits serve as reservoir hosts in these endemic areas.
Clinical Syndromes
The symptomatology ofF. buski infection relates directly to the worm burden in the
small intestine. Attachment of the flukes in the small intestine can produce
inflammation, ulceration, and hemorrhage. Severe infections produce abdominal
discomfort similar to that of a duodenal ulcer, as well as diarrhea. Stools may be
profuse, a malabsorption syndrome similar to giardiasis is common, and intestinal
obstruction can occur. Marked eosinophilia is also present. Although death can
occur, it is rare.
Laboratory Diagnosis
Stool examination reveals the large, golden, bile-stained eggs with an operculum
on the top (Fig. 75.3). The measurements and appearance ofF. buski eggs are
similar to those of the liver flukeFasciola hepatica, and differentiation of the eggs of
these species usually is not possible. Large (approximately 1.5 to 3.0 cm) adult
flukes (seeFig. 75.1) can rarely be found in feces or specimens collected at surgery.
Attempts have been made toward development of a molecular diagnostic tool for
discrimination ofF. buski from other fasciolids using ribosomal sequences.

Hazards and Diseases

S. Mas-Coma, in Encyclopedia of Food Safety, 2014

Etiology: The Parasite

Fasciolopsis buski is the only species included in the genus Fasciolopsis. It is a
trematode parasite commonly known as the giant Asian intestinal fluke, due to its

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large size, its geographical distribution restricted to Asia, and its location within the
host's body confined to the intestine. Together with Fasciola gigantica, it is the
largest of the digeneans to infect humans.
Fasciolopsis buski is usually elongated, oval in shape, without a cephalic cone. Its
size varies depending on the host species, and is between 2 and 10 cm in length
and 0.8 and 3 cm in width. The oral sucker is subterminal, small and approximately
one-fourth the size of the ventral sucker, which is situated not far behind the
former. An oval pharynx is present and the short esophagus leads to the caeca
which are unbranched and terminate near the posterior end of the body. The two
testes are highly branched, tandem, and situated in the posterior half of the body.
The branched ovary is pretesticular situated in the middle of the body slightly to
the right of the midline. A large cirrus pouch is present and opens at a genital pore
immediately anterior to the acetabulum. The vitelline glands are numerous and
small-sized, and extend from the level of the ventral sucker along the two lateral
fields up to the posterior end of the body, where bilateral glands join together
(Figure 1).

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Figure 1. Adult stage of Fasciolopsis buski, in ventral view. Note the unbranched
bilaterally descending caeca, two pronouncedly branched testes in longitudinal
tandem, slightly dextral branched ovary, and numerous brown eggs between ovary
and large ventral sucker or acetabulum.
The eggs are ellipsoidal, rounded at both ends, yellow and unembryonated, and
have a clear thin shell with a delicate operculum at one end (mean diameter of
operculum 27 µm). The eggs measure 120–140/70–90 µm (mean 138/82 µm)
(Figure 2).

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Figure 2. Eggs of Fasciolopsis buski: (a) egg isolated from the last part of the uterus
showing typical aspect, thin shell, hardly visible operculum on top, refrangible
brown-greenish granules equally distributed inside, and without irregular
protuberance at abopercular end; (b) and (c) two eggs found in stool sample of
Chinese patient (note small operculum microscopically focused in (b)).

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Intestinal Worms
Mark Feldman MD, in Sleisenger and Fordtran's Gastrointestinal and Liver Disease,
2021

Fasciolopsis buski
F. buski is the largest intestinal trematode that colonizes humans. Adults measure
7.5 cm long and 2 cm wide.
Epidemiology and Life Cycle
F. buski is endemic in southeast Asia and Indonesia and is acquired by ingesting
metacercariae encysted on freshwater plants.178 The metacercariae excyst in the
duodenum and attach to the small intestinal mucosa. Within 3 months, they
mature to adult flatworms and begin to lay eggs. The eggs pass with feces and, if
they are deposited into fresh water, they embryonate. Each egg releases a ciliated
miracidium that seeks a suitable snail to infect. The miracidium enters the snail
and develops into a sporocyst that asexually multiplies, releasing numerous
cercariae. The cercariae swim to freshwater plants, and each encysts to form a
metacercaria on the plant’s surface, awaiting ingestion by a mammal.
Clinical Features and Pathophysiology
AdultF. buski live for about one year and cause no symptoms in most people.179
Histology of jejunal biopsy specimens along with carbohydrate, fat, and protein
absorption were normal in one study of patients harboringF. buski;180 however, in
1952, a 15-year-old Thai girl, hospitalized for diarrhea and abdominal pain, died of
anasarca with more than 470 adult worms in her small intestine.181 No scientific
evidence supports the naturopathic belief thatFasciolopsis cures cancer or HIV-
AIDS.
Diagnosis and Treatment
Diagnosis is by finding parasite eggs in the stool (seeFig 114.3). Rarely the large
flatworm is found on endoscopy (Video 114.6).182,183 Treatment is one dose of
praziquantel 15 mg/kg given orally.

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Life Cycle of Parasites☆

M. McConnaughey, in Reference Module in Biomedical Sciences, 2014

Fasciolopsis buski
Fasciolopsis buski, the largest intestinal fluke infecting humans, can produce an
intestinal disorder characterized by diarrhea, abdominal pain, fever, ascites, and
intestinal obstruction. Most infections however, are asymptomatic. After ingestion,
the metacercariae inhabit the duodenum where they develop into adult flukes and
attach to the intestinal wall. Females produce immature eggs that are discharged
into the intestine and excreted in the stool. In water, these eggs become
embryonated and release miracidia, which invade intermediate hosts such as
snails. In the snails, the parasites undergo several developmental stages that
include sporocysts, rediae, and eventually cercariae. The cercariae are released from
the snails and encyst as metacercariae on aquatic plants. Human hosts become
infected by ingesting metacercariae on the aquatic plants.

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Medical Parasitology
Richard A. McPherson MD, MSc, in Henry's Clinical Diagnosis and Management
by Laboratory Methods, 2022

Fasciolopsis buski (Fasciolopsiasis)

This intestinal trematode is the largest species to infect humans, varying from 20
to 75 mm in length and from 8 to 20 mm in width. It occurs in many parts of
China, Southeast Asia, and India and is frequently found in pigs, which serve as a
natural reservoir host. Infection is acquired by ingesting infectious metacercariae
on aquatic food plants such as water chestnuts and water caltrop. Worms attach to
the wall of the duodenum and jejunum, where they mature to egg-laying adults in
about 3 months. Symptoms such as diarrhea, epigastric pain, and nausea may
develop if enough worms are present to produce ulceration of the superficial
mucosa. Eosinophilia may be present, even in those who are asymptomatic. The
treatment of choice for trematodiasis, with the exception of fascioliasis, is
praziquantel (Drugs for Parasitic Infections, 2013).

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Diagnosis is made by the finding of large (130–140 μm by 80–85 μm), yellow-
brown, oval, thin-shelled eggs (Fig. 65.20C). The operculum may often be
inconspicuous, and the eggs are passed unembryonated (i.e., there is no
identifiable miracidium within, as is seen with schistosomes). Differentiation
fromFasciola eggs generally is not possible, although these infections may be
differentiated on the basis of geographic history and symptoms. Eggs of
echinostome trematodes, which occasionally infect humans, are similar but smaller
(Ash & Orihel, 2007).

Infectious Diseases
Harrinarine Madhosingh M.D., Frederick S. Southwick M.D., in Medical Secrets
(Fifth Edition), 2012

53 List the tissue flukes and their typical associations

▪ Fasciolopsis buski: The infectious stage (metacercariae) is found in aquatic plants
such as water chestnuts, lotus roots, and water bamboo.
▪ Fasciola hepatica: A large liver fluke of sheep that can infect humans through
ingestion of a meal that contains infected watercress, chestnuts, or bamboo
shoots.
▪ Clonorchis sinensis: A liver fluke that can block bile ducts and lead to jaundice
and cholangitis, just as caused by Fasciola. Clonorchis is acquired by ingestion
of metacercaria in undercooked or raw freshwater fish.
▪ Paragonimus westermani: A lung fluke, acquired by ingestion of the organism in
raw or pickled crawfish or freshwater crabs.

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Trematodes
Brian F. Jones, Michael Cappello, in Encyclopedia of Gastroenterology, 2004

Intestinal Trematodes (Fasciolopsis buski, Heterophyes heterophyes, and

Metagonimus yokogawai)
The life cycle of Fasciolopsis buski requires a single snail intermediate host, which
becomes infected when eggs excreted in the feces of an infected human hatch to
release a miracidium. After developing in the snail, cercariae are released and
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encyst on water plants. These metacercaria are consumed by the definitive host; the
released larvae then migrate to the host intestine and develop into adults. Adult
worms in the intestine digest mucosal epithelial cells, which leads to inflammation
and microabscess formation. The symptoms of infection with F. buski include
abdominal or epigastric pain, nausea, diarrhea, and vomiting. Heavy infection may
be associated with intestinal obstruction or protein-losing enteropathy. The
diagnosis is made by identifying the characteristically large eggs, which measure
approximately 130 by 80 μm in size, in the feces of an infected individual.
Treatment is praziquantel (75 mg/kg), given in three divided doses for 1 day.
Infection with Heterophyes heterophyes and Metagonimus yokogawai occurs after
ingesting undercooked fish containing metacercariae. The immature adults then
migrate to the host small intestine, where they mate and attach to the intestinal
mucosa. Eggs excreted in the feces hatch to release miracidia, which then infect an
intermediate snail host. The snail sheds the cercariae, which infect a second
intermediate host, usually a freshwater fish. Symptoms in the human host are
usually mild, although heavily infected individuals may experience abdominal pain,
nausea, and diarrhea. Rarely the parasites will elicit an intestinal inflammatory
response at the mucosal surface that may lead to granuloma formation. Treatment
of Heterophyes and Metagonimus infections is praziquantel, 75 mg/kg administered
orally in three divided doses for 1 day.

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Trematodes (Schistosomes and Liver, Intestinal, and

Lung Flukes)
James H. Maguire, in Mandell, Douglas, and Bennett's Principles and Practice of
Infectious Diseases (Eighth Edition), 2015

Fasciolopsiasis
Human infection with the large intestinal fluke Fasciolopsis buski occurs in the Far
East, Southeast Asia, and southern Asia, where pigs are the major reservoir of
infection.139,167,168 The thick, fleshy adult worms range in length from 2 to 7.5 cm
and in breadth from 0.8 to 2 cm, making them the largest intestinal flukes that
parasitize humans. They inhabit the duodenum and jejunum, where they produce
large operculated eggs (135 × 80 µm) (see Fig. 290-2). On reaching fresh water, the
eggs hatch, releasing miracidia that penetrate a specific snail intermediate host in
which they multiply and develop into free-living cercariae. The cercariae encyst into
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metacercariae on almost any aquatic plant. The metacercariae survive in most
environments for up to 1 year. When raw or poorly cooked infected plants,
frequently water chestnut, bamboo, caltrop, and hyacinth and roots of the lotus,
are ingested by humans, the metacercariae excyst in the intestines, and, within 3
months, the parasites develop into mature worms that survive 6 months or more in
the human host.
Adult flukes live in the upper portion of the small intestine, where they attach to
the mucosa and produce local inflammation, ulceration, and abscesses.
Fasciolopsiasis is usually asymptomatic, but eosinophilia is common and may be
marked.10,116,166 In some cases, epigastric pain and diarrhea develop 1 or 2 months
after exposure. With heavy infections, flukes may cause transient obstruction and
ileus. Edema of the face and extremities may result from hypersensitivity to worm
metabolites or from hypoalbuminemia due to malabsorption or protein-losing
enteropathy.

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Parasites of the Gastrointestinal Tract

Blaine A. Mathison, Bobbi S. Pritt, in Encyclopedia of Infection and Immunity,
2022

Biology and epidemiology

Frequently known as the “giant intestinal fluke,” Fasciolopsis buski is a large
intestinal trematode endemic to freshwater habitats in Southeast Asia. Natural
reservoirs for human infection are primarily pigs, but also non-human primates,
dogs, and rabbits (Ma et al., 2017). Hot spots of human infection include China,
Nepal, Cambodia, India, Laos, Myanmar, Taiwan, Thailand, and Vietnam (Sah et al.,
2019).
Like all trematodes, F. buski has a complex life cycle involving multiple hosts. Adult
flukes reside in the small intestine of the definitive host (Fig. 18). Unembryonated
eggs are shed into the environment via the feces. Eggs in freshwater develop over a
period of 3–7 weeks, resulting in the formation of a first stage larva (miracidium)
within each egg. The eggs hatch and the miracidia infect an appropriate snail host,
which for F. buski are primarily members of the genera Segmentina and Hippeutis.
Within the snail, the parasite undergoes several cycles of asexual reproduction,
resulting in the formation of cercariae. The cercariae leave the snail host and encyst
on freshwater vegetation as metacercariae. The definitive host, including humans,
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becomes infected after eating uncooked vegetation harboring metacercariae or
from drinking water contaminated with liberated metacercariae (Sah et al., 2019).

Fig. 18. Fasciolopsis buski adult flukes seen in the large intestine during
colonoscopy. The smaller flukes are Gastrodiscoides hominis.
Courtesy of Dr. Sandeep T.

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Approaches to Design and Synthesis of Antiparasitic

Drugs
Satyavan Sharma, Nitya Anand, in Pharmacochemistry Library, 1997

2.2.3 Trematode infections

Several species of trematodes, commonly known as flat worms or flukes, infest the
digestive tract, liver, lungs and blood circulation of sheep, goats, cattle and other

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animals producing a broad spectrum of morbidity and occasional mortality.
2.2.3.1 Intestinal flukes
The important flukes which invade the gastrointestinal tract of ruminants are
Fasciolopsis buski, Gastrodiscoides hominis, Parampinstomuni cervi, Metagonimus
yokogawai, Heterophyes heterophyes and Echinostoma spp.
2.2.3.2 Liver flukes
These are particularly common in cattle sheep and goats producing significant
economic losses. The major liver flukes which infect ruminants are Fasciola
hepatica, F. gigantica, Fascioloides magna, Dicrocoelium dendriticum, Clonorchis
sinensis and Opisthorchis spp. These parasites usually cause hepatic problems in the
animals.
2.2.3.2 Lung flukes
Several species of Paragonimus, commonly known as lung flukes, infect lungs,
pleura and bronchi of cats, dogs and pigs. The most common lung flukes are
Paragonimus westermani and P. kellicoti.
2.2.3.3 Blood flukes
Blood fluke infections in cattle, sheep and goat are common in Africa, China and
India. Some important flukes invading the blood circulatory system of cattle, sheep
and goats are Schistosoma bovis, S. mattheei, S. nasalis, S. indicum, S. japonicum and
S. spindale.

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