Cercariae penetrate crabs & crayfish encysting in muscle & viscera as metacercariaeDefinitive host eats crustacean with metacercariae; juvenile excysts in the duodenumJuveniles penetrate the intestine and embed in abdominal wallReenter the coelom and penetrate the diaphragmThey wait for their mate in the pleural spacesFinally they penetrate the lung and the pair forms a cyst togetherWandering juveniles may locate in ectopic locations, such as brain, mesentery, pleura, or skinCats serve as reservoir hosts when no humans are aroundFigure 18.8 – Life cycle of Paragonimus westermaniPathology:Once in lung or ectopic site, worm stimulates an inflammatory responseParasite becomes enshrouded in a granulomaEggs in surrounding tissues result in pseudotuberclesWorms in spinal cord can cause paralysisFatal cases are seen when Paragonimus spp. locate in heart or brainPulmonary cases are rarely fatal; chronic cough, breathing difficulty, sputum containing bloodEpidemiology:Reservoir hosts often include felids, canids, rodents and pigsWorms can live 10 to 20 yearsHuman become infected by eating raw or insufficiently cooked crustaceansMarination in brine, vinegar, or wine have no affect on metacercariaeExposure can also come from contaminated fingers and cooking utensilsSome ethnic groups use of juices strained from crushed crab or crayfish for the medicinal purposes