Unusual mimicker of left ventricular aneurysm in contrast enhanced CT imaging: calcified hydatid cyst / Mimetismo infrecuente de aneurisma ventricular izquierdo en tomografía computarizada de contraste: quiste hidatídico calcificado

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Infection by and Molecular Features of Learedius learedi (Digenea: Schistosomatoidea) in Green Sea Turtles (Chelonia mydas) on the Ogasawara Islands, Japan.

Learedius learedi Price, 1934 , is a blood fluke found in sea turtles, and the adult fluke parasitizes the cardiovascular system of the host. In this study we surveyed 46 green sea turtles, Chelonia mydas, on the Ogasawara Islands, Japan, and blood flukes were detected in the heart and blood vessels of 26 turtles. The flukes were identified as L. learedi based on a detailed morphological description. In addition, molecular identification and characterization of the parasite were performed. The nucleotide sequences of nuclear internal transcribed spacer 2 (ITS2) regions were almost identical to those of L. learedi reported previously, but not to those of Hapalotrema spp., which is the closest related genus. The nucleotide sequences of the 28S ribosomal DNA region formed a single clade with those of the reference L. learedi in the phylogenetic tree, but not with those of Hapalotrema spp. Therefore, the nucleotide sequences of ITS2 and 28S are robust markers for distinguishing L. learedi from other species. The nucleotide sequences of the mitochondrial cytochrome c oxidase subunit 1 (COI) region were analyzed to evaluate the genetic variations in L. learedi. The COI haplotypes revealed the extremely high genetic diversity of the species as well as the host turtles on the Ogasawara Islands. The haplotype frequency in the mitochondrial DNA of the green sea turtles on the Ogasawara Islands is known to be significantly different from those in other Pacific rookeries. Although the number of analyzed flukes is small in this study, no haplotype was close to that in other areas; on the basis of the data, we hypothesized that L. learedi differentiated along with the host turtles on the Ogasawara Islands.

Helminth Infections and Cardiovascular Diseases: Toxocara Species is Contributing to the Disease.

Toxocariasis is the clinical term used to describe human infection with either the dog ascarid Toxocara canis or the feline ascarid Toxocara cati. As with other helminths zoonoses, the infective larvae of these Toxocara species cannot mature into adults in the human host. Instead, the worms wander through organs and tissues, mainly the liver, lungs, myocardium, kidney and central nervous system, in a vain attempt to find that, which they need to mature into adults. The migration of these immature nematode larvae causes local and systemic inflammation, resulting in the "larva migrans" syndrome. The clinical manifestations of toxocariasis are divided into visceral larva migrans, ocular larva migrans and neurotoxocariasis. Subclinical infection is often referred to as covert toxocariasis. One of the primary causes of death all around the world is cardiovascular disease that accounted for up to 30 percent of all-cause mortality. Cardiovascular disease and more precisely atherosclerotic cardiovascular disease, is predicted to remain the single leading cause of death (23.3 million deaths by 2030). A-quarter of people presenting the disease does not show any of the known cardiovascular risk factors. Therefore, there is considerable interest in looking for novel components affecting cardiovascular health, especially for those that could improve global cardiovascular risk prediction. This review endeavours to summarize the clinical aspects, new diagnostic and therapeutic perspectives of toxocaral disease with cardiovascular manifestations.

Malaria and Vascular Endothelium / A Malária e o Endotélio Vascular

Involvement of the cardiovascular system in patients with infectious and parasitic diseases can result from both intrinsic mechanisms of the disease and drug intervention. Malaria is an example, considering that the endothelial injury by Plasmodium-infected erythrocytes can cause circulatory disorders. This is a literature review aimed at discussing the relationship between malaria and endothelial impairment, especially its effects on the cardiovascular system. We discuss the implications of endothelial aggression and the interdisciplinarity that should guide the malaria patient care, whose acute infection can contribute to precipitate or aggravate a preexisting heart disease.

O acometimento do sistema cardiovascular em pacientes com doenças infecciosas e parasitárias pode ocorrer tanto por mecanismos intrínsecos à doença como em decorrência de intervenção medicamentosa. A malária é uma dessas doenças, tendo em vista que a agressão endotelial generalizada que se observa na infecção por Plasmodium pode causar distúrbios circulatórios. O objetivo deste artigo é discutir a relação entre malária e o comprometimento endotelial, em especial suas consequências sobre o sistema cardiovascular, a partir de uma revisão da literatura. Discutem-se as repercussões da agressão endotelial, bem como a interdisciplinaridade que deve nortear a atenção ao paciente malárico cuja infecção aguda pode contribuir para precipitar ou agravar doença cardíaca preexistente.

Malaria and vascular endothelium.

Involvement of the cardiovascular system in patients with infectious and parasitic diseases can result from both intrinsic mechanisms of the disease and drug intervention. Malaria is an example, considering that the endothelial injury by Plasmodium-infected erythrocytes can cause circulatory disorders. This is a literature review aimed at discussing the relationship between malaria and endothelial impairment, especially its effects on the cardiovascular system. We discuss the implications of endothelial aggression and the interdisciplinarity that should guide the malaria patient care, whose acute infection can contribute to precipitate or aggravate a preexisting heart disease.

Manifestaciones cardiovasculares de la toxocariasis humana / Cardiovascular manifestations of human toxocariasis

La toxocariasis es una infección parasitaria producida por un helminto que en el ser humano no alcanza su estadio adulto. El hombre es para sus especies, Toxocara canis y Toxocara cati, un hospedador paraténico. Dicha infección puede producir el síndrome de larva migrans visceral, el síndrome de larva migrans ocular y la toxocariasis inaparente. En el síndrome de larva migrans visceral el compromiso de órganos puede incluir hígado, pulmón, piel, sistema nervioso, musculoesquelético, riñón y corazón. Sobre este último, cada vez se reconoce más la importancia que pueden tener las manifestaciones cardiovasculares de la toxocariasis y la relevancia clínica de considerarlas. En el presente artículo, haciendo una búsqueda sistemática de información, se revisan los principales aspectos clinicopatológicos de las manifestaciones cardiovasculares de la toxocariasis incluyendo su fisiopatología, hallazgos de laboratorio, diagnóstico y opciones terapéuticas, con el objeto de llamar la atención acerca de la importancia de esta zoonosis y su relevancia para la medicina cardiovascular en adultos y en niños.

Toxocariasis is a parasitic infection produced by helminths that cannot reach their adult stage in humans. For their etiological species (Toxocara canis and Toxocara cati), man is a paratenic host. Infection by such helminths can produce a variety of clinical manifestations, such as: visceral larvae migrans syndrome, ocular larvae migrans syndrome and covert toxoca-riasis. In the visceral larvae migrans syndrome, the organs that are mainly involved include liver, lungs, skin, nervous system, muscles, kidneys and the heart. Regarding the latter, the importance of cardiovascular manifestations in toxocariasis, as well as its clinical relevance, has increasingly begun to be recognized. The current article is based on a systematic information search, focused mainly on the clinical and pathological aspects of cardiovascular manifestations in toxocariasis, including its pathophysiology, laboratory findings, diagnosis and therapeutical options, with the objective of highlighting its importance as a zoonosis and its relevance to the fields of cardiovascular medicine in adults and children.

Capacidad de agencia de autocuidado y factores relacionados con la agencia en personas con insuficiencia cardíaca de la ciudad de Medellín (Colombia) / Self-care agency ability and factors related to the agency in people with heart failure of Medellin (Colombia)

Objetivo. Explorar la asociación entre la capacidad de agencia de autocuidado con algunos factores básicos condicionantes relacionados con la agencia en personas con IC de la ciudad de Medellín (Colombia). Material y Método. Estudio de corte transversal que se llevó a cabo en una muestra por conveniencia de 266 personas con IC de dos instituciones hospitalarias de la ciudad de Medellín (Colombia) desde 2007 a 2011. Se utilizó un instrumento en el que se incluyeron variables sociodemográficas, de apoyo social y clínicas. Para la evaluación de la capacidad de agencia de autocuidado se empleó la versión de la Appraisal of Self-care Agency Scale –ASA- de Evers, validada al castellano por Gallegos. Resultados. La capacidad de agencia de autocuidado fue deficiente en el 47,0% de los participantes. Los mayores puntajes de ASA se encontraron en las personas de >=50 años, en los niveles socioeconómicos más altos, en los casados, en los que tenían educación tecnológica o universitaria, los que practicaban actividades recreativas, los que tenían cualquier tipo de apoyo social, estaban en clase funcional I y en la fracción de eyección de <=40%. En análisis de regresión logística mostró que la agencia de autocuidado suficiente está relacionada con la fracción de eyección, la edad y el estado civil. Conclusión. Fue deficiente la capacidad de agencia de autocuidado en la mitad de los participantes. Los factores básicos condicionantes, como la fracción de eyección, edad y estado civil, están asociados a una mejor capacidad de agencia de autocuidado(AU)

Objective: To explore the association between the ability of self-care agency with some basic conditioning factors related to the agency in people with heart failure of Medellin (Colombia) Material and methods: A cross-sectional study was conducted in a convenience sample of 266 people with heart failure of two hospitals in the city of Medellín (Colombia) from 2007 to 2011. An instrument which included socio-demographic variables, social support and clinics was used. To evaluate the ability of self-care agency was used the version of the Appraisal of Self-care Agency Scale-ASA of Evers, validated in Spanish by Gallegos. Results: The self-care agency ability was deficient in 47, 0% of the participants. The higher ASA scores were found in people >=51 years old, higher socioeconomic levels, married, technical or university education, those who practiced leisure activities, with any kind of social support and those with functional class I and ejection fraction of >=40%. Logistic regression analysis showed that sufficient self-care agency is related to ejection fraction, age and marital status. Conclusion: The self-care agency ability was deficient in the middle of the participants. Basic conditioning factors, like ejection fraction, age and marital status, were associated with better self-care agency ability(AU)

[Cardiovascular manifestations of human toxocariasis]. / Manifestaciones cardiovasculares de la toxocariasis humana.

Toxocariasis is a parasitic infection produced by helminths that cannot reach their adult stage in humans. For their etiological species (Toxocara canis and Toxocara cati), man is a paratenic host. Infection by such helminths can produce a variety of clinical manifestations, such as: visceral larvae migrans syndrome, ocular larvae migrans syndrome and covert toxocariasis. In the visceral larvae migrans syndrome, the organs that are mainly involved include liver, lungs, skin, nervous system, muscles, kidneys and the heart. Regarding the latter, the importance of cardiovascular manifestations in toxocariasis, as well as its clinical relevance, has increasingly begun to be recognized. The current article is based on a systematic information search, focused mainly on the clinical and pathological aspects of cardiovascular manifestations in toxocariasis, including its pathophysiology, laboratory findings, diagnosis and therapeutical options, with the objective of highlighting its importance as a zoonosis and its relevance to the fields of cardiovascular medicine in adults and children.

[Features hemodynamics and its relationship with some clinical manifestations in women with connective tissue dysplasia].

AIM: To elucidate genetically determined character of cardiovascular pathology with realization of its clinical manifestations at systemic, organ and tissue levels in patients with connective tissue dysplasia (CTD) at obstetric-gynecological setting. MATERIALS AND METHODS: This study involved 614 women with classified and non-classified forms of CTD including 268 primigravidas, mean age 24.8 ± 3.46 yr (group 1) and 346 gynecological patients with genital prolapse, mean age 44.5 ± 10 yr (group 2). Each group was divided into subgroups 1A and 2A with predominant clinical manifestations on the part of the stromal-muscular component and 1B and 2B with the predominance of the vascular component. The methods used included laboratory analysis, ECG, ultrasound, echocardiographic , X-ray, combined urodynamic studies, MGT and laser flowmetry. RESULTS: Prolapse of mitral valve (PMV) was diagnosed in 100 and 88.3% of the patients in groups 1 and 2 respectively with regurgitation in 1-2 valves in 140 (52.1%) and 143 (47.7%) ones, primary varicosis in 41 (15.2%) and 136 (39.5%), mixomatous degeneration in 65 (24.3%) and 107 (30.9%), predisposition to tissue hemorrhage in 37 (13.8%) and 64 (18.5%), vegetovascular dystonia in 50 and 60%. Patients of subgroup 1A with joint hypermobility and PMV exhibited a higher degree of uterine maturity (4.6 ± 1.75 scores). Rapid labor correlated with apical forms of genital prolapse (subgroups 1A, 2A); in the latter subgroup, they occurred in 83% ofthe patients, grade III rectocele occurred in 62.5%, protrusion and relaxation of pelvic floor in 50%. Pathology of the anorectal segment of pelvic diaphragm was diagnosed in more than 50% of the parous and nulliparous women (subgroups 1A and 2A). End diastolic volume was 102.7 ± 31.08 and 65.7 ± 59.48 ml in subgroups 2A and 2B respectively in association with a decrease of left ventricle mass to 135.6 ± 36.6 and 168.5 ± 86.97 g Hyperemic bloodflow prevailed in subgroup 1A while microcirculation index increased to 6.6 ± 1.84, perfusion coefficient to 2.2 ± 0.91, variation coefficient to 28.9 ± 5.46, relative HF amplitude to 21.9 ± 5.1 (control: 18.3 ± 1.29). CONCLUSION: CTD is always realized at the level of cardiovascular system. Its form and the type of dysregulation of suprasegmental CNS regions are genetically determined and inter-related In combination with minor cardiac abnormalities, they determine the type of hemodynamics including microcirculation and the degree of dysmorphism in the form of disorders in pelvic organs and structures including changes in the stromal-vascular histion level. The type of hemodynamics (microcirculation) determines dysregulatory processes in cells and intercellular matrix with the development of pathomorphological changes in the form of rheologic disturbances, vasculitis, thickening and loosening of basal membrane, smooth cell dystrophy, swelling of collagen fibers, loss of their elasticity, and reduction of the collagenous network.

Helminth infection in populations undergoing epidemiological transition: a friend or foe?

Helminth infections are highly prevalent in developing countries, especially in rural areas. With gradual development, there is a transition from living conditions that are dominated by infection, poor sanitation, manual labor, and traditional diet to a situation where burden of infections is reduced, infrastructure is improved, sedentary lifestyle dominates, and processed food forms a large proportion of the calorie intake. The combinations of some of the changes in lifestyle and environment are expected to result in alteration of the landscape of diseases, which will become dominated by non-communicable disorders. Here we review how the major helminth infections affect a large proportion of the population in the developing world and discuss their impact on the immune system and the consequences of this for other infections which are co-endemic in the same areas. Furthermore, we address the issue of decreasing helminth infections in many parts of the world within the context of increasing inflammatory, metabolic, and cardiovascular diseases.

Permanent pacing in patients with Chagas' disease.

BACKGROUND: Chagas' disease is an endemic disease in most Latin American countries. The cardiomyopathy associated with this condition often requires permanent pacing due to bradycardia. The aim of this study was to compare the indications for pacemaker implantation, intraoperative measurements, and long-term follow-up of patients with Chagas' cardiomyopathy (ChCM) and ischemic cardiomyopathy (ICM) referred for pacemaker implantation. METHODS: Retrospective study including consecutive patients with ChCM (Group 1) and ICM (Group 2), who underwent pacemaker implantation in a single center. RESULTS: We analyzed 360 patients. Patients in Group 1 were younger (66.29 ± 7.01 vs 75.3 ± 7.11 years; P = 0.0001) and more often male (72% vs 60%; P = 0.05). Sinus node dysfunction (SND) was more prevalent in Group 1 (70% vs 52%; P = 0.03). Atrioventricular block was less prevalent in Group 1 (30% vs 48%; P = 0.04). No significant differences were found with respect to left ventricular ejection fraction (54.2 ± 9.1 vs 53.4 ± 8.2%; P = NS) and baseline QRS duration (119 ± 34 vs 108 ± 29 ms; P = NS). Right bundle branch block was more frequent in Group 1 (44% vs 12%; P = 0.0001), and left bundle branch block in Group 2 (6% vs 22%; P = 0.0001). Implantation time was longer in Group 1 (39 ± 19 vs 29 ± 13 minutes; P = 0.001) and was with higher atrial and ventricular pacing thresholds (1.4 ± 0.8 vs 1.0 ± 0.5 V; P = 0.001 and 1.2 ± 0.8 vs 0.6 ± 0.8 V; P = 0.001, respectively). During a follow-up of 42.8 ± 13.6 months, Group 1 had a higher incidence of new atrial fibrillation (34% vs 25.5%; P = 0.001), and there was a nonsignificant trend toward more displacements of the ventricular lead (6% vs 3.5%; P = 0.3). There were no deaths during the follow-up. CONCLUSIONS: ChCM patients receiving pacemakers are younger and more frequently have SND compared to those with ICM. Pacemaker implant is longer in patients with ChCM disease and is with higher pacing thresholds. The incidence of new atrial fibrillation during the follow-up is significantly higher in patients with ChCM.

Reviews on trichinellosis (III): cardiovascular involvement.

Cardiovascular complaints represent the most important complications of trichinellosis and are particularly evident in the moderate and severe courses of the disease. An overview of 17 epidemiological studies on trichinellosis (including 5268 cases) indicated that cardiovascular events occurred in 26% of patients (range: 1.5%-75%). This narrative systematic review focuses exclusively on the cardiovascular involvement of trichinellosis and includes a brief overview and analysis of selected cases reported in the literature. Our primary goal was to increase the awareness of infectious diseases specialists, cardiologists, and general practitioners about these major complications and their possible fatal outcomes. To our knowledge, this is the first international review of this topic. Eighty-nine cases were detailed enough to allow pooled analysis (in terms of sex, age, source of infection, clinical characteristics, outcome, and routine laboratory parameters). The mean age of the analyzed group was 36.8±14.7 years (range: 3-80), with most cases in the age group of 18-29 years (25.8%, n=23). Males slightly predominated (53.9%), and pork was responsible for 91.2% of the infections. Electrocardiographic (ECG) changes represented the most common findings (80.9%). The mean eosinophil count was 25.9%±18.9% (range: 1-76). Heart failure significantly predominated in patients who died (p=0.047), whereas ECG abnormalities were reported more frequently in those who made complete recovery (p<0.0001). Because of their life-threatening character (our systematic analysis detected a case fatality ratio of 22.5%), we believe that cardiovascular complications must be considered in any patient suspected or diagnosed with trichinellosis. At the same time, practitioners should be able to establish the correct diagnosis in a timely manner and to make the best decision toward the management of these cases. Additionally, public health services located in endemic regions must be perpetually aware of this condition and must implement efficient prophylactic measures.

[Cardiomyocyte myosin heavy chain composition change after cryptosporidial gastroenteritis].

Cardiovascular diseases are the most common case of human death in developed countries. Thus, the discovering of their new risk factors is of primary importance. Based on epidemiology studies, vertebrate life-history traits comparison and cross-species cardiomyocyte transcriptome analysis, we suggest that one of these factors could be infectious gastroenteritis. This disease outflows recourses from cardio-vascular system and triggers pathological stimuli, like tachyarrhythmia, inflammation, malapsorption and energy depletion thereby disturbing cardiomyocyte metabolism and function. To test this hypothesis, we challenged gastroenteritis in neonatal rats with widespread human parasite Cryptosporidium parvum (Apicomplexa, Sporozoa). The results obtained by the methods of immunocytochemistry, quantitative morphometry and real-time PCR, indicate that moderate cryptosporidiosis lasting four days induces dramatic shift in myosin isoform expression ration toward isoform beta (with low ATPase activity) both at mRNA (by 1.7-4.5 folds) and protein (by 2.5-6 folds) levels. Antithetical manner of this shift and coherence between changes in mRNA and protein suggest that cryptosporidiosis affects all main steps of a complex myosin heavy chain regulatory network. Since the overexpression of myosin heavy chain beta (showing several times lower ATPase activity than myosin heavy chain alfa) is a generally accepted marker of human cardiac failure, we can consider cryptosporidial gastroenteritis as a new risk factor of cardiac contractile ability impairment. Our data can be interesting for clinicians.

Variation in common lipid parameters in malaria infected patients.

The heart is remarkably resilient even in the face of heavy parasite sequestration and other vital organ dysfunction, and deaths from cardiac arrhythmias in severe malaria are rare. Malaria may prove fatal for patients with pre-existing cardiac failure due to valvular stenosis or myocardial disease. High grade fever, parasitaemia, and fluid overload can all contribute to the problem. Cardiac arrhythmias are very rarely observed in severe falciparum malaria. An attempt has been made to evaluate the risk factors for cardiovascular diseases in malaria infected patients. In the present study the levels of total cholesterol, low density lipoproteins, triglycerides were high and the levels of high density lipoproteins were low in malaria infected patients compared to controls. The markers of free radical induced injury i.e. malondialdehyde were high. The study therefore suggests the importance of assessing these markers of oxidative stress along with the other routine investigations in malaria infected patients for initiating therapy in addition to primary and secondary preventive measures to mitigate the devastating consequences hyperlipidemia in malaria infected patients leading to cardiovascular diseases.

Pre-transplant Toxoplasma gondii seropositivity among heart transplant recipients is associated with an increased risk of all-cause and cardiac mortality.

OBJECTIVES: We evaluated the risk of mortality, development of cardiac allograft vasculopathy (CAV), and acute cellular rejection among Toxoplasma gondii (T. gondii) seropositive heart transplant (HTx) recipients and the 4 donor/recipient seropairing groups. BACKGROUND: Chronic T. gondii infection is known to trigger potentially adverse immunoregulatory changes, but the long-term implication for HTx recipients has not been assessed previously. METHODS: Frozen pre-HTx serum samples of 288 recipients and 246 donors were evaluated for T. gondii serostatus using Platelia immunoglobulin G immunoassay. Patients had undergone prospective serotesting using alternative assays, and results determined by the 2 methods were compared. Data regarding mortality, CAV, and acute cellular rejection were available for all patients. RESULTS: Overall, 211 recipients (73%) were seronegative and 77 (27%) were seropositive. In total, 82 recipients died, 76 developed CAV, and 82 had 1 or more episode of treated cellular rejection. Recipient seropositivity was associated with a significantly higher risk of all-cause (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.1 to 3.4; p = 0.02) and CAV mortality (HR 4.4, 95% CI 1.3 to 15.6; p = 0.02) and a higher risk of developing advanced CAV (HR 2.7, 95% CI 1.2 to 5.8; p = 0.01). Seropositivity did not influence the number of rejection episodes, and donor/recipient seropairing was not a risk factor for any end point. CONCLUSIONS: T. gondii seropositivity among HTx recipients is associated with an increased risk of all-cause and CAV mortality and of development of advanced CAV. This may be mediated via immunoregulatory changes triggered by chronic T. gondii infection and needs to be explored further.

Effects of Brugia pahangi infection on the cardiovascular system of stroke-prone spontaneously hypertensive rats.

To determine if filarial infection causes any effect on the cardiovascular system of the host animal, stroke-prone spontaneously hypertensive rats were infected with Brugia pahangi under the assumption that these rats would reveal pathological changes more clearly and in a shorter period than would ordinary rats. The infection resulted in loss of body weight, increase in heart weight, enlargement of left ventricle, and higher mortality rate.

[Cerebral malaria in non-immune subjects. Current aspects in African endemic areas]. / Neuropaludisme chez le sujet non immun. Aspects actuels en zone d'endémie africaine.

The current clinical and therapeutic aspects of cerebral malaria in non-immune adult subjects living in endemic areas of Africa were evaluated in 10 men (mean age: 40 +/- 11.4 years). On admission, 8 patients had fever, 3 were truly comatose with a Glasgow score of 7 or more. All had negative central venous pressure and only one was in a state of hyperkinetic shock. Respiratory symptoms were present in 8 cases, and jaundice was observed in 8 cases. Three patients has a haemoglobin level lower than 8 g/100 ml, and 8 had thrombocytopenia. Blood creatinine levels above 240 mumol/l and blood bilirubin levels above 50 mumol/l were found in 6 and 8 patients respectively. Plasma creatine phosphokinase was above 500 IU/l in 7 cases, and PaO2 was below 70 mmHg in 7 cases. All patients received quinine, combined with doxycycline in 6 cases. Infectious complications occurred in 5 patients, with 2 septic shocks. Two patients developed acute pulmonary oedema. Five patients died. This study shows that cerebral malaria in non-immune subjects living in endemic areas produces multivisceral deficiency similar to that observed in imported malaria. Its prognosis can be improved by loading doses of quinine and by a better prevention of nosocomial infections.

Studies on cardiovascular fluke (Digenea: Spirorchiidae) infections in sea turtles from the Great Barrier Reef, Queensland, Australia.

Twenty-seven sea turtles (23 Chelonia mydas and four Eretmochelys imbricata) from northeast Queensland were found to be infected with cardiovascular flukes and/or their eggs. Five had originated from turtle farms in the Torres Strait, five from an oceanarium on Magnetic Island (146 degrees 56'E, 19 degrees S) and the remainder from coral reefs in the Torres Strait or near Townsville. The incidence of flukes and/or eggs in the groups was 4.8 per cent (5 of 104), 33.3 per cent (5 of 15) and 72.2 per cent (17 of 22), respectively. Affected animals ranged in size from 18 to 108 cm (curved carapace length) and weighed between 0.5 and 77 kg. The average number of flukes per host was 47. Flukes were recovered from the three chambers of the heart and major vessels (right aortic arch and brachiocephalic artery), where they were attached to the walls or free in the lumen. They were subsequently identified as Haplotrema spp. and/or Learedius spp. In 59.2 per cent (16 of 27) of turtles, flukes were not found, although their eggs were detected microscopically. Gross pathological changes associated with the presence of flukes included thickening and hardening of arterial walls (four turtles), thrombus formation (three), chronic pneumonia (two) and an excess of pericardial or peritoneal fluid (four). Microscopically, the essential changes was that of chronic inflammation, as evidenced by the proliferation of epithelial cells, reticulo-endothelial cells and fibroblasts in areas accessible to flukes and/or eggs. Multiple diffuse egg granulomas were a prominent feature of most organs, the spleen and lungs being predilection sites. Proliferative changes had occurred in the endocardium and in the endothelium of vessels supplying the spleen, stomach, intestine and pancreas (18 turtles). The walls of major arteries, lungs, liver, brain, crop and stomach were also acutely inflamed (eight turtles). Haemorrhage was recorded in the lungs and/or brain of eight turtles with heavy fluke infestations. Other vascular changes, viz. congestion, oedema and hypertrophy of arterial/arteriolar walls, resulted from the inhibition of blood flow by parasitic emboli.