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We present a case report of invasive hepatic fascioliasis. Ramified hypodense lesions with peripheral distribution were found in the CT-scan. These lesions disappeared after treatment with Bithionol. CT-scan plays an important role in the diagnosis of invasive fascioliasis whereas ultrasound is useful in the chronic phase. Both are helpful to evaluate response to treatment.
Enzyme-linked immunosorbent assay (ELISA) and enzyme linked immunoelectrotransfer blot technique (EITB) were employed for the detection of circulating Fasciola antibodies in infected human sera using a specific Fasciola antigen, prepared by immunoaffinity purification of homogenates of Fasciola hepatica adult worms. Ninety two individuals diagnosed clinically and parasitologically were classified into: Fascioliasis group (21 patients), schistosomiasis group (21 patients) and subjects harbouring other parasitic infections (50 patients). Eighteen healthy individuals served as normal controls. ELISA was 100% sensitive and 93% specific with 96.5% diagnostic efficacy, whereas EITB was 100% sensitive and specific with 100% diagnostic efficacy. Our data revealed that ELISA can be used as a good screening test while EITB can serve as a confirmatory test for immunodiagnosis of fascioliasis.
Human fascioliasis has been recently become a health problem in Alexandria and Dakahlia governorates. This paper report a new focus of human fascioliasis.
The effectiveness of the molluscicide N-tritylmorpholine (Frescon, Shell) in the control of fascioliasis was tested in various field conditions. The effect was not only measured by the study of populations of L. truncatula but its use in prevention was also determined by turning tracer lambs out to grass in treated and control field. The studies showed that Frescon applied at the recommended dose rate is a reliable agent, even in the prevention of acute outbreaks of fascioliasis. The preventive effect was found to be most marked on treatment in the spring (preferable to single treatment during the summer), which is of particular importance in view of the fact that infections may occur in the southern Netherlands during the early grazing season.
The pulmonary performance and airway reactivity were evaluated in 16 acute and 12 chronic fascioliasis patients before and after treatment with triclabendazole in a trial to clarify some underlying pulmonary changes which can explain the chest symptomatology that may accompany this intestinal fluke. Before treatment, the maximum voluntary ventilation was impaired in the acute and chronic cases. In the acute stage, the affection was in the small airways (as denoted by lower values of FEF75% compared to control), while in the chronic stage, the impairment was more generalized including not only the small and large airways (as shown by diminished FVC, FEV1, FEFmax, FEF25%, FEF50% and FEF75%) but also, the upper airway (as noticed by lower values of FIVC and FIF50% compared to the corresponding control values). By individual analysis of the dose response slopes (DRS), 37.5% of acute and 33.3% of chronic cases had bronchial hyperactivity. After triclabendazole treatment and cure of the patients, most of the pulmonary flow rates improved significantly compared to the pre-treatment values. Moreover, all cases regained normal bronchial reactivity and the DRS diminished significantly than during fascioliasis infection. It is concluded that, although the fluke doesn't have a cycle in the lung, yet it may have an impact on the pulmonary performance and airway reactivity which subsides greatly after treatment with triclabendazole.
BACKGROUND: To assess the usefulness of an enzyme immuno-assay test for the diagnosis of two familial outbreaks of Fasciola hepatica parasitosis in the Zamora area, where watercress are a normal part of the diet. PATIENTS AND METHODS: The microbiological diagnosis of two familial outbreaks of fascioliasis was analyzed, which included the search for eggs in feces by the Kato technique and two serologic tests, one screening test by indirect hemagglutination, and a confirmatory test by enzyme-immunoassay in 12 patients. RESULTS: Five out of the six seropositive patients had eggs detected in their feces. To note that two of the patients with eosinophilia that excreted eggs--one asymptomatic and the other with abdominal pain--had a positive result in the EIA test only and with high titers. CONCLUSIONS: The EIA test is useful for the diagnosis and study of fascioliasis outbreaks to interpret the significance of low titers in the screening test in patients with eosinophilia.
BACKGROUND: Fascioliasis is a zoonosis mainly involving sheep but which occasionally may be found in man as an accidental host. It is acquired by the consumption of herbs (watercress, wild endive, and dandelion) contaminated with metacercarias. The adult phase is established in the biliary tree. Most of the human infections are asymptomatic or with unspecific self limited abdominal symptoms making diagnosis difficult. METHODS: A case of human fascioliasis is of note because of two aspects: a) the infrequent, severe life threatening form of presentation: recurrent subcapsular hepatic hematomas, and b) favorable evolution of the patient on treatment with triclabendazol (to date its use is not approved in humans). RESULTS: Resistance to treatment with praziquantel was observed at a dosis of 75 mg/day for 2 days, being repeated 15 days later with no response. The patient was posteriorly treated with 10 mg/kg of a single dosis of triclabendazol following approval as "compassive use" with a favorable clinical response. CONCLUSIONS: This unusual disease requires a high index of suspicion to achieve diagnosis. Treatment with triclabendazol should be studied as a possible treatment of choice given is efficacy, absence of adverse effects and comfortable dosage.
Fascioliasis has not been confirmed as a human disease entity until now in Korea despite of sporadic discovery of ova of Fasciola sp. in human fecal materials being never traced to the confirmation of infection. Almost all of the cases with ova in their stool have been related with consumption of cattle liver whether eaten in raw or processed. The present authors confirmed a human fascioliasis case who was a Korean housewife of 42-year-old living in Seoul, during the exploratory laparotomy. The patient had been healthy until October 1975 when abrupt onset of urticaria, dyspepsia, epigastric discomfort developed. And the fluctuation of these symptoms was followed by epigastric colicky pain attacks from December 4, 1975. A complete worm of Fasciola sp. was removed during the bile-duct exploration with stone forceps in lower half of common bile duct, on January 20, 1976. The patient only agreed that she had eaten some raw liver of cattle on September 1975 but denied any possible sources of infection such as drinking of untreated water, handling of water flower and grass, and eating of raw watercress. The measurements of the removed worm: 35. 61 mm in body length, 14.00 mm in maximum body width(Length/width ratio, 2.54:1), distribution of testes to body length 33.9%, number of branches of ovary 22, the size of intrauterine ova 157.2 x 108. 4 micrometer in average. These findings are not compatible with the classical descriptions of both Fasciola hepatica and F. gigantica, and it was concluded it is so-called Fasciola sp. which is intermediate between two species as proposed by many Japanese workers.
There is some portion of patients with clinically manifested acute viral hepatitis, which are seronegative to hepatitis A markers. They have to be differentiated with other patients with B, C, D hepatitis, mechanical jaundice, etc. Such clinical cases make physician to recall the parasitic diseases, such as fascioliasis, which affects hepatobiliary system, causes prolongation of cholestasis and dystrophic changes in the biliary tract and likely to cause liver cirrhosis. In the presented case the initial diagnosis was severe acute Hepatitis A (anti-HAV IgM+), though the peripheral blood examination showed moderate eosinophilia, ultrasound investigation revealed multiple sites of damage in the liver, which made us to consider fascioliasis, the latter was confirmed by the serological analysis. Appropriate medical treatment was effective and the state of the patient has improved.
Proliferation of bile duct-like epithelial cells is a common feature of extrahepatic biliary obstruction and it is also present in other forms of liver disease. Experimental infestation with Fasciola hepatica induces hyperplasia of ductular cells together with different functional alterations, such as hypercholeresis, in the rat. We have investigated the contribution of ductular biliary secretion to the hypercholeretic phenomenon in rats with experimental fascioliasis. Infestation was induced by oral administration of 20 metacercariae of F. hepatica. Twelve weeks later, histological study of the liver showed a hyperplastic reaction with proliferation of bile duct-like structures. Basal bile flow in infested animals was significantly higher than that of control animals (+17%), while biliary secretion of bile acids did not significantly differ between both groups. Bile flow increase was associated in parasitized animals with a significantly lower [14C]mannitol bile:plasma ratio (-23%). Intravenous secretin administration (0.3 CU/100 g body wt min) induced a significant increase in the biliary concentration of bicarbonate (+21%) and an enhancement of bile flow (+21%) only in the animals with ductular proliferation. Taurocholate infusion (0.5 nmol/100 g body wt min) produced a similar bile flow increase both in control rats and in rats with proliferated biliary ductules. These results indicate that proliferated bile ductules and ducts spontaneously secrete bile in response to infestation by F. hepatica and that secretin-stimulated bile flow originates at the proliferated biliary structures.
The diffusion-in-gel enzyme-linked immunosorbent assay (DIG-ELISA) for antibodies to Fasciola hepatica was evaluated using adult fluke excretory-secretory products as antigen. The sensitivity and specificity of the test were compared with those of the indirect hemagglutination (IHA) technique. The results of the DIG-ELISA showed that the reaction zone diameters obtained with 42 sera from sheep with natural or experimental exposure to F. hepatica were significantly greater than those obtained with 85 sera from ovines infected with other parasites. Both sensitivity and specificity were 100% in the DIG-ELISA, whereas the sensitivity was 68.2% and the specificity was 100% in the IHA. The data suggest that the DIG-ELISA is a valuable serodiagnostic test for sheep fascioliasis.
Three patients with fascioliasis are presented in whom CT demonstrated abscesses and granulomas and permitted control of the disease's evolution after medical treatment.
The epidemiology of Fasciola gigantica Cobbold was studied in the definitive host and the epidemiological cycle was determined. The incidence of immature flukes was high in September to December and mature flukes from December to March. A survey of chronic fascioliasis was conducted covering almost the whole country. The prevalence of the disease was high in the Northern and Central Regions. Based on the epidemiological findings a control programme for the disease in Malawi was prepared.
Lymnaea auricularia race rufescens and Lymnaea luteola were shown to transmit F. gigantica in the Koshi hills of Nepal. The ecology of the snails was studied at nine different habitats in Hattikharka panchayat, the highest numbers occurring immediately after the end of the monsoon. Mature F. gigantica infections in the snails were detected from May to August and again in November. The prevalence of the infection in cattle was highest during the summer monsoon and in January and February. A control programme for fascioliasis based on these findings is suggested which requires that cattle be treated in February and possibly again in late August.
Repeated use of modern anthelmintics gave good control of fascioliasis in sheep in a village in the inter-montane plain of the Yemen Arab Republic despite the presence on the same pasture of untreated animals. The sheep mainly acquired the infection during the drier winter season and it is probable that effective control could be achieved by regular treatment of all animals over that period.
Fascioliasis initially involves the liver parenchyma and then the biliary ducts. The disease can mimic most hepatobiliary diseases at different stages of involvement. We report a case in which the final diagnosis was reached by microscopic demonstration of Fasciola hepatica eggs in bile obtained by percutaneous transhepatic biliary drainage. Computed tomographic findings that were misinterpreted as metastatic liver disease are presented, and the roles of percutaneous transhepatic cholangiography and biliary drainage are discussed.
We report a case of necrotic granuloma of the liver by human fascioliasis. The lesion showed unusual findings at sonography, computed tomography, and magnetic resonance imaging that have not been reported previously.
Fasciola hepatica is a trematode which is found worldwide. The diagnosis is usually delayed because the disease is relatively rare and the parasite or its eggs must be shown in bile samples for verification. We report three cases in which the diagnosis of fascioliasis was established by simple US-guided aspiration of the gallbladder. This new diagnostic method is less invasive, safe, and easy compared with the conventional endoscopic methods.