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PubMed1999

Fascioliasis: sonographic abnormalities of the biliary tract and evolution after treatment with triclabendazole.

Diagnosis of infection with the liver fluke Fasciola hepatica is usually difficult. Ultrasonography (US) might be a useful diagnostic alternative, and we assessed the value of sequential US in the diagnosis and monitoring of fascioliasis in 76 patients at baseline and for 60 days after treatment with triclabendazole. At baseline, biliary abnormalities were observed in 52 patients. Crescent-shaped parasites were seen in 11 patients; in 2 cases parasites were spontaneously moving and in 4 patients parasites were motionless. Postprandial examination revealed parasites adhering to the gallbladder wall in a further 5 cases. In 3 further cases, gallbladder contents were mobile but did not sediment downwards after patients changed position. Non-specific abnormalities were: impaired gallbladder contractility (n = 23), gallbladder tenderness (n = 19), debris (n = 6), calculi (n = 5), wall thickening (n = 2) and bile duct dilatation (n = 12). During day 1-7, Fasciola-like crescents in the gallbladder or passing through the bile duct were detected in another 15 patients, impaired gallbladder contractility in 16, gallbladder tenderness in 16, and bile duct dilatation in an additional 28 patients. Thirty-two patients with these US abnormalities experienced colic-like abdominal pain accompanied by increased alkaline phosphatase in 25 cases. During day 30-60, abnormalities regressed completely in 45 patients; 2/6 triclabendazole failures were evident by detection of living parasites. Biliary tract abnormalities are frequently observed by US, but the detection-rate of Fasciola hepatica is disappointingly low despite the parasite's relatively large size. US findings must therefore be interpreted together with other clinical measurements. The visualization of parasites being expelled through the dilated common bile duct allowed the causal interpretation of post-therapeutic abdominal pain and increase of liver enzymes. When triclabendazole is given on suspicion, visualization of worm expulsion and bile duct dilatation by US may be used to confirm diagnosis.

Adolescent↗
PubMed1985

Laparoscopic findings in eight cases of liver fascioliasis.

Laparoscopic findings observed in eight patients with fascioliasis are described, five cases in the invasive or acute phase of liver distomatosis, and three cases in the chronic phase. In all cases yellowish-white nodules of 1 to 4 mm in diameter were seen on the liver surface, and in four patients they also appeared on the parietal peritoneum. Close to these nodules, ribbed or vermiform formations of a color and consistency similar to that of the nodules were observed in five patients. It is thought that these findings correspond to parasitic microabscesses in contact with intrahepatic bile ducts. Other findings were areas of capsular thickening, adhesions, dilation of subcapsular lymph vessels and flattened zones of a cicatricial aspect. This last feature appeared only in the chronic form of the disease.

Adult↗
PubMed1987

Hepatic fascioliasis in the abattoirs of Basrah.

Hepatic fascioliasis due to Fasciola gigantica among slaughtered animals was studied at the Basrah abattoirs from October 1984 to September 1985. The infection rates were 4.8, 3.3, 0.72 and 0.13% for buffaloes, cattle, sheep and goats respectively. The approximate annual loss due to condemnation of infected livers is estimated as 29,855 Iraqi dinars.

Abattoirs↗
PubMed2000

Acute fascioliasis with multiple liver abscesses.

Human fascioliasis is distributed worldwide with several foci of high endemicity. Being a rare disease in Europe, we describe here a case in the initial hepatic phase of the disease. Therapeutic and, with reference to the 2 distinct stages of disease, diagnostic standards are discussed.

Acute Disease↗
PubMed2002

A Scandinavian case of domestically acquired human fascioliasis.

A 30-y-old farmhand was admitted to our clinic in September 2000 with a 6-week history of increasing fatigue and polydipsia/polyuria after an initial short spell of gastroenteritis. No evidence of disease was discovered. During follow-up he developed leucocytosis with prominent eosinophilia, leading to the discovery of multiple liver abscesses and subsequently to the diagnosis of human fascioliasis of domestic origin. Although not uncommon in Europe, the infestation has hitherto not been reported from Scandinavia. The patient was successfully treated with praziquantel.

Adult↗
PubMed1979

Fascioliasis: nitrogen balance studies and the disposition of excessive proline in rats.

Nitrogen balance studies were conducted and the results compared between rats infected with Fasciola hepatica and uninfected rats as follows: Rats with 90 to 100 day infections were randomly selected and then matched by weight to uninfected controls. All rats were then fed a 6% protein diet for 3 days. Nitrogen balance data indicated that infected rats excreted significantly higher urinary nitrogen than the healthy ones. As large quantities of proline were known to be released into the host in fascioliasis it was suggested that the excessive proline might cause depressed nitrogen balance. In view of this possibility and because any pathological effects of the excessive proline would likely be most apparent in the organs involved in its handling, a proline disposition study was carried out. For this part of the study, the levels of the proline in various regions of the gut, the urine, the feces and the portal blood of both infected and control rats were measured and compared. Proline levels were found to be elevated in portal blood, duodenal contents, colonic contents, urine and feces.

Animals↗
PubMed1997

Human fascioliasis: clinical features and diagnostic difficulties in Egyptian children.

Human fascioliasis (HF) has been reported in children worldwide and occasionally from Egypt. In the past 7 years we diagnosed 16 children aged 3.5-11 years (mean age: 6.5 years), 13 of them were boys, as HF. They were referred to Cairo University, Paediatric Hospital (CUPH), with pyrexia of undetermined origin (PUO) and abdominal pain. Diagnosis was based on high peripheral blood eosinophilia (14-82 per cent) in all patients along with Fasciola hepatica egg detection on direct stool smear in three or stool concentration in four, antibody detection by indirect haemagglutination test (IHAT) in seven egg-negative patients and ultrasonographic detection of hepatic and/or biliary lesions of HF in two egg-negative patients. Percutaneous liver biopsy confirmed the diagnosis of an eosinophilic abscess (parasitic granuloma) in 12 of 13 patients. Therefore, HF does occur in Egyptian children and its diagnosis needs a high index of suspicion supported by stool microscopy, serology, imaging procedures, and probably liver biopsy.

Animals↗
PubMed1999

Human fascioliasis in Egyptian children: successful treatment with triclabendazole.

Human fascioliasis (HF) is an increasingly recognized public health problem in Egypt. During the past two years we diagnosed HF in 40 Egyptian children. Diagnosis was based on some or all of the following criteria: fever, tender hepatomegaly and high eosinophilia (febrile eosinophilic syndrome), presence of Fasciola hepatica eggs in stools, and/or serodiagnosis using the indirect haemagglutination test (IHAT). Eight of the 40 children had failed to respond to previous treatment with praziquantel. All children were treated with triclabendazole in a dose of 10 mg/kg as a single oral dose. Within 2 months, 31 children (78 per cent) were cured as evidenced by clinical well-being, normalization of eosinophil counts, Fasciola antibody titres, and absence of Fasciola hepatica eggs in stools. The remaining nine cases achieved clinical and laboratory cure after a second dose of triclabendazole. No side-effects were encountered in any of the cases. We conclude that triclabendazole is an effective, well-tolerated, easy to administer drug that should be considered in HF.

Anthelmintics↗
PubMedDate not supplied

Computed tomography of hepatic fascioliasis.

In seven patients with active fascioliasis of the liver, CT revealed nodular intrahepatic lesions of diminished attenuation, as well as peripheral branching formations. Computed tomography was negative in a single patient with quiescent disease. Computed tomography can be a useful tool for the diagnosis of this disease during the invasive period and also to evaluate response of patients to medical treatment.

Adolescent↗
PubMed1988

Pharmacokinetics and efficacy of triclabendazole in goats with induced fascioliasis.

The pharmacokinetics of triclabendazole were evaluated in normal goats and in goats artificially infected with Fasciola hepatica. Triclabendazole and its metabolites were determined using a novel high performance liquid chromatographic method with fluorimetric detection after solid-phase extraction. In normal goats triclabendazole given orally was metabolized rapidly to its sulphoxide and sulphone derivatives. The maximum plasma concentrations for the sulphoxide and sulphone were similar ranging from 9 to 19 micrograms/ml and these were attained at an average 12.8 and 25.6 h, respectively, after administration. Both metabolites were eliminated slowly from plasma with elimination half-lives of 22.4 h for the sulphoxide and 19.4 h for the sulphone. They persisted at measurable concentrations in plasma for up to seven days. In milk, the two metabolites occurred in low concentrations and none of them was detectable (sulphoxide less than 0.04 microgram/ml, sulphone less than 0.02 microgram/ml) after seven days. The pharmacokinetic behaviour of triclabendazole was not altered in animals with fascioliasis. Efficacy of the drug against immature (six-week) F. hepatica was 100%.

Animals↗
PubMed1980

Comparative automated assay of anti-P1 antibodies in acute hepatic distomiasis (fascioliasis) and in hydatidosis.

An automated assay of anti-P1 allohemagglutinins has been carried out on 133 P2 subjects: 13 with acute hepatic distomiasis (Fascioliasis), 20 with hydatidosis and 100 healthy blood donors. Anti-P1 were detected in 100% of the distomatid sera, in 50% of the hydatid and in 29% of the healthy individuals. When compared to a reference serum test (anti-P1 standard), their concentration was found to be weak in healthy subjects, moderate in hydatidosis and exceptionally increased in acute distomiasis (up to 5-6 times the standard anti-P1 level). The 2-mercaptoethanol treatment showed that even the increased distomatid anti-P1 sera were of an IgM nature. The respective origin, synthesis and strength of these allohemagglutinins are discussed and the advantages of using distomatid IgM anti-P1 as human sera test are emphasized.

Autoanalysis↗
PubMed1982

Evolution of fascioliasis after eating wild watercress.

Fascioliasis is rarely reported in humans although it is endemic in sheep and cattle. We describe the illness of a 60-year-old widow who ate wild watercress which is the usual source of infestation. Laparotomy for suspected liver abscesses revealed necrotic tracts on the surface of the liver left by the invasion of numerous flukes. Diagnosis was made during the latent phase by the detection of serum antibody to fasciola hepatica antigen obtained from a sheep. Symptoms returned during the cholestatic phase. Mature flukes were then present in the large bile ducts and ova appeared in the stools. Symptoms resolved twelve weeks after presentation.

Australia↗
PubMed1992

Use of LANDSAT MSS imagery and soil type in a geographic information system to assess site-specific risk of fascioliasis on Red River Basin farms in Louisiana.

A geographic information system (GIS) was constructed in an ERDAS environment using maps of soil types from the USDA Soil Conservation Service, LANDSAT satellite multispectral scanner data (MSS), boundaries for 25 study farms, and slope and hydrologic features shown in a two-quadrangle (USGS, 7.5') area in the Red River Basin near Alexandria, Louisiana. Fecal sedimentation examinations were done in the fall of 1989, spring of 1990, and fall and winter of 1990-1991 on 10-16 random samples per herd. Fecal egg shedding rates for F. hepatica ranged from 10-100% prevalence and 0.3-21.7 eggs per two grams of feces (EP2G). For Paramphistomum spp., a rumen fluke also transmitted by F. bulimoides but not affected by flukicides, egg shedding rates ranged from 10-91% prevalence and 0.1-42.8 EP2G. Soil types present ranged from sandy loams to hydric, occasionally flooded clays. Herd Paramphistomum spp. egg shedding rates increased with the proportion of hydric clays present, adjusted for slope and major hydrologic features. F. hepatica infection intensity followed a similar trend, but were complicated by differing treatment practices. Results suggest that earth observation satellite data and soil maps can be used, with an existing climate forecast based on the Thornthwaite water budget, to develop a second generation model that accounts for both regional climate variation and site-specific differences in fascioliasis risk based on soils prone to snail habitat.

Animals↗
PubMed1983

Impairment of drug metabolism by the liver in experimental fascioliasis in the rat.

Fascioliasis has been produced in the rat by an oral administration of 20 metacercariae of Fasciola hepatica. Hepatic microsomal cytochrome P450 and b5 contents and both aminopyrine demethylase and aniline hydroxylase activities have been measured during the course of the experimental distomiasis. The cytochrome P450 concentration and microsomal drug metabolizing enzymes generally fell by weeks 3 to 8 post-infestation and recovered to normal values thereafter. For the same period, both the histoenzymatically assayed liver cytochrome oxidase and arylsulphatase activities were reduced whereas there were correlated increases in glutamic pyruvic and glutamic oxaloacetic plasma transaminases. Tissue inflammation and destruction provoked by young histophagous migrating flukes could be responsible for these changes that have already been observed in several hepatic diseases. The possible influence of naturally-induced fasciolasis on liver drug metabolism is discussed.

Aminopyrine N-Demethylase↗
PubMed1991

[Three cases of human fascioliasis].

Three patients with hepatic fascioliasis are presented. (case 1) A 36-year-old female was admitted in January, 1988, because of intermittent high-grade fever. Laboratory findings included white blood cell count 8,050/mm3 with 29% eosinophils, and CRP 9.5 mg/dl. There was a positive intradermal reaction to Fasciola hepatica antigen. Liver biopsy revealed eosinophilic abscess, granulation and many Charcot-Leyden crystals. (case 2) A 54-year-old male was admitted in June, 1985, because of abdominal fullness. Marked hepatomegaly was noticed. Laboratory findings included white blood cell count 10,200/mm3 with 26% eosinophils, and CRP 2.2 mg/dl. (case 3) A 48-year-old male was admitted in March, 1989, because of intermittent high-grade fever. Hepatomegaly was noticed. Laboratory findings included white blood cell count 7,310/mm3 with 30.3% eosinophils, and CRP 3.5 mg/dl. His condition was complicated by pleuritis with invasion of Fasciola hepatica. In all patients, stool specimens were negative for ova and immunoelectrophoresis was positive for F. hepatica antigen. Computed tomography demonstrated multiple low-density areas in the periphery of the liver in cases 1 and 3, and disseminated areas in case 2. After treatment with bithionol 40 mg/kg every other day for 40 days, all three patients became asymptomatic.

Adult↗
PubMed1977

Fascioliasis: role of proline in bile duct hyperplasia.

In animals fascioliasis, extensive hyperplasia of the main bile duct occurs that often results in enlargement of the duct to more than 20 times the normal. We report that proline infused into the abdominal cavity of rats caused hyperplasia of the bile duct resembling that produced in the early stages of the disease. We suggest that Fasciola hepatica, which synthesizes and releases large amounts of proline, induces enlargement of the bile duct by a similar mechanism.

Animals↗
PubMed2001

Immunodiagnosis of human fascioliasis by an enzyme-linked immunosorbent assay (ELISA) and a micro-ELISA.

Enzyme-linked immunosorbent assay (ELISA) and micro-ELISA were evaluated for their ability to detect anti-Fasciola hepatica antibodies in humans by using excretory-secretory antigen. The sensitivity of each method was 100%, but the specificity was 100% for ELISA and 97% for micro-ELISA. The micro-ELISA could be used as a screening assay and ELISA could be used as a confirmatory method for the serodiagnosis of human fascioliasis.

Animals↗
PubMed1999

Vaccination with cathepsin L proteinases and with leucine aminopeptidase induces high levels of protection against fascioliasis in sheep.

The potential of different parasite proteinases for use as vaccine candidates against fascioliasis in sheep was studied by vaccinating animals with the cathepsin L proteinases CL1 and CL2 and with leucine aminopeptidase (LAP) purified from adult flukes. In the first trial, sheep were immunized with CL1 or CL2 and the mean protection levels obtained were 33 and 34%, respectively. Furthermore, a significant reduction in egg output was observed in sheep vaccinated either with CL1 (71%) or with CL2 (81%). The second trial was performed to determine the protective potential of the two cathepsin L proteinases assayed together, as well as in combination with LAP, and of LAP alone. The combination of CL1 and CL2 induced higher levels of protection (60%) than those produced when these enzymes were administered separately. Those sheep that received the cocktail vaccine including CL1, CL2, and LAP were significantly protected (78%) against metacercarial challenge, but vaccination with LAP alone elicited the highest level of protection (89%). All vaccine preparations induced high immunoglobulin G titers which were boosted after the challenge infection, but no correlations between antibody titers and worm burdens were found. However, the sera of those animals vaccinated with LAP contained LAP-neutralizing antibodies. Reduced liver damage, as assessed by the level of the liver enzyme gamma-glutamyl transferase, was observed in the groups vaccinated with CL1, CL2, and LAP or with LAP alone.

Animals↗