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PubMed1996

MR findings in human fascioliasis.

Fasciola hepatica is a trematode of herbivorous mammals, and man is infected by accidental ingestion of contaminated raw aquatic vegetables or water. There have been many reports on computed tomographic and cholangiographic features of human fascioliasis. However, findings of magnetic resonance (MR) imaging have not been reported. Hepatic fascioliasis produces three types of lesions in MR images arranged in tract-like fashion. The outermost area presents as an iso-signal area in T1WI, with slightly higher signal intensity in T2WI and diffuse enhancement after i.v. contrast. The second type presents as a well defined low signal area in T1WI, not enhanced, and also shows low signal intensity in T2WI. The third type has low signal intensity in T1WI, is not enhanced, and has high signal intensity in T2WI which is similar to fluid-containing inflammatory lesions such as pyogenic abscess. These findings suggest various changes associated with traumatic hepatitis caused by the migration of the worm in the liver. This diverse signal intensity can be a suggestive finding of fascioliasis.

Fascioliasis↗
PubMed1999

Endoscopic therapy of fascioliasis resistant to oral therapy.

BACKGROUND: We present an endoscopic approach to patients with fascioliasis resistant to oral pharmacotherapy. A staged study was performed in which the effect of flushing the biliary system with a fasciolicidal solution was evaluated. METHODS: In phase I of the study, four agents (povidone iodine, potassium permanganate, chlorhexidine, and sodium bicarbonate) were tested in vitro for their effect on Fasciola worm viability. In phase II, patients resistant to oral pharmacotherapy for fascioliasis were referred for endoscopic retrograde cholangiopancreatography and flushing of the biliary system with the solution found to be most effective in phase I. RESULTS: Povidone iodine proved to be the most effective solution against Fasciola worm viability. Nine patients had the biliary system flushed with povidone iodine. The presence of a Fasciola worm was demonstrated in the bile duct of all patients. In one patient an extra worm was found in the gallbladder. All patients were negative for Fasciola ova on repeated follow-up stool examination. CONCLUSIONS: We recommend washing the biliary system of patients with fascioliasis resistant to oral pharmacotherapy with povidone iodine because it is effective against the worms in the bile ducts and gallbladder and usually leaves the patient with an intact papilla.

Administration, Oral↗
PubMed1993

Fascioliasis: case reports and review.

Fasciola hepatica, a zoonotic liver fluke, can cause disease in humans. Fascioliasis, while common in some tropical and developing countries, is uncommon in the United States. We report two cases of fascioliasis that illustrate both the hepatic and biliary stages of the disease. Clinical features and diagnostic aspects including serologic, radiographic, and histopathologic studies are emphasized. Praziquantel was ineffective in treatment of both patients. Bithionol appears to be an effective treatment for fascioliasis.

Bithionol↗
PubMed1999

Experimental hepatobiliary fascioliasis in rabbits: a radiology-pathology correlation.

RATIONALE AND OBJECTIVES: The authors sought to correlate the radiologic findings of hepatobiliary fascioliasis with pathologic features. METHODS: Serial ultrasound, computed tomography (CT), and magnetic resonance findings in seven rabbits with experimentally induced fascioliasis were obtained every other week. Direct cholangiogram was also obtained after the rabbits were killed. Radiology-pathology correlation was done in specimens. RESULTS: In the parenchymal phase (an acute phase of parenchymal invasion of a larva), CT showed subcapsular clustered areas of low attenuation. Magnetic resonance appearance was similar in shape but better than CT in characterizing the hemorrhagic nature of the lesion. Ultrasound findings were nonspecific in this phase. In the ductal phase (a stationary phase after residing in the bile duct), CT showed dilatation of central ducts with symmetric periportal hypoattenuation (periportal tracking). Magnetic resonance could not depict mild ductal dilatation. Ultrasound was most valuable in demonstrating the moving worm within the dilated duct. Pathologically, the hepatic parenchymal lesions consisted of a cluster of eosinophilic granulomas with hemorrhagic change (migratory tract of the flukes). Ductal changes were observed predominantly in the central bile ducts. Periportal lymphangiectasia was also noted. CONCLUSIONS: Computed tomography or magnetic resonance can demonstrate the characteristic evolutionary pattern of fascioliasis that reflects the unique life cycle of Fasciola hepatica. The role of ultrasound, although limited in the parenchymal phase, was most useful in the ductal phase in that it demonstrated the moving worms themselves.

Animals↗
PubMed1992

Human fascioliasis successfully treated with triclabendazole.

Fascioliasis, caused by the common liver fluke Fasciola hepatica, is an endemic infection in sheep and cattle in many parts of Australia. Infections in humans in Australia have been reported infrequently and the most appropriate therapy for human fascioliasis remains to be determined. This case report describes a patient with the infection unsuccessfully treated with multiple high doses of praziquantel, mebendazole or albendazole. The infection was successfully eliminated by the administration of triclabendazole in two single doses of 900 mg (12 mg/kg) two days apart. No side effects were observed after the treatment. Based on our experience and that recently reported in the literature, triclabendazole may be regarded as the drug of choice for the treatment of human fascioliasis.

Abdominal Pain↗
PubMed1985

A survey of fascioliasis in beef cattle killed at abattoirs in southern Queensland.

The overall prevalence of fascioliasis in beef cattle found in an abattoir survey completed in May 1983 in southern Queensland, was 1.1%. Prevalence was 36% in the Stanthorpe Shire, varied from greater than 1 to 10% in 12 shires and was 1% or less in 24 shires. Fascioliasis was not recorded from the other 46 shires in the area of the survey. Prevalence was less than 1% in female cattle of all ages. In males, prevalence increased with age from 0.6% in 17-month-old cattle to 4.7% in 4-year-old cattle. The differences in sex-specific prevalences may be due to differences in susceptibility to the parasite between sexes, differences in susceptibility to the parasite between sexes, differences in management between sexes, or artefacts associated with sampling for a disease of very low prevalence. The presence of the exotic snail species, Lymnaea columella and L. viridis was confirmed in southern Queensland in 1977. These snails are suitable intermediate hosts for Fasciola hepatica and may widen the endemic area for liver fluke because of their more aquatic character and greater tolerance to high temperatures than L. tomentosa, the traditional snail host in Queensland. We suggest that introduced snails have not yet had a substantial impact on the importance of fascioliasis to the beef industry of southern Queensland. The survey provides baseline data for the future monitoring of this potentially important parasitic disease.

Abattoirs↗
PubMed1997

MRI appearances of fascioliasis complicating liver iron overload.

A case of hepatic fascioliasis with an unusual appearance on MRI due to liver iron overload is presented. The diagnosis of fascioliasis was based on positive serological tests and the presence of eggs in the bile. Hepatic lesions of fascioliasis exhibited hyperintense signals on T1 weighted images as well as proton density and T2 weighted images. Histological study of biopsy specimens from the lesions showed central necrosis and peripheral fibrosis with inflammatory cells including eosinophils. Abundant iron deposition in hepatocytes and Kupffer cells was found in specimens from the surrounding liver. These findings suggested that this appearance on MR images was probably due to a decrease in signal intensity in surrounding liver.

Fascioliasis↗
PubMed2005

Asymptomatic fascioliasis.

A 72-year-old Japanese man displayed asymptomatic eosinophilia for 4 months. Computed tomography showed multiple space-occupying lesions in the liver. Zoonotic liver flukes were suspected based on occupational exposure to cattle, serological and radiological findings. Immunological examination was helpful in diagnosing the disease and laparoscopy was crucial in confirming Fasciola hepatica and excluding the possibility of malignant hepatic tumors. Human fascioliasis was finally diagnosed and praziquantel administered. Blood eosinophilia resolved within 4 months and liver tumors almost disappeared within 12 months. From our experience, laparoscopy with liver biopsy is very important for diagnosing human fascioliasis, particularly for asymptomatic fascioliasis.

Aged↗
PubMed2003

Usefulness of 8 kDa protein of Fasciola hepatica in diagnosis of fascioliasis.

This study was designed to detect and evaluate an antigenicity of low molecular weight proteins of Fasciola hepatica in fascioliasis. Low molecular weight protein of F. hepatica was purified by ammonium sulfate precipitation and Sephacryl S-100 HR gel filtration. The protein obtained was estimated to be 8 kDa on 7.5-15% gradient sodium dodecyl sulfate gel electrophoresis. Immunoblotting studies showed that the 8 kDa protein reacted with human fascioliasis sera, but not other trematodiasis sera. This result suggests that the 8 kDa protein of F. hepatica is one of diagnostic antigens in human fascioliasis without cross-reaction with other human trematodiasis.

Animals↗
PubMed1999

Parasite-specific antibody profile in human fascioliasis: application for immunodiagnosis of infection.

The antibody isotype response to an adult Fasciola worm antigen preparation (FWAP) was examined in sera from 60 Egyptians with parasitologically confirmed fascioliasis by an ELISA. The FWAP-specific IgG1 and IgG4 antibodies were found in 97-100% of the patients. The ratio of the mean absorbance values between infected patients and healthy controls was 9.7 and 29.7 for IgG1 and IgG4 antibodies, respectively. The IgM, IgA, IgG2, and IgG3 antibodies were less dominant. In contrast to IgG1 antibodies, which were often detected in sera from patients infected with Schistosoma, Echinococcus granulosus, Ascaris lumbricoides, Ancylostoma duodenale, or Hymenolepis nana, FWAP-specific IgG4 antibodies were detected exclusively in the sera of patients with fascioliasis. The data thus support the conclusion that an IgG4/ELISA with crude FWAP as antigen may be used for sensitive and accurate immunodiagnosis of human fascioliasis.

Adolescent↗
PubMed1992

Human ectopic fascioliasis in Australia: first case reports.

OBJECTIVE: To describe the manifestations of two cases of migratory ectopic fascioliasis diagnosed in Australia, including the first report of lymphatic infection. PRESENTATION: Both patients presented with acute, superficial swellings. In the first, a 46-year-old woman, the lump was found to be a cervical lymph node containing a mature Fasciola hepatica which had released eggs into surrounding tissues. The second patient was a 34-year-old male abattoir worker, in whom the subcutaneous lesion resembled an infected sebaceous cyst and contained an immature fluke. FINDINGS: Both lesions were resected and diagnosed histologically. Fasciola eggs were not found in the faeces of either patient. Blood eosinophilia was not detected in either case. A serological test for fascioliasis was carried out in the second case and the result was positive. In both cases, infection was probably acquired in Australia, although neither patient had eaten watercress. OUTCOME: Neither patient was specifically treated with anthelminthic agents, and neither suffered further complications. CONCLUSION: Migratory fascioliasis occurs in Australia. It can present as superficial or deep focal lesions, not necessarily in association with peripheral blood eosinophilia or Fasciola eggs in faeces. Serological tests may be helpful in diagnosing such cases.

Adult↗
PubMed2001

Clinico-epidemiological study of human fascioliasis in an endemic focus in Dakahlia Governorate, Egypt.

Human fascioliasis is increasing in the Nile Delta particularly in Dakahlia Governorate, where it reached 7.47%. In this study, the tetrad of fascioliasis was established as high eosinophilia (100%), fever (85.6%), painful hepatomegaly (81.93%) and anaemia (100%). The laboratory results showed ESR accelerated in 87%, ALT elevated in 21.5%, AST elevated in 21.9%, S. bilirubin elevated in 16.5%, gamma GT elevated in 80.6%, and SAP elevated in 76.4%. Abdominal ultrasonography showed variable findings, as hepatomegaly, splenomegaly, periportal fibrosis, thickened wall of gall bladder, dilated common bile duct, dilated biliary radicals (partial), dilated common bile duct and biliary radicals (total), Fasciola worms in gall bladder, Fasciola worms in common bile duct, stones in gall bladder, stones in bile duct, cystic lesions in the liver, local lesions in the liver and ascitis. The highest was hepatomegaly in 81.93% of fascioliasis patients and the lowest was biliary dilated radicles (partial) in 0.26%.

Abdomen↗
PubMedDate not supplied

Hepatic fibrosis due to fascioliasis and/or schistosomiasis in Abis 1 village, Egypt.

An epidemiological study of fascioliasis and/or schistosomiasis was conducted in Abis 1 village. Stool specimens were collected from 2492 individuals and examined. Fascioliasis, alone or combined with schistosomiasis, was more prevalent among children aged between 5 years and 15 years than in adults. Serum procollagen III peptide (PIIIP) levels were determined as an indicator of active fibrosis, and liver histopathology and ultrasonography used as indicators of established fibrosis. PIIIP levels were significantly higher in children than in adults, and in mixed infections than in fascioliasis alone. In adults, fibrosis around granulomata detected by histopathology and grade 3 periportal fibrosis detected by sonography were encountered more frequently in dual than in single infections.

Adolescent↗
PubMed1999

IL-10, IFN-gamma and TNF-alpha in acute and chronic human fascioliasis.

The three cytokines, IL-10 (Th2 product), IFN-gamma (Th1 product) and TNF-alpha work in concert. The present work was undertaken to study the level of these cytokines during the acute and chronic stages of human fascioliasis in an attempt to assess the involvement of Th1 and Th2 cells in regulation of the immune response in this disease. Sera of twenty six Fasciola patients were obtained and divided into two groups: twelve with acute and fourteen with chronic fascioliasis, sera of a control group were studied simultaneously. During the acute stage, a significant increase was observed in IL-10, IFN-gamma as well as TNF-alpha and specific antibody level. In the chronic phase, a significant increase of IL-10 level was observed. IFN-gamma showed a lower level as compared to the acute stage but TNF-alpha was still high. Accordingly, in fascioliasis in the early phase of infection B cells, macrophages, Th1 and Th2 cells were all activated. They cooperate in overcoming the parasite and work to the benefit of the host. With time and after maturation of the evading worms, Th2 action predominates. IL-10 (Th2 cytokine) which is antagonistic to IFN-gamma (Th1 product) and consequently to TNF-alpha limits the immunopathology that may be caused by the latter.

Acute Disease↗
PubMed1999

Detection of Fasciola-specific excretory/ secretory (E/S) protein fraction band (49.5 kDa) and its utilization in diagnosis of early fascioliasis using different diagnostic techniques.

The objective of the present work is to evaluate Fasciola E/S antigens for diagnosis of early fascioliasis utilizing different diagnostic techniques. Using enzyme-linked immunoelectro-transfer blot (EITB), Fasciola-specific E/ S protein fraction band (49.5 kDa) was determined and electroeluted. The mono-specific antibodies against this specific fraction band were prepared by immunizing pathogen-free rabbit. Assessment of the prepared mono-specific antibodies in diagnosis of human fascioliasis was performed through the detection of E/S copro-antigens by enzyme-linked immunosorbent assay (ELISA) in stool eluates obtained from patients with confirmed fascioliasis, other parasites as well as from other healthy individuals. Serum samples were collected and tested to detect serum antibodies against Fasciola E/S antigen using EITB and counter immunoelectrophoresis (CIEP). Analysis of Fasciola adult worm E/S products by SDS/PAGE revealed a number of bands, the molecular weight (MW) of which ranged from 14-200 kDa; with three major bands (27.5, 32.5 and 55 kDa). Fasciola EIS 49.5 kDa protein fraction proved to be specific to F. gigantica. Cross reaction with S. mansoni was observed at higher MW (110-120 kDa). The sensitivity, specificity and diagnostic accuracy of EITB were 45.2%, 100% and 70.7%, respectively, while those of CIEP were 38.7%, 100% and 67.2%, respectively. ELISA technique using mono-specific anti-49.5 kDa to detect copro-antigens proved to be practical and reliable. It showed higher sensitivity (91.4%) and higher diagnostic accuracy (91.8%), while the specificity was 92.3%. In addition, ELISA had higher negative predictive value (88.9%) and fair positive predictive value (94.1%).

Animals↗
PubMed1992

Ultrasonographic findings in the gall bladder in human fascioliasis.

This study included forty patients with incubating or open fascioliasis. All were subjected to repeated stool examination, serological and haematological study using IHAT in the former. Ultrasonography was done for upper abdomen stressing on gall bladder and assessing its function. Eighteen patients were diagnosed as incubating fascioliasis by positive IHAT, high eosinophilic count and negative stool examination for Fasciola eggs. No gall bladder changes could be detected by U.S. among those patients. Twenty two patients passed eggs in their stool were diagnosed as open Fasciola. Their gall bladder through U.S. revealed flukes in twelve of them. A weak gall bladder contractility was observed in 64% with open fascioliasis.

Animals↗
PubMed2003

Role of circulating Fasciola antigens and IgG4 isotype in assessment of cure from fascioliasis.

Sixty-eight individuals were included in this study, 30 of them presented with Fasciola infection, 20 were infected with other parasites but not Fasciola (infected control group) and 18 individuals were parasite-free (normal control group). For all groups, stool analysis by modified formol-ether technique and Kato thick smears for egg counts and the circulating Fasciola antigens (CFAgs) and anti- Fasciola IgG4 isotype were estimated by ELISA technique. Complete blood count, liver functions tests and abdominal ultra-sonography were performed for all Fasciola-infected patients. Patients with fascioliasis received a myrrh-derived drug (Mirazid) in a dose of 10 mg/kg b.wt., one hour before breakfast for six consecutive days. Remeasuring of the above parameters was performed one and three months after therapy. Detection of CFAgs was found to be a useful marker for assessment of core. No cross reaction was observed between Fasciola and other parasites by using CFAg (100% specificity). The level of these antigens correlated positively with signs of cure; parasitologically, clinically or ultrasonographically. Detection of IgG4 isotype was found to be a more sensitive and accurate immunodignostic tool for fascioliasis, but it was not a useful marker for assessment of cure. Mirazid drug possesses high therapeutic efficacy (100% cure rate) on fascioliasis without remarkable side effects.

Adolescent↗
PubMed2003

Clinical signs and household characteristics associated with human fascioliasis among rural population in Egypt: a case-control study.

The symptomatology associated with human fascioliasis has been studied mostly in hospitalised subjects. Very little is known about clinical signs and symptoms associated with infections in human endemic zones, as well as on possible new ways of transmission which might be responsible for the increased number of human cases reported in recent years. This information is of great importance to facilitate diagnosis and plan effective control measures. With the objective to identify clinical signs, blood tests, household characteristics and hygienic habits associated with human fascioliasis, a cross-sectional case-control study was implemented among the rural population of three endemic foci in the Nile Delta, Egypt. Clinical history was collected from 53 cases of fascioliasis and the same number of individually matched controls. They received a complete clinical examination and a range of blood tests was performed on them. Information on socio-economic conditions, dietary and hygienic habits was also collected. The most important complaints, associated with the infection, were right abdominal pain (Odds Ratio 20, P = 0.005), epigastric burning (o.r. 16, P = 0.007) and nausea (o.r. 8, P = 0.05). Blood analyses reported a marked increase in blood eosinophils (o.r 1.3, P = 0.001) among cases. The presence of cows (o.r 3.2), buffaloes (o.r 3.0) and goats (o.r 2.6) in the household was closely associated with the infection together with the habit to bring those animals to the canal for bathing and/or drinking (o.r. 3.2). Among dietary habits investigated, eating raw seeds was more common in cases than controls (o.r. 9, P = 0.03) and emerged as a possible new way of infection.

Abdominal Pain↗