Fascioliasis is infection with the liver fluke Fasciola hepatica, which is acquired by eating polluted watercress or other water plants. Flukes are parasitic flatworms that contaminate different parts of the body (eg, capillary, GI tract, lungs, liver) depending upon the types. F. hepatica is the sheep and livestock liver fluke. Incidental human fascioliasis, gotten by eating watercress polluted by sheep or cattle dung, takes place in Europe, Africa, China, and South America but is unusual in the United States.
In acute infection, immature flukes migrate through the intestinal wall, the peritoneal cavity, the liver capsule, and the parenchyma of the liver before getting in the biliary ducts where they develop to adulthood in about 3 to 4 months.
Acute infection causes abdominal pain, hepatomegaly, nausea, vomiting, periodic fever, urticaria, eosinophilia, malaise, and weight-loss due to liver damage. Chronic infection may be asymptomatic or lead to intermittent abdominal pain, cholelithiasis, cholangitis, obstructive jaundice, or pancreatitis.
Heavy infection can cause sclerosing cholangitis and biliary cirrhosis. Ectopic sores may happen in the intestinal wall, lungs, or other organs. Pharyngeal fascioliasis has actually been reported after consumption of infected raw liver in the Middle East.
- Antibody assays
- Tiny assessment of stool or duodenal or biliary product for eggs
CT often shows hypodense sores in the liver during the acute stage of infection. Ultrasonography, CT, MRI, ERCP, or cholangiography can find biliary tract problems in chronic disease. Antibody detection assays are useful in:
- The early stages of infection before eggs are produced
- Chronic infection when egg production is erratic or low
Loss of noticeable antibodies occurs 6 to12 mo after cure.
In chronic infections, eggs may be recovered from the stool or from duodenal or biliary products. The eggs are indistinguishable from those of Fasciolopsis buski. In endemic areas, eggs can likewise be seen in stool after ingestion of infected animal livers. Hence, patients need to asked to follow a liver-free diet for a number of days before their stool is analyzed.
How Is Fascioliasis Treated?
Triclabendazole is the drug of choice for treatment of fascioliasis. It is the medication recommended by the World Health Organization. It is not yet commonly available to treat people. In the United States, it is not approved by the Food and Drug Administration. However, it is offered through CDC, under an investigational protocol. Similar to all medications, use of triclabendazole need to be individualized. It is a benzimidazole compound that is active against immature and adult Fasciola parasites. The therapy typically is effective and safe. Triclabendazole is offered orally, with food, to improve absorption.
The medication comes in scored tablets. The dosage is determined on the basis of the patient’s weight. The typical program is a single oral dose of 10 mg of triclabendazole per kg of body weight (10 mg/kg). Two-dose (double-dose) triclabendazole therapy can be offered to patients who have severe or heavy Fasciola infections (numerous parasites) or who did not react to single-dose therapy. Of note, some professionals routinely use 2-dose therapy, which might have a greater action rate, on the basis of restricted information.
Two-dose therapy implies that the patient is offered 2 specific dosages of 10 mg/kg, separated in time by 12 to 24 hours. In other words, the patient gets a total dosage of 20 mg/kg, given in 2 divided doses, 12 to 24 hours apart.