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Tanabe MB, Caravedo MA, Clinton White A, Cabada MM. An Update on the Pathogenesis of Fascioliasis: What Do We Know? Res Rep Trop Med 2024; 15:13-24. [PMID: 38371362 PMCID: PMC10874186 DOI: 10.2147/rrtm.s397138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024] Open
Abstract
Fasciola hepatica is a trematode parasite distributed worldwide. It is known to cause disease in mammals, producing significant economic loses to livestock industry and burden to human health. After ingestion, the parasites migrate through the liver and mature in the bile ducts. A better understanding of the parasite's immunopathogenesis would help to develop efficacious therapeutics and vaccines. Currently, much of our knowledge comes from in vitro and in vivo studies in animal models. Relatively little is known about the host-parasite interactions in humans. Here, we provide a narrative review of what is currently know about the pathogenesis and host immune responses to F. hepatica summarizing the evidence available from the multiple hosts that this parasite infects.
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Affiliation(s)
- Melinda B Tanabe
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Maria A Caravedo
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - A Clinton White
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Cusco Branch – Alexander von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Miguel M Cabada
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Cusco Branch – Alexander von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru
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2
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Abdominal angiostrongyliasis: pathologic findings in Swiss mice infected with different doses of Angiostrongylus costaricensis. J Helminthol 2020; 94:e169. [PMID: 32631461 DOI: 10.1017/s0022149x20000516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abdominal angiostrongyliasis is caused by Angiostrongylus costaricensis, the definitive and intermediate hosts of which are wild rodents and terrestrial molluscs, respectively. Humans are accidental hosts and can be infected by ingesting the third-stage (infective) larvae (L3). It remains unclear whether the number of L3 inoculated is related to lesion severity. Our aim was to analyse histopathological alterations in Swiss mice infected with different doses of A. costaricensis. Thirty-two mice were randomly divided into four groups (n = 8/group): uninfected, control mice; mice infected with a low dose (five L3); mice infected with an intermediate dose (15 L3); and mice infected with a high dose (30 L3). The frequency of intestinal thrombi, splenitis, eggs/larvae, hepatic infarction and acute pancreatitis differed among the groups, the last being considered a significant finding. We conclude that different infective doses alter the histopathological aspects of the infection in Swiss mice, those aspects being more pronounced at medium and high doses, with no effect on the development of the disease. This experimental model shows that the parasite life cycle can be maintained in Swiss mice through the inoculation of a low dose (five L3).
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Pattarapuntakul T, Ovartlarnporn B, Rojsanga W, Yungyoo T. Biliary Fascioliasis in Chronic Calcific Pancreatitis Presenting with Ascending Cholangitis and Biliary Stricture. Case Rep Gastroenterol 2019; 13:438-444. [PMID: 31762732 PMCID: PMC6873016 DOI: 10.1159/000503277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/04/2019] [Indexed: 12/04/2022] Open
Abstract
Biliary fascioliasis is a rare infection of the hepatobiliary system. In human, it is known to present with two main phases; acute phase (hepatic phase) presenting with abdominal pain or abnormal liver biochemistry then chronic phase (biliary phase) presenting with biliary obstruction or cholangitis. Optimal treatment of biliary fascioliasis consists of endoscopic retrograde cholangiography with removal of the parasite and single oral dose of triclabendazole. We report a rare case of biliary fascioliasis in chronic calcified pancreatitis who presented with ascending cholangitis and biliary stricture. A 63-years-old Thai man was referred to our hospital for treatment of clinical symptoms severe cholangitis. Magnetic resonance cholangiopancreatography showed evidence of distal common bile duct stricture associated with chronic calcific pancreatitis. ERCP was performed, that found a few amorphous filling defects in the common bile duct and distal biliary stricture. After removal of the foreign body of what seems to be a fluke parasite followed with single oral dose triclabendazole thereafter, the clinical symptom was improved dramatically.
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Affiliation(s)
- Tanawat Pattarapuntakul
- NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Bancha Ovartlarnporn
- NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Worapot Rojsanga
- NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Thanaidpon Yungyoo
- Internal Medicine, Shanghai Medical College, Fudan University, Shanghai, China
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Harrington D, Lamberton PHL, McGregor A. Human liver flukes. Lancet Gastroenterol Hepatol 2018; 2:680-689. [PMID: 28786389 DOI: 10.1016/s2468-1253(17)30111-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/26/2017] [Accepted: 04/03/2017] [Indexed: 12/12/2022]
Abstract
Liver fluke infections occur in people worldwide. In some low-income regions, a combination of ecological, agricultural, and culinary factors leads to a very high prevalence of infection but, in higher-income regions, infections are uncommon. Infection is associated with substantial morbidity and several liver fluke species are recognised as biological carcinogens. Here, we review the epidemiology, clinical significance, and diagnostic and treatment strategies of human infection with these pathogens.
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Affiliation(s)
- David Harrington
- Department of Infectious Diseases and Tropical Medicine, Northwick Park Hospital, London, UK.
| | - Poppy H L Lamberton
- Institute of Biodiversity, Animal Health, and Comparative Medicine, and Wellcome Centre for Molecular Parasitology, University of Glasgow, Glasgow, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Alastair McGregor
- Department of Infectious Diseases and Tropical Medicine, Northwick Park Hospital, London, UK; Faculty of Medicine, Imperial College London, London, UK
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Rawla P, Bandaru SS, Vellipuram AR. Review of Infectious Etiology of Acute Pancreatitis. Gastroenterology Res 2017; 10:153-158. [PMID: 28725301 PMCID: PMC5505279 DOI: 10.14740/gr858w] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/31/2017] [Indexed: 12/15/2022] Open
Abstract
While gallstones and alcoholism are widely known to be the most common causative agents of acute pancreatitis, about 10% of cases are thought to be caused by infectious microorganisms. These microorganisms include viruses (e.g. mumps, Coxsackie B, and hepatitis), bacteria (e.g. Mycoplasma pneumoniae and leptospirosis), and parasites (e.g. Ascaris lumbricoides, Fasciola hepatica, and hydatid disease). Each organism causes acute pancreatitis through diverse mechanisms. The review is primarily conducted in an attempt to provide a better understanding of the possibility of acute pancreatitis presenting as a complication relating to these organisms, and the aim is to guide future diagnoses, management, and predictions of complications.
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Affiliation(s)
- Prashanth Rawla
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA
| | - Sathyajit S Bandaru
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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6
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Lübbert C, Schneitler S. Parasitic and infectious diseases of the biliary tract in migrants and international travelers. Expert Rev Gastroenterol Hepatol 2016; 10:1211-1225. [PMID: 27677833 DOI: 10.1080/17474124.2016.1240614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In recent years, global and regional crises have led to extraordinary worldwide migration, accompanied by an increase in long-distance travel from Western countries. Both are linked to a rising incidence of rare parasitic and infectious diseases in first world countries, including in the biliary tract. Areas covered: A selective literature research in PubMed was performed to review the most important parasitic and infectious biliary diseases, which are caused by a wide variety of pathogens and may be latent over long periods, with chronic courses leading to cholangitis, hepatic failure or development of cholangiocarcinoma. Parasites such as Ascaris, Fasciola and Clonorchis/Opisthorchis are particularly important and may trigger biliary diseases or predisposition for bacterial superinfections. Viral or protozoal cholangitis is mainly a problem of impaired immunity. Expert commentary: Currently, these entities are still rare in migrants and long-distance travelers. However, a significant increase in Western countries has to be expected. Incidences are most likely underestimated because of protracted clinical latency. Diagnosis depends on the relevant pathogens, the host's immune status and the extent or distribution of biliary obstruction. Modern tomographic methods, ERCP and specific microbiological/parasitological/virological tests are of crucial diagnostic importance. Antimicrobial/antiparasitic/antiviral therapy along with ERCP and interventional sonography/radiology provide effective treatment options.
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Affiliation(s)
- Christoph Lübbert
- a Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology , Leipzig University Hospital , Leipzig , Germany.,b Interdisciplinary Center for Infectious Diseases , Leipzig University Hospital , Leipzig , Germany
| | - Sophie Schneitler
- a Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology , Leipzig University Hospital , Leipzig , Germany
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Parelkar SV, Oak SN, Maydeo A, Sanghvi BV, Joshi PB, Chaubal N, Patil RT, Sahoo SK, Lal PJ, Sampath N, Koticha A. Biliary fascioliasis: Management in a child using endoscopic retrograde cholangio pancreatography. J Indian Assoc Pediatr Surg 2013; 18:23-4. [PMID: 23599579 PMCID: PMC3628240 DOI: 10.4103/0971-9261.107012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 9-year-old boy presented with right upper abdominal pain and fever. The radiologic investigations revealed multiple cholangitic abscesses with cholangitis and worms in common bile duct. Endoscopic retrograde cholangio pancreatographic (ERCP) sphincterotomy, basketing, ballooning and extraction of Fasciola hepatica worms from the common bile duct were done.
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Affiliation(s)
- Sandesh V Parelkar
- Department of Pediatric Surgery, Seth G. S. Medical College and KEM Hospital, Mumbai, India
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Keshishian J, Brantley SG, Brady PG. Biliary Fascioliasis Mimicking Sphincter of Oddi Dysfunction. South Med J 2010; 103:366-8. [DOI: 10.1097/smj.0b013e3181d413d8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ezzat RF, Karboli TA, Kasnazani KA, Hamawandi AM. Endoscopic management of biliary fascioliasis: a case report. J Med Case Rep 2010; 4:83. [PMID: 20205932 PMCID: PMC2841078 DOI: 10.1186/1752-1947-4-83] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 03/06/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Fasciola hepatica, an endemic parasite common in Iraq and its neighboring countries, is a very rare cause of cholestasis worldwide. Humans can become definitive hosts of this parasite through their ingestion of a contaminated water plant, for example, contaminated watercress. Symptoms of cholestasis may appear suddenly and, in some cases, are preceded by long periods of fever, eosinophilia, and vague gastrointestinal symptoms. Here we report the case of a woman with a sudden onset of symptoms of cholangitis. Her infection was proved by endoscopic retrograde cholangiography to be due to Fasciola hepatica infestation. CASE PRESENTATION A 38-year-old Kurdish woman from the northern region of Iraq presented with fever, right upper quadrant abdominal pain, and jaundice. An examination of the patient revealed elevated total serum bilirubin and liver enzymes. An ultrasonography also showed a dilatation of her common bile duct. During endoscopic retrograde cholangiopancreatography, a filling defect was identified in her common bile duct. After sphincterotomy and balloon extraction, one live Fasiola hepatica was extracted and physically removed. CONCLUSION Fasciola hepatica should be a part of the differential diagnosis of common bile duct obstruction. When endoscopic retrograde cholangiopancreatography is available, the disease can be easily diagnosed and treated.
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Affiliation(s)
- Rajan F Ezzat
- Kurdistan Gastrointestinal Center, Sulaimanyah Teaching Hospital, Sulaimanyah, Iraq.
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Bahcecioglu IH, Ataseven H, Aygen E, Coskun S, Kuzu N, Ilhan F. Fasciola hepatica case with hemobilia. ACTA MEDICA (HRADEC KRALOVE) 2007; 50:155-156. [PMID: 18035756 DOI: 10.14712/18059694.2017.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Fasciola hepatica (FH) can lead to important hepatobiliary diseases. Here we present a case of hemobilia associated with biliary FH, which is quite a rare case. The 41-year-old patient, who underwent common bile duct exploration due to hemobilia, was found to have arterial bleeding associated with ulcer caused by a dead parasite in the common bile duct. Hemobilia is a very rare complication associated with FH. When searching for the cause of hemobilia, FH should be considered.
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Affiliation(s)
- Ibrahim Halil Bahcecioglu
- Firat University, Faculty of Medicine, Department of General Surgery, Internal Medicine and Immunology, Elazig, Turkey.
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Sezgin O, Altintaş E, Dişibeyaz S, Saritaş U, Sahin B. Hepatobiliary fascioliasis: clinical and radiologic features and endoscopic management. J Clin Gastroenterol 2004; 38:285-91. [PMID: 15128078 DOI: 10.1097/00004836-200403000-00017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fasciola hepatica is a zoonotic liver fluke that can cause disease in humans. Fascioliasis is an uncommon disease. We retrospectively analyzed 9 cases of fascioliasis and reviewed the relevant literature. A high index of suspicion and specific ultrasonographic findings are very helpful in the diagnosis of the disease. However, serological studies and endoscopic retrograde cholangiopancreatography confirm the diagnosis. The disease has 2 stages: hepatic stage and biliary stage. While several drugs are used during the hepatic stage, endoscopic retrograde cholangiopancreatography is particularly effective in the biliary stage.
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Affiliation(s)
- Orhan Sezgin
- Mersin University Medical Faculty, Gastroenterology Department, Mersin, Turkey.
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Cosme A, Ojeda E, Cilla G, Torrado J, Alzate L, Beristain X, Orive V, Arenas J. [Fasciola hepatica. study of a series of 37 patients]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:375-80. [PMID: 11674955 DOI: 10.1016/s0210-5705(01)70204-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To analyze the clinical, bacteriologic, diagnostic and therapeutic features of patients with Fasciola hepatica (FH) in our hospital. PATIENTS AND METHOD We reviewed all the patients with a diagnosis of fascioliasis from 1975 to 1999 in the Aranzazu Hospital in San Sebastián (Guipúzcoa, Spain). Diagnosis was made by direct vision of adult parasites during surgery and/or the presence of ova in stool examinations and/or positive serologic tests in patients with symptoms consistent with parasitosis. RESULTS Thirty-seven patients were included (23 men and 14 women), aged 19 to 71 years. Ingestion of watercress was confirmed in 27. Seven cases occurred as part of familiar outbreaks. Thirty-two were in the liver invasive stage and in 5 the biliary tree was invaded. The most common features were eosinophilia (91.8%), malaise and weight loss (75.6%), elevated alkaline phosphatase (74.2%), and abdominal pain (72.9%). Adult worms in the biliary ducts were observed in 3 patients and ova in feces were observed in 6. In 13 of 27 patients indirect hemagglutination test was ( 1/1,280. Data significant to confirmation of liver involvement were provided by laparoscopy in 12 of 13 patients and by imaging techniques in 13 of 31 patients. Four patients had cholelithiasis and of these, 2 also showed adult parasites in the common bile duct. Three patients underwent surgery. Therapy with dehydroemetine and/or bithionol was followed by complete remission in 30 patients, although 6 required repeat treatment cycles. The remaining 4 patients were cured by praziquantel. CONCLUSIONS Most of the patients in these series reported consumption of watercress and all patients showed the symptoms typical of parasite disease. Imaging techniques proved to be of great utility in confirming the diagnosis of hepato-biliary disease. In most of the patients therapy with dehydroemetine and/or bithionol (in one or several cycles) was followed by complete remission.
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Affiliation(s)
- A Cosme
- Servicio de Digestivo, Hospital de Aránzazu, San Sebastián, Guipúzcoa
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Richter J, Freise S, Mull R, Millán JC. Fascioliasis: sonographic abnormalities of the biliary tract and evolution after treatment with triclabendazole. Trop Med Int Health 1999; 4:774-81. [PMID: 10588772 DOI: 10.1046/j.1365-3156.1999.00482.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- J Richter
- Institute of Tropical Medicine, Berlin, Germany
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Dias LM, Silva R, Viana HL, Palhinhas M, Viana RL. Biliary fascioliasis: diagnosis, treatment and follow-up by ERCP. Gastrointest Endosc 1996; 43:616-20. [PMID: 8781945 DOI: 10.1016/s0016-5107(96)70203-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- L M Dias
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Portugal
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Arjona R, Riancho JA, Aguado JM, Salesa R, González-Macías J. Fascioliasis in developed countries: a review of classic and aberrant forms of the disease. Medicine (Baltimore) 1995; 74:13-23. [PMID: 7837967 DOI: 10.1097/00005792-199501000-00002] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Cases of human infestation by Fasciola hepatica are not uncommon in Spain and other European countries. We report our experience with 20 patients diagnosed from 1982 to 1991 and present a critical review of published cases from western countries. Because F. hepatica has a special tropism for the liver, abdominal pain, hepatomegaly, and constitutional symptoms are among the most common manifestations of acute-stage fascioliasis. However, in the chronic stage, biliary colic and cholangitis are the predominant manifestations. The clinical spectrum of fascioliasis is variable, and patients may present with extrahepatic abnormalities, such as pulmonary infiltrates, pleuropericarditis, meningitis, or lymphadenopathy. Therefore, a high index of suspicion is required to establish a correct diagnosis. Eosinophilia is the most frequent laboratory abnormality. The CT scan has become a useful technique in the diagnostic work-up. A definitive diagnosis may be established by the observation of parasite ova in the feces, but most cases may be diagnosed by serologic methods. Triclabendazole and bithionol are the most effective drugs against F. hepatica. The efficacy of praziquantel is controversial.
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Affiliation(s)
- R Arjona
- Department of Internal Medicine, Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
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