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A case of ectopic intraabdominal fascioliasis presented with acute abdomen
Abstract
Human fascioliasis with Fasciola species occurs worldwide and is most common among rural people who tend sheep and eat uncooked water vegetables, particularly watercress. The natural history of the acute phase begins with ingestion of metacercariae encysted on various kinds of aquatic vegetation such as watercress. Fascioliasis primarily involves the liver, bile ducts, gallbladder, and occasionally ectopic sites. We describe herein a case of ectopic fascioliasis. This uncommon form of disease was peritonitis; both visceral and parietal peritoneal layers were affected with the formation of multiple nodules and ascites.
... Spesies cacing hati yang menginfeksi manusia adalah F. hepatica. Kasus fascioliasis pada manusia menurut Tanir et al. (2011) dapat terjadi pada organ yang salah yaitu di luar hati (fascioliasis ektopik). Xuan et al. (2005) dan Cheng et al. (2007) menyatakan bahwa fascioliasis ektopik meliputi kejadian pada sub kutan, paru, jantung, mata, otak, lambung, sekum, epididimis, dan nodus limfe. ...
... Xuan et al. (2005) dan Cheng et al. (2007) menyatakan bahwa fascioliasis ektopik meliputi kejadian pada sub kutan, paru, jantung, mata, otak, lambung, sekum, epididimis, dan nodus limfe. Tanir et al. (2011) melaporkan bahwa gejala yang muncul dari fascioliasis ektopik pada rongga peritonium, omentum, dan dinding usus halus anak laki-laki berumur enam tahun adalah demam tinggi, diare, dan kehilangan 2 kg berat badan dalam waktu 10 hari. Corresponding author : umm1334@yahoo.com ...
... Bahwa cacing muda memasuki tubuh manusia melewati saluran pencernaan, tetapi cacing muda juga dapat terdistribusikan ke lokasi yang salah. Tanir et al. (2011) ...
Pathology anatomy changes in liver and bile duct of Aceh cattle infected with fasciola gigantic
ABSTRACT. This study was conducted in Banda Aceh Municipality, Aceh Province to report the pathological changes in liver of Aceh cattle infected with Fasciola gigantica. In this study, livers of male aceh cattles were collected from slaughter area when Qurban in Idul Adha during two years (2011 to 2012). A total of 15 aceh cattle livers were examined. Establishment of F. gigantica were observed, and pathological changes of liver were identified. The result showed that out of 15 male Aceh cattle livers 6 (40%) were found infected with F. gigantica. The common pathological changes found in this study were the hepatic damage, and the bile ducts were changes in size and shape with the dilated lumen. The bile ducts were found filled with blackish brown exudate, which contained adult F. gigantica. In conclusion, fascioliasis is greatly responsible for hepatic damage, and currently expanding as an important veterinary public health problem.
... Bu hastaların neredeyse tamamında etken, olgunlaşmamış larvalarsa da erişkin parazitlerin de neden olduğu az sayıda ektopik vaka rapor edilmiştir. İnsanlarda en sık görülen ektopik lezyonlar gastrointestinal sistemdedir (4,22,23). Karın duvarı, pankreas, dalak, deri altı dokusu, kalp, kan damarları, akciğer ve plevra boşluğu, iskelet kası, apendiks ve epididimden bildirilen olgular da bulunmaktadır. ...
... Ektopik lezyonların patolojik etkileri, göç yollarının enflamasyon ve fibrozisinin yol açtığı doku hasarından kaynaklanmaktadır (4,22,23). Lübnan ve diğer ...
Fasciolasis, also called trematode, is a zoonosis caused by Fasciola hepatica or Fasciola gigantica. Fasciola spp. It lives in the bile ducts of sheep, cattle, buffalo, goats, donkeys, horses and rabbits, and its eggs are dispersed into the environment with the feces of these animals. Transmission to humans occurs through consumption of watercress, green vegetables and water contaminated with metacercariae. Fever, hepatomegaly and abdominal pain are the typical clinical triad of fasciolosis. The increasing number of human cases in many countries on five continents and the results of studies on the pathogenicity, immunity and chronic period of the disease suggest that fasciolosis can no longer be considered only as a secondary zoonotic disease. Fasciolosis is a priority on the agenda of the World Health Organization with the definition of foodborne human trematode disease. In this chapter; Two pediatric cases and one adult case, one of whom presented a classic picture of hepatic fasciolosis and the other developed cholangitis as a result of treatment side effects, are presented.
... Besides animals, this disease can also affect humans. In humans, fasciolosis can occur outside the liver, known as ectopic fasciolosis (Tanir et al., 2011). Just like livestock, humans can have fasciolosis when they eat the infective stage, i.e., metacercaria (Nguyen et al., 2017). ...
Infectious diseases pose a significant threat to livestock health and productivity, particularly in developing countries. Fasciolosis, caused by infestation of Fasciola sp., is one such disease of concern. This case report focuses on the anatomic pathologic changes observed in the liver of Bali cattle infested with Fasciola gigantica. The cattle involved in this study were Bali cattle slaughtered at the Mambal Slaughterhouse in Badung, Bali, Indonesia between December 2021. During the specified period, 2 out of the 16 slaughtered cattles tested positive for Fasciola gigantica, representing an infection rate of 12.5%. The primary objective of composing this article is to disseminate information pertaining to the anatomical and pathological alterations observed in Bali cattle as a consequence of fasciolosis. Regarding the observation, the liver exhibited hepatomegaly, characterized by enlarged size and blunt edges, and adult flukes were found in the bile ducts. The surface of the liver parenchyma displayed proliferation of connective tissue, and there was evidence of enlarged portal lymph nodes. Based on these findings, it can be concluded that the Bali cattle in this case report were afflicted with fasciolosis.
... In this study, we reported a higher incidence of fascioliasis in Turkey than in previous studies [30][31][32][33][34][35] . We attribute the higher rate of positivity for fascioliasis in this study to the choice of investigation group from individuals with complaints. ...
Objective:
Fasciola hepatica and Fasciola gigantica are liver trematodes that cause fascioliasis in humans and animals. In Turkey, the medical importance of fascioliasis has been increasing in humans, and it continues to cause great economic loss in the field of animal husbandry. Therefore, it is important to diagnose fascioliasis quickly and reliably. The aim of this study is to show that the ELISA test is a reliable and specific method for diagnosing fascioliasis both in the early stage and in the acute stage.
Patients and methods:
In this study, 640 individuals aged 7-75 years who showed one or more symptoms of fascioliasis, such as abdominal pain, fever, weight loss, weakness, fatigue, headache, sweating, nausea, vomiting, allergic urticaria, liver mass, hypereosinophilia, or liver enzyme elevation, were recruited from the Dicle University Research and Application Hospital in southeastern Turkey. Serum and fecal samples were taken from them to investigate if the Fasciola hepatica IgG antibody was present in the serum and if eggs were present in the feces. To detect the IgG antibodies, an enzyme-linked immunosorbent assay (ELISA) kit was used. The stool samples were analyzed for three consecutive days in mini Parasep fecal parasite concentrator tubes using the native-lugol and sedimentation methods. Abdominal ultrasonography and computed tomography were performed in all the patients.
Results:
Among the subjects of this study, 90 (14%) were positive for fascioliasis, of whom 85 (94.4%) were adults and 5 (5.5%), children; 73 (81.1%) were women and 17 (18.8%), men; 57 (63.3%) lived in the rural areas and 33 (36.6%), in the city center; 90 (14%) were positive for Fasciola hepatica IgG antibodies; (20%) had helminth eggs in their stools; and 85 (94.4%) had a history of eating watercress.
Conclusions:
According to the epidemiological classification for fascioliasis by Mas-Coma, the Dicle Basin, which is the setting of this study, is indeed a hyperendemic region. Thus, ELISA is a reliable and specific method of diagnosing fascioliasis, both in the early phase and in the acute phase, when the eggs are no longer seen in the stool.
... 67 Peritonitis diagnosed in the chronic case 5 is a complication already emphasized in children. 68,69 Ectopic case five demonstrates that adult flukes have the capacity to abandon the liver, reach the intestine, and restart migration crossing the intestinal wall. ...
Fascioliasis is reported in five Vietnamese children aged 4 years or younger. A 10-month-old girl child and a 12-month-old boy child are the youngest patients ever diagnosed. Eggs in stools suggested an infection occurred at 5-6 months and 7-8 months of age, respectively. DNA sequencing and egg size indicated this to be the first report of a verified Fasciola gigantica infection in so small children. No specific diagnosis could be obtained in two 3-year-old children detected in the acute phase. A big and gravid ectopic F. gigantica-like worm was surgically found in a 4-year-old boy presenting with peritonitis. A worldwide review showed only 38 past cases in preschool children. They included 3, 7, 12, and 16 cases of 1, 2, 3, and 4 years, respectively, with a faster infection increase in males from 2 years onward. Reports were from all continents, except Oceania, including severe complications and death. The causal agent, when specifically diagnosed, was always Fasciola hepatica. Analyses include detection in hospital, surveys, and family outbreaks; infection sources; disease phases; parasite burden; ectopic cases; symptom onset; eosinophilia; biochemical markers; and clinical complications. C-reactive protein, creatinine, and γ-glutamyl transferase are the most useful biomarkers. A serological test and a coprological analysis are recommended for so small children, in which typical symptoms may be overlooked. Treatment problems were described with many drugs, except triclabendazole. Triclabendazole should be considered the drug of choice for such small children. The possibility of a very early infection by Fasciola spp. should be henceforth considered.
... In addition to acute and chronic stages of infection, asymptomatic chronic fascioliasis was the subject of case reports [39][40][41][42] as well as studies by El-Morshedy et al. 35 and Villegas et al. 34 A small number of case reports have also described the efficacy of triclabendazole in ectopic fascioliasis. 17,[42][43][44] In most reports, parasites were not identified to the species level, but given the geographical distribution of each species, it is likely that F. hepatica was involved in most cases. In one published study performed in China, 45 F. gigantica was identified using serology and molecular techniques, and improvement of clinical signs and symptoms was reported in all patients. ...
Fascioliasis occurs on all inhabited continents. It is caused by Fasciola hepatica and Fasciola gigantica, trematode parasites with complex life cycles, and primarily affects domestic livestock. Humans become infected after ingestion of contaminated food (typically wild aquatic vegetables) or water. Fascioliasis may be difficult to diagnose as many symptoms are non-specific (e.g. fever, abdominal pain and anorexia). Treatment options are limited, with older effective therapies such as emetine and bithionol no longer used due to safety issues and unavailability, and most common anthelminthics having poor efficacy. Clinical trials conducted over a 25-year period, together with numerous case reports, demonstrated that triclabendazole has high efficacy in the treatment of human fascioliasis in adults and children and in all stages and forms of infection. Triclabendazole was approved for human use in Egypt in 1997 and in France in 2002 and a donation program for the treatment of fascioliasis in endemic countries was subsequently established by the manufacturer and administered by the World Health Organization. Here the published data on triclabendazole in the treatment of human fascioliasis are reviewed, with a focus on more recent data, in light of the 2019 US Food and Drug Administration approval of the drug for use in human infections.
... Abdominal EF was the most common type of ectopic infection. The 6 cases of abdominal ectopic were reported from Korea and Turkey (between 1982 and 2015) [4,[40][41][42][43][44]. In these cases, the cecum, colon, and mesocolon were main involved sites (Supplementary Table 1). ...
Fascioliasis is a tropical zoonotic disease caused by the Fasciola parasite. The adult parasite usually resides in the liver and biliary ducts; however, several cases of ectopic fascioliasis (EF) have been reported. This study is a highlight on EF according to the confirmed case reports. In a setting of systematic review, we found 25 eligible articles containing 26 confirmed cases of EF (any date until 30 November 2018), including abdominal and intestinal EF in six cases, skin and subcutaneous tissues in five cases, eye in four cases, brain and pancreas in three cases, neck and lymph node in two cases, and lung, dorsal spine, and peritoneal cavity in one case, respectively. The result indicates that fascioliasis can have diverse ectopic forms and should be more attended in the endemic regions of fascioliasis in order to distinguish from other endemic diseases.
... Indirect haemagglutination (IHA – commercialized: Fumouze Diagnostics) (see numerous references in Esteban et al. 1998). The IHA test is a technique still used frequently in endemic areas, using purified adult F. hepatica F 1 as antigen (El-Shazly et al. 2002; Haseeb et al. 2003b; El-Ahl et al. 2007; Hammami et al. 2007; Deveci et al. 2011; Gökçe et al. 2011; Kaya et al. 2011; Sakru et al. 2011; Tanir et al. 2011; KaradağÖncel et al. 2012; Yalav et al. 2012). ...
SUMMARY Before the 1990s, human fascioliasis diagnosis focused on individual patients in hospitals or health centres. Case reports were mainly from developed countries and usually concerned isolated human infection in animal endemic areas. From the mid-1990s onwards, due to the progressive description of human endemic areas and human infection reports in developing countries, but also new knowledge on clinical manifestations and pathology, new situations, hitherto neglected, entered in the global scenario. Human fascioliasis has proved to be pronouncedly more heterogeneous than previously thought, including different transmission patterns and epidemiological situations. Stool and blood techniques, the main tools for diagnosis in humans, have been improved for both patient and survey diagnosis. Present availabilities for human diagnosis are reviewed focusing on advantages and weaknesses, sample management, egg differentiation, qualitative and quantitative diagnosis, antibody and antigen detection, post-treatment monitoring and post-control surveillance. Main conclusions refer to the pronounced difficulties of diagnosing fascioliasis in humans given the different infection phases and parasite migration capacities, clinical heterogeneity, immunological complexity, different epidemiological situations and transmission patterns, the lack of a diagnostic technique covering all needs and situations, and the advisability for a combined use of different techniques, at least including a stool technique and a blood technique.
Fascioliasis is infection by liver flukes, Fasciola spp. The two species that infect humans are Fasciola hepatica and Fasciola gigantica. Other herbivorous animals such as cattle, goats, water buffalo, horses, camels, hogs, rabbits, and deer can be infected with Fasciola spp. Humans acquire Fasciola after ingestion of food and water that are contaminated with Fasciola metacercaria, especially aquatic plants. Fascioliasis is usually mild disease in human. Clinical manifestrations are related with the the phases of infection. In migratory phase, symptoms may occur when metacercariae excyst in the duodenum and young liver flukes migrate through the intestinal wall to the liver capsule and hepatic parenchyma before reaching the bile ducts. Clinical symptoms include abdominal pain in the right hypochondrium, dyspepsia and anorexia, nausea, vomiting, and hepatomegaly. Systemic manifestration such as urticaria and eosinophilia are also common presentation. After Fasciola reside in the biliary tract, most of cases are asymptomatic. Biliary track obstruction can accidentally occur and might lead to cholangitis. Triclabendazole 10 mg/kg as a single dose is the current drug of choice for fascioliasis treatment and triclabendazole two doses of 10 mg/kg for 1 day is effective in severe or persistent infections, with cure rates of 79% and 92%, respectively. Currently, there is no vaccine for prevent Fasciola infection. Proper cooking or cleaning food especially aquatic plants before consumption will prevent accidental Fasciola infection. Adequate mass treatment among infected animals in endemic areas and proper sanitary in the livestock farm are important for disease control. Figure 1 ภาพถ่ายตัวเต็มวัยพยาธิ Fasciola hepatica (Linnaeus, 1758) (A) และ Fasciola gigantica (Cobbold, 1855) (B)(ได้รับการอนุเคราะห์ภาพจาก รศ.ดร.อุรุษา แทนขำ ภาควิชาปรสิตหนอนพยาธิ คณะเวชศาสตร์เขตร้อน มหาวิทยาลัยมหิดล)
The trematodes Fasciola hepatica and F.gigantica can infect a broad range of hosts, and cause the disease Fasciolosis. Fasciolosis is a disease of economic importance, with livestock infection having a considerable impact on the agriculture industry. Human infection is now considered of public health importance and is hyperendemic in some regions. The incidence of animal and human infections is increasing in parts of the world. This review will provide an overview of our current understanding of Fasciola, from distribution, diversity and disease development, to current control measures and progress towards an effective vaccine. Fasciola excrete and secrete a broad range of molecules while residing in the host. The repertoire of molecules changes as the parasite matures, reflecting the different needs of the fluke during parasite development. These molecules, which are involved in important parasite functions, are often found in the parasites excretory-secretory material, and function at the host-parasite interface. Common among these molecules are antioxidents as well as a variety of proteases, including cathepsin proteases. The roles of these key molecules during Fasciola infection, including their ability to modulate host immune responses will be a focus of the review. The findings from recent transcriptome and proteome analysis will also be a discussed, as will the potential for RNA interference in characterisation of this parasite.
Human fascioliasis, caused by Fasciola hepatica, is emerging as an important chronic zoonotic disease in many areas of the world, including Turkey. It primarily involves the liver and may also cause severe damage in the tissue. Herein we report on a patient with ectopic intra-abdominal fascioliasis that presented to our clinic with abdominal pain and distention. Physical and radiological examination as well as an exploratory laparotomy revealed a 10 x 10-cm mass in the splenic flexura of the colon and multiple cystic formations in the liver, spleen, and omentum, which mimicked peritoneal carcinoma. Histopathological examination revealed a granulomatous reaction due to parasites. Left hemicolectomy and partial omental resection were performed. Subsequent serological and histological examinations resulted in the diagnosis of fascioliasis. Laparotomy and treatment with triclabendazole were well tolerated by the patient. Ectopic cases of fascioliasis cannot be easily distinguished from peritoneal carcinoma involving the colon, mesocolon, and omentum, and physicians must therefore be aware of this form of infestation.
Fasciola hepatica, a zoonotic liver fluke, can also cause disease in humans. Common symptoms are epigastric pain, upper abdominal pain and malaise. Fever and arthralgia are common in acute fascioliasis. Eosinophilia is the predominant laboratory finding, especially in patients with the acute form of the disease. Diagnosis and treatment is not easy, as physicians rarely encounter this disease, and effective drugs are not available in many countries. Human fascioliasis may be underestimated. Patients with eosinophilia and abdominal pain should be evaluated for F. hepatica infestation by parasitological, radiological and serological tests.
We report the case of a 50-year-old man who presented with systemic vasculitis associated with Fasciola hepatica infection. The patient presented with severe skin, kidney, spleen, ophthalmic, and neurological compromise. An immunological examination for primary vasculitis was negative and other infections were discounted by microbiological and serological analyses. The patient was treated with steroids without clinical response. The Fasciola hepatica infection was confirmed by the presence of specific immunoglobulin G (IgG) serum antibodies detected by a quantitative enzyme-linked immunosorbent assay (ELISA) with an optical density (OD) of 0.483 OD units (normal value<0.170 OD units) and a high-titre complement fixation (1/80 dilution). The patient received treatment with triclabendazole and all symptoms and systemic manifestations resolved within weeks. Hence, this previously unreported vasculitis-associated infection, if identified opportunely, can be treated and cured.
Triclabendazole (TCBZ) has been the drug of choice to treat liver fluke infections in livestock for >20 years, due to its high activity against both adult and juvenile flukes. More recently, it has been used successfully to treat human cases of fascioliasis. Resistance to TCBZ first appeared in the field in Australia in the mid-1990s. Since then, resistance has been reported from a number of countries throughout Europe: Ireland, Scotland, Wales, Spain and The Netherlands. The heavy reliance on a single drug puts treatment strategies for fascioliasis at risk. Should resistance develop further, the prospect is an alarming one. This review will present an overview of progress in understanding the mechanism of resistance to TCBZ, examining possible changes in the target molecule, in drug influx/efflux mechanisms and in the metabolism of TCBZ by the fluke. The review will also consider ways to deal with resistance, covering drug-oriented options such as: the use of alternative drugs, drug combinations and the search for new compounds.
This investigation was carried out to determine the frequency of the fasciolosis in Erciş, a town in the Van province located in the Eastern Turkey. The study includes 500 asymptomatic subjects (322 males and 178 females) whose ages ranged from 5 to 75 years. In all subjects, stool samples were examined at initiation of the study and one week later to rule out pseudoparasitosis. The methods of flotation (in saturated saline solution) and sedimentation (in formalin-ether solution) were used in examination of the stool samples. Fasciola hepatica eggs were detected in nine (1.8%) out of 500 subjects. In conclusion, our data showed that the prevalence of human fasciolosis was high in our region because watercress consumption was common. We also think that human fasciolosis is more frequent than expected in Turkey. To determine the exact prevalence of the disease, extensive serological investigations should be performed in different regions of Turkey.
A 40 year-old woman living in Gialai, Kontum, Vietnam, developed a red solid mass in the epigastric region. From ultrasound investigation, liver abscess and myositis of the intercostal muscle was diagnosed. Two weeks after treatment with antibiotics, the mass disappeared, but a migratory track developed in the right upper quadrant of the abdomen. An aspiration of the vesicular end of the serpiginous track showed a light brown, living worm that was later identified as an immature Fasciola sp. This is the first case report of cutaneous fascioliasis in the form similar to creeping eruption.
Fascioliasis, caused by the liver fluke Fasciola hepatica, is an infection that occurs worldwide, although humans are accidental hosts. F. hepatica infection comprises two stages, hepatic and biliary, with different signs and symptoms. Stool examination and ELISA can be used for the initial diagnosis. Radiographic techniques, such as computerised tomography and ultrasonography, as well as magnetic resonance imaging, are used widely for confirmation and follow-up of the disease. Invasive techniques, such as percutaneous cholangiography, endoscopic retrograde cholangiography and liver biopsy, may aid in the diagnosis but are not essential. Triclabendazole is recommended as the first-line agent for the treatment of F. hepatica infection, with bithionol as an alternative.
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.
Fascioliasis is a zoonotic disease that is acquired by ingestion of the metacercaria form on uncooked aquatic plants, and humans act as an accidental host. Diagnosis is confirmed by the demonstration of the parasites or evidence of them in faeces and serology. In the absence of these data, delays or misdiagnosis may occur since it may mimic many diseases. In this study, we present three cases, among them two were similar to the above-mentioned statement. The first case, to the best of our knowledge, is the first case with adult-type living fluke in the gall bladder, diagnosed by laparoscopic cholecystectomy.
Objective:
Parasites residing in the biliary tree include Clonorchis sinensis, Opisthorchis viverrini, Opisthorchis felineus, and Fasciola hepatica. They are willowy, leaf-like, flat flukes dwelling in the bile ducts and gallbladder. Human ascarides, Ascaris lumbricoides, dwelling in the small intestine, inadvertently migrate into the bile ducts and cause biliary obstruction. The purpose of this article is to illustrate typical imaging findings of liver fluke infection and biliary ascariasis.
Conclusion:
Adult flukes of Clonorchis and Opisthorchis measure 8-15 mm and adult flukes of Fasciola measure 20-40 mm in length. The presence of flukes in the bile ducts causes dilatation of the bile ducts, varying degrees of chronic inflammation followed by adenomatous hyperplasia, and bile duct wall thickening. Imaging findings of clonorchiasis and opisthorchiasis include visualization of adult flukes in the bile ducts and gallbladder, diffuse dilatation of the peripheral small intrahepatic bile ducts with no or minimal dilatation of the large bile ducts, and thickening of the bile duct wall. In biliary fascioliasis and ascariasis, adult worms are visualized in the dilated bile ducts and gallbladder.