Fasciola hepatica infection at a University Clinic in Turkey (original) (raw)
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The Journal of Infection in Developing Countries, 2016
Introduction: In this study, clinical, laboratory, radiological, and serological examinations of fascioliasis patients were analyzed, and data with a significant impact on differential diagnosis were evaluated. Methodology: Clinical, radiological, and laboratory findings and treatment responses of a total of 22 fascioliasis patients, treated between October 2009 and September 2014, were evaluated. Nineteen patients were diagnosed with fascioliasis at the invasive phase and three patients at the chronic phase. Patients were followed up for clinical, laboratory, and radiology findings for a period of three months to one year after treatment. Results: The most frequent complaints in both groups were abdominal pain, and the most common physical examination finding was epigastric tenderness. In the performed examination, an eosinophil elevation in whole blood count was detected in 19 patients (100%) in the hepatic phase, and in 2 patients (66.6%) in the biliary phase. The results of the Fasciola hepatica indirect hemagglutination assay (IHA) test ordered in the diagnosis were positive in all patients. Treatment with 10 mg/kg/day triclabendazole for two consecutive days was effective. Live parasites were extracted from patients in the biliary phase with endoscopic retrograde cholangiopancreatography. In the follow-ups, remission in IHA titer and clinical and radiological improvement was achieved in all patients. Conclusions: If hypereosinophilia is detected by peripheral smear in patients who are admitted with complaints such as abdominal pain, weakness, nausea, myalgia, and weight loss, radiological evaluation and serological tests should be performed and fascioliasis should be considered in the differential diagnosis.
Evaluation of cases with Fasciola hepatica infection: experience in 6 children
Asian Pacific Journal of Tropical Disease, 2013
Objective: To evaluate 6 pediatric cases diagnosed as fascioliasis. Methods: Patients diagnosed as fascioliasis are retrospectively interpreted. Results: Herein 6 pediatric cases having a mean age of (12.7±3.1) years with different complaints including fever, weakness, paleness, sweating, cough, headache, rectal bleeding, abdominal pain, and abdominal distension admitting to our hospital are evaluated. Conclusions: Diagnosis of fascioliasis needs a high index of suspicion supported by stool microscopy, serology, imaging procedures, and in difficult cases even liver biopsy. Triclabendazole resistance should be kept in mind in unresponsive cases.
Hepatic fascioliasis due to Fasciola hepatica: a two-case report
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006
Two cases of hepatic fascioliasis due to Fasciola hepatica were retrieved from our surgical-pathology file since the hospital's foundation in 1969 up to 2005. The diagnosis of hepatic fascioliasis was based on detection of one live fluke in a large cystic lesion in the lobectomized liver specimen in one case and of deposited eggs in the large liver specimen obtained from open biopsy in the other Hepatic fascioliasis is rather rare and almost worldwide in distribution including Thailand. The diagnosis should be considered in the patient from endemic areas consisting of the northern, northeastern and upper-central regions of the country, with a history of ingesting fresh water plants or drinking untreated water and having fever right-upper-quadrant pain or intrahepatic cystic lesion(s) together with absolute peripheral blood eosinophilia.
The Variable Presentations and Broadening Geographic Distribution of Hepatic Fascioliasis
Clinical Gastroenterology and Hepatology, 2012
We report 2 unrelated cases of hepatic fascioliasis in travelers returning to the United States from Africa and the Middle East. The first case presented with acute infection. Prominent clinical features included abdominal pain, elevated liver transaminases, serpiginous hepatic lesions, pericapsular hematoma, and marked peripheral eosinophilia. The second case was diagnosed in the chronic stage of infection and presented with right upper quadrant abdominal pain, cystic hepatic lesions, and an adult fluke in the common bile duct. We review the life cycle of Fasciola species, the corresponding clinical features during the stages of human infection, diagnostic methods, and the evolving understanding of the epidemiology of human fascioliasis, particularly emphasizing fascioliasis in African countries.
Istanbul Medical Journal, 2014
Fasciola hepatica (FH) is a liver fluke that may mimic many other diseases, potentially leading to misdiagnosis. A 25-year-old patient who was admitted to our clinic with hepatic lesions and diagnosed with fascioliasis is presented in this report. Difficulties in the diagnosis of FH infestation and the role of radiological evaluation are emphasized. We suggest that FH infestation should be taken into consideration in patients being evaluated for hepatic mass and elevated liver enzymes, especially if accompanied by eosinophilia, or if the patient is known to have visited an endemic region.
Infection with Fasciola hepatica
Clinical Microbiology and Infection, 2005
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.
Seroprevalence of human fascioliasis in Van province, Turkey
The Turkish Journal of Gastroenterology, 2015
Background/Aims: Fasciola hepatica is a rare zoonotic parasite that infects the liver of many mammals including humans. The aim of this study was to determine the seroprevalence of fascioliasis in Van province by ELISA (antibody detection) on the assumption that not all cases could be detected by stool examination alone. Materials and Methods: A total of randomly selected 1,600 patients, directed from affiliated outpatient clinics to Yüzüncü Yıl University Medical Faculty Parasitology Laboratory, were enrolled in the study. Their mean age was 44.44±19.00 years. Blood samples were collected from all the patients, and their stool samples were examined. For the stool examination, native-lugol and sedimentation (in formalin-ethyl acetate) methods were employed. ELISA for F. hepatica was performed on the blood samples from all patients. Seropositive patients were treated with triclabendazole. Results: F. hepatica was detected by ELISA in 89 (5.6%) of the 1,600 patients, but eggs were identified on the stool examination in only 29 (1.8%) patients. The prevalence of F. hepatica was higher in females (7.2%) than in males (4.2%) and was higher in the ≥36-year age group (6.7%) than in the ≤35-year age group (4.4%). Abdominal pain (93.3%), fatigue (88.8%), and weight loss (69.7%) were the most common symptoms. Eosinophilia was present in 89.9% of the patients. All seropositive patients had a history of eating raw aquatic plants. Conclusion: Stool examination alone is not sufficient to diagnose F. hepatica. Serological tests such as ELISA must be used together with stool examination.
Fascioliasis in Eosinophilic Patients in the Isparta Region of Turkey
Infection, 2003
The aim of this study was to investigate fascioliasis in a group of eosinophilic and non-eosinophilic patients in the Isparta region of Turkey. Patients and Methods: All cases were examined for antibodies against Fasciola hepatica by the modified ES-ELISA method. Seropositive patients with fascioliasis were investigated by radiological and laboratory evaluations. Results: Of the 756 eosinophilic patients, 6.1% were found to be positive for fascioliasis by ES-ELISA, while the rate was only 0.9% among the non-eosinophilic group (statistically significant, p < 0.001). Among the seropositives, 19 cases were evaluated further. Ultrasonographic findings were found in 14 of the 19 cases. In six of nine cases, computed tomography findings were related to fascioliasis. F. hepatica eggs were found in nine of the 19 cases. Conclusion: Fascioliasis was demonstrated in the Isparta region of Turkey for the first time. The higher prevalence of fascioliasis among patients with eosinophilia indicates the importance of this sign for this infection.
Fascioliasis is highly endemic in the Andean region of South America. Newer serological assays have improved our ability to diagnose acute fascioliasis. The diagnosis was established by Fasciola hepatica serology (Fas2-ELISA or Western blot) in 10 patients. Identifiable exposure included ingestion of watercress (N ס 8), alfalfa juice (N ס 5), and lettuce (N ס 1). Computed tomography of the abdomen showed hepatomegaly (N ס 9), track-like hypodense lesions with subcapsular location (N ס 8), and subcapsular hematoma (N ס 2). Radiologic sequelae included cyst calcifications detectable at least 3 years after treatment. Stool examinations were negative for F. hepatica eggs; serology was positive (Arc II [N ס 2], Fas2-ELISA [N ס 6], Western blot [N ס 2]). The syndrome of eosinophilia, fever, and right upper quadrant pain, elevated transaminases without jaundice, hypodense liver lesions on CT, and an appropriate exposure history suggests acute fascioliasis. Fascioliasis is specifically treatable with a single dose of triclabendazole.
Fascioliasis: 3 cases with three different clinical presentations
The Turkish Journal of Gastroenterology, 2012
(karaci¤er fleriti) adl› trematodun etken oldu¤u zoonotik bir infestasyon olan fasiyoliazis, primer olarak koyun ve s›¤›r gibi otçul hayvanlar›n hastal›¤›d›r. ‹nsanlar, su teresi gibi su bitkilerinin çi¤ yenmesiyle konak olurlar. Akut fazda atefl, eozinofili ve silik gastrointestinal semptomlardan kronik fazda kolanjit, kolesistit, safrayolu t›kan›kl›¤›, karaci¤erd›fl› infestasyon veya asemptomatik eozinofili gibi genifl bir yelpazede klinik tablolara neden olabilir. Bununla beraber, özellikle akut fazda silik semptomlar nedeniyle ço¤unlukla atlanabilmektedir. Tan›y› kolaylaflt›ran yeni serolojik testlerin kullan›lmas›yla, bildirilen olgu say›-s›nda art›fl olmufltur. Burada, semptomlar›n bafllang›c›ndan sonra s›ras›yla bir hafta, üç ay ve bir buçuk y›l sonra tan› koydu¤umuz üç olgunun klinik, laboratuvar de¤erlendirmesi ve tedavi yaklafl›m›n› bildirmekteyiz. Anahtar kelimeler: Fasciola hepatica, hepatit, triklabendazol Fascioliasis, which is a zoonotic infestation caused by the trematode Fasciola hepatica (liver fluke), is primarily a disease of herbivorous animals such as sheep and cattle. Humans become accidental hosts through ingesting uncooked aquatic plants such as watercress. It presents a wide spectrum of clinical pictures ranging from fever, eosinophilia and vague gastrointestinal symptoms in the acute phase to cholangitis, cholecystitis, biliary obstruction, extrahepatic infestation, or asymptomatic eosinophilia in the chronic phase. However, it may often be overlooked, especially in the acute phase, because of vague symptoms. As a result of newly introduced serological assays facilitating the diagnosis, there has been an increase in the number of reported cases. Here, we report the clinical and laboratory assessment and therapeutic approach of a series of three cases diagnosed (in order of) one week, three months and one and a half years after presentation of the first symptoms of the disease.