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Salahshour F, Tajmalzai A. Imaging findings of human hepatic fascioliasis: a case report and review of the literature. J Med Case Rep 2021; 15:324. [PMID: 34162437 PMCID: PMC8223301 DOI: 10.1186/s13256-021-02945-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Abstract
Background Fascioliasis is a food-borne hepatobiliary zoonosis caused by Fasciola hepatica and Fasciola gigantica. Human infestations are predominantly seen in developing countries where the disease is endemic, but, due to the increase in international travel rates, hepatic fascioliasis is also appearing in nonendemic areas including Europe and the USA. The clinical and laboratory findings are usually nonspecific. Cross-sectional imaging can be very helpful in the diagnosis of fascioliasis as well as to differentiate it from other liver diseases with a very similar clinical picture. The objectives of this case report are to discuss imaging findings of hepatic fascioliasis and to review the literature.
Case presentation We report the case of a 35-year-old Iranian patient who presented with right upper quadrant pain, low-grade fever, fatigue, and anorexia. The patient had a history of recent travel to the Gilan Province of Iran, almost a month before the onset of symptoms, which is an endemic area of fascioliasis in the country. Laboratory examinations revealed eosinophilia, elevated hepatic enzymes, and slightly raised C-reactive protein. Contrast-enhanced computed tomography of the patient shows clusters of focal ill-defined hypodense lesions with mild peripheral enhancement in the right liver lobe and subcapsular regions. Magnetic resonance imaging of the liver revealed multiple ill-defined lesions of low signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image, extending from the liver capsule into deeper parenchyma toward periportal regions, which shows mild peripheral enhancement on post-contrast images. Imaging-based diagnosis of fascioliasis was made depending on the characteristic distribution of subcapsular tracts/lesions on the above-mentioned imaging, which was then confirmed by serologic tests using enzyme-linked immunosorbent assay. The patient was treated with triclabendazole, showing great clinical improvement, and was eventually discharged in good health condition. Conclusion The imaging findings in this case report highlight the importance of cross-sectional imaging for further evaluation of suspected cases of fluke-induced liver disease. The hypothesis of hepatic fascioliasis should be always considered when consistent radiological findings are observed. Clusters of tortuous subcapsular lesions with peripheral contrast enhancement extending into deeper liver parenchyma are characteristic imaging findings that strongly suggest hepatic fascioliasis.
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Affiliation(s)
- Faeze Salahshour
- Department of Radiology, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abasin Tajmalzai
- Department of Radiology, Tehran University of Medical Sciences (TUMS), Tehran, Iran. .,Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan.
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2
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Surgically resected hepatic mass caused by fascioliasis. Clin J Gastroenterol 2021; 14:662-667. [PMID: 33471251 DOI: 10.1007/s12328-021-01339-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
Fascioliasis is a parasitic infestation caused by the digenetic trematodes Fasciola hepatica and F. gigantica. It is not commonly seen in developed countries, so diagnosis there is always difficult as a result of confusion with other hepatic or biliary disorders. A 56-year-old man presented at our hospital with a hepatic mass that had been inadvertently discovered by ultrasonography. Abdominal computed tomography revealed a multi-cystic lesion distributed along the branch of the right bile duct. Endoscopic retrograde cholangiopancreatography showed serrated changes ranging from the upper level of the common bile duct to the right hepatic bile duct. Eosinophilia was not observed and tumor marker levels were within normal ranges. Following right lobectomy combined with bile duct reconstruction, a histological examination revealed cholangitis with inflammatory cell infiltration accompanied by parasite egg-like structures and Charcot-Leyden crystals. An additional serologic test was positive for F. hepatica antibodies. A diagnosis of fascioliasis was thus confirmed by histopathology and serology. Fascioliasis should be suspected if imaging findings such as multiple small hypodense lesions in the liver are observed, and serologic tests can be useful for differential diagnosis.
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3
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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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4
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Botelho MC, Almeida F, Richter J, Sarmento A. Commentary: Human Liver Flukes. Front Public Health 2018; 6:122. [PMID: 29761097 PMCID: PMC5936791 DOI: 10.3389/fpubh.2018.00122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/12/2018] [Indexed: 01/24/2023] Open
Affiliation(s)
- Monica Catarina Botelho
- Instituto Nacional de Saude Dr. Ricardo Jorge, Porto, Portugal.,i3S, Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | | | - Joachim Richter
- Institut für Tropenmedizin und Internationale Gesundheit Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Antonio Sarmento
- i3S, Instituto de Investigação e Inovação em Saúde, Porto, Portugal.,Centro Hospitalar São João, Porto, Portugal
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5
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Fullerton JK, Vitale M, Vitale GC. Therapeutic Endoscopic Retrograde Cholangiopancreatography for the Treatment of Fasciola hepatica Presenting as Biliary Obstruction. Surg Innov 2016; 13:179-82. [PMID: 17056782 DOI: 10.1177/1553350606292745] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human infection with the Fasciola hepatica liver fluke is a rare cause of biliary obstruction, especially within the United States. Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants. Symptoms during the acute phase include fever, right upper quadrant pain, eosinophilia, and hepatomegaly. During the chronic stage of infection, the parasite may remain asymptomatic for many years. This article presents a case of biliary obstruction due to Fasciola hepatica that was diagnosed and treated successfully with endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
- James K Fullerton
- Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA
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6
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Ha JS, Choi HJ, Moon JH, Lee YN, Tae JW, Choi MH, Lee TH, Cha SW. Endoscopic Extraction of Biliary Fascioliasis Diagnosed Using Intraductal Ultrasonography in a Patient with Acute Cholangitis. Clin Endosc 2015; 48:579-82. [PMID: 26668810 PMCID: PMC4676668 DOI: 10.5946/ce.2015.48.6.579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/14/2015] [Accepted: 03/15/2015] [Indexed: 11/22/2022] Open
Abstract
Fasciola hepatica infection may result in biliary obstruction with or without cholangitis in the chronic biliary phase. Because clinical symptoms and signs of F. hepatica are similar to other biliary diseases that cause bile duct obstruction, such as stones or bile duct malignancies, that are, in fact, more common, this condition may not be suspected and diagnosis may be overlooked and delayed. Patients undergoing endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the evaluation of bile duct obstruction may be incidentally detected with the worm, and diagnosis can be confirmed by extraction of the leaf-like trematode from the bile duct. Intraductal ultrasonography (IDUS) can provide high-resolution cross-sectional images of the bile duct, and is useful in evaluating indeterminate biliary diseases. We present a case of biliary fascioliasis that was diagnosed using IDUS and managed endoscopically in a patient with acute cholangitis.
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Affiliation(s)
- Ji Su Ha
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Hyun Jong Choi
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Yun Nah Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Jae Woong Tae
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Moon Han Choi
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Tae Hoon Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Sang-Woo Cha
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
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Biliary Fasciola gigantica infestation in a nonendemic area--An intraoperative surprise. J Pediatr Surg 2015; 50:1983-6. [PMID: 26362003 DOI: 10.1016/j.jpedsurg.2015.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/06/2015] [Accepted: 08/09/2015] [Indexed: 11/22/2022]
Abstract
A 7year old girl infected with the zoonotic trematode, Fasciola gigantica is reported because of the extreme rarity of this condition in our region. Because of the overlap in symptomatology and radiological features, the more common amebic/pyogenic liver abscess in the initial hepatic migratory phase and later choledochal cyst/biliary ascariasis when the parasite was finally located in the extrahepatic bile ducts, were thought of delaying effective treatment. The diagnosis was confirmed only by surgical exploration. The characteristic contrast enhanced computed tomography scan features retrospectively identified were multiple clustered hypodense lesions in the liver with peripheral enhancement in the acute hepatic migratory phase, and periportal tracking in the previously affected areas of the liver with biliary dilatation and a linear hypointense lesion within the common bile duct in the chronic phase. Although a known association, she did not have eosinophilia. This child, who became symptomatic at the age of 5.5years, also appears to be one of the youngest patients reported with Fasciola gigantica.
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8
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Kang BK, Jung BK, Lee YS, Hwang IK, Lim H, Cho J, Hwang JH, Chai JY. A case of Fasciola hepatica infection mimicking cholangiocarcinoma and ITS-1 sequencing of the worm. THE KOREAN JOURNAL OF PARASITOLOGY 2014; 52:193-6. [PMID: 24850964 PMCID: PMC4028458 DOI: 10.3347/kjp.2014.52.2.193] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 11/30/2022]
Abstract
Fascioliasis is a zoonotic infection caused by Fasciola hepatica or Fasciola gigantica. We report an 87-year-old Korean male patient with postprandial abdominal pain and discomfort due to F. hepatica infection who was diagnosed and managed by endoscopic retrograde cholangiopancreatography (ERCP) with extraction of 2 worms. At his first visit to the hospital, a gallbladder stone was suspected. CT and magnetic retrograde cholangiopancreatography (MRCP) showed an intraductal mass in the common bile duct (CBD) without proximal duct dilatation. Based on radiological findings, the presumed diagnosis was intraductal cholangiocarcinoma. However, in ERCP which was performed for biliary decompression and tissue diagnosis, movable materials were detected in the CBD. Using a basket, 2 living leaf-like parasites were removed. The worms were morphologically compatible with F. hepatica. To rule out the possibility of the worms to be another morphologically close species, in particular F. gigantica, 1 specimen was processed for genetic analysis of its ITS-1 region. The results showed that the present worms were genetically identical (100%) with F. hepatica but different from F. gigantica.
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Affiliation(s)
- Bong Kyun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Bong-Kwang Jung
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Yoon Suk Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - In Kyeom Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Hyemi Lim
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Jaeeun Cho
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Jin-Hyeok Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Jong-Yil Chai
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
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9
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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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10
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Hepatobiliary fascioliasis in non-endemic zones: a surprise diagnosis. Arab J Gastroenterol 2013; 14:29-30. [PMID: 23622808 DOI: 10.1016/j.ajg.2012.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
Abstract
Fascioliasis is a zoonotic infection caused by Fasciola hepatica. Because of population migration and international food trade, human fascioliasis is being an increasingly recognised entity in nonendemic zones. In most parts of Asia, hepatobiliary fascioliasis is sporadic. Human hepatobiliary infection by this trematode has two distinct phases: an acute hepatic phase and a chronic biliary phase. Hepatobiliary infection is mostly associated with intense peripheral eosinophilia. In addition to classically defined hepatic phase and biliary phase fascioliasis, some cases may have an overlap of these two phases. Chronic liver abscess formation is a rare presentation. We describe a surprise case of hepatobiliary fascioliasis who presented to us with liver abscess without intense peripheral eosinophilia, a rare presentation of human fascioliasis especially in non-endemic zones.
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11
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Abstract
Liver disease is an important source of morbidity among ill returning travelers. Jaundice is one of the most common and obvious symptoms of liver disease, the differential diagnosis of which is extensive, especially in travelers. Jaundice in travelers can arise from both infectious and noninfectious causes. We herein summarize the most common parasitic etiologies that may lead to jaundice in the returned traveler, visitors of friends and relatives, or new immigrants, and describe the etiology, epidemiology, and pathogenesis of clinical features of each.
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Affiliation(s)
- Wilson W Chan
- Calgary Laboratory Services, Calgary, Alberta, Canada
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12
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Goral V, Senturk S, Mete O, Cicek M, Ebik B, Kaya B. A case of biliary Fascioliasis by Fasciola gigantica in Turkey. THE KOREAN JOURNAL OF PARASITOLOGY 2011; 49:65-8. [PMID: 21461271 PMCID: PMC3063928 DOI: 10.3347/kjp.2011.49.1.65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 01/29/2011] [Accepted: 01/29/2011] [Indexed: 11/29/2022]
Abstract
A case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37- year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.
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Affiliation(s)
- Vedat Goral
- Department of Gastroenterology, Dicle University School of Medicine, Diyarbakir, Turkey.
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13
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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: 8] [Impact Index Per Article: 0.6] [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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15
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Moghadami M, Mardani M. Fasciola hepatica: a cause of obstructive jaundice in an elderly man from Iran. Saudi J Gastroenterol 2008; 14:208-10. [PMID: 19568541 PMCID: PMC2702927 DOI: 10.4103/1319-3767.43279] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 02/02/2008] [Indexed: 12/07/2022] Open
Abstract
Fascioliasis is a zoonotic infection caused by Fasciola hepatica. Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants in endemic area. The north of Iran is one of the regions. This disease is rarely seen with jaundice caused by obstruction of the biliary tree. We report a case of human fascioliasis with obstructive jaundice who was diagnosed using endoscopic retrograde cholangiopancreatography (ERCP). This report confirms the diagnostic role of ERCP in patients with obstructive jaundice caused by biliary fascioliasis.
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Affiliation(s)
- Mohsen Moghadami
- Department of Internal Medicine, Shiraz Medical School, Shiraz, Iran.
| | - M. Mardani
- Infectious Disease Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
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Gil Gil F, Cervero Jiménez M, Torres Perea R, Jusdado Ruiz-Capillas JJ. Fasciolasis hepatobiliar sin eosinofilia. Rev Clin Esp 2006; 206:464. [PMID: 17042995 DOI: 10.1157/13093479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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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: 24] [Impact Index Per Article: 1.2] [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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Reddy DN, Sriram PVJ, Rao GV. Endoscopic diagnosis and management of tropical parasitic infestations. Gastrointest Endosc Clin N Am 2003; 13:765-73, x-xi. [PMID: 14986797 DOI: 10.1016/s1052-5157(03)00072-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Biliary parasitosis is one of the common causes of biliary obstruction in developing countries and can often be confused with stone disease. With increased worldwide travel and immigration, these conditions are not limited to the developing countries alone. Ascariasis, hydatid liver disease, clonorchiasis, and fascioliasis are the commonly encountered parasitic infestations of the biliary tract usually presenting with biliary colic or cholangitis. Endoscopy has an important role in the diagnosis and emergent management of these conditions and in elective endoscopic therapy of associated complications. Endoscopic sphincterotomy and bile ductal clearance, along with pharmacotherapy, are the mainstays of treatment.
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Ropero NM, Cebrián AC, Moreno RG. Fascioliasis hepática en un hombre de 65 años. Semergen 2003. [DOI: 10.1016/s1138-3593(03)74237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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