Albumin metabolism in chronic fasciola hepatica infections of cattle

Hemobilia and liver flukes in a patient from Thailand

A patient from Southeast Asia presented with abdominal pain, fever, jaundice, and upper gastrointestinal bleeding of unknown origin. Opisthorchis viverrini eggs were found in the stool and multiple hepatic filling defects were noted on liver scan and sonogram. Endoscopic retrograde cholangiopancreatography revealed cholelithiasis and crescent-like filling defects in the biliary system. At surgery, the gallbladder was filled with clotted blood and pigmented stones. During T-tube drainage of the common bile duct, small elliptical flukes (4 X 3 mm) identified as O. viverrini were recovered. Despite adequate biliary drainage, the patient continued to have high fevers. On the 53rd postoperative day, a larger fluke (2.8 X 0.8 cm) identified as a Fasciola hepatica migrated down the T-tube. Institution of therapy with bithional resulted in complete clinical resolution within 3 wk. Six years later the patient returned with fever, jaundice, and right upper quadrant pain. Two large pigmented stones were found in the common bile duct and were removed after endoscopic sphincterotomy. The stones had developed even though there was no evidence of recurrent helminthic infection.

On the ultrastructure of epithelial cells in bile ducts of cattle chronically infected with fasciola hepatica

This paper describes briefly the normal ultrastructure of bile-duct epithelial cells in cattle and the main ultrastructural alterations produced in them by chronic infection with Fasciola hepatica. The studies showed only inconsiderable abnormalities in the ultrastructure of the epithelium in infections of a low degree as also during the recovery phase of the disease. On the other hand, in heavily infected livers pronounced ultrastructural alterations were seen in the surface epithelium of the main intrahepatic bile ducts invaded by the flukes. In such areas the intercellular spaces were filled with dense homogeneous material, and intact desmosomes and junctional complexes were not regularly seen, which indicates that foreign material may leak into the bile. The extracellular material was probably composed of albumin, and the significance of the present results regarding the etiology of hypoalbuminaemia during chronic fascioliasis is discussed.