|
Clinical Features:
During the acute phase (caused by the migration of the immature fluke through the hepatic parenchyma), manifestations include abdominal pain, hepatomegaly, fever, vomiting, diarrhea, urticaria and eosinophilia, and can last for months.
In the chronic phase (caused by the adult fluke within the bile ducts), the symptoms are more discrete and reflect intermittent biliary obstruction and inflammation.
Occasionally, ectopic locations of infection (such as intestinal wall, lungs, subcutaneous tissue, and pharyngeal mucosa) can occur.
Laboratory
Diagnosis:
Microscopic identification of
eggs is useful in the chronic (adult) stage. Eggs can be recovered in the stools or in
material obtained by duodenal or biliary drainage. They are morphologically
indistinguishable from those of Fasciolopsis buski. False fascioliasis
(pseudofascioliasis) refers to the presence of eggs in the stool resulting not from an
actual infection but from recent ingestion of infected livers containing eggs.
This situation (with its potential for misdiagnosis) can be avoided by having the patient
follow a liver-free diet several days before a repeat stool examination. Antibody
detection tests are useful especially in the early invasive stages, when the eggs
are not yet apparent in the stools, or in ectopic fascioliasis.
Diagnostic findings
Treatment:
Unlike infections with other flukes,
Fasciola hepatica infections may not respond to praziquantel. The drug of choice is triclabendazole with bithionol as an alternative.
See recommendations in The Medical Letter for complete information.
|
|
