Fasciola hepatica
Background
- Parasite: Fasciola hepatica
- "Liver fluke" or "Sheep liver fluke"
- Eggs in stool of infected mammals (sheep/cattle) → snail → aquatic vegetation → human
- Infected by eating raw watercress or water plants contaminated by immature larvae
- Immature larvae migrate from intestine → abdominal cavity → liver → bile duct (mature adult)
Clinical Features
- Nausea, vomiting, abdominal pain/tenderness, hepatomegaly
- Fever, rash, SOB
- Marked peripheral eosinophilia
- Liver hematoma
- Chronic: Inflammation and obstruction of liver, gallbladder, pancreas
- Biliary colic, cholangitis, cholelithiasis, obstructive jaundice
- Ectopic fascioliasis: Erythematous itchy nodules
- Pharyngeal fascioliasis: pharyngitis with edema, congestion, suffocation
Differential Diagnosis
- Amebiasis, larva migrans, cysticercosis, ascariasis, hepatitis, parasitic infection
- Biliary atresia, cholecystitis, cholelithiasis, cholestasis
Workup
- CBC: Leukocytosis, anemia, eosinophilia
- Elevated ESR and LFT
- Stool ova and parasites, culture
- Microscopy
- Endoscopy or surgery, biopsy
- Serology (ELISA), PCR
- CT abdomen, US, ERCP, cholangiography, MRI
Management
- Triclabendazole (10mg/kg PO x 1-2 days)
- Alternative: Bithionol and nitazoxnide
- ID and GI consult
- Possible surgery consult
Sources
- http://www.cdc.gov/parasites/fasciola/gen_info/index.html
- Leder K, et al. Liver flukes: Fascioliasis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 24, 2014.
- Tolan RW, et al. (2013, Apr 12). Fascioliasis. eMedicine. Retrieved 12/24/2014 from http://emedicine.medscape.com/article/997890-overview