Clinical presentation and management of Fasciola hepatica infection: single-center experience

Abstract

Aim: To identify the characteristic clinical, laboratory and radiological findings and response to treatment in patients with fascioliasis.

Methods: Patients who were diagnosed with Fasciola hepatica infection were included in this prospective study. Initial clinical, laboratory and radiological findings were recorded. All patients were followed until a complete response was achieved or for 6 mo after treatment discontinuation.

Results: Fasciola hepatica infection was diagnosed in 30 patients (24 females; mean age: 42.6 years) between January 2008 and February 2011. Twenty-two (73%) patients had hepatic phase fascioliasis, 5 patients had biliary phase, and 3 patients had biliary phase associated with acute pancreatitis. Of the 8 patients with biliary phase fascioliasis, 2 patients displayed features that overlapped with both hepatic and biliary phase. Abdominal pain and right upper abdominal tenderness were the most prominent signs and symptoms in all patients. Eosinophilia was the most prominent laboratory abnormality in both patients with hepatic and biliary phase (100% and 50%, respectively). Multiple nodular lesions like micro-abscesses on abdominal computerized tomography were the main radiological findings in patients with hepatic phase. Small linear filling defects in the distal choledochus were the main endoscopic retrograde cholangiopancreatography (ERCP) findings in patients with biliary phase. Patients with hepatic phase were treated with triclabendazole alone, and patients with biliary phase were treated with triclabendazole and had live Fasciola hepatica extracted from the bile ducts during ERCP.

Conclusion: Fasciola hepatica infection should be considered in the differential diagnosis of patients with hepatic or biliary disease and/or acute pancreatitis associated with eosinophilia.

Keywords: Cholangitis; Fasciola hepatica; Liver abscesses; Pancreatitis; Triclabendazole.

Figure 1

A 19-year-old female patient presented with right upper abdominal pain and fever lasting 3 wk. Abdominal computerized tomographic examination showed enlargement of the liver and extensive micro-abscesses (arrows).

Figure 2

A 19-year-old female patient presented with right upper abdominal pain and fever lasting 3 wk. Abdominal computerized tomographic examination showed enlargement of the liver and extensive micro-abscesses (arrows).

Figure 3

A 70-year-old female patient presented with right upper abdominal pain lasting 16 wk. Abdominal computerized tomographic examination showed low density masses with hazy margins located to medial segment of the left lobe (arrow).

Figure 4

In the patient whose pre-treatment computerized tomographic image is shown in Figure 1, abdominal computerized tomographic examination showed residual lesions (arrow) and minimally enlarged spleen 6 mo after treatment with triclabendazole.

Figure 5

Live and mobil Fasciola hepatica removed from the choledochus by balloon catheter during endoscopic retrograde cholangiopancreatography. A: A 35-year-old female patient presented with acute pancreatitis associated with elevated liver enzymes. Endoscopic retrograde cholangiopancreatography image showed a radiolucent, roughly crescent-shaped shadow in the common bile duct (arrows); B: A 49-year-old female patient presented with acute cholangitis associated with eosinophilia. Arrow: Head of Fasciola hepatica; Arrowhead: Body of Fasciola hepatica.