Humans become incidentally exposed to this infection, increasingly so during the last two decades [1] [2], but some remain asymptomatic [3]. The overt disease appears after an incubation period that may be as long as several months. Symptoms become obvious during the acute phase, which lasts for 2 to 4 months and is followed by a chronic one. The acute stage is characterized by internal bleeding due to he fact that the liver is invaded by the trematodes. Symptoms include fever, dyspepsia, ascites, intense abdominal pain, mainly localized in the upper right quadrant, diarrhea, appetite loss, flatulence, skin rash of urticarial type, dyspnea, cough, chest pain and nausea. The chronic stage is less disturbing, when the patient experiences obstructive jaundice, biliary colic, fat food intolerance, change in bowel habits, pruritus and intermittent abdominal pain. This is when Fasciola reaches the bile duct and is eliminated through the intestines. At this stage, complications such as hepatic fibrosis, pancreatitis or gallstones elimination may set in. Two additional phases can be considered: a latent one, consisting of occasional symptomatic relapses, similar to those encountered in the acute phase; and ectopic disease, that occurs when the larvae migrate to the skin [4], spleen, lungs, heart, brain, genitourinary tract, pancreas, eye, muscles or subcutaneous tissue [5]. Additional signs sometimes include pruritic or painful subcutaneous nodules. Clinical examination reveals these abnormalities and others, such as hepatomegaly, pallor and weight loss. Laryngeal edema and pharyngitis are also possible in individuals that have the habit of consuming raw or insufficiently thermally processed animal liver.

• Fever

  A young boy from rural background in Bihar presented with diarrhea, vomiting, hepatic tenderness, jaundice and fever along with peripheral eosinophilia. Examination of stool revealed yellow-brown eggs of Fasciola hepatica. [ncbi.nlm.nih.gov]

  Cough * Diarrhea * Diarrhea * Eggs in stool * Enlarged liver * Enlarged spleen * Eosinophilia * Epigastric pain * Facial swelling * Fever * Fever * Indigestion * Itching * Jaundice * Nausea * Vomiting Prevention - Fascioliasis Not supplied. [checkorphan.org]

• Weight Loss

  We report a case of an otherwise healthy 47 year-old male presenting with abdominal pain, night-time sweating, anorexia, weight loss and loose stools that had several hepatic nodules visible in the abdominal CT scan. [ncbi.nlm.nih.gov]

  Clinical examination reveals these abnormalities and others, such as hepatomegaly, pallor and weight loss. [symptoma.com]

• Cape Verde

  Verde, Ethiopia, Ireland and Dominican Republic. [7] Few cases of fascioliasis were found in refugees from Southeast Asia living in the USA. [8] Due to endemic prevalence of lymnaeid snails in the USA, the domestically acquired cases of fascioliasis [emedicine.com]

• Chills

  A 56 year-old Korean housewife/farmer/goat keeper suffered from right upper quadrant pain and fever with chills. [ncbi.nlm.nih.gov]

  At this stage the patient presents with right upper quadrant pain and obstructive jaundice, fever, and chills, with tender hepatomegaly, eosinophilia, and abnormal liver function tests. [saudijgastro.com]

  Beside stomachache, she also developed severe diarrhea ( 20 times/per day), occasional bloating, fever (39–40 C), chills, occasional dizziness, weakness, fatigue, increased blood eosinophil and granulocyte counts, jaundice, body hives, and ostealgia, [parasitol.kr]

• Veterinarian

  I’m sitting in my usual study spot, at my favorite cafe, composing my final post for Merck Manuals Vet Student Stories as a student veterinarian. I’m in shock that these... More Featured [merckvetmanual.com]

  Kenya Veterinarian 27. Hillver, G.V. (2005). “ Fasciola antigens as vaccines against Fascioliasis and Schistosomiasis.” Journal of Helminthology 79. Khandewal et al. (2008). “Biliary Parasites: Diagnostic and Therapeutic Strategies.” [globalhealthprimer.emory.edu]

• Abdominal Pain

  Prominent clinical features included abdominal pain, elevated liver transaminases, serpiginous hepatic lesions, pericapsular hematoma, and marked peripheral eosinophilia. [ncbi.nlm.nih.gov]

  The chronic stage is less disturbing, when the patient experiences obstructive jaundice, biliary colic, fat food intolerance, change in bowel habits, pruritus and intermittent abdominal pain. [symptoma.com]

• Nausea

  A 28-year-old Hispanic woman who frequently visited northern Central Mexico presented at 36 weeks of gestation with nausea, vomiting, and right upper quadrant pain. She was diagnosed with cholelithiasis. [ncbi.nlm.nih.gov]

  CASE: A 28-year-old Hispanic woman who frequently visited northern Central Mexico presented at 36 weeks of gestation with nausea, vomiting, and right upper quadrant pain. She was diagnosed with cholelithiasis. [jhu.pure.elsevier.com]

• Diarrhea

  A young boy from rural background in Bihar presented with diarrhea, vomiting, hepatic tenderness, jaundice and fever along with peripheral eosinophilia. Examination of stool revealed yellow-brown eggs of Fasciola hepatica. [ncbi.nlm.nih.gov]

  Cough * Diarrhea * Diarrhea * Eggs in stool * Enlarged liver * Enlarged spleen * Eosinophilia * Epigastric pain * Facial swelling * Fever * Fever * Indigestion * Itching * Jaundice * Nausea * Vomiting Prevention - Fascioliasis Not supplied. [checkorphan.org]

  Symptoms include fever, dyspepsia, ascites, intense abdominal pain, mainly localized in the upper right quadrant, diarrhea, appetite loss, flatulence, skin rash of urticarial type, dyspnea, cough, chest pain and nausea. [symptoma.com]

  Symptoms of the acute phase of Fascioliasis include hepatomegaly, diarrhea, eosinophilia, abdominal pain, fever, urticaria, and vomiting. [medic8.com]

  Symptoms of the acute phase of the disease include fever, abdominal pain, nausea, diarrhea, and eosinophilia. The disease later progresses to a latent phase during which symptoms are not as severe, with a chronic or obstructive phase following. [mdmag.com]

• Epigastric Pain

  The symptoms of infection, such as pyrexia of unknown origin, epigastric pain, and abdominal distension, were suggestive. [ncbi.nlm.nih.gov]

  Diarrhea * Eggs in stool * Enlarged liver * Enlarged spleen * Eosinophilia * Epigastric pain * Facial swelling * Fever * Fever * Indigestion * Itching * Jaundice * Nausea * Vomiting Prevention - Fascioliasis Not supplied. [checkorphan.org]

  Chronically infected people in this phase may also be asymptomatic or may present with biliary colic, epigastric pain, nausea, jaundice, or pruritus. The long-term prognosis depends on the extent of the liver and biliary damage. [wwwnc.cdc.gov]

  In this stage, patient experiences epigastric pain, biliary colic, intolerance to fatty food, jaundice, nausea, pruritus, tenderness in the right upper-quadrant. There may be liver enlargement along with spleen enlargement or ascites. [epainassist.com]

• Left Upper Quadrant Pain

  A 46-year-old Korean woman was admitted with left upper quadrant pain. She had taken praziquantel for hepatic fascioliasis, which had been diagnosed at another hospital, and then developed abdominal pain. [ncbi.nlm.nih.gov]

• Thrombosis

  One patient suffered portal vein thrombosis, which might be a rare complication of acute fascioliasis. All patients were successfully treated with triclabendazole. [ncbi.nlm.nih.gov]

• Jaundice

  Patient may be asymptomatic or presents with jaundice and biliary colic or right hypochondriac pain due to bile duct obstruction with gastrointestinal symptoms. [ncbi.nlm.nih.gov]

• Hepatomegaly

  Because F. hepatica has a special tropism for the liver, abdominal pain, hepatomegaly, and constitutional symptoms are among the most common manifestations of acute-stage fascioliasis. [ncbi.nlm.nih.gov]

  C Abdominal pain Gastrointestinal disturbances: loss of appetite, flatulence, nausea, diarrhoea Urticaria Respiratory symptoms (very rare): cough, dyspnoea, chest pain, hemoptysis Hepatomegaly and splenomegaly Ascites Anaemia Jaundice. [omicsonline.org]

• Biliary Colic

  We describe fascioliasis as a cause of recurrent biliary colics in a young male necessitating multiple hospitalizations over a period of four years. [ncbi.nlm.nih.gov]

  The chronic stage is less disturbing, when the patient experiences obstructive jaundice, biliary colic, fat food intolerance, change in bowel habits, pruritus and intermittent abdominal pain. [symptoma.com]

  Chronically infected people in this phase may also be asymptomatic or may present with biliary colic, epigastric pain, nausea, jaundice, or pruritus. The long-term prognosis depends on the extent of the liver and biliary damage. [wwwnc.cdc.gov]

• Corneal Edema

  During ophthalmoscopy, a worm was recognized penetrating the iris, occupying the anterior chamber for a brief period, returning back behind the iris, and leaving corneal edema with hyphyema. [ncbi.nlm.nih.gov]

• Arthralgia

  * Diarrhea * Itching * Jaundice * Enlarged liver * Enlarged spleen * Facial swelling * Eosinophilia * Cirrhosis in long-term untreated cases Causes - Fascioliasis * Abdominal pain * Appetite loss * Arthralgias * Cough * Diarrhea * Diarrhea * Eggs in [checkorphan.org]

• Pruritus

  The chronic stage is less disturbing, when the patient experiences obstructive jaundice, biliary colic, fat food intolerance, change in bowel habits, pruritus and intermittent abdominal pain. [symptoma.com]

  Chronically infected people in this phase may also be asymptomatic or may present with biliary colic, epigastric pain, nausea, jaundice, or pruritus. The long-term prognosis depends on the extent of the liver and biliary damage. [wwwnc.cdc.gov]

  In this stage, patient experiences epigastric pain, biliary colic, intolerance to fatty food, jaundice, nausea, pruritus, tenderness in the right upper-quadrant. There may be liver enlargement along with spleen enlargement or ascites. [epainassist.com]

  During this acute phase, the patient complains of headache, anorexia, nausea and vomiting, pruritus, right hypochondrial pain, and high fever with tender hepatomegaly, urticaria, and marked eosinophilia. [saudijgastro.com]

  Patient may be asymptomatic or presents as gastrointestinal symptoms, chronic cholecystitis, cholangitis and liver abscesses which may be accompanied by biliary colic, epigastric pain, jaundice, pruritus and upper right quadrant pain [ 3 ]. [bmcresnotes.biomedcentral.com]

• Cutaneous Manifestation

  Other symptoms included fever, nausea/vomiting, and cutaneous manifestations. In all cases, marked eosinophilia was present. All patients lived in an urban environment, and three reported the consumption of raw watercress. [ncbi.nlm.nih.gov]

• Intracranial Hemorrhage

  An intracranial infection occasionally caused by F hepatica or other parasites can be indicated by a fever of unknown origin, eosinophilia, and iterative intracranial hemorrhages. [ncbi.nlm.nih.gov]

Fascioliasis is usually first suspected based on patient history and clinical examination. An additional suggestion is offered by the complete blood cell count, which reveals eosinophilia, although this is not a specific finding. However, in some patients the eosinophil count is normal and leukocytosis is present [6]. Furthermore, the eosinophil count may diminish during the chronic phase of the disease [7]. The erythrocyte sedimentation rate is often elevated, as are hepatic parameters, such as transaminases, alkaline phosphatase, bilirubin and gamma-glutamyl transpeptidase, indicating hepatocellular or cholestatic injury.

An immunogram, if performed, will detect increased levels of immunoglobulins E and G. Specific antibodies are elevated during the acute phase and may be detected using enzyme immunoassays. Stool examination may be negative, but, when positive it reveals the presence of Fasciola eggs, thus establishing the diagnosis. Multiple sample examination is required. However, this test is considered to have low sensitivity, but the FLOTAC technique, which uses a device to achieve flotation of the samples, may be superior in this regard [8]. The stool may also be subject to enzyme-linked immunosorbent assay (ELISA) examination for coproantigens [9]. Rapid diagnosis can be achieved using polymerase chain reaction assays [10] [11].

Imaging techniques that are sometimes useful include chest radiographies, abdominal ultrasounds (which can reveal hypodense liver areas) and abdominal magnetic resonance imaging and computer tomography, describing tunnel-like lesions inside the liver [12]. However, the gold standard for diagnosis is considered to be the endoscopic retrograde cholangiography [6].

• Direct Bilirubin Increased

  However, the value of ALP, alpha-amylase and direct bilirubin increased (135 U/L, 185 U/L and 6.0 μM/L; the normal value is 35–130 U/L, 72–182 U/L and Based on routine, the doctors suspected a parasitic disease for the 4 patients, who were referred to [parasitol.kr]

• Fasciola Hepatica

  People seropositive for Fasciola hepatica underwent abdominal ultrasonography, physical examination, biochemistry, and stool tests for the detection of Fasciola hepatica eggs. [ncbi.nlm.nih.gov]

  "Fasciola Hepatica." Parasitology.org. 16 May 2001 . "Fasciola Hepatica." Zoo Lab. U. of Wisconsin. 19 May 2001. "Fasciola Hepatica: The Liver Fluke." Cambridge U. Schistosome Research Group. 11 May 2001. "Fascioliasis." Health Network. 19 May 2001. [stanford.edu]

  The adult flukes ( Fasciola hepatica : up to 30 mm by 13 mm; F. gigantica : up to 75 mm) reside in the large biliary ducts of the mammalian host. Fasciola hepatica infect various animal species, mostly herbivores (plant-eating animals). [emedicine.com]

1. Fürst T, Duthaler U, Sripa B, et al. Trematode infections: liver and lung flukes. Infect Dis Clin North Am. 2012;26(2):399-419.
2. Cabada MM, White AC Jr. New developments in epidemiology, diagnosis, and treatment of fascioliasis. Curr Opin Infect Dis. 2012;25(5):518-22.
3. Fürst T, Keiser J, Utzinger J. Global burden of human food-borne trematodiasis: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(3):210-21.
4. Guirre Errasti C, Merino Angula J, Flores Torres M, et al. Unusual forms of Fasciola hepatica infestation: report of two cases. Med Clin (Barc). 1981;76 :125–8.
5. Mas-Coma S, Agramunt VH, Valero MA. Neurological and ocular fascioliasis in humans. Adv Parasitol. 2014; 84:27-149.
6. Ashrafi K, Bargues MD, O'Neill S, et al. Fascioliasis: a worldwide parasitic disease of importance in travel medicine. Travel Med Infect Dis. 2014;12(6):636-49.
7. el-Shabrawi M, el-Karaksy H, Okasha S, et al. Human fascioliasis: clinical features and diagnostic difficulties in Egyptian children. J Trop Pediatr. 1997;43(3):162-6.
8. Keiser J, Duthaler U, Utzinger J. Update on the diagnosis and treatment of food-borne trematode infections. Curr Opin Infect Dis. 2010;23(5):513-20.
9. Ubeira FM, Muiño L, Valero MA, et al. MM3-ELISA detection of Fasciola hepatica coproantigens in preserved human stool samples. Am J Trop Med Hyg. 2009;81(1):156-62.
10. Ai L, Dong SJ, Zhang WY, et al. Specific PCR-based assays for the identification of Fasciola species: their development, evaluation and potential usefulness in prevalence surveys. Ann Trop Med Parasitol. 2010;104(1):65-72.
11. Le TH, Nguyen KT, Nguyen NT, et al. Development and evaluation of a single-step duplex PCR for simultaneous detection of Fasciola hepatica and Fasciola gigantica (family Fasciolidae, class Trematoda, phylum Platyhelminthes). J Clin Microbiol. 2012;50(8):2720-6.
12. Chamadol N, Laopaiboon V, Techasatian P, et al. Computerized tomographic findings of hepatic fascioliasis compared with melioidosis-caused liver abscesses. J Med Assoc Thai. 2010;93(7):838-48.