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

  Liver Lesions, Fever and Eosinophilia Caused by Fasciola hepatica in a 15-year-old Girl. Indian J Pediatr. 2015 Oct;82(10):967-8. WHO headquarters, Geneva, Switzerland 17–18 October 2006. [tropicalgastro.com]

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

  Severe abdominal pain with persistent fever and jaundice may occur in people who develop cholangitis ( bile duct infection ) as a complication. [healthhype.com]

  He developed a fever, was very fatigued, and had constant stomach pains. Steve was worried that he might have contracted something during his trip to Mexico, so he went to the nearest hospital to get checked out. [study.com]

• Chronic Infection

  Antibody detection assays are useful in The early stages of infection before eggs are produced Chronic infection when egg production is sporadic or low Loss of detectable antibodies occurs 6 to 12 mo after cure. [merckmanuals.com]

  In chronic infections, eggs may be recovered from the stool or from duodenal or biliary materials. The eggs are indistinguishable from those of Fasciolopsis buski. [msdmanuals.com]

  Patients with chronic infections experience hardening of the liver (fibrosis) as a result of the long-term inflammation. [farmgrid.org]

  Prolonged infection and/or high parasite load leads to chronic hepatobiliary damage and can result in chronic biliary cirrhosis, sclerosing cholangitis, and even cholangiocarcinoma.[1][10][11] Fasciola’s migration out of the intestine and up into the [statpearls.com]

• Weight Loss

  Several had fever and significant weight loss. Blood investigations, chest xray, urine and stool examinations were ordered. All patients had ultrasound (USG) of the abdomen done elsewhere which showed indeterminate liver lesions. [tropicalgastro.com]

  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]

  Symptoms and Signs Acute infection can cause abdominal pain, hepatomegaly, nausea, vomiting, intermittent fever, urticaria, eosinophilia, malaise, and weight loss due to liver damage. [merckmanuals.com]

  Symptoms and Signs of Fascioliasis Acute infection can cause abdominal pain, hepatomegaly, nausea, vomiting, intermittent fever, urticaria, malaise, and weight loss due to liver damage. [msdmanuals.com]

• Pallor

  Paleness of the skin ( pallor ). Hives (urticaria) has also been observed in about 20% of cases. Other symptoms like dizziness and sweating may also occur with fascioliasis although this is mainly seen in children. [healthhype.com]

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

  Clinical signs included weight loss, mucosal pallor, apathy, depression, muscle tremors, and drooling; these were followed by death within approximately 24 h. Some sheep were found dead. [dspace.uasm.md]

  Pallor of the skin. Unintentional weight loss. Hepatomegaly, which is liver enlargement. Patient may or may not experience tenderness. Dizziness and sweating can also occur; however, this is more often seen in children. [epainassist.com]

  Ascites, abdominal haemorrhage, icterus, pallor of membranes, weakness may be observed in sheep. Acute Type II Fasciolosis: infectious dose is 1000-5,000 ingested metacercariae. [en.wikipedia.org]

• Intermittent Fever

  We describe a 58-year-old female patient who presented with a 2-month history of intermittent fever and abdominal pain. An abdominal computed tomography (CT) revealed confluent low-density lesions in the liver. [ncbi.nlm.nih.gov]

  Symptoms and Signs Acute infection can cause abdominal pain, hepatomegaly, nausea, vomiting, intermittent fever, urticaria, eosinophilia, malaise, and weight loss due to liver damage. [merckmanuals.com]

  Symptoms and Signs of Fascioliasis Acute infection can cause abdominal pain, hepatomegaly, nausea, vomiting, intermittent fever, urticaria, malaise, and weight loss due to liver damage. [msdmanuals.com]

  More usually the invasive phase lasts many weeks, with the most common symptoms being intermittent fever, hepatomegaly, and abdominal pain, although up to 50% of infections may be subclinical.[6] Abdominal pain is usually in the epigastrium or right hypochondrium [patient.info]

• Abdominal Pain

  Symptoms and Signs of Fascioliasis Acute infection can cause abdominal pain, hepatomegaly, nausea, vomiting, intermittent fever, urticaria, malaise, and weight loss due to liver damage. [msdmanuals.com]

  pain in February 2011. [jpgmonline.com]

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

  Symptoms and Signs Acute infection can cause abdominal pain, hepatomegaly, nausea, vomiting, intermittent fever, urticaria, eosinophilia, malaise, and weight loss due to liver damage. [merckmanuals.com]

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

• Nausea

  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]

  Symptoms Early (acute) symptoms of fascioliasis may include fever, nausea, vomiting, diarrhea, a swollen liver, liver function abnormalities, skin rashes, shortness of breath and abdominal pain or tenderness. [dshs.state.tx.us]

  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]

• Diarrhea

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

  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]

  School Exclusion Policy Children with confirmed fascioliasis should be kept out of school or childcare until they are diarrhea and fever-free. [dshs.state.tx.us]

  The symptoms of this disease are loss of weight; accumulation of fluids in the abdomen due to liver damage; ‘bottle-jaw’ or collection of fluid in the lower jaw; diarrhea; lethargy followed by death. Treatment. The drug of choice is triclabendazole. [parasito.fkkmk.ugm.ac.id]

• Epigastric Pain

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

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

  The symptoms of this phase, such as biliary colic, nausea, intolerance to fatty food, right upper quadrant pain, epigastric pain, obstructive jaundice, and pruritus, are the result of a blockade in the biliary tract and inflammation in the gall bladder [dshs.state.tx.us]

  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]

• Failure to Thrive

  This phase is usually asymptomatic but occasionally can present as chronic epigastric and right upper quadrant pain, nausea, vomiting, diarrhea, hepatomegaly, jaundice, and failure to thrive. Peripheral eosinophilia will not likely be present. [statpearls.com]

  Usually asymptomatic, but occasionally can present as chronic epigastric and right upper quadrant pain, nausea, vomiting, diarrhea, hepatomegaly, jaundice, and failure to thrive. Peripheral eosinophilia will not likely be present. [healthjade.net]

• 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]

  Acute epigastric pain, fever, pruritus, jaundice, hepatomegaly, and eosinophilia are common. [med-chem.com]

• Hepatomegaly

  Symptoms and Signs of Fascioliasis Acute infection can cause abdominal pain, hepatomegaly, nausea, vomiting, intermittent fever, urticaria, malaise, and weight loss due to liver damage. [msdmanuals.com]

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

  Acute epigastric pain, fever, pruritus, jaundice, hepatomegaly, and eosinophilia are common. [med-chem.com]

  This hepatic phase lasts for 4 months and patient presents with fever, nausea, vomiting, urticaria, right hypochondriac pain, hepatomegaly, hypergamma-globulinaemia, anaemia and marked eosinophilia. [tropicalgastro.com]

  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]

• Biliary Colic

  The spectrum of biliary fascioliasis ranges from recurrent biliary colics to acute cholangitis. The long term complications are gall stones, sclerosing cholangitis and biliary cirrhosis. [ncbi.nlm.nih.gov]

  The symptoms of this phase, such as biliary colic, nausea, intolerance to fatty food, right upper quadrant pain, epigastric pain, obstructive jaundice, and pruritus, are the result of a blockade in the biliary tract and inflammation in the gall bladder [dshs.state.tx.us]

  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]

• Recurrent Jaundice

  Chronic common bile duct obstructions may develop and lead to recurrent jaundice, cholelithiasis, pancreatitis, and more seriously, ascending cholangitis. [statpearls.com]

• 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]

  Patients in this phase usually experience non-specific symptoms, such as loss of appetite, weight loss, right upper quadrant pain, fever, sweating, urticaria, and arthralgia[6]. [wjgnet.com]

• Pruritus

  The symptoms of this phase, such as biliary colic, nausea, intolerance to fatty food, right upper quadrant pain, epigastric pain, obstructive jaundice, and pruritus, are the result of a blockade in the biliary tract and inflammation in the gall bladder [dshs.state.tx.us]

  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]

  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]

  Acute epigastric pain, fever, pruritus, jaundice, hepatomegaly, and eosinophilia are common. [med-chem.com]

  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]

• Asthenia

  Among the clinical symptoms, only asthenia and dizziness were statistically associated with F. hepatica infection. These are not likely to be caused by fascioliasis, which mainly produces gastrointestinal symptoms. [the-medical-dictionary.com]

  In the clinical picture, there were two variables associated with fascioliasis, asthenia (X 2 = 5.07, p = 0.024) and dizziness (X 2 = 6.69, p = 0.01), among those considered as important clinical characteristics. [scielo.br]

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].

• Enlargement of the Liver

  Chronic phase Stomach pains, anemia, pancreatitis (inflammed pancreas), wide-spread bacterial infections, hepatomegaly (enlargement of the liver). [study.com]

  Enlargement of the liver ( hepatomegaly ) which may be tender or non-tender. Malaise (a general feeling of being unwell). Unexplained weight loss. Paleness of the skin ( pallor ). Hives (urticaria) has also been observed in about 20% of cases. [healthhype.com]

• 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

  Fascioliasis Essentials Sheep liver fluke disease Fasciola hepatica Fascioliasis is a liver disease of animals (sheep, cattle and other herbivores, but also dogs) and less frequently of humans. It is caused by the large trematode Fasciola hepatica. [parasite-diagnosis.ch]

  Praziquantel, which is helpful against other Fasciola infections, may not work on Fasciola hepatica infections. [medic8.com]

  [Fasciola hepatica] " " Ein Fall von chronischer Fasziolose beim Pferd " " A case of chronic fascioliasis in horse " [agris.fao.org]

  Metabolomic and systematic biochemical analysis of sheep infected with Fasciola hepatica. [unboundmedicine.com]

• Fasciolopsis Buski

  The eggs are identical to those of the Fasciolopsis buski. Eggs may be present in stool but rather than from infection, the cause may be the consumption of infected livers with eggs in them. This is known as False Fascioliasis or Pseudofascioliasis. [medic8.com]

  Fasciolopsiasis Fasciolopsiasis, an infection by Fasciolopsis buski, the giant intestinal fluke prevails throughout most of the Orient. [histopathology-india.net]

  Fasciolopsis buski, restricted to specific regions of Asia, causes fasciolopsiasis. The incidence of these trematodiases is underestimated due to under-reporting and to the lack of sensitive and widely accepted tool for their diagnosis. [digital.csic.es]

  The adults have a life span of about one year. 5 Fasciola hepatica (ou) 6 Fasciola hepatica (femela) 7 Adult fluke of Fasciolopsis buski Adult fluke of Fasciolopsis buski. The adult flukes range in size: 20 to 75 mm by 8 to 20 mm. 8 Fascioliasis. [slideplayer.com]

  Fig. 21.25 Fasciolopsis buski, adult fluke. Whole mount. (Courtesy of Dr. Herman Zaiman). Next Page Previous Page Fascioliasis Fascioliasis is an infection by the sheep liver fluke Fasciola hepatica ( Figs. 21.23 and 21.24 ). [web.archive.org]

[…] patients who had post treatment repeat blood investigation showed resolution of eosinophilia. 100% patients who had post treatment imaging showed remarkable radiological regression of disease. [tropicalgastro.com]

Single treatment of invasive fascioliasis with triclabendazole. [rarediseases.org]

Bithionol (Bitin) treatment in established fascioliasis in Egyptians J Trop Med Hyg, 91 (1988), pp. 240 [17.] J.F. Rossignol, H. Abaza, H. [elsevier.es]

It is reasonable to repeat all positive tests at 3 months post-treatment. [statpearls.com]

Treatment failures are common with praziquantel; it is not recommended. In some patients, extraction of adult flukes from the biliary tract by ERCP may be useful. [msdmanuals.com]

Prognosis The disease rarely kills in humans. The prognosis is excellent with adequate treatment. Prevention Water-grown vegetables should be washed with 6% vinegar or potassium permanganate for 5-10 minutes, which kills the encysted metacercariae. [patient.info]

Diagnosis - Fascioliasis The list of diagnostic tests mentioned in various sources as used in the diagnosis of Fascioliasis includes: * Eggs in stool Prognosis - Fascioliasis Not supplied. Treatment - Fascioliasis Not supplied. [checkorphan.org]

The long-term prognosis depends on the extent of the liver and biliary damage. DIAGNOSIS Detection of eggs in stool or duodenal or biliary aspirates. [wwwnc.cdc.gov]

Etiology Fascioliasis is a parasitic zoonotic infection caused by two trematode species: Fasciola hepatica and F. gigantica. Both are leaf-shaped and large enough to be visible to the naked eye. [paho.org]

Objectives: Review the etiology of fascioliasis. Describe the history and exam findings of fascioliasis. Summarize the management and treatment options of fascioliasis. [statpearls.com]

(Etiology) Fascioliasis is caused by parasitic worms belonging to the genus Fasciola that are found on certain water plants (watercress, algae, etc.) around the world The pathogens that are involved include Fasciola hepatica (sheep liver fluke or common [dovemed.com]

Other causes as pancreatic neoplasm [ 4 ], hypercalcemia, hyperlipidemia, drugs intake and infectious diseases are less frequent etiologic factors. Acute pancreatitis is an extremely rare finding on the course of Fasciola hepatica infection. [pancreas.imedpub.com]

The transmission patterns of fascioliasis vary in different epidemiological settings [30]. [intechopen.com]

[…] of Fascioliasis in Kermanshah Province, Western Iran. ( 30181994 ) Bozorgomid A...Rokni MB 2018 23 A Case of Fascioliasis in A Wild Nutria, Myocastor coypus, in Republic of Korea. ( 30196671 ) Kim HS...Hong IH 2018 24 Epidemiological and ultrasonographic [malacards.org]

Fasciola, lymnaeids and human fascioliasis, with a global overview on disease transmission, epidemiology, evolutionary genetics, molecular epidemiology and control. Adv Parasitol 2009;69:41-146. [ PUBMED ] [ FULLTEXT ] 2. [jpgmonline.com]

Studies have shown that human fascioliasis presents marked heterogeneity, including different epidemiological situations and transmission patterns in different endemic areas. [typeset.io]

A complete understanding of molecular epidemiology is expected to help greatly in designing global actions and local interventions for control of fascioliasis. [ncbi.nlm.nih.gov]

Dargie, The pathophysiological effects of gastrointestinal and liver parasites in sheep, Digestive Physiology and Metabolism in Ruminants, 10.1007/978-94-011-8067-2_17, (349-371), (1980). J.D. Dargie, C.I. Berry and J.J. [doi.org]

University Tropical Parasitology: Protozoans, Worms, Vectors and Human Diseases This course provides students an understanding of important human parasitic diseases, including their life cycles, vectors of transmission, distribution and epidemiology, pathophysiology [coursera.org]

The pathophysiological effects of gastrointestinal and liver parasites in sheep. In: Ruckbusch Y. and Thivend P. [fao.org]

The pathophysiology of fascioliasis can be related to liver damage brought on by immature flukes that migrate and feed, as well as immunological reactions to chemicals produced by the parasites … PMC Free PDF New perspectives for fascioliasis in Upper [unboundmedicine.com]

This activity describes the pathophysiology and presentation of fascioliasis and highlights the importance of the interprofessional team in its management. Objectives: Review the etiology of fascioliasis. [statpearls.com]

Article Navigation From Danchurchaid and Institute Nacional de Laboratorios de Salud, La Paz, Bolivia ; the National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia ; and Laboratory of Parasite Immunology and [doi.org]

Prevention & Treatment The best way to prevent fascioliasis is to avoid consuming produce and water that may be contaminated with the flatworm larvae (especially in less developed areas that do not have proper sanitation techniques). [study.com]

Misdiagnosis can be prevented by not consuming liver before a stool exam. During the earlier stages of the disease, antibody detection can also be used. Treatment for Fascioliasis includes the drugs triclabendazole or bithionol. [medic8.com]

Prevention and Treatment Liver fluke infection can be easily prevented and effectively treated. People living in endemic regions need to be informed against risky behavior and about the symptoms for early diagnosis. [healthhype.com]

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