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

  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]

  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]

  […] pain, fever Malaise, fever Exposure Watercress Fresh salad Watercress Watercress Fresh salad Fresh salad Travel destination Bali Bali Bali Bali, Java Bali Bali Presumptive diagnosis Pyogenic liver abscess Malignancy Malignancy Pyogenic liver abscess [mja.com.au]

• 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]

• Fever of Unknown Origin

  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]

  Among individuals who presented with fever of unknown origin to an Egyptian hospital, 4% had F. hepatica. F. hepatica caused disease that formerly occurred in scattered endemic foci along the Nile River and has now spread throughout the Nile Valley. [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]

  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]

• 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 - Fascioliasis The list of signs and symptoms mentioned in various sources for Fascioliasis includes the 20 symptoms listed below: * Fever * Nausea * Vomiting * Appetite loss * Indigestion * Abdominal pain * Diarrhea * Cough * Eggs in stool * [checkorphan.org]

  Here, we present a 44-year-old female patient who presented to our hospital with complaints of abdominal pain, nausea, vomiting, anorexia and weight loss. [ncbi.nlm.nih.gov]

• Diarrhea

  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]

  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]

  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

  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]

  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]

  […] cases Causes - Fascioliasis * Abdominal pain * Appetite loss * Arthralgias * Cough * Diarrhea * Diarrhea * Eggs in stool * Enlarged liver * Enlarged spleen * Eosinophilia * Epigastric pain * Facial swelling * Fever * Fever * Indigestion * Itching * Jaundice [checkorphan.org]

• Hepatomegaly

  Computed tomography of the abdomen showed hepatomegaly (N = 9), track-like hypodense lesions with subcapsular location (N = 8), and subcapsular hematoma (N = 2). [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]

  The patient had the typical diagnostic tetrad of fever, eosinophilic leukocytosis, tender hepatomegaly, and fluke ova in the stools. [jamanetwork.com]

• 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 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]

• 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]

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

• Myelopathy

  OBJECTIVE: Parasitic myelopathy is rare. We report ectopic infestation of the spine by Fasciola hepatica. CLINICAL PRESENTATION: A young woman presented with gradual onset paraplegia with bladder and bowel involvement. [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 http://www.parasitology.org/imagehtml/Fhepatica.htm >. "Fasciola Hepatica." Zoo Lab. U. of Wisconsin. 19 May 2001. "Fasciola Hepatica: The Liver Fluke." Cambridge U. [stanford.edu]

Nitazoxanide efficacy against fascioliasis was 94.0% and 100% after first and second treatment courses, respectively. The few children, for whom a second treatment course was needed, were concomitantly infected by moderate ascariasis burdens. [ncbi.nlm.nih.gov]

Until recently, however, bithionol was the only treatment available for fascioliasis and its cost, high doses, and the extended length of treatment effectively prohibited its use for large-scale campaigns. [stanford.edu]

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]

Prognosis in fascioliasis patients with neurological manifestations is discussed, with emphasis on sequelae and fatal cases, and the care of patients with ophthalmologic manifestations is added. [ncbi.nlm.nih.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]

(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]

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. [joplink.net]

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]

Key words: Fasciola spp., clinical epidemiology, reemerging disease Dr. [a.u-tokyo.ac.jp]

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]

Incidence of human infection has increased over the past 20 years. [2, 3, 4] Pathophysiology Sheep, cattle and goats are the definitive hosts. Other alternate herbivore hosts are horses, pigs, buffaloes, donkeys and pigs. [emedicine.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]

The immunological test and molecular identification of eggs were confirmed at the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China. [ncbi.nlm.nih.gov]

The recommended regimen is 10 mg/kg body weight administered as a single dose in both clinical practice and preventive chemotherapy interventions. [who.int]

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