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

  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]

  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]

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

• 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]

  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]

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

  The acute stage of fascioliasis hepatica begins with the slow migration of F. hepatica through the liver parenchyma; the mature flukes digest and consume hepatocytes, dig tunnels and caves, and reside in the liver for months, causing hepatitis, chills [frontiersin.org]

• 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

  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]

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

• Nausea

  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]

  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]

  The case A 65-year-old retired teacher presented with a 3-months’ history of upper abdominal discomfort and nausea. [pmj.bmj.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

  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]

  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]

  During the acute phase, manifestations include abdominal pain, hepatomegaly, fever, vomiting, diarrhea, urticaria and eosinophilia. Occasionally, infection occurs in intestinal wall, lungs, subcutaneous tissue, and pharyngeal mucosa. [yeastgenome.org]

  Fascioliasis often does not present with symptoms in the early stages of infection, but some people and animals will experience nausea, vomiting, abdominal pain and inflammation, fever, gastrointestinal bleeding, and diarrhea. [ivdresearch.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 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]

  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]

• 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

  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]

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

  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]

  During the acute phase, manifestations include abdominal pain, hepatomegaly, fever, vomiting, diarrhea, urticaria and eosinophilia. Occasionally, infection occurs in intestinal wall, lungs, subcutaneous tissue, and pharyngeal mucosa. [yeastgenome.org]

• 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]

  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]

• Recurrent Jaundice

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

  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]

  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]

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

  Fasciola hepatica (liver fluke) is a common parasitic infection of cattle and sheep in the UK. [unboundmedicine.com]

  Fasciola hepatica in bovines in Brazil: data availability and spacial distribution. [scielo.br]

  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-infektion bei neurologischer symptomatik. [cambridge.org]

  Fasciola infection is both treatable and preventable. Above Images: Left: Fasciola hepatica egg in an unstained wet mount (400x magnification). F. hepatica eggs are broadly ellipsoidal, operculated, and measure 130–150 μm by 60–90 µm. [cdc.gov]

Timely treatment with triclabendazole is the quickest way to control morbidity associated with fascioliasis. [who.int]

Moreover, the drug holds promise as a useful therapeutic alternative to praziquantel in the treatment of paragonimiasis. [mmv.org]

Off-label This medication may not be approved by the FDA for the treatment of this condition. [drugs.com]

In this case, targeted treatment of school-age children (5-14 years), or universal treatment of the entire population living in those areas, are both appropriate options. [paho.org]

Our group documented treatment failures after multiple courses of treatment in 7/19 (37%) patients referred to our center for treatment.83 Ramadan et al reported on 67 Egyptian patients with acute fascioliasis treated with a single triclabendazole dose [dovepress.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]

(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]

Objectives: Review the etiology of fascioliasis. Describe the history and exam findings of fascioliasis. Summarize the management and treatment options of fascioliasis. [ncbi.nlm.nih.gov]

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]

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]

Review Epidemiology of fascioliasis in human endemic areas S Mas-Coma. J Helminthol. 2005 Sep. [pubmed.ncbi.nlm.nih.gov]

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. [QxMD MEDLINE Link]. Tolan RW Jr. [emedicine.medscape.com]

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.medscape.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. [ncbi.nlm.nih.gov]

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]

PAHO/WHO also supports the countries of the Region in strengthening diagnosis, treatment, and education to prevent the disease in the communities where it is endemic. [paho.org]

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

Fasciola infection is both treatable and preventable. Above Images: Left: Fasciola hepatica egg in an unstained wet mount (400x magnification). F. hepatica eggs are broadly ellipsoidal, operculated, and measure 130–150 μm by 60–90 µm. [cdc.gov]

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]

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