ß-Blockers in Hepatosplenic Schistosomiasis: A Narrative Review.

Hepatosplenic schistosomiasis (HSS) is a serious complication of chronic schistosomiasis that can result in portal hypertension and variceal bleeding. ß-blockers, a class of medications commonly used to treat hypertension and other cardiovascular conditions, have been investigated for their potential use in preventing variceal bleeding in HSS. Several studies have shown that ß-blockers can reduce portal pressure and prevent variceal bleeding effectively in these patients. However, there are limited data on the long-term efficacy and safety of ß-blockers in this setting, and further research is needed to determine the optimal use of these medications. This review summarizes the evidence supporting current recommendations of ß-blocker use in patients with HSS.

Toxocara canis and Fasciola hepatica Co-Infection Leading to Hepatic Abscess: A Case Report.

Toxocariasis is a zoonotic disease caused by ingesting eggs from soil contaminated with Toxocara canis and Toxocara cati, commonly found in feces of infected dogs and cats, leading to a range of clinical symptoms including fever, abdominal pain and gastrointestinal manifestations. Fascioliasis is also a zoonotic disease caused by liver flukes Fasciola hepatica and Fasciola gigantica, which can be contracted through consumption of contaminated water or aquatic plants, leading to various clinical features. Here, we report a case of a 39-year-old woman diagnosed with a liver abscess caused by co-infection of T. canis and F. hepatica, as confirmed by serological tests. Although the existence of a pet dog and an experience of eating raw water dropwort are potential clues for diagnosis, it cannot be determined as the source of infection because the source of infection has not been clearly identified. After administrating albendazole and triclabendazole sequentially, the patient showed improvement in blood test and imaging findings. Clinicians should be aware of parasitic co-infection and take appropriate management.

Fascioliasis associated with chronic cholecystitis in a woman from Sistan and Baluchestan province, a non-endemic region in Southeastern Iran.

BACKGROUND: Fascioliasis, caused by Fasciola hepatica, is a neglected zoonotic food-borne trematodiasis. The Caspian littoral in northern Iran is endemic for the disease, and human fascioliasis is well-known in that region. In the present study, we report the diagnosis, identification, and clinical management of a human case of fascioliasis associated with common bile duct (CBD) obstruction from a non-endemic remote area in southeastern Iran. CASE PRESENTATION: A 42-year-old female was admitted to Afzalipour Medical Center hepatobiliary surgery ward in Kerman with abdominal pain for the past three months. Dilated biliary tract and an ill-defined mass in CBD were reported in abdominal ultrasonography and magnetic resonance cholangiopancreatography, respectively. During distal CBD operation, nine leaf-like motile flatworms were isolated. A morphological study confirmed all the isolates as Fasciola, and further molecular investigations, identified the flukes as F. hepatica using both pepck multiplex PCR and cox1 sequencing. CONCLUSION: Molecular and morphological findings of the study indicated the presence of human fascioliasis in the southeastern province of Sistan and Baluchestan in Iran. Fascioliasis is among the etiologies of chronic cholecystitis, and physicians should consider chronic cholecystitis associated with fascioliasis in the differential diagnosis. In the present report, endoscopic ultrasound was usefully applied for the accurate diagnosis of biliary fasciolosis.

Hepatosplenic schistosomiasis: a rare cause of chronic liver disease with portal hypertension diagnosed by abdominal ultrasound.

Hepatosplenic schistosomiasis (HSS) is a major cause of chronic liver disease with portal hypertension (pHTN) in Africa, Asia, and America. Abdominal ultrasound is essential for diagnosis.

Human fascioliasis presenting as liver abscess: clinical characteristics and management.

BACKGROUND: Human fascioliasis, caused by the liver flukes F. hepatica, and F. gigantica, is a neglected tropical disease that causes health problems in many regions of the world. This disease can be classified as either acute or chronic based depending on the clinical manifestations and laboratory findings. METHODS: We retrospectively reviewed the demographic data, clinical features, radiologic manifestations, and the response to specific treatment of patients diagnosed with hepatic fascioliasis as well as fasciola liver abscess in Thailand. RESULTS: A total of 175 patients were included in the study, 126 patients were females (72%), while the mean age was 47.8 years (16-84 years). The most common symptoms were abdominal pain (74.9%), weight loss (29.1%) and fever (28%). Peripheral eosinophilia was observed in 92% of patients. The typical radiologic findings discovered conglomerated hypodensity which are rim-enhancing lesions located in the subcapsular and peripheral region of the liver. Most of patients were improved after a single dose of triclabendazole treatment. Adding antibiotic had no statistical impact on treatment outcome (p = 0.78). CONCLUSIONS: Human fascioliasis presents with a wide clinical spectrum; therefore, a high index of suspicion is required to establish a correct diagnosis. Clinicians need to be aware of hepatic fascioliasis when patients in such endemic areas present as hypereosinophilia and typical liver imaging. Prompt specific treatments will contribute towards a satisfactory outcome in patients.

Asociación de fascioliasis con el estado nutricional y coinfección enteroparasitaria en niños / Association of fascioliasis to nutritional status and enteroparasite coinfection in children

Introducción: La fascioliasis es causada por el trematodo Fasciola hepatica que afecta a animales herbívoros, omnívoros y al humano. Los niños de edad escolar son los más afectados y el órgano más dañado es el hígado. Este parásito requiere de reservorio y huésped intermediario para completar su ciclo biológico. Objetivo: Determinar la asociación de la fascioliasis con el estado nutricional y coinfección enteroparasitaria en niños. Métodos: La investigación se realizó entre septiembre de 2016 y abril de 2017 en el distrito de Santa María de Chicmo, región Apurímac. El estudio fue analítico de corte transversal. La población de niños de 6 a 16 años estuvo constituida por 2 172 individuos. El tamaño de muestra fue de 435 niños y se determinó mediante un muestreo simple al azar. Además, para que el muestreo fuera más eficiente se distribuyó el tamaño total de la muestra entre los estratos I.E. Primaria e I.E. Secundaria, para un resultado de 209 y 226 muestras, respectivamente. Sin embargo, se logró tomar 493 muestras coprológicas y serológicas repartidas proporcionalmente entre la totalidad de 23 instituciones educativas. Resultados: La prevalencia de fascioliasis fue de 5,3 por ciento (26/493; IC95 por ciento =3,2-7,4). Las instituciones educativas con mayor prevalencia fueron: Taramba con 17,2 por ciento (5/29; IC95 por ciento = 5,9-35,8), Libertadores de América con 16,1 por ciento (5/31; IC95 por ciento = 5,5-33,7), Mariano Melgar con 15 por ciento (3/20; IC95 por ciento = 3,2-37,9) y Nuestra Señora de Guadalupe con 10,8 por ciento (4/37; IC95 por ciento = 3-25,4). No se encontró asociación de fascioliasis con la valoración nutricional antropométrica ni con la coinfección enteroparasitaria en niños (p˃ 0,05). Conclusiones: La fascioliasis no estaría afectando el estado nutricional de los niños; asimismo, los signos clínicos, atribuidos a fascioliasis, corresponderían también a la alta presentación de parásitos entéricos(AU)

Introduction: Fascioliasis is caused by the trematode Fasciola hepatica and affects herbivorous and omnivorous animals as well as humans. Schoolchildren are the most affected group, and the organ most commonly targeted is the liver. This parasite requires an intermediate reservoir and host to complete its biological cycle. Objective: Determine the association of fascioliasis to nutritional status and enteroparasite coinfection in children. Methods: An analytical cross-sectional study was conducted from September 2016 to April 2017 in the district of Santa María de Chicmo, Apurímac Region. The child population aged 6-16 years was composed of 2 172 individuals. The sample size was 435 children, and it was determined by simple random sampling. Additionally, in order for the sampling to be more efficient, the total sample size was distributed between the strata Primary E.I. and Secondary E.I., for 209 and 226 samples, respectively. However, 493 coprological and serological samples were proportionally taken from the total 23 educational institutions. Results: Prevalence of fascioliasis was 5.3 percent (26/493; CI95 percent=3.2-7.4). The educational institutions with the highest prevalence were Taramba with 17.2 percent (5/29; CI95 percent= 5.9-35.8), Libertadores de América with 16.1 percent (5/31; CI95 percent= 5.5-33.7), Mariano Melgar with 15 percent (3/20; CI95 percent= 3.2-37.9) and Nuestra Señora de Guadalupe with 10.8 percent (4/37; CI95 percent= 3-25.4). No association was found between fascioliasis and nutritional anthropometric assessment or enteroparasite coinfection in children (p˃ 0.05). Conclusions: Fascioliasis was not found to affect the nutritional status of children. On the other hand, the clinical signs attributed to fascioliasis also correspond to the high presentation of enteric parasites(AU)

Fasciola Hepatica Induced Hepatic Abscess Treated with Triclabendazole.

Fascioliasis is a zoonotic disease caused by Fasciola hepatica that infects mainly cattle, sheep, and goats. Humans can be infected by water or aquatic plants contaminated with metacercariae. The authors encountered two cases of F. hepatica infection. One patient reported abdominal discomfort with marked eosinophilia. The other patient had chest discomfort with marked eosinophilia. The abdominal CT images revealed hypodense lesions in the liver. The ultrasonography-guided liver biopsy findings in both patients were indicative of parasitic infections. Serological tests confirmed the definite diagnoses. Both patients were treated with a single dose of triclabendazole, which is the treatment of choice for fascioliasis. These findings suggest that a diagnosis of fascioliasis, particularly in the acute phase, should be considered in patients with abdominal pain, marked eosinophilia, and hypodense hepatic lesions on CT.

Fasciolasis Hepática, serie de casos reportados en Matanzas. Cuba / Hepatic fasciolosis, a series of cases reported in Matanzas, Cuba

RESUMEN Introducción: la fasciolasis hepática es una enfermedad parasitaria de difícil diagnóstico. La variada y múltiple sintomatología que caracteriza la enfermedad, la expulsión intermitente y tardía de los huevos del parasito, así como el difícil acceso a los estudios inmunológicos en las zonas rurales atenta contra la confirmación de parasitosis en casos esporádicos. En la provincia de Matanzas en los últimos años se constataron enfermos sospechosos de fasciolosis procedentes de Pedro Betancourt con diversos síntomas digestivos, fiebre y eosinofilia. Objetivo: caracterizar los aspectos clínicos y epidemiológicos de los pacientes diagnosticados de fasciolosis hepática. Materiales y Método: se realizó un estudio observacional, descriptivo a pacientes hospitalizados con el diagnóstico presuntivo de fasciolosis hepática en el Servicio de Medicina Interna del Hospital Faustino Pérez en el período enero del año 2011 a diciembre del 2013. La recolección de datos se realizó a través del interrogatorio, examen físico, Historia clínica y encuestas epidemiológicas. Resultados: se muestra la presencia de consumo de plantas acuáticas y consumo de agua sin hervir en los afectados. La fase aguda de la enfermedad en estos pacientes se caracterizó por fiebre, dolor abdominal, hepatomegalia y gran eosinofilia. Conclusiones: el diagnóstico de certeza se realizó a través de pruebas inmunológicas. Esto se debe a que a pesar de los múltiples exámenes parasitológicos de las heces fecales no se identificó huevos. Los pacientes del estudio fueron tratados con el triclabendazol y se logró mejoría clínica de los pacientes y pocas reacciones adversas (AU).

SUMMARY Introduction: the hepatic fasciolosis is a parasitic disease of difficult prognosis. The varied and multiple symptoms characterizing the disease, the intermittent and late ejection of the parasite eggs, and also the difficult access to immunological studies in the country areas sometimes attempts against the confirmation of parasitism. During the last years, in the province of Matanzas, several sick persons from Pedro Betancourt were suspicious of fasciolosis with different digestive symptoms, fever and eosinophilia. Objective: to characterize the clinical and epidemiological aspects of the patients diagnosed of hepatic fasciolosis. Materials and method: an observational, descriptive study was performed in in-patients of the Service of Internal Medicine of the Hospital Faustino Perez with the presumptive diagnosis of hepatic fascilosis in the period January 2011-December 2013. Data collection was made through questioning, physical examination, clinical record and epidemiological inquiries. Results: risk behaviors are evidenced given the water plants and un-boiled water consumption in affected persons. The acute `hase in these individuals is characterized by fever, abdominal pain, hepatomegaly and big eosinophilia. The diagnosis of certainty was made by immunologic tests. The patients were treated with triclabendazol with clinical improvement and little adverse reactions. Conclusions: health professionals when assisting a patient from a country area with eating habits of fresh vegetable consumption and suggestive clinical characteristics should carry out studies to confirm Fasciola hepatica infection (AU).

Case Report: Subarachnoid Hemorrhage and Eosinophilic Meningitis due to Disseminated Fascioliasis.

Human infection with the trematode Fasciola occurs with a worldwide prevalence of up to 17 million. Sheep and cattle are the normal host. Infection typically results in hepatobiliary disease, but extrahepatic manifestations are occasionally reported. Here, we present the case of a previously healthy 31-year-old Kurdish woman, admitted to hospital with a subarachnoid hemorrhage, eosinophilic meningitis, and lung and liver disease. A diagnosis of Fasciola infection was made based on strongly positive serology in blood and cerebrospinal fluid. The patient improved following treatment with triclabendazole and prednisolone.

Co-infection of cattle with Fasciola hepatica or F. gigantica and Mycobacterium bovis: A systematic review.

The liver flukes, Fasciola hepatica and F. gigantica, are common trematode parasites of livestock. F. hepatica is known to modulate the immune response, including altering the response to co-infecting pathogens. Bovine tuberculosis (bTB), caused by Mycobacterium bovis, is a chronic disease which is difficult to control and is of both animal welfare and public health concern. Previous research has suggested that infection with liver fluke may affect the accuracy of the bTB skin test, but direction of the effect differs between studies. In a systematic review of the literature, all experimental and observational studies concerning co-infection with these two pathogens were sought. Data were extracted on the association between fluke infection and four measures of bTB diagnosis or pathology, namely, the bTB skin test, interferon γ test, lesion detection and culture/bacterial recovery. Of a large body of literature dating from 1950 to 2019, only thirteen studies met the inclusion criteria. These included studies of experimentally infected calves, case control studies on adult cows, cross sectional abattoir studies and a herd level study. All the studies had a medium or high risk of bias. The balance of evidence from the 13 studies included in the review suggests that liver fluke exposure was associated with either no effect or a decreased response to all of the four aspects of bTB diagnosis assessed: skin test, IFN γ, lesion detection and mycobacteria cultured or recovered. Most studies showed a small and/or non-significant effect so the clinical and practical importance of the observed effect is likely to be modest, although it could be more significant in particular groups of animals, such as dairy cattle.

Fascioliasis: A challenging differential diagnosis for radiologists.

We report a case of a 39 year old male who presented with nausea and right upper quadrant pain. Marked eosinophilia and a hypoechoic liver lesion on ultrasound were identified. The differential diagnosis included neoplasms, infectious diseases and hepatic abscess. Indirect hemagglutination test using purified adult Fasciola hepatica f1Ag confirmed serologic diagnosis of fascioliasis. Radiologists should keep in mind the importance of correlating imaging, clinical and laboratory findings in order to reach the correct diagnosis.

Absceso hepático gigante por Fasciola hepatica / A giant liver abscess due to Fasciola hepatica infection

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A giant liver abscess due to Fasciola hepatica infection.

A 60-year-old female patient with a 3-month history of upper right quadrant pain, nausea, fluid evacuation, yellowing, weight loss, intolerance to the oral route, liver disease and hepatomegaly without impaired liver function tests Performs diagnosis by CT scan of giant hepatic abscess, which is managed by means of percutaneous drainage and antibiotic, is determined as etiology, infection by hepatic fasciola.

Highlights of human ectopic fascioliasis: a systematic review.

Fascioliasis is a tropical zoonotic disease caused by the Fasciola parasite. The adult parasite usually resides in the liver and biliary ducts; however, several cases of ectopic fascioliasis (EF) have been reported. This study is a highlight on EF according to the confirmed case reports. In a setting of systematic review, we found 25 eligible articles containing 26 confirmed cases of EF (any date until 30 November 2018), including abdominal and intestinal EF in six cases, skin and subcutaneous tissues in five cases, eye in four cases, brain and pancreas in three cases, neck and lymph node in two cases, and lung, dorsal spine, and peritoneal cavity in one case, respectively. The result indicates that fascioliasis can have diverse ectopic forms and should be more attended in the endemic regions of fascioliasis in order to distinguish from other endemic diseases.

An unusual cause of graft loss in pediatric liver transplant recipient-Fasciola hepatica.

Fascioliasis is caused by the trematode liver fluke Fasciola hepatica. Humans are accidental hosts getting infected after ingesting contaminated plants or water. 90 million people in 75 nations are at risk of infection with F hepatica. Immunosuppressed patients are higher risk of acquiring infection and may present with atypical manifestations. Patients can present with hepatic involvement, biliary features or a combination of both. Confirmation of the diagnosis is by demonstration of live parasites or eggs in bile or feces, serology (immunoelectrophoresis, indirect immunofluorescence, indirect hemagglutination), ELISA, typical imaging findings or a combination of any of the above. The drug of choice for treatment is triclabendazole. Fascioliasis should always be considered as a possibility in post-LT patients with findings of hepatobiliary disorder from endemic areas. Unfamiliarity with this infection in non-endemic areas often eludes prompt diagnosis thereby increasing the morbidity. We report the first case of fascioliasis in a pediatric liver transplant recipient leading to graft loss and mortality.

Obstructive jaundice of a parasitic etiology.

We present the case of a patient with colic pain in the epigastrium and right hypochondrium, which was accompanied by choluria and acholia and slightly elevated levels of bilirubin and eosinophilia. Abdominal echography and magnetic resonance imaging identified a biliary obstruction and endoscopic retrograde cholangiopancreatography was used to extract 3 adult worms identified as Fasciola hepatica. This case highlights the need to consider the suspicion of biliary obstruction caused by Fasciola hepatica in the presence of obstructive jaundice, with or without eosinophilia.

Negative serology of Fasciola hepatica infection in patients with liver cancer in Peru: a preliminary report.

INTRODUCTION: The etiology of several hepatocellular carcinoma (HCC) cases remains largely unknown. Although Fasciola hepatica has been associated with liver fibrosis in Latin America, it has not yet been associated with HCC. This study aimed to determine the existence of specific IgG antibodies against F. hepatica in the serum samples of HCC patients. METHODS: In total, 13 serum samples from 13 HCC patients were screened using Fas2-ELISA. RESULTS: Fas2-ELISA demonstrated negative results in all HCC patients included in this study. CONCLUSIONS: The pre-existence of F. hepatica infection in HCC patients needs to be further investigated in epidemiological and experimental studies.