A Case of Fascioliasis in the Intrahepatic Duct with Concurrent Clonochiasis / 대한소화기학회지

The main causes of biliary obstruction are stones and cancers. Fascioliasis is a very rare case which causes biliary obstruction. Fascioliasis is a zoonosis caused by Fasciola hepatica which infects herbivores like sheep and cattle. F. hepatica lives in the biliary system or the liver parenchyma of a host. In Korea, the occurrence of this infection in human is very rare and only few cases have been reported. A 32-year-old male presented with upper abdominal pain and jaundice. His laboratory finding revealed elevated liver transaminases. Abdomen CT scan showed mild left intrahepatic bile duct dilatation. On ERCP, adult F. hepatica worms were found and were thus removed. Concurrently, clonorchiasis was diagnosed by stool exam and serologic enzyme-linked immunosorbent assay test. Clonorchiasis was treated with praziquantel. Herein, we report a case of intrahepatic bile duct dilatation due to F. hepatica infection with concurrent Clonorchis sinensis infestation.

Morphological and Molecular Characterization of Lymnaeid Snails and Their Potential Role in Transmission of Fasciola spp. in Vietnam

Freshwater snails of the family Lymnaeidae play an important role in the transmission of fascioliasis worldwide. In Vietnam, 2 common lymnaeid species, Lymnaea swinhoei and Lymnaea viridis, can be recognized on the basis of morphology, and a third species, Lymnaea sp., is known to exist. Recent studies have raised controversy about their role in transmission of Fasciola spp. because of confusion in identification of the snail hosts. The aim of this study is, therefore, to clarify the identities of lymnaeid snails in Vietnam by a combination of morphological and molecular approaches. The molecular analyses using the second internal transcribed spacer (ITS2) of the nuclear ribosomal DNA clearly showed that lymnaeids in Vietnam include 3 species, Austropeplea viridis (morphologically identified as L. viridis), Radix auricularia (morphologically identified as L. swinhoei) and Radix rubiginosa (morphologically identified as Lymnaea sp.). R. rubiginosa is a new record for Vietnam. Among them, only A. viridis was found to be infected with Fasciola spp. These results provide a new insight into lymnaeid snails in Vietnam. Identification of lymnaeid snails in Vietnam and their role in the liver fluke transmission should be further investigated.

A Case of Biliary Fascioliasis by Fasciola gigantica in Turkey

A case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37- year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.

Fascioliasis among animal, snail and human hosts in Kafr El-Sheikh governorate with special reference to species infecting humans

The present study was aimed at determining the source and species of Fasciola that infect human donkeys in Kafr El-Sheikh Governorate in the West of the Nile Delta in Egypt, and to determine which snail species act as intermediate hosts for Fasciola infection in this area. The study recorded the presence of Fasciola infection in 3 native breed local non-imported hosts other than man in 6 climaticly selected sites in Kafr-El-Sheikh Governorate, Egypt. A percentage of 14.5%, 26.6%, 12.28% and 6.02 from the examined buffaloes, sheep, donkeys and human respectively sharing incontamination of the neuter around the present human by different Fasciola eggs. The incidence was high in summer and autumn than the other seasons and it was higher in Sedi Salem and Motobus than the other study sites. Examination of 100 eggs from each host showed egg size can not be used as a main criteria in differentiation between F. hepatica and gigantca. Fasciola eggs of different size were extracted from gall bladder of some slaughtered cases in which the flukes detected in the liver were identified as F. gigantica only. Upon dissection of 1972 L. caillaudi, 268 L. alexandrina, 502 Bulinus species, 11316 B. alexandrina, 1398 Cleopatra species, 8520 Physa acuta, 420 Melania tuberculata, 2132 Vivipara [Bellamya] unicolar, 144 Neritina nilotica and 1570 Planorbis philippi, Fasciola parthenitae were not detected in snails other than L. Caillaudi [the known IMH of Fasciola in Egypt]. The fact proved that there is no accomodation was occurred in any of the surrounding snail to transmit Fasciola to animal or man. The present study showed that Fasciola of human and donkeys in the study sites was Fasciola gigantica not F. hepatica, this appear in its tendency to develop in L. caillaudi not in L. truncatula snails with successive radial generation as that described previously for F. gigantica. Moreover early mature fluke extracted from laboratory infected rabbits by the produced encysted metacercariae had the characteristic features described previously for F. gigantica

Human fascioliasis: prevalence and early detection in Seiger, Tanta city, Gharbia governorate

The study of the prevalence of fascioliasis in Egypt is critical for the effective prevention of this disease. The study was carried out in Seiger, a district of Tanta City. Gharbia Governorate. A random sample of 943 [39.44%] of 2391 total population of school children aged 6-15 years was examined for parasitic infection, out of them 332 [35.2%] were suffering from parasitic infection. Of the 943 school children 26 [2.75%] cases were positive for Fasciola gigantica. It was diagnosed by repeated stool analysis in 15 cases, but 26 cases were diagnosed by serologic immunodiffusion test, denoting the importance of serodiagnosis in survey studies for fascioliasis and early detection of infection before excretion of Fasciola ova in patients' stools. The cases of fascioliasis were significantly related to environmental conditions and human dietary habits of using stagnant water canal in washing raw vegetables, the presence of Lymnaea cailliaudi snails, rearing Fasciola infected sheep and cows in houses and the presence of animal shelters nearby the source of water. The clinical findings among cases of fascioliasis were; gastrointestinal symptoms [dyspepsia. anorexia, diarrhea and vomiting] in all cases, right upper quadrant abdominal pain in 92.30% of cases, headache and dizziness in 46.15%, fever in 53.85% and enlarged liver was found in 26.92% of cases. The significant laboratory findings among cases of fascioliasis were low mean blood Hb [7 19 +/- 2.01 mg/dl], high mean W.B.C. count [18.418 +/- 5.529/c.mm]. high mean blood Hb [7.19 +/- 2.01 mg/dl], high mean W.B.C. count [18.418 +/- 5.529/c.mm], high mean blood eosinophilic count [38.33%+24.64] and highly positive immunodiffusion test. These data reflect the role of clinical examination and laboratory investigation of routine school health care in early detection of fascioliasis and orienting the responsible health personnel regarding this. Also, the role of health education to prevent filthy habits under certain risky environmental conditions for fascioliasis. Regarding the treatment of Fasciola gigantica, results showed that, praziquantel in a dose of 75 mg/kg/day for 10 days was effective in 86.71% of treated cases, but praziquantel in the same dose plus metronidazole 50 mg/kg/day for 21 days was effective in the treatment of all studied cases of fascioliasis