Fascioliasis as cause of hepatomegaly and eosinophilia in Egyptian children: a clinical and laboratory study

ABSTRACT

Fifty five children clinically suspected to have fascioliasis were classified according to clinical examination and absolute eosinophilic count into 3 groups; Group [I] 17 cases with hepatomegaly and eosinophilia Group [II] 18 cases with hepatomegaly. Group [Ill] 20 cases with eosinophilia. Group [IV] consisted of 20 apparently healthy children as control. All patients and controls were subjected to repeated stool analysis by both direct smear and formol ether concentration method[FEC] and sera were examined by indirect haemagglutination test [IHA] for fascioliasis. Erythrocytic sedimentation rate [ESR in mm/hr] and haemoglobin [Hb in gm/dl] were also estimated. Results showed that first stool examination was positive for Fasciola eggs in 6 cases only. Other 3 cases showed positive stool analysis for fascioliasis after follow up for 4, 6 and 7 wks respectively. These 3 cases were showing persistently highly positive titres by IHA before the appearance of eggs. So, by interpretation of results of stool analysis and lHA, fascioliasis was proved in 9 cases out of 55 [incidence of 16.4%]. Clinical examination of the 9 fascioliasis cases showed hepatomegaly in 7 cases, splenomegaly in3 cases, fever in 7 cases, nausea and vomiting in 7 cases, diarrhea in 6 cases, right hypochondrial pain in 6 cases and jaundice in 5 cases. Eosinophilia was found in 7 cases. It was concluded that fascioliasis should be considered in differential diagnosis of children with eosinophilia and hepatomegaly [incidence of 29.4%]. Presence of either hepatomegaly or eosinophilia perse is also a guide to search tor fascioliasis [incidences of 11.1% and 10% respectively]. Repeated stool analysis using FEC for a period up to 3 months, at least, in clinically suspected stool negative fascioliasis children and application of IHA for fascioliasis in the period prior to appearance of eggs in stools are highly recommended