Fasciola hepatica: Difference between revisions
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==Background== | ==Background== | ||
* [[Parasite]]: ''Fasciola hepatica'' | *[[Parasite]]: ''Fasciola hepatica'' | ||
* "Liver fluke" or "Sheep liver fluke" | *"Liver fluke" or "Sheep liver fluke" | ||
* Eggs in stool of infected mammals (sheep/cattle) → snail → aquatic vegetation → human | *Eggs in stool of infected mammals (sheep/cattle) → snail → aquatic vegetation → human | ||
* Infected by eating raw watercress or water plants contaminated by immature larvae | *Infected by eating raw watercress or water plants contaminated by immature larvae | ||
* Immature larvae migrate from intestine → abdominal cavity → liver → bile duct (mature adult) | *Immature larvae migrate from intestine → abdominal cavity → liver → bile duct (mature adult) | ||
==Clinical Features== | ==Clinical Features== | ||
* [[Nausea]], [[vomiting]], [[abdominal pain]]/tenderness, [[hepatomegaly]] | *[[Nausea]], [[vomiting]], [[abdominal pain]]/tenderness, [[hepatomegaly]] | ||
* [[Fever]], [[rash]], [[SOB]] | *[[Fever]], [[rash]], [[SOB]] | ||
* Marked peripheral [[eosinophilia]] | *Marked peripheral [[eosinophilia]] | ||
* Liver hematoma | *Liver hematoma | ||
* Chronic: Inflammation and obstruction of liver, gallbladder, pancreas | *Chronic: Inflammation and obstruction of liver, gallbladder, pancreas | ||
** [[Biliary colic]], [[cholangitis]], [[cholelithiasis]], obstructive [[jaundice]] | **[[Biliary colic]], [[cholangitis]], [[cholelithiasis]], obstructive [[jaundice]] | ||
* Ectopic fascioliasis: Erythematous itchy nodules | *Ectopic fascioliasis: Erythematous itchy nodules | ||
* Pharyngeal fascioliasis: pharyngitis with edema, congestion, suffocation | *Pharyngeal fascioliasis: pharyngitis with edema, congestion, suffocation | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* [[Amebiasis]], [[larva migrans]], [[cysticercosis]], [[ascariasis]], [[hepatitis]], [[parasitic infection]] | *[[Amebiasis]], [[larva migrans]], [[cysticercosis]], [[ascariasis]], [[hepatitis]], [[parasitic infection]] | ||
* Biliary atresia, [[cholecystitis]], [[cholelithiasis]], cholestasis | *Biliary atresia, [[cholecystitis]], [[cholelithiasis]], cholestasis | ||
{{Helminth Types}} | {{Helminth Types}} | ||
==Diagnosis== | ==Diagnosis== | ||
* CBC: Leukocytosis, anemia, eosinophilia | *CBC: Leukocytosis, anemia, eosinophilia | ||
* Elevated ESR and LFT | *Elevated ESR and LFT | ||
* Stool ova and parasites, culture | *Stool ova and parasites, culture | ||
* Microscopy | *Microscopy | ||
* Endoscopy or surgery, biopsy | *Endoscopy or surgery, biopsy | ||
* Serology (ELISA), PCR | *Serology (ELISA), PCR | ||
* CT abdomen, US, ERCP, cholangiography, MRI | *CT abdomen, US, ERCP, cholangiography, MRI | ||
==Management== | ==Management== | ||
* [[Triclabendazole]] (10mg/kg PO x 1-2 days) | *[[Triclabendazole]] (10mg/kg PO x 1-2 days) | ||
* Alternative: Bithionol and nitazoxnide | *Alternative: Bithionol and nitazoxnide | ||
* ID and GI consult | *ID and GI consult | ||
* Possible surgery consult | *Possible surgery consult | ||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
* http://www.cdc.gov/parasites/fasciola/gen_info/index.html | *http://www.cdc.gov/parasites/fasciola/gen_info/index.html | ||
* Leder K, et al. Liver flukes: Fascioliasis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 24, 2014. | *Leder K, et al. Liver flukes: Fascioliasis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 24, 2014. | ||
* Tolan RW, et al. (2013, Apr 12). Fascioliasis. eMedicine. Retrieved 12/24/2014 from http://emedicine.medscape.com/article/997890-overview | *Tolan RW, et al. (2013, Apr 12). Fascioliasis. eMedicine. Retrieved 12/24/2014 from http://emedicine.medscape.com/article/997890-overview | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Tropical Medicine]] | [[Category:Tropical Medicine]] | ||
Revision as of 07:33, 5 July 2016
Background
- Parasite: Fasciola hepatica
- "Liver fluke" or "Sheep liver fluke"
- Eggs in stool of infected mammals (sheep/cattle) → snail → aquatic vegetation → human
- Infected by eating raw watercress or water plants contaminated by immature larvae
- Immature larvae migrate from intestine → abdominal cavity → liver → bile duct (mature adult)
Clinical Features
- Nausea, vomiting, abdominal pain/tenderness, hepatomegaly
- Fever, rash, SOB
- Marked peripheral eosinophilia
- Liver hematoma
- Chronic: Inflammation and obstruction of liver, gallbladder, pancreas
- Biliary colic, cholangitis, cholelithiasis, obstructive jaundice
- Ectopic fascioliasis: Erythematous itchy nodules
- Pharyngeal fascioliasis: pharyngitis with edema, congestion, suffocation
Differential Diagnosis
- Amebiasis, larva migrans, cysticercosis, ascariasis, hepatitis, parasitic infection
- Biliary atresia, cholecystitis, cholelithiasis, cholestasis
Helminth infections
Cestodes (Tapeworms)
- Taenia saginata
- Taenia solium (Cysticercosis)
- Diphyllobothrium latum
- Hymenolepis nana
- Echinococcus granulosus
Trematodes (Flukes)
- Fasciola hepatica
- Fasciolopsis buski
- Opistorchis viverrini
- Schistosoma spp
- Chlonorchis sinensis
- Paragonimus spp.
Nematodes (Roundworms)
- Ascaris lumbricoides
- Enterobius vermicularis (Pinworm)
- Filarial worms
- Hookworm
- Necator americanus
- Ancylostoma duodenale
- Cutaneous larva migrans (Ancylostoma braziliense)
- Dracunculiasis
- Strongyloides stercoralis
- Trichuris trichiura (Whipworm)
- Anisakis
- Toxocara spp.
- Trichinosis
Diagnosis
- CBC: Leukocytosis, anemia, eosinophilia
- Elevated ESR and LFT
- Stool ova and parasites, culture
- Microscopy
- Endoscopy or surgery, biopsy
- Serology (ELISA), PCR
- CT abdomen, US, ERCP, cholangiography, MRI
Management
- Triclabendazole (10mg/kg PO x 1-2 days)
- Alternative: Bithionol and nitazoxnide
- ID and GI consult
- Possible surgery consult
See Also
References
- http://www.cdc.gov/parasites/fasciola/gen_info/index.html
- Leder K, et al. Liver flukes: Fascioliasis. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2014. www.uptodate.com. Accessed December 24, 2014.
- Tolan RW, et al. (2013, Apr 12). Fascioliasis. eMedicine. Retrieved 12/24/2014 from http://emedicine.medscape.com/article/997890-overview