Ectopic Fascioliasis Research Articles

Extra-hepatic fascioliasis with peritoneal malignancy tumor feature

Fascioliasis is a zoonose parasitic disease caused by Fasciola hepatica and Fasciola gigantica and is widespread in most regions of the world. Ectopic fascioliasis usually caused by juvenile Fasciola spp., but in recent years a few cases of tissue-embedded ova have been reported from different endemic areas. A 79-year-old Iranian man resident in Eird-e-Mousa village from Ardabil Province, north-west of Iran, complained with abdominal pain, nausea, and intestinal obstruction symptoms referred to Ardabil Fatemi hospital. In laparotomy multiple intestinal masses with peritoneal seeding resembling of a malignant lesion were seen. After appendectomy and peritoneal mass biopsy with numerous intraperitoneal adenopathy, paraffin embedded blocks were prepared from each tissues. A blood sample was taken from the patient 5months later for serological diagnosis. Histopathological examination of sections showed fibrofatty stroma with dense mixed inflammatory cells infiltration and fibrosis in peritoneal masses. Large numbers of ova of Fasciola spp. were noted with typical circumscribed granulomas. Despite of anti-fasciola treatment, IHA test for detecting anti F. hepatica antibodies was positive 5months after surgery with a titer of 1/128. Due to multiple clinical manifestation of extra-hepatic fascioliasis, its differential diagnosis from intraperitoneal tumors or other similar diseases should be considered.

A case of ectopic intraabdominal fascioliasis presented with acute abdomen

Human fascioliasis with Fasciola species occurs worldwide and is most common among rural people who tend sheep and eat uncooked water vegetables, particularly watercress. The natural history of the acute phase begins with ingestion of metacercariae encysted on various kinds of aquatic vegetation such as watercress. Fascioliasis primarily involves the liver, bile ducts, gallbladder, and occasionally ectopic sites. We describe herein a case of ectopic fascioliasis. This uncommon form of disease was peritonitis; both visceral and parietal peritoneal layers were affected with the formation of multiple nodules and ascites.

A case of ectopic fascioliasis in the skin

A four-year-old boy presented to the hospital with a four-month history of recurrent bouts of fever and abdominal pain. Half a month before being admitted to hospital, multiple red cutaneous nodules had emerged at the left epigastric region and a dark red serpentine track appeared under the skin at the same site. The day after the patient was admitted to the hospital, a living worm broke through the skin and appeared at one end of the subcutaneous track. The flatworm was identified as Fasciola hepatica in its juvenile stage. Eosinophilia was distinct in our patient and provides an important clue to diagnosing parasitosis.

A 6-Year-Old Boy with Facial Swelling and Monocular Blindness

Diagnosis: Ocular fascioliasis. The shape of the organism, including the cephalic cone, was consistent with Fasciola hepatica (figure 1). FAST-ELISA [1] demonstrated the presence of antibodies to excretory-secretory antigens, and Western blot demonstrated fasciola excretorysecretory antigens. It is likely that the complete paralysis of extraocular movements was the result of retro-orbital tension on nerves and muscles, attributable to inflammation and/or a possible postsurgical arteriovenous fistula. Over the ensuing months, the left cornea become calcified. Triclabendazole was administered at a dose of 10 mg per kg of body weight, and the patient experienced no adverse events. The liver fluke Fasciola hepatica is endemic in many temperate countries, and it primarily infects the biliary tract of sheep and other ruminants. Humans may be an accidental host, and ectopic disease may occur when immature flukes migrate to sites other than the biliary tree. Fascioliasis results from the ingestion of metacercaria encysted on aquatic vegetation, such as watercress. Following encystment in the duodenum, immature flukes usually migrate across the intestinal wall to the liver over a period of 5-6 weeks, with eggs appearing in the feces by ~4 months. This unusual case represents one possible manifestation of ectopic fascioliasis. Other ectopic sites include subcutaneous tissues, he CNS, lung, stomach, and cecum and epididymis. Morphologically, adult flukes are described as leaf-shaped, with a cephalic cone, and are approximately 1.5 x 3 cm in area. In this case, we considered infections with other large migrating helminths, such as Gnathostoma spinigerum, Paragonimus westermanii, and Spirometra mansoni, but the morphology and epid miology were most suggestive of fascioliasis, and this diagnosis was confirmed by the detection of F. hepatica-specific antibodies.

Multiple brain hemorrhages and hematomas associated with ectopic fascioliasis in brain and eye

Background Fascioliasis is a parasitic infection caused by Fasciola hepatica. Human beings can be infected accidentally by an ingestion of the metacercariae; and the parasite exists almost persistently in the bile ducts, but rarely in other organs. We report an interesting case of ectopic fascioliasis in both the brain and the right eye of a school-aged boy, which was associated with 2 unruptured intracranial aneurysms. To our knowledge, no case report such as this has been found in the medical literature. Case Description After an ingestion of Potamon denticulata (a fresh crab) for 4 months, a 10-year-old boy presented with neurologic manifestations caused by 5 episodes of intracranial hemorrhages and hematomas. The boy simultaneously suffered repeated affliction in the right eye accompanied by headache, vomiting, ophthalmalgia, exophthalmos, and abducens nerve palsy. Digital subtraction angiography revealed 2 unruptured intracranial aneurysms. The definitive diagnosis of this case had been confirmed by an observation of the parasite moving out of the patient's swelling conjunctiva and by the results of the laboratory tests. The patient was treated with praziquantel and completely recovered. The 2 aneurysms were not surgically treated but underwent a long-term follow-up. The follow-up DSA revealed that one aneurysm disappeared but the other remained unchanged. Conclusions Multiple brain hemorrhages and hematomas can be associated with ectopic fascioliasis in brain and eyes. An intracranial infection occasionally caused by F hepatica or other parasites can be indicated by a fever of unknown origin, eosinophilia, and iterative intracranial hemorrhages. Ingestion of P denticulata may be an uncommon transmission route of fascioliasis. Fascioliasis can be successfully treated.

An Unusual Case of Biliary Colic…Itʼs Not Always a Stone!

Case: We describe a case of a 67 year old woman visiting from Mexico who presented to the ER with epigastric pain, nausea and vomiting for 3 days. Physical exam revealed an overweight afebrile woman with stable vitals. She was jaundiced and had mild epigastric tenderness. Labs revealed WBC 15.4, TB 5, BD 2.3, ALP 321, GGT 846, AST 529, ALT 430 and lipase 200. Eosinophil count was normal.Viral serology for Hep A, B and C were negative. CT abdomen showed a dilated CBD to 11 mm and Cholelithiasis. Patient underwent an ERCP which confirmed the dilated CBD and cholelithiasis. There was a small filling defect in the right hepatic duct.Biliary sphincterotomy and balloon sweeps of the CBD and CHD was performed. The balloon sweeps resulted in extraction of two adult worms, which were later identified by the CDC as Fasciola hepatica. Discussion: Human fascioliasis is a huge public health concern worldwide.Clinical presentations are typically are of 3 types −1) An acute/Liver phase lasts about 6 weeks and typically presents with fever, hepatomegaly, and eosinophilia. 2) Chronic/biliary phase, which is usually asymptomatic but may present with biliary colic, cholangitis, cholelithiasis and obstructive jaundice.3) Ectopic Fascioliasis. Methods of diagnosis include identification of ova and parasite in stool studies, duodenal aspirates, bile specimens. Serological diagnostic tests are also available. CT scan may show dense nodules, tracts, subcapsular hematoma, thickened capsule, parenchymal calcifications. Treatment with antiparasitic agents is effective with high cure rates.Due to increasing migration of people from endemic areas, we should expect to see more such cases in the USA.

Indirect evidence of ectopic pancreatic fascioliasis in a human

Fascioliasis is not common in humans and, furthermore, its ectopic migration into the pancreas is extremely rare. A definitive diagnosis of ectopic fascioliasis is based on the demonstration of flukes in the affected organ. If the flukes invade the parenchyma, however, imaging studies are limited in the detection of worms and surgical identification is required. We encountered a clinical case of probable ectopic pancreatic fascioliasis diagnosed through indirect evidence. A 46-year-old Korean woman was admitted with left upper quadrant pain. She had taken praziquantel for hepatic fascioliasis, which had been diagnosed at another hospital, and then developed abdominal pain. Peripheral eosinophilia, hyperamylasemia and hyperlipasemia were documented. Abdominal computed tomography (CT) revealed multiple, hypodense foci which had coalesced, forming irregular nodules in the medial and lateral segments of the left lobe of the liver, and similar 2- to 3-cm sized, hypodense lesions in the body and isthmus of the pancreas. IgG antibody against Fasciola hepatica was positive. Bithionol was given orally, and the patient's symptoms and biochemistry then improved, with reversal of eosinophilia. Radiological studies showed normalization of the liver and pancreas at the 10th week, and the serology for Fasciola hepatica was negative at the fifth month.

Human ectopic fascioliasis in Australia: first case reports

To describe the manifestations of two cases of migratory ectopic fascioliasis diagnosed in Australia, including the first report of lymphatic infection. Both patients presented with acute, superficial swellings. In the first, a 46-year-old woman, the lump was found to be a cervical lymph node containing a mature Fasciola hepatica which had released eggs into surrounding tissues. The second patient was a 34-year-old male abattoir worker, in whom the subcutaneous lesion resembled an infected sebaceous cyst and contained an immature fluke. Both lesions were resected and diagnosed histologically. Fasciola eggs were not found in the faeces of either patient. Blood eosinophilia was not detected in either case. A serological test for fascioliasis was carried out in the second case and the result was positive. In both cases, infection was probably acquired in Australia, although neither patient had eaten watercress. Neither patient was specifically treated with anthelminthic agents, and neither suffered further complications. Migratory fascioliasis occurs in Australia. It can present as superficial or deep focal lesions, not necessarily in association with peripheral blood eosinophilia or Fasciola eggs in faeces. Serological tests may be helpful in diagnosing such cases.

A Human Case Of Ectopic Fascioliasis In Korea.

A case of ectopic fascioliasis involving cecum and ascending colon was reported. This case was a 19-year old Korean female who had a history of postprandial aggravation of intermittent abdominal pain of 3 weeks duration. She was presented with an abdominal mass in the right upper quadrant, for which an operation(right hemicolectomy) was performed. Whole cecum and ascending colon showed multifocal tunnel-like necrotizing granulmas with central cavitations. Numerous Charcot-Leyden crystals were seen along tracts of the worm. The lesion was distributed throughout the entire thickness of the wall. Parasitological examination confirmed the worm found in the intestinal wall to be juvenile form of Fasciola species. Possibilities were discussed on the localization of the fluke and the mode of infection of present case.

Fatal Ectopic Fascioliasis in a Guinea Pig Breeding Colony from Malacca

Fatal Ectopic Fascioliasis in a Guinea Pig Breeding Colony from Malacca

THE ZOONOSIS OF ANIMAL PARASITES IN IRAQ. X. A CONFIRMED CASE OF HUMAN ECTOPIC FASCIOLIASIS.

SummaryThe first confirmed case of ectopic human fascioliasis in Iraq is reported. Based on morphological characteristics, the fluke recovered was identified as an immature specimen of Fasciola gigantica. The source of infection is believed to have resulted either from the consumption of certain raw vegetables or from contaminated water containing the metacercarial stage of the parasite.