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 | ||
==Workup== | ==Workup== | ||
* CBC: Leukocytosis, anemia, eosinophilia | * CBC: Leukocytosis, anemia, eosinophilia | ||
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* 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== | |||
*[[Parasitic diseases]] | |||
==Sources== | ==Sources== | ||
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* 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:TropMed]] | |||
Revision as of 03:44, 28 December 2014
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
Workup
- 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
Sources
- 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