Human fascioliasis successfully treated with triclabendazole

Fascioliasis, caused by the common liver fluke Fusciolu hepatica , is an endemic infection in sheep and cattle in many parts of Australia. Infections in humans in Australia have been reported infrequently and the most appropriate therapy for human fascioliasis remains to be determined. This case report describes a patient with the infection unsuccessfully treated with multiple high doses of praziquantel, mebendazole or albendazole. The infection was successfully eliminated by the administration of triclabendazole in two single doses of 900 mg (12 mg/kg) two days apart. No side effects were observed after the treatment. Based on our experience and that recently reported in the literature, triclabendazole may be regarded as the drug of choice for the treatment of human fascioliasis. (Aust NZ J Med 1992; 22: 45–47.)     

Human fascioliasis caused by F. hepatica

The paper deals with the possibility of invasion and parasitizing of Fasciola hepatica in man. Data of observations and references are presented.     

Human fascioliasis: cure by mebendazole? A case report

We report a case of invasive human Fasciola hepatica infection in which, for the first time, a successful treatment with high doses of mebendazole (4 g/day for 3 weeks) was achieved. This therapy resulted in a prompt and prolonged normalization of eosinophil counts, liver enzymes abnormalities and specific serological tests together with the disappearance of liver necrosis indicating the eradication of liver flukes. The efficacy of mebendazole in the treatment of fascioliasis must be confirmed by further studies.     

Asymptomatic fascioliasis

A 72-year-old Japanese man displayed asymptomatic eosinophilia for 4 months. Computed tomography showed multiple space-occupying lesions in the liver. Zoonotic liver flukes were suspected based on occupational exposure to cattle, serological and radiological findings. Immunological examination was helpful in diagnosing the disease and laparoscopy was crucial in confirming Fasciola hepatica and excluding the possibility of malignant hepatic tumors. Human fascioliasis was finally diagnosed and praziquantel administered. Blood eosinophilia resolved within 4 months and liver tumors almost disappeared within 12 months. From our experience, laparoscopy with liver biopsy is very important for diagnosing human fascioliasis, particularly for asymptomatic fascioliasis.     

Human fascioliasis in Egypt: effect of infection and efficacy of bithionol treatment

The present study was conducted on 14 patients with established fascioliasis. The effect of infection on the haematological and biochemical parameters was determined and the liver and gall bladder were studied by ultrasonography. Bithionol was given in the dose of 30 mg kg-1 body weight every other day for 5 doses. The therapeutic efficacy was assessed by egg and eosinophilic counts and quantitative estimation of antibody titres by indirect haemagglutination test. Results revealed that fascioliasis caused normocytic hypochromic anaemia and eosinophilia. Serum bilirubin, ALT and AST were within normal range. Ultrasonography showed a normal echogenic pattern of the liver and gall bladder. One case showed thickness of the gall bladder wall which was tender under the transiducer. Fasciola eggs disappeared completely after the 5th dose giving a cure rate of 100%. Antibody titres reached a normal level at the end of the 3rd month post treatment. Bithionol proved to be a potent fasciolicidal drug with minimal side-effects.     

MR findings in human fascioliasis

Fasciola hepatica is a trematode of herbivorous mammals, and man is infected by accidental ingestion of contaminated raw aquatic vegetables or water. There have been many reports on computed tomographic and cholangiographic features of human fascioliasis. However, findings of magnetic resonance (MR) imaging have not been reported.
Hepatic fascioliasis produces three types of lesions in MR images arranged in tract‐like fashion. The outermost area presents as an iso‐signal area in T1WI, with slightly higher signal intensity in T2WI and diffuse enhancement after i.v. contrast. The second type presents as a well defined low signal area in T1WI, not enhanced, and also shows low signal intensity in T2WI. The third type has low signal intensity in T1WI, is not enhanced, and has high signal intensity in T2WI which is similar to fluid‐containing inflammatory lesions such as pyogenic abscess.
These findings suggest various changes associated with traumatic hepatitis caused by the migration of the worm in the liver. This diverse signal intensity can be a suggestive finding of fascioliasis.     

CT findings in human fascioliasis

Three patients with fascioliasis are presented in whom CT demonstrated abscesses and granulomas and permitted control of the disease's evolution after medical treatment.     

IgE production in rat fascioliasis

F. hepatica infection of rats caused a prolonged elevation of serum total IgE reflecting the continued presence of live worms in the host. Infection with 40 metacercariae stimulated higher total IgE levels than infection with 20 metacercariae. The parasite specific IgE response was biphasic, the first peak coinciding with the migratory phase in the liver parenchyma and the second with the establishment of flukes in the bile ducts.