Ectopic fascioliasis mimicking a colon tumor

Fasciola hepatica, a leaf shaped trematode that is common in cattle, sheep and goats, is acquired by eating raw water plants like watercress or drinking water infected with the encysted form of the parasite. The varied clinical presentations of fascioliasis still make a high index of suspicion mandatory. Besides having a wide spectrum of hepatobiliary symptoms like obstructive jaundice, cholangitis and liver cirrhosis, the parasitic infection also has extrabiliary manifestations. Until recently, extrahepatic fascioliasis has been reported in the subcutaneous tissue, brain, lungs, epididymis, inguinal lymph nodes, stomach and the cecum. In this report, a strange manifestation of the fasciola infection in a site other than the liver, a colonic fascioliasis, is presented.     

片形吸虫病11例临床分析

目的 总结片形吸虫病的临床资料,为片形吸虫病的防治积累临床经验。方法 回顾性分析11例片形吸虫病病例的流行病学特点、实验室资料、临床特征和治疗方案。结果 11例片形吸虫病患者均来自宾川县州城镇,有家庭聚集现象,以农民为主,青年女性多见。患者均有发热、肝区疼痛、肝大,ALT和AST轻度升高,ALP和GGT明显升高,嗜酸性粒细胞增多,红细胞沉降率增快,CRP和免疫球蛋白升高。10例血象高,9例有不同程度的贫血,骨髓培养和血培养阴性,甲、乙、丙、丁、戊型肝炎病原学阴性,CT/磁共振成像均提示肝实质内散在多发低密度影,肝占位性病变,AFP及癌胚抗原正常。给予三氯苯达唑驱虫治疗,同时保肝、对症支持治疗,疗效显著。结论 要重视片形吸虫病在大理州宾川县的流行,诊断时要关注流行病学史。该病预防的关键是加强健康宣教,提高居民食品卫生意识,加强牲畜的治疗和放牧管理,防止粪便污染,改善椎实螺孳生环境。     

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.     

Seroprevalence of fascioliasis in the eastern region of Turkey: an eight-year investigation

Background/AimsFascioliasis is a zoonotic disease and one of the most neglected infectious diseases in humans. Its prevalence has been increasing significantly during the last decades. This study aimed to investigate the prevalence of fascioliasis using direct microscopy and indirect hemagglutination (IHA) technique in a region in Eastern Anatolia of Turkey.Material and MethodsThis study was conducted on the serum samples obtained from 817 patients (372 male and 445 female) between 2011 and 2018, who were suspected to have fascioliasis. IHA was used to investigate anti-Fasciola hepatica antibodies in the serum samples. Stool specimens were obtained from the seropositive patients and were examined with the native-Lugol method to identify the parasites.ResultsIt was determined that 5.5% (45/817) of all the patients were F. hepatica seropositive and 6.4% (52/817) were borderline positive. Positivity was 5.7% (21/372) among males and 5.4% (24/445) among females, and the difference in the infection rates between these groups was not significant (p=0.913). The highest number of patients who applied to the clinic was in the “45 and over” age group (317 patients); 270 patients were in the 25–44 age group. A maximum positivity of 10.3% was observed in the 7–14 age group.ConclusionPreviously, fascioliasis was considered a rare infection in humans; however, it has emerged as an important public health problem in the world. Considering fascioliasis in patients with clinical symptoms, not only with direct observation but also using serological methods, would be effective in early diagnosis and treatment of the disease.     

The Northern Bolivian Altiplano: a region highly endemic for human fascioliasis.

The worldwide importance of human infection by Fasciola hepatica has been recognized in recent years. The endemic region between Lake Titicaca and the valley of La Paz, Bolivia, at 3800-4100 m altitude, presents the highest prevalences and intensities recorded. Large geographical studies involving Lymnaea truncatula snails (malacological, physico-chemical, and botanic studies of 59, 28 and 30 water bodies, respectively, inhabited by lymnaeids; environmental mean temperature studies covering a 40-year period), livestock (5491 cattle) and human coprological surveys (2723 subjects, 2521 of whom were school children) were conducted during 1991-97 to establish the boundaries and distributional characteristics of this endemic Northern Altiplano region. The endemic area covers part of the Los Andes, Ingavi, Omasuyos and Murillo provinces of the La Paz Department. The human endemic zone is stable, isolated and apparently fixed in its present outline, the boundaries being marked by geographical, climatic and soil-water chemical characteristics. The parasite distribution is irregular in the endemic area, the transmission foci being patchily distributed and linked to the presence of appropriate water bodies. Prevalences in school children are related to snail population distribution and extent. Altiplanic lymnaeids mainly inhabit permanent water bodies, which enables parasite transmission during the whole year. A confluence of several factors mitigates the negative effects of the high altitude.     

High fascioliasis infection in children linked to a man-made irrigation zone in Peru

We detected 10 protozoan and nine helminth species in surveys of 338 5-15 year-old Quechua schoolchildren in three communities of the Asillo zone of the Puno region, located at a very high altitude of 3910 m in the Peruvian Altiplano. The area proved to be hyperendemic for human fascioliasis with a 24.3% overall mean prevalence of Fasciola hepatica, local prevalences ranging between 18.8 and 31.3%, and infection intensities of up to 2496 eggs per gram of faeces (epg), with 196-350 epg (mean: 279 epg) and 96-152 epg (123 epg) as arithmetic and geometric means, respectively. Prevalences did not significantly vary between schools and in relation to sex. No statistical differences were found in intensities between schools, nor according to sex or age groups between and within schools, although the highest overall egg counts were detected in girls and in the youngest age group. Asillo zone is a man-made irrigation area built only recently to which both liver fluke and lymnaeid snails have quickly adapted. The region appears to be isolated from the Northern Bolivian Altiplano natural endemic area. Such man-made water resources in high altitude areas of Andean countries pose a high fascioliasis risk. Significant positive association of F. hepatica with protozooses following a one host life cycle, such as Giardia intestinalis, suggests that human infection mainly occurs through drinking water. This is supported by additional evidence such as the absence of typical aquatic vegetation in the drainage channels inhabited by lymnaeid snails, the absence of aquatic vegetables in the traditional nutrition habits of the Quechua inhabitants, and the lack of potable water systems inside dwellings, which requires inhabitants to obtain water from irrigation canals and drainage channels.     

A population-based coprological study of human fascioliasis in a hyperendemic area of the Bolivian Altiplano

Summary The community of Chijipata Alta, at an altitude of 3850 m, near the southern coast of Lake Titicaca in the Northern Altiplano of Bolivia, was surveyed for human fascioliasis. The global prevalence (66.7%) and intensity (eggs per gram of faeces - epg: range: 24–4440; arithmetic mean: 1001; geometric mean: 390) proved to be the highest known in the world by means of coprological techniques. These results suggest the existence of highly hyperendemic subzones among the large human fascioliasis-endemic zone of the Bolivian Northern Altiplano. Despite the decrease in prevalence and intensity from children (75.0%, 24–4440 epg) to adults (41.7%, 144–864 epg), our findings show that in an hyperendemic zone adult subjects either maintain the parasites acquired when young or are newly infected as the consequence of inhabiting a zone of high infection risk.     

Assessing the validity of an ELISA test for the serological diagnosis of human fascioliasis in different epidemiological situations

Objectives To improve the diagnosis of human fascioliasis caused by Fasciola hepatica and Fasciola gigantica, we evaluated the diagnostic accuracy of an enzyme‐linked immunosorbent assay (ELISA), with Fasciola antigen from the adult liver fluke, for the detection of IgG against fascioliasis in human sera. Methods The sera of 54 fascioliasis cases, originating from three endemic areas, were used in this evaluation: (i) a hyperendemic F. hepatica area where humans usually shed a great number of parasite eggs in faeces (11 sera); (ii) an epidemic F. hepatica area where humans usually shed small amounts of parasite eggs (24 sera) and (iii) an overlap area of both Fasciola species and where human shedding of parasite eggs in faeces is usually scarce or non‐existent (19 sera). One hundred and sixty‐eight patients with other parasitic infections and 89 healthy controls were also analysed. Results The respective sensitivity and specificity of this assay were 95.3% (95% confidence intervals, 82.9–99.2%) and 95.7% (95% confidence intervals, 92.3–97.5%). No correlation between egg output and the OD450 values of the F. hepatica IgG ELISA test was observed. Conclusions This test could be used both as an individual serodiagnostic test for human fascioliasis when backed up by a compatible clinical history together with a second diagnostic technique for other cross‐reactive helminth infections, and in large‐scale epidemiological studies of human fascioliasis worldwide.     

人肝片形吸虫病1例报告

<正>1临床资料患者,女,41岁,因肝区胀痛2个月余入院。2个月前无诱因出现肝区胀痛,伴发热(体温最高38℃),当地医院予抗感染后疼痛症状缓解,体温下降,但此后症状时有反复发作。入院1 d前当地医院腹部CT平扫提示肝左叶低密度灶。转本院,入院时查体:无肝掌、蜘蛛痣,皮肤巩膜无黄染,心肺听诊无异常,腹平软,无压痛及反跳痛,肝脾肋下未及,肝区叩痛阳性,     

The serum antibody response of infected rats, rabbits, lambs and calves to Fasciola hepatica adult antigen fractions separated by preparative flatbed iso-electrofocussing

Electrofocusing of F. hepatica adult antigen in granulated gels separated the material into 22 arbitrary fractions. Polyacrylamide gel analysis demonstrated groups of proteins with similar iso-electric points in 19 of the fractions. A microplate ELISA detected antigens in all 22 fractions and was used to test the serum antibody response in infected rats, rabbits, lambs and calves to these antigen fractions. The results indicated that rat and calf sera gave a much stronger response than rabbit and lamb sera to the antigens which separated above pH 7.0. It is possible that the greater efficiency of the rat and bovine immune systems in combating re-infection with F. hepatica may be related to this response.     

肝片形吸虫病1例

报道1例胆管结石嵌顿患者, 术中发现4条肝片形吸虫。对患者进行了感染源追溯, 该病例可能由于生食或半生 食含有囊蚴的水生植物茭白而感染。     

肝片形吸虫感染宿主细胞免疫的研究进展

肝片形吸虫病是一种危害严重的人兽共患病,肝片形吸虫主要感染反刍动物及包括人类在内的哺乳动物,是一个严重威胁健康、影响经济发展的公共卫生问题。目前治疗肝片形吸虫病的药物少、疗效有限。大量研究表明,肝片形吸虫受宿主免疫应答的调控,本文对肝片形吸虫病的发病机制、肝片形吸虫主要参与诱导的几种机体细胞免疫反应及相关的研究进展进行综述.以期为肝片形吸虫病的临床治疗提供资料。     

Neutralization of the activity of a Fasciola hepatica cathepsin L proteinase by anti-cathepsin L antibodies

Fasciola hepatica secretes a cathepsin L proteinase that is suggested to play an in vivo role in immunoprotection since the enzyme can cleave host immunoglobulin. In the present report, rabbit anti-cathepsin L IgG was shown to bind to the cathepsin L enzyme and inhibit its ability to cleave IgG molecules. Cathepsin L can prevent the antibody-mediated attachment of eosinophils to newly excysted juveniles in in vitro assays; however, if anti-cathepsin L IgG are mixed with the cathepsin L prior to the addition of the enzyme to the assay, eosinophils attach to the newly excysted juveniles. Thus it is possible to prepare antibodies that can bind and disrupt the biological activity of the F. hepatica cathepsin L.     

云南省片形吸虫和片形吸虫病研究进展

片形吸虫病是一种人兽共患寄生虫病,严重危害人类生命健康、阻碍社会经济发展.片形吸虫主要感染牛、羊等反刍动物,但近年来随着诊断水平的提升,人体片形吸虫感染病例报道有所增多.云南省人体片形吸虫病多年来主要以散在病例发生,并出现过暴发流行,已引起高度关注.本文主要就云南省片形吸虫虫种分布和片形吸虫病研究状况进行综述.     

Does Fasciola hepatica infection modify the response of acute hepatitis C virus infection to IFN-α treatment?

Immunologic response to acute hepatitis C is mainly a Th1 response, whereas fasciolopsiasis is associated with a diverse T-cell response. Interferon-alpha has immunomodulatory effects and enhances Th1 immune response. Fasciola infection could theoretically interfere with the Th1 immune response, even when acquired after an initial response to interferon-alpha treatment for acute hepatitis C virus (HCV) infection. We report here the case of a male patient who acquired Fasciola hepatica infection after an initial response to IFN-alpha therapy with a favorable outcome     

Evolution of Fascioliasis after Eating Wild Watercress

Abstract: Evolution of fascioliasis after eating wild watercress. J. Croese, G. Chapman and N. D. Gallagher. Aust. HZ. J. Med., 1982, 12 , pp. 525–527.
Fascioliasis is rarely reported in humans although it is endemic in sheep and cattle. We describe the illness of a 60-year-old widow who ate wild watercress which is the usual source of infestation. Laparotomy for suspected liver abscesses revealed necrotic tracts on the surface of the liver left by the invasion of numerous flukes. Diagnosis was made during the latent phase by the detection of serum antibody to fasciola hepatica antigen obtained from a sheep. Symptoms returned during the cholestatic phase. Mature flukes were then present in the large bile ducts and ova appeared in the stools. Symptoms resolved twelve weeks after presentation.     

A study of the antigens produced by adult Fasciola hepatica maintained in vitro

Summary Metabolic antigen of adult Fasciola hepatica was prepared by concentrating the culture medium in which 100 adult flukes had been maintained in vitro for 7 days. Serological reactions between this antigen and sera from fluke-infected rabbits, rats and sheep were studied using immunodiffusion in agar and enzyme linked immunosorbent assay. The used medium contained a number of antigenic components and their various reactions with the sera from these different hosts were investigated.     

Passive protection against fasciolosis in mice by immunization with a monoclonal antibody (ES-78 MoAb)

Recently, we reported a partial characterization of the epitope recognized by the ES-78 monoclonal antibody (MoAb). This monoclonal antibody was obtained from spleen lymphocytes of a mouse immunized with excretory-secretory antigens of Fasciola hepatica adult worms. In the present study, we report the results obtained in experiments of passive protection using this MoAb in BALB/c mice infected with 15 Fasciola hepatica metacercariae. The monoclonal antibody was able to reduce the parasite burden when administered 24 h before challenge but not when delivered 7 days after challenge. The antibody recognition of digestive tract structures in 3-week-old parasites was demonstrated by immune histochemical techniques. The antigens purified by affinity chromatography using this antibody had molecular weights of 14-20, 25-29 and 36-45 kDa and demonstrated proteinase activity similar to cathepsin L. These results suggest that the antigens carrying the epitope recognized by the ES-78 MoAb may be used as target in the protection against fasciolosis.     

Malignant transformation of ectopic pancreatic cells in the duodenal wall

Ectopic pancreas (EP) is the relatively uncommon presence of pancreatic tissue outside the normal location of the pancreas. This condition is usually asymptomatic and rarely complicated by pancreatitis and malignant transformation. A few cases of neoplastic phenomena that developed from EP into the duodenal wall are described in the literature. Herein we report a case of gastric outlet obstruction due to adenocarcinoma arising from EP of the duodenal wall. The patient underwent a Whipple‘s procedure and had...     

两型肝片吸虫同工酶等电点聚焦电泳比较研究

本文以等电点聚焦电泳对两型肝片吸虫过氧化物酶、苹果酸脱氢酶、酯酶同工酶进行了比较研究。结果显示,两型肝片吸虫过氧化物酶同工酶谱有显著性差别,苹果酸脱氢酶及酯酶同工酶谱也出现变异酶带。提示两型肝片吸虫已发生了一定程度的遗传分化。