Hepatic fascioliasis: case report and review

Abdul-Hadi, Salha; Contretas, Rosa; Tombazzi, Claudio; Alvarez, Marta; Melendez, Maribel

doi:10.1590/S0036-46651996000100013

Abstracts

A well documented case of hepatic fascioliasis (HF), successfully treated with triclabendazole, is reported. Predominant clinical manifestations were fever, marked eosinophilia and abdominal pain. Triclabendazole was given as two single oral doses of 10 mg/kg each. Neither side effects nor clinical or parasitological relapses were seen after three months of follow up Based on this experience and few other similar reports in the literature, triclabendazole might be a valid therapeutical alternative in the treatment of human fascioliasis.

Fasciola hepatica; Hepatic fascioliasis; Eosinophilia; Triclabendazole

Os autores relatam um caso bem documentado de fasciolíase hepática (FH) tratado com êxito com triclabendazole. As manifestações clínicas predominantes foram febre, eosinofilia marcante e dor abdominal. Triclabendazole foi dado em duas doses únicas orais de 10 mg/kg cada. Não houve efeitos colaterais, nem recaídas clínicas ou parasitológicas até três meses após tratamento. Baseados nesta experiência e em outros poucos dados revistos na literatura, triclabendazole poderia ser uma alternativa terapêutica válida no tratamento da fasciolíase humana.

CASE REPORT

Hepatic fascioliasis: case report and review

Fasciolíase hepática. Relato de um caso e revisão da literatura

Salha Abdul-Hadi^I; Rosa Contretas^I; Claudio Tombazzi^II; Marta Alvarez^II; Maribel Melendez^II

^IInstitute of Tropical Medicine, Universidad Central de Venezuela, Caracas, Venezuela

^IIUniversity Hospital of Caracas, Caracas, Venezuela

^{Correspondence to} Correspondence to: Dra. Salha Abdul-Hadi Sección de Hematología. Instituto de Medicina Tropical Apartado 2109, Caracas 1051, Venezuela

SUMMARY

A well documented case of hepatic fascioliasis (HF), successfully treated with triclabendazole, is reported. Predominant clinical manifestations were fever, marked eosinophilia and abdominal pain. Triclabendazole was given as two single oral doses of 10 mg/kg each. Neither side effects nor clinical or parasitological relapses were seen after three months of follow up

Based on this experience and few other similar reports in the literature, triclabendazole might be a valid therapeutical alternative in the treatment of human fascioliasis.

Keywords:Fasciola hepatica; Hepatic fascioliasis; Eosinophilia; Triclabendazole.

RESUMO

Os autores relatam um caso bem documentado de fasciolíase hepática (FH) tratado com êxito com triclabendazole.

As manifestações clínicas predominantes foram febre, eosinofilia marcante e dor abdominal. Triclabendazole foi dado em duas doses únicas orais de 10 mg/kg cada. Não houve efeitos colaterais, nem recaídas clínicas ou parasitológicas até três meses após tratamento.

Baseados nesta experiência e em outros poucos dados revistos na literatura, triclabendazole poderia ser uma alternativa terapêutica válida no tratamento da fasciolíase humana.

Full text available only in PDF format.

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Recebido para publicação em 23/03/1995.

Aceito para publicação em 05/02/1996.

1. ATIAS, A. - Fascioliasis. In: ATIAS, A. & NEGHME, A., ed. Parasitologia Clínica. 2. ed. Santiago de Chile, Publicaciones Técnicas-Mediterráneo, 1984. p. 300-308.
2. BASSIOUNY, H.K.; SOLIMAN, N.K.; EL-DALY, S.M. & BADR, N.M. - Human fascioliasis in Egypt: effect of infection and efficacy of bithionol treatment. J. trop. Med. Hyg., 94: 333-337, 1991.
3. BENNETT, J.L. & KÖHLER, P. - Fasciola hepatica: action in vitro of triclabendazole on immature and adult stages. Exp. Parasit., 63: 49-57, 1987.
4. BORAY, J.C.; CROWFOOT, P.D.; STRONG, M.B. et al. - Triclabendazole a new drug for the treatment of immature and mature Fasciola hepatica infections in sheep. Vet. Rec., 113: 315-317, 1983.
5. BRITO, E.; OLAZABAL, E.; PEREZ, O. et al. - Fascioliasis humana epidémica, Cuba 1983. III. Indices trematódicos. G.E.N. (Caracas), 41: 58-61, 1987.
6. CHANG, E.C.; CHOI, H.L.; PARK, Y.W. et al. - Sub-cutaneous fascioliasis: a case report. Kor. J. Parasit., 29: 403-405, 1991.
7. CHIRINOS, A.R. - Familia Fasciolidae. Morfología y Biología. Manual práctico de Parasitología veterinaria. Maracaibo, Editorial de la Universidad del Zulia, 1990. v.1. p. 86-93.
8. CONSTANTE, B.M. & FONTOURA, D.S.A. - Fasciolíase, In: VERONESI, R., ed. Doenças infecciosas e parasitárias. Rio de Janeiro. Guanabara Koogan, 1982. p. 962-967.
9. DIAZ, J.; PIŃA, B.; LASTRE, M. et al. - Fascioliasis humana epidérmica, Cuba 1983. VI. Estudio clínico de 40 nińos del Hospital Provincial de Sagua La Grande. G. E. N. (Caracas), 44: 385-388, 1990.
10. DIAZ UNGRIA, C. - Helmintos de Venezuela. Barquisimeto, Centro Experimental de Estudios Superiores. Escuela de Cięncias Veterinarias, Parasitología y Zoología Médica, 1967. p. 6-7.
11. DIAZ UNGRIA, C. - Helmintos endoparásitos de Venezuela. Maracaibo, Facultad de Ciencias Veterinarias. Universidad del Zulia, 1968. p. 7-8.
12. ESPINO, A.M.; MILLAN, J.C. & FINLAY, C.M. - Detection of antibodies and circulating excretory-secretory antigens for assessing cure in patients with fascioliasis. Trans. roy. Soc. trop. Med. Hyg., 86: 649, 1992.
13. FARAG, H.F.; RAGAB, M.; SALEM, A. & SADEK, N. - A short note on praziquantel in human fascioliasis. J. trop. Med. Hyg., 89: 79-80, 1986.
14. FARIA, S.L.S. - Control quimioterapeútico contra Fasciola hepatica en bovinos, en una zona endémica con infestación todo el ańo. Guanare, Universidad Nacional Experimental de Los Llanos Occidentales Ezequiel Zamora UNELLEZ, 1994. p. 1-107.
15. FARID, Z.; TRABOLSI, B.; BOCTOR, F. & HAFEZ, A. - Unsuccessful use of praziquantel to treat acute fascioliasis in children [letter] J. infect. Dis., 154: 920-921, 1986.
16. GONZALEZ, R.; PEREZ, R.; PEREZ, O. et al. - Fascioliasis humana epidémica, Cuba 1983. II. Estudio epidemiológico. G. E. N. (Caracas), 41: 53-57, 1987.
17. HARINASUTA, T.; PUNGPAK, S. & KEYSTONE, J.S. - Trematode infections. Opisthorchiasis, clonorchiasis, fascioliasis, and paragonimiasis. Infect. Dis. clin. N. Amer., 7: 699-716, 1993.
18. HILLYER, G.V. & SOLER DE GALANES, M. - Initial feasibility studies of FAST-ELISA for the immunodiagnosis of fascioliasis. J. Parasit., 77: 362-365, 1991.
19. LAIRD, P.P. & BORAY, J.C. - Human fascioliasis successfully treated with triclabendazole. Aust. N. Z. J. Med, 22: 45-47, 1992.
20. LANG, H.; EGGERS, R. & BIRCHER, J. - Increased systemic availability of albendazole when taken with a fatty meal. Europ. J. Clin. Pharmacol., 34: 315-317, 1988.
21. LOUTAN, L.; BOUVIER, M.; ROJANAWISUT, B. et al. - Single treatment of invasive fascioliasis with triclabendazole. Lancet, 2: 383, 1989.
22. MELERO, M.; RIGOU, R.C.; LLOVERAS, J. & GENNARO, O. - Fascioliasis hepática. Causa infrecuente de síndrome febril prolongado con hipereosinofilia e imágenes hipodensas en la tomografia computadorizada de hígado. Medicina, 51: 244-248, 1991.
23. MORA, P.; GEA, F.; AGUD, J.L. et al. - Hepatic fascioliasis. Resistence to praziquantel treatment and the radiological findings. Rev. esp. Enferm. dig., 82: 197-199, 1992.
24. O'MALLEY, K.E.; SLOAN, T.; JOYCE, P. & BAIRD, A.W. - Type I hypersensitivity reactions intestinal mucosae from rats infected with Fasciola hepatica. Paras. Immunol., 15: 449-453, 1993.
25. PESSÔA, S.B. & VIANNA, M.A. - Trematódeos parasitas do fígado e do pulmăo. In: PESSÔA, S.B. & VIANNA, M.A., ed. Pessôa parasitología médica. Rio de Janeiro, Guanabara Koogan, 1982. p. 425-432.
26. PRICE, T.A.; TUAZON, C.U. & SIMON, G.L. - Fascioliasis: case reports and review. Clin. infect. Dis., 17: 426-430, 1993.
27. RODRIGUEZ, A. & GONZALEZ, H. - Sobre un nuevo caso humano de fascioliasis hepática en Venezuela. Rev. Inst. Nac. Hig., 8: 111-114, 1975.
28. SAPUNAR, J.; LATORRE, R.; GUERRA, M. & DEFILIPPI, C. - Clinical considerations on 2 cases of hepatic fascioliasis. Importance of the imaging examinations Bol. chil. Parasit., 47: 70-76, 1992.
29. SHAHEEN, H.I.; KAMAL, K.A.; FARID, Z. et al. - DOT-enzyme linked immunosorbent assay (DOT-ELISA) for the rapid diagnosis of human fascioliasis. J. Parasit., 75: 549-552, 1989.
30. SHERLOCK, S. - The liver in infections. In: SHERLOCK, S. & DOOLEY, J. ed. Diseases of the liver and biliary system. London, Blackwell Scientific Publications, 1993. p. 471-502.
31. STARK, M.E.; HERRINGTON, D.A.; HYLLYER, G.V. & McGILL, D.B. - An international traveler with fever, abdominal pain, eosinophilia, and a liver lesion (clinical conference) Gastroenterology, 105: 1900-1908, 1993.
32. VERGANI, F. - Datos biológicos experimentales sobre el caracol Limnaea (Galba) cubensis P. 1911. Bol. Inst. vet., 7: 34-55, 1955.
33. WARREN, K.S. - Blood flukes (schistosomes) and liver flukes. In: RODES, J.; BENHAMOU, J.P.; BIRCHER, J.; McINTYRE, N. & RIZZETTO, M., ed. Oxford text book of clinical hepatology. New York, Oxford Medical Publications, 1991. p. 714-739.
34. WESSELY, K.; REISCHIG, H.L.; HEINERMAN, M. & STEMPKA, R. - Human fascioliasis treated with triclabendazole (Fasinex^R) for the first time. Trans. roy. Soc. trop. Med. Hyg., 82: 743-744, 1988.
35. WORLD HEALTH ORGANIZATION - Fascioliasis. Wkly. epidem. Rec, 67: 326-329, 1992.

Correspondence to:

Dra. Salha Abdul-Hadi

Sección de Hematología. Instituto de Medicina Tropical

Apartado 2109, Caracas 1051, Venezuela

Publication Dates

Publication in this collection
22 Sept 2006
Date of issue
Feb 1996

History

Accepted
05 Feb 1996
Received
23 Mar 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ATIAS, A. - Fascioliasis. In: ATIAS, A. & NEGHME, A., ed. Parasitologia Clínica. 2. ed. Santiago de Chile, Publicaciones Técnicas-Mediterráneo, 1984. p. 300-308.

[2] 2. BASSIOUNY, H.K.; SOLIMAN, N.K.; EL-DALY, S.M. & BADR, N.M. - Human fascioliasis in Egypt: effect of infection and efficacy of bithionol treatment. J. trop. Med. Hyg., 94: 333-337, 1991.

[3] 3. BENNETT, J.L. & KÖHLER, P. - Fasciola hepatica: action in vitro of triclabendazole on immature and adult stages. Exp. Parasit., 63: 49-57, 1987.

[4] 4. BORAY, J.C.; CROWFOOT, P.D.; STRONG, M.B. et al. - Triclabendazole a new drug for the treatment of immature and mature Fasciola hepatica infections in sheep. Vet. Rec., 113: 315-317, 1983.

[5] 5. BRITO, E.; OLAZABAL, E.; PEREZ, O. et al. - Fascioliasis humana epidémica, Cuba 1983. III. Indices trematódicos. G.E.N. (Caracas), 41: 58-61, 1987.

[6] 6. CHANG, E.C.; CHOI, H.L.; PARK, Y.W. et al. - Sub-cutaneous fascioliasis: a case report. Kor. J. Parasit., 29: 403-405, 1991.

[7] 7. CHIRINOS, A.R. - Familia Fasciolidae. Morfología y Biología. Manual práctico de Parasitología veterinaria. Maracaibo, Editorial de la Universidad del Zulia, 1990. v.1. p. 86-93.

[8] 8. CONSTANTE, B.M. & FONTOURA, D.S.A. - Fasciolíase, In: VERONESI, R., ed. Doenças infecciosas e parasitárias. Rio de Janeiro. Guanabara Koogan, 1982. p. 962-967.

[9] 9. DIAZ, J.; PIŃA, B.; LASTRE, M. et al. - Fascioliasis humana epidérmica, Cuba 1983. VI. Estudio clínico de 40 nińos del Hospital Provincial de Sagua La Grande. G. E. N. (Caracas), 44: 385-388, 1990.

[10] 10. DIAZ UNGRIA, C. - Helmintos de Venezuela. Barquisimeto, Centro Experimental de Estudios Superiores. Escuela de Cięncias Veterinarias, Parasitología y Zoología Médica, 1967. p. 6-7.

[11] 11. DIAZ UNGRIA, C. - Helmintos endoparásitos de Venezuela. Maracaibo, Facultad de Ciencias Veterinarias. Universidad del Zulia, 1968. p. 7-8.

[12] 12. ESPINO, A.M.; MILLAN, J.C. & FINLAY, C.M. - Detection of antibodies and circulating excretory-secretory antigens for assessing cure in patients with fascioliasis. Trans. roy. Soc. trop. Med. Hyg., 86: 649, 1992.

[13] 13. FARAG, H.F.; RAGAB, M.; SALEM, A. & SADEK, N. - A short note on praziquantel in human fascioliasis. J. trop. Med. Hyg., 89: 79-80, 1986.

[14] 14. FARIA, S.L.S. - Control quimioterapeútico contra Fasciola hepatica en bovinos, en una zona endémica con infestación todo el ańo. Guanare, Universidad Nacional Experimental de Los Llanos Occidentales Ezequiel Zamora UNELLEZ, 1994. p. 1-107.

[15] 15. FARID, Z.; TRABOLSI, B.; BOCTOR, F. & HAFEZ, A. - Unsuccessful use of praziquantel to treat acute fascioliasis in children [letter] J. infect. Dis., 154: 920-921, 1986.

[16] 16. GONZALEZ, R.; PEREZ, R.; PEREZ, O. et al. - Fascioliasis humana epidémica, Cuba 1983. II. Estudio epidemiológico. G. E. N. (Caracas), 41: 53-57, 1987.

[17] 17. HARINASUTA, T.; PUNGPAK, S. & KEYSTONE, J.S. - Trematode infections. Opisthorchiasis, clonorchiasis, fascioliasis, and paragonimiasis. Infect. Dis. clin. N. Amer., 7: 699-716, 1993.

[18] 18. HILLYER, G.V. & SOLER DE GALANES, M. - Initial feasibility studies of FAST-ELISA for the immunodiagnosis of fascioliasis. J. Parasit., 77: 362-365, 1991.

[19] 19. LAIRD, P.P. & BORAY, J.C. - Human fascioliasis successfully treated with triclabendazole. Aust. N. Z. J. Med, 22: 45-47, 1992.

[20] 20. LANG, H.; EGGERS, R. & BIRCHER, J. - Increased systemic availability of albendazole when taken with a fatty meal. Europ. J. Clin. Pharmacol., 34: 315-317, 1988.

[21] 21. LOUTAN, L.; BOUVIER, M.; ROJANAWISUT, B. et al. - Single treatment of invasive fascioliasis with triclabendazole. Lancet, 2: 383, 1989.

[22] 22. MELERO, M.; RIGOU, R.C.; LLOVERAS, J. & GENNARO, O. - Fascioliasis hepática. Causa infrecuente de síndrome febril prolongado con hipereosinofilia e imágenes hipodensas en la tomografia computadorizada de hígado. Medicina, 51: 244-248, 1991.

[23] 23. MORA, P.; GEA, F.; AGUD, J.L. et al. - Hepatic fascioliasis. Resistence to praziquantel treatment and the radiological findings. Rev. esp. Enferm. dig., 82: 197-199, 1992.

[24] 24. O'MALLEY, K.E.; SLOAN, T.; JOYCE, P. & BAIRD, A.W. - Type I hypersensitivity reactions intestinal mucosae from rats infected with Fasciola hepatica. Paras. Immunol., 15: 449-453, 1993.

[25] 25. PESSÔA, S.B. & VIANNA, M.A. - Trematódeos parasitas do fígado e do pulmăo. In: PESSÔA, S.B. & VIANNA, M.A., ed. Pessôa parasitología médica. Rio de Janeiro, Guanabara Koogan, 1982. p. 425-432.

[26] 26. PRICE, T.A.; TUAZON, C.U. & SIMON, G.L. - Fascioliasis: case reports and review. Clin. infect. Dis., 17: 426-430, 1993.

[27] 27. RODRIGUEZ, A. & GONZALEZ, H. - Sobre un nuevo caso humano de fascioliasis hepática en Venezuela. Rev. Inst. Nac. Hig., 8: 111-114, 1975.

[28] 28. SAPUNAR, J.; LATORRE, R.; GUERRA, M. & DEFILIPPI, C. - Clinical considerations on 2 cases of hepatic fascioliasis. Importance of the imaging examinations Bol. chil. Parasit., 47: 70-76, 1992.

[29] 29. SHAHEEN, H.I.; KAMAL, K.A.; FARID, Z. et al. - DOT-enzyme linked immunosorbent assay (DOT-ELISA) for the rapid diagnosis of human fascioliasis. J. Parasit., 75: 549-552, 1989.

[30] 30. SHERLOCK, S. - The liver in infections. In: SHERLOCK, S. & DOOLEY, J. ed. Diseases of the liver and biliary system. London, Blackwell Scientific Publications, 1993. p. 471-502.

[31] 31. STARK, M.E.; HERRINGTON, D.A.; HYLLYER, G.V. & McGILL, D.B. - An international traveler with fever, abdominal pain, eosinophilia, and a liver lesion (clinical conference) Gastroenterology, 105: 1900-1908, 1993.

[32] 32. VERGANI, F. - Datos biológicos experimentales sobre el caracol Limnaea (Galba) cubensis P. 1911. Bol. Inst. vet., 7: 34-55, 1955.

[33] 33. WARREN, K.S. - Blood flukes (schistosomes) and liver flukes. In: RODES, J.; BENHAMOU, J.P.; BIRCHER, J.; McINTYRE, N. & RIZZETTO, M., ed. Oxford text book of clinical hepatology. New York, Oxford Medical Publications, 1991. p. 714-739.

[34] 34. WESSELY, K.; REISCHIG, H.L.; HEINERMAN, M. & STEMPKA, R. - Human fascioliasis treated with triclabendazole (Fasinex^R) for the first time. Trans. roy. Soc. trop. Med. Hyg., 82: 743-744, 1988.

[35] 35. WORLD HEALTH ORGANIZATION - Fascioliasis. Wkly. epidem. Rec, 67: 326-329, 1992.

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