Fascioliasis B66.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Fasciolosis; Giant liver fluke infection; Infection by large liver flukes; Sheep Sail Infection

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de Brie, 1379; Leukart, 1882; Thomas, 1883

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Trematode infection. Common zoonosis in cattle, sheep and other herbivores. Sporadic infections of humans after consumption of edible aquatic plants such as watercress, rarely also of water containing metazercaria.

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  • Fasciola hepatica (sheep liver fluke): hermaphroditic, leaf-shaped fluke, 2-4 cm long and about 1 cm wide. The surface is covered with numerous tegumentary spines; head, mouth and abdominal suckers can be found.
  • Fasciola gigantica (giant liver fluke): like Fasciola hepatica, but larger up to 7.5 cm and narrower.

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  • About 2.5 million people worldwide are infected (WHO), mainly in areas with appropriate dietary habits: in the Nile Delta, Peru, Cuba, France, Middle East, other European countries such as Germany, Austria, Switzerland, as well as in Central and South America, Africa and Asia.
  • Fasciola gigantica: Gambia, Vietnam, Laos, Iraq, Uzbekistan, Hawaii.

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  • The adults live predominantly in the bile ducts and produce eggs there, which are then excreted through the intestines with the stool; after a 1-2 week maturation, mirazidia hatch from the eggs, which penetrate the intermediate host snails of the genus Lymnaeidae. There the mirazidia mature into cercaria, which are then disintegrated and leave the snail. On grasses, the metacercaria can persist for a long time and be taken up by the final host. There the larvae excrete in the duodenum, penetrate the intestinal wall, enter the liver capsule via the abdominal cavity and migrate into the bile ducts where they mature into adults.
  • Preparation time until egg excretion: 3-4 months.
  • Life span of adults in cattle and sheep: 3-5 years.

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Liver parenchyma, bile ducts and gallbladder; ectopic localizations such as nasal pharynx.

Clinical features
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  • Integument: Icterus and occasionally urticaria attacks. In the foreground are the extracutaneous manifestations.
  • Extracutaneous manifestations:
    • Acute stage: often asymptomatic; in many larvae: after incubation period of 2-6 weeks fever, right-sided and epigastric upper abdominal pain, nausea, vomiting, enlarged, pressure-tolerated liver, right basal lung infiltrates.
    • Chonic stage: after variable interval of days, months to years after infection chronic or intermittent inflammation and obstruction of the bile ducts with persistent or colicky pain, fever, nausea, vomiting and icteric episodes.

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Leukocytosis; eosinophilia, liver enzyme and cholestasis parameter increase.

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  • Detection in faeces, bile and punctates (eggs 130-160 x 60-90 µm, light brown, lid, still immature when deposited); often detection is only possible after enrichment procedures, preferably by sedimentation of larger amounts of faeces. Bile extraction after stimulation with magnesium sulphate or cholecystokinin. Enterotest, eggs are hardly distinguishable from those of the intestinal fluke Fasciolopsis buski.
  • Accidental presence of faeces: exclude consumption of infected liver of slaughtered animals.
  • ELISA: Cross-reactions with antigens from other trematodes are possible.
  • Imaging: sonography; in CT: multiple hypodense areas, dilatation and thickening of the bile ducts; further PTC, ERCP, laparascopy.

Differential diagnosis
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Clonorchiasis; opisthorchiasis; bilharzia (schistosomiasis); echinococcosis; viral hepatitis; cholelithiasis; tumours.

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  • Bacterial secondary infections of the bile ducts
  • Liver abscesses
  • Aberrant migration of individual leeches to ectopic localizations.

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  • Triclabendazole: Single dose 10 mg/kg bw/day postprandial.
  • Alternatively biothionol (lorothidol, bitin [available from international pharmacies]): 30-50 mg/kg bw/day in 3 doses every other day, alternating with a day without treatment. 5-15 treatment days.
  • In asymptomatic cases: wait for spontaneous release (within 12 months after infection).

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Good, except for extremely severe infections and serious complications. Spontaneous healing is possible due to mostly premature expulsion or death of the adults, some of which calcify.

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  • For wet sheep and cattle pasture: avoid watercress, stalks of riparian plants and fallen fruit.
  • Chemical and biological slug control measures, e.g. keeping ducks, lowering the groundwater level.

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  1. Arauco R et al (2007) Human fascioliasis: a case of hyperinfection and an update for clinicians. Foodborne Pathog Dis 4: 305-312
  2. Barduagni P, Hassanein Y et al (2007) Use of triclabendazole for treatment of patients co-infected by Fasciola spp. and S. mansonii in Behera Governorate, Egypt. Parasitol Res
  3. Haswell-Elkins MR, Levri E (2003) Food-borne Trematodes. In: Cook GC, Zumla A Manson's Tropical diseases. WB Saunders, 21st Edition, pp. 1474-1478


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020