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Fascioliasis, Liver fluke, Eosinophilic liver abscess, Parasitic infestration, Treatment
Fascioliasis is infection by liver flukes, Fasciola spp. The two species that infect humans are Fasciola hepatica and Fasciola gigantica. Other herbivorous animals such as cattle, goats, water buffalo, horses, camels, hogs, rabbits, and deer can be infected with Fasciola spp. Humans acquire Fasciola after ingestion of food and water that are contaminated with Fasciola metacercaria, especially aquatic plants. Fascioliasis is usually mild disease in human. Clinical manifestrations are related with the the phases of infection. In migratory phase, symptoms may occur when metacercariae excyst in the duodenum and young liver flukes migrate through the intestinal wall to the liver capsule and hepatic parenchyma before reaching the bile ducts. Clinical symptoms include abdominal pain in the right hypochondrium, dyspepsia and anorexia, nausea, vomiting, and hepatomegaly. Systemic manifestration such as urticaria and eosinophilia are also common presentation. After Fasciola reside in the biliary tract, most of cases are asymptomatic. Biliary track obstruction can accidentally occur and might lead to cholangitis. Triclabendazole 10 mg/kg as a single dose is the current drug of choice for fascioliasis treatment and triclabendazole two doses of 10 mg/kg for 1 day is effective in severe or persistent infections, with cure rates of 79% and 92%, respectively. Currently, there is no vaccine for prevent Fasciola infection. Proper cooking or cleaning food especially aquatic plants before consumption will prevent accidental Fasciola infection. Adequate mass treatment among infected animals in endemic areas and proper sanitary in the livestock farm are important for disease control.
Figure 1 ภาพถ่ายตัวเต็มวัยพยาธิ Fasciola hepatica (Linnaeus, 1758) (A) และ Fasciola gigantica (Cobbold, 1855) (B)
(ได้รับการอนุเคราะห์ภาพจาก รศ.ดร.อุรุษา แทนขำ ภาควิชาปรสิตหนอนพยาธิ คณะเวชศาสตร์เขตร้อน มหาวิทยาลัยมหิดล)