Fascioliasis is a parasitic invasion caused by a hepatic or giant fluke and characterized by a primary lesion of the hepatobiliary system.
Fasciolosis (fasciolosis) is helminthiasis of the trematodoz group. It affects mainly the hepatobiliary system. The causative agent of this disease, fasciola, is detected and described by Malpighi in 1698.
Etiology of fascioliasis
In puberty, fascioli parasitize humans and cattle (bile ducts and gall bladder, very rarely lungs and other organs). Helminth eggs are excreted in the feces of infested people and animals. When eggs get into the water, after 4-6 weeks miracid larvae, penetrating into mollusks, are developed. The tailed larva-cercariae leaves the mollusk and is encapsulated. Such a larva (adolescariae) in the body of people and animals is ingested with drinking water and by eating herbs growing in stagnant waters.
Pathogenesis of fascioliasis
The main thing in the pathogenesis of fascioliasis is sensitization of the body by the products of helminth metabolism, which further leads to allergic reactions. In the early phase of fascioliasis, microabscesses and micronecrosis form the liver parenchyma, and later – adenomatous growth of the epithelium of the bile ducts and purulent cholangitis.
The incubation period lasts 1-8 weeks. The disease begins with an increase in body temperature, sometimes up to 39 ° C, which can be debilitating, undulating and hectic. During the examination of the patient subicteric sclera attracts attention. Patients complain of pain in the right hypochondrium and epigastrium, nausea, and sometimes vomiting. The liver, especially its left lobe (pathognomonic symptom of Kryukov) is enlarged, dense, painful on palpation. An enlarged liver progresses and is accompanied by severe pain. After an attack of pain, the size of the liver quickly return to normal. Sometimes the spleen is enlarged. In the blood, there is observed leukocytosis from 20,000 to 50,000, eosinophils – up to 4,000 in 1 mm3 of blood. Acute symptoms gradually subside when fasciolosis enters a chronic stage. It is mainly observed dyspeptic phenomena and moderate abdominal pain. Often the pain becomes paroxysmal in the type of biliary colic, the gallbladder increases. The duration of the attack of pain lasts from several hours to a week.
Diagnosis of fascioliasis
It is difficult to diagnose fasciolosis in the early phase, since the parasite starts laying eggs only after 3-4 months after ingestion. Allergic reactions are more significant in the diagnostic plan, in the late phase – symptoms of cholangitis, dyskinesia of the gallbladder and hepatitis. The epidemiological anamnesis and specific reactions of precipitation and complement fixation contribute significantly to the diagnosis. Fascioliasis with opisthorchiasis and trichinosis, during which fever and eosinophilia are also observed, are differentiated. For the diagnosis of trichinosis, a muscle biopsy is performed to detect microscopic parasites in them. In opisthorchiasis, helminth eggs are found in duodenal contents and feces after only 1 month after infection. It is possible to exclude the diagnosis of trichinosis and opisthorchiasis and confirm the diagnosis of fascioliasis only through careful laboratory research.
Treatment of fascioliasis
Surgical intervention is indicated only during surgical complications of fascioliasis – destructive cholecystitis and abscesses of the liver, requiring urgent surgical intervention. When fasciols enter the abdominal cavity, peritonitis may occur. If fasciols exit the lungs, spontaneous pneumothorax is possible. Migrating fasciola carry fiber caused by fascioli. All these complications also require urgent surgical intervention.