Hepatic fluke: symptoms, treatment, diagnosis

Hemophagus hepatic is a parasitic worm belonging to the class of digenetic flukes (trematodes). Infection is possible when using infected freshwater fish in raw or poorly cooked form. The parasite can live on water plants, for example on some types of watercress, also used for food. After entering the gastrointestinal tract, the flukes are moved from the intestine to the bile ducts of the liver, where they begin to grow. Infection can occur completely asymptomatic, but often hepatic fluke causes disorders of the biliary system, which includes the bile ducts of the liver and the gallbladder. Although in developed countries infection with this worm (fascioliasis) is rare, the fact remains: the disease is periodically diagnosed, and mainly among people who traveled to regions where such parasites are most common.

What is fascioliasis?

Initially, the disease was known only to veterinarians, and a dangerous worm named Fasciola hepatica hit mainly cattle in South Africa. Cows, goats and sheep were carriers of adult flukes, laying eggs in the water. The eggs hatched worms, which are in the juvenile stage of development. Young hepatic hepatitis infected certain types of slugs living in water bodies, and grew, gradually moving to plants (for example, watercress), where it was eaten together with greens by domestic animals grazing in the area. Worms gnawed the intestinal walls and remained in the liver, where they reached adult forms of development and began to lay eggs. Human fascioliasis is the same cycle, only in the human body.

Infection

Hepatic fluke (see photo in the article) presents a danger for those who eat raw or poorly fried (undercooked) freshwater fish, as well as raw plants on the leaves of which live parasites. Among such plants are the watercress, wild mint, dandelions, pistachia and some other representatives of the flora growing in the water or along the banks of water bodies and used to make fresh salads. In rare cases, a person can catch an infection due to the use of contaminated water.

Simple rinsing of edible leaves with water does not protect against parasitic larvae, but they die during cooking and washing plants with 6% acetic acid or potassium permanganate.

Infection by eating meat of infected animals is impossible.

Symptoms

If a person has picked up such a parasite as a hepatic fluke, the symptoms of infection may be completely absent. However, in most cases, patients note unusual signs of pathology within a month after eating exotic dishes containing water plants or raw fish. At this stage of the disease, the symptoms are primarily associated with the process of penetration of the worm into the liver. The movement of the scapula can be accompanied by an increase in body temperature, itching, abdominal pain, skin rash and even coughing. Once the worm reaches the adult stage of development in the liver, the signs of pathology become similar to those of the obstruction of the bile duct. Pain in the abdomen is more associated with pain caused by stones in the gallbladder. Jaundice appears, and the bile ducts become more vulnerable to infection - cholangitis. Almost always there is weakness, lethargy, loss of appetite, weight loss.

An adult liver fluke can live in the human liver for twelve years, but even after the death of the parasite, the symptomatology is likely to persist due to damage to the bile duct. The lethal outcome of the disease is extremely rare.

Diagnostics

At an early stage of the disease with fascioliasis, the immune system of the human body responds to infection by changing the number of white blood cells - eosinophilia, which makes it possible to prescribe a presumptive diagnosis. Ultrasound examination, like scanning internal organs using computed tomography (CT), allows you to track the pathways of worm movement within the liver. Even if the parasite has already settled on a specific area of the bile ducts, intestinal and liver damage will still be visible on ultrasound. In addition, if a hepatic fluke is suspected, the feces of the worm are found in the feces. There are also specific studies aimed at testing the response of the immune system to the presence of a parasite, but not all clinics can afford such an expensive diagnosis.

Treatment

Get rid of the parasite is simple enough - you need to take a single dose of a drug called "Triclabendazole." Unfortunately, it is not available for purchase in the countries of South Africa, where locals and tourists most often turn to physicians with complaints about the characteristic symptoms of fascioliasis, but with the confirmation of the diagnosis it is possible to arrange individual delivery of the medicine. Specialists also recommend keeping bed rest and sticking to a diet rich in animal and vegetable proteins. You may need to take vitamins and iron supplements in addition.

In advanced cases, when severe fascioliasis and active adult hepatic fluke are diagnosed, the treatment can consist in performing a surgical operation to remove the harmful parasite by the method of endoscopic retrograde cholangiopancreatography.

Prevention

• Withstand water plants in a 6% solution of acetic acid or potassium permanganate for 5-10 minutes.
• Vegetables growing in water should be carefully boiled before consumption.
• Keep an eye on the cleanliness of the areas on which edible plants grow; Do not allow them to be contaminated with sewage.
• Treat sheep and cattle if the veterinarian diagnosed fascioliasis. A single dose of "Triclabendazole" is also used for the treatment of animals.

Currently, scientists are working to create a vaccine against fascioliasis.