Dicroceliasis

Infectious diseases

Clinicals - History

Fact Explanation
Abdominal discomfort Dicroceliasis is caused by a trematode called Dicrocoelium dendriticum, the lanceolate fluke. The infection occurs as a result of accidental oral ingestion of ants infected with metacercaria. After ingestion, the metacercariae encysted in the duodenum. Some adults reside in the duodenum and many ascend the biliary tract through the ampulla of Vater. Presence and attachment to the biliary and intestinal mucosa causes an abdominal discomfort or pain in the upper quadrant or the epigastrium. As the parasite is longer and slender, it travels way up more distal parts of the bile ducts. In heavier infections bile ducts and the biliary epithelium may become enlarged which is followed by fibrosis around the ducts. Hence, the abdominal discomfort may be attributed to enlargement of the liver in such instances. Abdominal discomfort
Dicroceliasis is caused by a trematode called Dicrocoelium dendriticum, the lanceolate fluke. The infection occurs as a result of accidental oral ingestion of ants infected with metacercaria. After ingestion, the metacercariae encysted in the duodenum. Some adults reside in the duodenum and many ascend the biliary tract through the ampulla of Vater. Presence and attachment to the biliary and intestinal mucosa causes an abdominal discomfort or pain in the upper quadrant or the epigastrium. As the parasite is longer and slender, it travels way up more distal parts of the bile ducts. In heavier infections bile ducts and the biliary epithelium may become enlarged which is followed by fibrosis around the ducts. Hence, the abdominal discomfort may be attributed to enlargement of the liver in such instances.
Diarrhea Watery diarrhea may also develop in some cases. It is usually mild and owing to the localized inflammatory reaction of the intestinal mucosa. Diarrhea is relapsing in some patients. Diarrhea
Watery diarrhea may also develop in some cases. It is usually mild and owing to the localized inflammatory reaction of the intestinal mucosa. Diarrhea is relapsing in some patients.
Jaundice This is attributed to the mechanical obstruction of the proximal parts of the biliary tree. But such obstructions are very rare as the parasite can migrate and resides in more distal parts owing to its slender body. Jaundice
This is attributed to the mechanical obstruction of the proximal parts of the biliary tree. But such obstructions are very rare as the parasite can migrate and resides in more distal parts owing to its slender body.
Complications Rarely in heavy infections, patients may get liver abscesses, cholecystitis and very rarely cirrhosis. Complications
Rarely in heavy infections, patients may get liver abscesses, cholecystitis and very rarely cirrhosis.
At risk population Dicroceliasis is more common in regions such as Europe, northern Asia, America and northern Africa. The parasite tends to be found in areas that favor the intermediate hosts (snails and sheep), such as fields with dry, chalky and alkaline soils. At risk population
Dicroceliasis is more common in regions such as Europe, northern Asia, America and northern Africa. The parasite tends to be found in areas that favor the intermediate hosts (snails and sheep), such as fields with dry, chalky and alkaline soils.

Clinicals - Examination

Fact Explanation
Abdominal tenderness Tender hepatomegaly is caused by mechanical obstruction of bile ducts in severe infections. Heavy parasite load cause in severe and lasting inflammation around the intrahepatic biliary duct. This results in tender enlargement of the liver. Abdominal tenderness
Tender hepatomegaly is caused by mechanical obstruction of bile ducts in severe infections. Heavy parasite load cause in severe and lasting inflammation around the intrahepatic biliary duct. This results in tender enlargement of the liver.

Investigations - Diagnosis

Fact Explanation
Full blood count Acute phase is characterized by high degree of eosinophilia. Leukocytosis may occur. Full blood count
Acute phase is characterized by high degree of eosinophilia. Leukocytosis may occur.
Liver function tests Gamma-glutamyl transpeptidase, ALT, alkaline phosphatase may be high in severe disease. Liver function tests
Gamma-glutamyl transpeptidase, ALT, alkaline phosphatase may be high in severe disease.
Microscopic examination Microscopic demonstration of eggs in the stool or in duodenal aspirate is the most practical diagnostic method. Eggs of Dicrocoelium dendriticum are operculated and measure 35-45 µm long by 20-30 µm wide. The eggs are thick-shelled and usually dark brown in color. Eggs are fully embryonated when shed in feces. Microscopic examination
Microscopic demonstration of eggs in the stool or in duodenal aspirate is the most practical diagnostic method. Eggs of Dicrocoelium dendriticum are operculated and measure 35-45 µm long by 20-30 µm wide. The eggs are thick-shelled and usually dark brown in color. Eggs are fully embryonated when shed in feces.

Management - Supportive

Fact Explanation
Prevention Condemnation of contaminated livers of hosts like cows, pigs and sheep eliminates any possibility of food-borne infection. Prevention
Condemnation of contaminated livers of hosts like cows, pigs and sheep eliminates any possibility of food-borne infection.

Management - Specific

Fact Explanation
Praziquantel Praziquantel as a single dose (25 mg/kg or less) is the current treatment of choice. Frequently occurring side effects are dizziness, headache, and malaise. Approximately 90% of all patients have abdominal pain or cramps with or without nausea and vomiting.
Praziquantel is not approved for treatment of children less than 4 years old. Niclosamide is used in such instances.
Praziquantel
Praziquantel as a single dose (25 mg/kg or less) is the current treatment of choice. Frequently occurring side effects are dizziness, headache, and malaise. Approximately 90% of all patients have abdominal pain or cramps with or without nausea and vomiting.
Praziquantel is not approved for treatment of children less than 4 years old. Niclosamide is used in such instances.

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