Fasciolopsiasis

Infectious diseases

Clinicals - History

Fact Explanation
Diarrhea Fasciolopsiasis is caused by the trematoda called Fasciolopsis buski or the "Intestinal fluke". It is Found naturally in pigs, humans and dogs.
The parasite infects an amphibious snail after being released by infected feces. Metacercaria released from the snails encyst on the fruits and roots of water plants such as water caltrop, water chestnut and lotus. These cysts will be ingested along with the edible water plants which are eaten raw by pigs and humans. The adult parasite normally develops and inhabits the duodenal and jejunal mucosa. Clinical features are related to the parasitic load. Most infections are mild and asymptomatic. Heavy infection causes extensive intestinal and duodenal erosion, ulceration, haemorrhage, abscess and catarrhal inflammation as the adult parasites attach to intestinal mucosa using their ventral suckers. These pathologies cause insidious onset diarrhea. These are usually watery in nature. Diarrhea may be alternating with constipation and hunger pangs.
Malabsorption may lead to steatorrhea as well.
Diarrhea
Fasciolopsiasis is caused by the trematoda called Fasciolopsis buski or the "Intestinal fluke". It is Found naturally in pigs, humans and dogs.
The parasite infects an amphibious snail after being released by infected feces. Metacercaria released from the snails encyst on the fruits and roots of water plants such as water caltrop, water chestnut and lotus. These cysts will be ingested along with the edible water plants which are eaten raw by pigs and humans. The adult parasite normally develops and inhabits the duodenal and jejunal mucosa. Clinical features are related to the parasitic load. Most infections are mild and asymptomatic. Heavy infection causes extensive intestinal and duodenal erosion, ulceration, haemorrhage, abscess and catarrhal inflammation as the adult parasites attach to intestinal mucosa using their ventral suckers. These pathologies cause insidious onset diarrhea. These are usually watery in nature. Diarrhea may be alternating with constipation and hunger pangs.
Malabsorption may lead to steatorrhea as well.
Abdominal pain Abdominal pain may be attributed to several causes. Severe parasitic load can cause widespread intestinal erosions, ulceration and rarely perforations. This abdominal pain in more common in the morning and relieved by food. Patient may develop intestinal obstruction with severe mechanical occlusion of the lumen. In such cases severe abdominal pain in the periumbilical area is accompanied by constipation and/ or poor appetite, nausea and vomiting. Abdominal pain
Abdominal pain may be attributed to several causes. Severe parasitic load can cause widespread intestinal erosions, ulceration and rarely perforations. This abdominal pain in more common in the morning and relieved by food. Patient may develop intestinal obstruction with severe mechanical occlusion of the lumen. In such cases severe abdominal pain in the periumbilical area is accompanied by constipation and/ or poor appetite, nausea and vomiting.
Abdominal swelling Severe inflammation of the intestinal wall and rarely intestinal perforation cause inflammatory reactions in the peritoneal cavity causing extravasation of tissue fluids. Abdominal swelling
Severe inflammation of the intestinal wall and rarely intestinal perforation cause inflammatory reactions in the peritoneal cavity causing extravasation of tissue fluids.
Facial Oedema Intestinal trauma caused by adult parasite triggers a localized and generalized allergic reaction. Generalized allergic reaction is characterized by a facial edema. Facial Oedema
Intestinal trauma caused by adult parasite triggers a localized and generalized allergic reaction. Generalized allergic reaction is characterized by a facial edema.
Hives Generalized toxic and allergic reactions causes red, itchy, raised areas of skin that appear in varying shapes and sizes. Hives
Generalized toxic and allergic reactions causes red, itchy, raised areas of skin that appear in varying shapes and sizes.
History of travel to endemic araes The patient may have a history of travelling in asian countries including China, Taiwan, South-East Asia, Indonesia, Malaysia and India or places where there is a suitable snail host (Segmentina nitidella) are at a higher risk. Humans eat uncooked watercress and other aquatic plants in uncooked/under cooked forms as in salads or on sandwiches may also get infested. History of travel to endemic araes
The patient may have a history of travelling in asian countries including China, Taiwan, South-East Asia, Indonesia, Malaysia and India or places where there is a suitable snail host (Segmentina nitidella) are at a higher risk. Humans eat uncooked watercress and other aquatic plants in uncooked/under cooked forms as in salads or on sandwiches may also get infested.

Clinicals - Examination

Fact Explanation
Pallor This is a rare finding and when present is owing to severe bleeding into the lumen or peritoneal cavity or nutritional deficiencies secondary to malabsorption. All these results in anemia which reflects as conjunctival pallor. Pallor
This is a rare finding and when present is owing to severe bleeding into the lumen or peritoneal cavity or nutritional deficiencies secondary to malabsorption. All these results in anemia which reflects as conjunctival pallor.
Urticaria Red, itchy raised areas (hives) occur all over the body due to allergy. Urticaria
Red, itchy raised areas (hives) occur all over the body due to allergy.
Loss of weight This is due to malabsorption syndrome due to severe parasite load and ulcerations. Loss of weight
This is due to malabsorption syndrome due to severe parasite load and ulcerations.
Abdominal swelling Intestinal inflammation or intestinal perforations rarely results in peritonitis. This leads to accumulation of fluids in the peritoneal cavity. Abdominal swelling
Intestinal inflammation or intestinal perforations rarely results in peritonitis. This leads to accumulation of fluids in the peritoneal cavity.
Abdominal tenderness Peritoneal inflammation and intestinal perforation cause either generalized or centrally localized abdominal tenderness. Abdominal tenderness
Peritoneal inflammation and intestinal perforation cause either generalized or centrally localized abdominal tenderness.

Investigations - Diagnosis

Fact Explanation
Full blood count Parasitic infestation is characterized by high degree of eosinophilia. Leukocytosis and severe anemia may also occur. Full blood count
Parasitic infestation is characterized by high degree of eosinophilia. Leukocytosis and severe anemia may also occur.
Erythrocyte sedimentation rate (ESR) Patients have an elevated erythrocyte sedimentation rate. Erythrocyte sedimentation rate (ESR)
Patients have an elevated erythrocyte sedimentation rate.
Microscopic examination of stool Microscopic identification of the ova or adult worms in the stool or vomitus is the basis of specific diagnosis. However, the eggs of Fasciolopsis buski are indistinguishable from those of Fasciola hepatica. Microscopic examination of stool
Microscopic identification of the ova or adult worms in the stool or vomitus is the basis of specific diagnosis. However, the eggs of Fasciolopsis buski are indistinguishable from those of Fasciola hepatica.
Enzyme-linked immunosorbent assay (ELISA) ELISA has a less importance in diagnosis and rarely performed. Enzyme-linked immunosorbent assay (ELISA)
ELISA has a less importance in diagnosis and rarely performed.
Polymerase chain reaction (PCR) assays PCR is used as a rapid diagnostic assay for Fasciolopsiasis. Polymerase chain reaction (PCR) assays
PCR is used as a rapid diagnostic assay for Fasciolopsiasis.

Management - Supportive

Fact Explanation
Prevention roperly clean and process raw vegetables by immersing in boiling water for few seconds, then followed by peeling and washing in clean water, avoidance of eating water plants raw, in endemic areas, snail control, proper treatment of night soil using lime and copper sulfate and chemotherapy to decrease the human reservoir of infection are preferred methods of prevention. Prevention
roperly clean and process raw vegetables by immersing in boiling water for few seconds, then followed by peeling and washing in clean water, avoidance of eating water plants raw, in endemic areas, snail control, proper treatment of night soil using lime and copper sulfate and chemotherapy to decrease the human reservoir of infection are preferred methods of prevention.

Management - Specific

Fact Explanation
Praziquantel Praziquantel is the drug of choice for treatment. Treatment is effective in early or light infections. Heavy infections are more difficult to treat. Praziquantel 20 mg/kg 8 hourly for 1 day is the recommended dose. Other anthelmintics that can be used include thiabendazole, mebendazole, levamisole and pyrantel pamoate are also effective. Praziquantel
Praziquantel is the drug of choice for treatment. Treatment is effective in early or light infections. Heavy infections are more difficult to treat. Praziquantel 20 mg/kg 8 hourly for 1 day is the recommended dose. Other anthelmintics that can be used include thiabendazole, mebendazole, levamisole and pyrantel pamoate are also effective.

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