DISEASES CAUSED BY FLUKES IN THE BILE DUCT Triclabendazole 10 mg / kg single dose; repeat treatment may be required As for C. sinensis but for 1 day only Praziquantel 25 mg / kg 8-hourly for 2 days Treatment Avoid contaminated watercress Cook fish Cook fish Prevention As for C. sinensis , also serology As for C. sinensis Ova in stool or duodenal aspirate Diagnosis Unexplained fever, tender liver, may be ectopic, e . g . subcutaneous fluke As for C. sinensis Often symptom - free, recurrent jaundice Symptoms Toxaemia, cholangitis, eosinophilia As for C. sinensis E . coli cholangitis, abscesses, biliary carcinoma Pathology Cosmopolitan, including UK Far East, especially North - east Thailand Far East, especially South China Geographical distribution Encysts on vegetation Freshwater fish Freshwater fish 2nd intermed host Snails Snails Snails 1st intermed host Ova in faeces on to wet pasture As for C. sinensis Ova in faeces, water Mode of spread Sheep, cattle Dogs, cats, foxes, pigs Dogs, cats, pigs Other mammalian hosts Fasciola hepatica Opisthorchis felineus Clonorchis sinensis Parasite Fascioliasis Opisthorchiasis Clonorchiasis
Biliary cirrhosis : due to the peri - ductal fibrosis
3 . Obstructive jaundice : Obstruction of the common bile duct by Fasciola adults +.
4. Biliary sludge / stones : in gall bladder & biliary tree may be formed in chronic patients, which remains unchanged after therapy may predispose to recurrent cholecystitis, cholangitis or biliary stone
5. Bleeding : Bleeding may occur due to ulcerations in the common bile duct (haemobilia)
6. Death : rare, major causes of death are biliary bleeding & biliary cirrhosis
The detection of circulating Fasciola antigen & coproantigen is an efficient immuno-diagnostic tool to assess the effect of therapy in fascioliasis, as antigenaemia in the host reflects an active infection
Role of antibody detection to assess treatment efficacy is controversial.
Some claim that none of the Fasciola isotypes change after treatment, even after 6 months,
others documented the drop of antibodies rapidly after successful treatment
The number of humans infected with Fasciola species has increased significantly since 1980 & several geographical areas have been described as endemic for the disease in humans, with prevalence & intensity ranging from low to very high.