61 - Freie Mitteilung
HPB II & general oncology
16. Mai 2019, 13:45 - 15:15, Bellavista 5, 6. OG
Fasciola hepatica infection: A tricky diagnosis
S. Perrodin, L. Wälti, B. Gottstein, C. Kim-Fuchs, D. Candinas, V. Banz, Presenter: S. Perrodin (Bern)
Fasciola hepatica is a foodborne trematode flatworm present worldwide. Definitive hosts are mostly ruminants such as cattle and sheep, with humans being incidental hosts. In Switzerland, Fasciola infection in humans is rare. Unfortunately, many patients are likely to undergo multiple unnecessary investigations before the parasite is suspected and fascioliosis diagnosed, especially if symptoms are unspecific. We present our experience with Fasciola hepatica.
Single center retrospective study including all patients diagnosed with Fasciola hepatica from 2005 to 2018. Diagnosis was considered positive if a positive serology and/or eggs in stool samples correlated to clinical presentation (symptoms and/or imaging). Patients were excluded if serology was considered false positive or was weakly positive in the setting of another more likely diagnosis. Personal data, laboratory values, imaging, treatment and outcome were collected from patient files.
Sixty patients had a positive serology during this time period. Forty-four were considered false positive and excluded, leaving thirteen patients for analyses. 46.2% were male, mean age was 45.8 (17-80). Four patients (30.8%) were asymptomatic, nine (69.2%) presented with symptoms ranging from right upper quadrant pain (44.4%) and generalized pruritus (33.3%) to weight loss and night sweats (33.3%). The mean duration of symptoms until diagnosis was 8.9 months (1-48). Five patients (38.5%) had documented eosinophilia, four (30.8%) elevated liver enzymes and seven (53.8) elevated cholestasis parameters. Mean antibody level on serology was 88 AU/ml (3-134). Of the ten (76.9%) patients with imaging, ultrasound was used most frequently (53.8%), followed by magnetic resonance imaging (30.8%), Computed tomography and endoscopic retrograde cholangiopancreatography (23.1%). The most common findings were bile duct dilatation, followed by hepatic lesions. Treatment consisted of Triclabendazol 10 mg/Kg. One patient needed a second treatment course for persistent disease. There were no recurrences.
With a low incidence of Fasciola hepatica in humans in Switzerland, correct diagnosis is often substantially delayed. Raising awareness among Swiss physicians is paramount, and a higher level of suspicion necessary when confronted with unspecific symptoms or liver images, thus avoiding a long delay in diagnosis as well as unnecessary tests.