Professional Documents
Culture Documents
It causes hepatic
fibrosis in ruminants and humans known as Fascioliasis.
Fasciola hepatica– liver fluke. Image created with biorender.com. Image Source: CDC.
It is large enough to be visible to the naked eye measuring (3cm length by 1.2cm
breadth), flat leaf-shaped flukes, gray or brown in color.
It has a conical projection anteriorly containing an oral sucker and a ventral sucker at the
base of the cone which allows it to attach to the lining of the biliary ducts.
Its intestine is bifurcated and incomplete and bears lateral branches.
The adult worm lives in the biliary tract of the definitive host for many years-about 5
years in sheep and 10 years in humans.
Like all other trematodes, it is hermaphrodite with both male and female reproductive
organs.
The eggs are yellow-brown, large, ovoid, operculated, bile-stained, and measure 140
μm by 80 μm.
The eggshell is smooth and fined with a double line.
Eggs contain an immature larva, the miracidium.
F. hepatica and Fasciolopsis buski eggs cannot be differentiated.
It unembryonated when freshly passed.
Image Source: CDC.
Metacercaria larva is the infective form for man and other definitive hosts.
Other larval forms are miracidia, rediae, and sporocysts.
Mode of transmission
The sheep and other definitive hosts including man get the infection by eating water
plants and watercress
containing metacercariae.
Image Source: CDC.
Development in Water
Development in snails
The miracidium infects the suitable snail in particular those of the family Lymnaeidae,
which are the intermediate host.
Inside the snail, the miracidium multiplies and transforms into sporocysts, which further
develop into two generations of rediae. Finally, the rediae give rise to cercariae.
The cercariae escape from the snails in water and infect the water plants where they
encyst to form metacercariae.
The vegetation or water contaminated with metacercariae larvae when ingested by the
definitive host causes infection and the cycle is repeated.
a. Stool microscopy
Demonstration of typical operculated eggs in feces or aspirated bile from the duodenum
is the best method of diagnosis.
In the case of acute conditions, stool microscopy is not useful as the worm burden is less.
Concentration techniques (sedimentation methods) can be followed to increase the
sensitivity. Floatation methods are not useful
The operculated eggs of F. hepatica are similar to that of F. gigantica, F. buski,
Echinostoma, and Gastrodiscoides.
b. Blood picture
Reveals eosinophilia.
c. Serological test
In the case of ectopic infections where eggs are not present in the stool, serological tests
can be used, the FAST-ELISA being most popular for the detection of specific
antibodies.
ELISA becomes positive within 2 weeks of infection and is negative after treatment. It
has a sensitivity of 95%.
Others include counter electrophoresis and the western blot technique.
In chronic fascioliasis, Fasciola coproantigen may be detected in stool.
They are useful for seroepidemiological study and to monitor the response to treatment.
d. Molecular Methods
DNA probes and polymerase chain reaction (PCR) are available to detect F. hepatica-
specific genes in stool specimens.
e. Imaging
f. Others
Treatment of Fascioliasis
Currently, triclabendazole is the drug of choice selected by the Center for Disease
Control and Prevention. The recommended dose is 10 mg/kg as a single dose.
Triclabendazole is a good drug to target both immature and mature forms of the
trematode, may therefore be employed during the acute and chronic phases of the
treatment.
The alternative drug is bithionol (30–50 mg for 10–15 days), Prednisolone at a dose of
10–20 mg/kg is used to control toxemia.
Prophylaxis of Fascioliasis
Fascioliasis can be prevented by following ways:
Health education
Improving sanitation
Preventing pollution of watercourses with sheep, cattle, and human feces.
Proper disinfection of watercresses and other water vegetations before consumption.
Control of snails
Treatment of infected person.