FASCIOLOPSIS BUSKI

Symptoms/Clinical Manifestations:
Most patients are asymptomatic or may present with various symptoms, such as
abdominal pain, abdominal distention, diarrhea, poor appetite, vomiting, and anemia
with eosinophilia.
Heavy infection can be fatal and is associated with malnutrition, intestinal inflammation,
intestinal perforation, small bowel stricture, ulceration, hemorrhage, and abscess
formation.
The worms inhabit the duodenum and jejunum, and can also be found in much of the
intestinal tract, including the stomach, in moderate and heavy infections.
If the adult worms move to the ileocecal region, shifting pain in the right lower quadrant
can occur and can be misdiagnosed as appendicitis.
If the infection moves to the biliary tract, it can cause cholangitis, jaundice, biliary
dilatation, or obstruction, as seen in our case and Zhou’s case.
In fact, F. buski, as an intestinal parasite, rarely migrates to the biliary tract, but Fasciola
hepatica, which belongs to the same family, Fasciolidae, is indeed a biliary parasite,
often leading to biliary obstruction, cholangitis, gallstones, sclerosing cholangitis, and so
on.34 Therefore, we should focus on distinguishing it from other biliary parasites and
biliary diseases.
epidemic areas (China and India)
Then, we reviewed the disease history in detail again and found that the patient’s
hometown was rich in water chestnuts
This is a very interesting case, and we hypothesize that the worms may initially stay in
the gastrointestinal tract and then migrate to the biliary tract and cause recurrent
abdominal pain for many years.
In heavy infections, in which worms disturb the secretion of intestinal juices, cause
excess mucus secretion, and obstruct the passage of food.13 Most patients are
asymptomatic or may present with various symptoms, such as abdominal pain,
abdominal distention, diarrhea, poor appetite, vomiting, and anemia with
eosinophilia.17,30 Heavy infection can be fatal and is associated with malnutrition,
intestinal inflammation, intestinal perforation, small bowel stricture, ulceration,
hemorrhage, and abscess formation.20 In addition, generalized toxic and allergic
symptoms, usually in the form of edema, particularly of the face, abdominal wall, and
lower extremities, can occur.
CLINICAL MANIFESTATIONS
The severity of symptoms usually is correlated with the number of parasites. Epigastric
pains resembling “hunger pains” or peptic ulcer disease have been reported as early as
30 days after exposure. Diarrhea and abdominal pain may be intermittent and may
occur separately or simultaneously. In heavy infections, nausea and vomiting may
develop. Facial edema, anasarca, and ascites are encountered in advanced, severe
infections. Eosinophilia with counts greater than 30 percent is not an uncommon
occurrence. Leukocytosis and mild anemia may be noted.
In endemic areas, it is not unusual for a child to have multiple intestinal parasites and a
borderline nutritional status. Fasciolopsiasis adds an additional burden to the host
defense mechanisms and may be responsible, in concert with the other stresses, for
significant morbidity.

Physical Examination:
Female Normal hemoglobin level: 121-151 g/L
Normal Neutrophil: 40-60%
Normal Eosinophil: 1-4%
Normal ALP: 44-147 IU/L

Diagnosis
Based on the provided diagnostic evaluation:
Routine blood examination:
Hemoglobin level: 116g/L (indicating mild anemia)(normal 12-16 g/dl- grams per deciliter
or 120-160g/L)
Neutrophils: 71.1% (within normal range for adults:40-75%)
Eosinophils: 8.0% (elevated, suggesting a parasitic infection)(Normal in adults 0-6%)
Liver Function Test:
Alkaline Phosphatase (ALP) level: 152 U/L(normal between 20- 140 units per liter ,
(slightly elevated, indicating possible liver involvement)
Bilirubin: Normal (suggesting no significant liver dysfunction)
Routine Occult Blood test: No abnormal changes (suggesting no gastrointestinal
bleeding)
Parasitic Life Cyle:
Immature eggs are discharged into the intestine and stool . Eggs become
embryonated in water , eggs release miracidia , which invade a suitable snail
intermediate host . In the snail the parasites undergo several developmental stages
(sporocysts , rediae , and cercariae ). The cercariae are released from the
snail and encyst as metacercariae on aquatic plants . The mammalian hosts
become infected by ingesting metacercariae on the aquatic plants. After ingestion, the
metacercariae excyst in the duodenum and attach to the intestinal wall. There they
develop into adult flukes (20 to 75 mm by 8 to 20 mm) in approximately 3 months,
attached to the intestinal wall of the mammalian hosts (humans and pigs) . The adults
have a life span of about one year.
Pathophysiology:
mechanism of parasitic infection: -ingestion of water plants that is contaminated with
metacercariae
host-parasite interaction:
- Fasciolopsis buski is a parasitic flatworm that infects humans and pigs, causing
intestinal fluke infections known as fasciolopsiasis. The interaction involves the parasite
attaching to the intestinal wall, where it feeds on host tissue and produces eggs that are
then excreted in the host's feces, completing its life cycle when ingested by a suitable
intermediate host, usually freshwater snails. This interaction can lead to symptoms such
as abdominal pain, diarrhea, and malnutrition in the host.
immunological response:
The immunological response to Fasciolopsis buski infection involves both innate and
adaptive immune mechanisms. Initially, the innate immune system recognizes the
presence of the parasite through pattern recognition receptors, triggering inflammatory
responses and the recruitment of immune cells to the site of infection. This includes the
activation of macrophages, neutrophils, and eosinophils, which play a role in containing
and eliminating the parasite.Treatment:
Slide 1: The duration of praziquantel treatment varies depending on the severity of the
infection and the patient's response to therapy.
In most cases: single dose of praziquantel is sufficient to eliminate adult flukes from the
gastrointestinal tract.
In heavy infection or complications, such as biliary obstruction, multiple doses of
praziquantel may be required over several days or weeks to achieve complete parasite
clearance. The duration of treatment should be determined by the treating physician
based on the individual patient's clinical status and response to therapy.
Slide 2:
Praziquantel works by disrupting the integrity of the parasite's cell membrane, leading to
paralysis and subsequent expulsion from the gastrointestinal tract. Clinical
improvement, including relief of abdominal pain, distension, diarrhea, and other
gastrointestinal disturbances, is typically observed shortly after treatment. Follow-up
stool examinations may be performed to confirm parasite clearance and assess
treatment efficacy.
Discussion:
Slide 1: Fasciolopsiasis presents a diagnostic challenge due to its varied clinical
manifestations, which can overlap with other gastrointestinal disorders. Abdominal pain,
distension, and digestive disturbances are common symptoms shared with conditions
such as appendicitis, cholecystitis, and choledocholithiasis. When Fasciolopsis buski
migrates to the biliary tract, it can cause symptoms resembling those of biliary diseases,
including jaundice, cholangitis, and biliary obstruction. Moreover, differentiation between
F. buski and other parasitic infections, particularly Fasciola hepatica, is crucial but
challenging due to their similar presentations. This complexity necessitates thorough
diagnostic evaluation and expertise to ensure accurate identification and management.
Slide 2: The diagnosis of fasciolopsiasis often requires specialized diagnostic tests,
such as stool examination and serological testing, which may not always yield definitive
results. Furthermore, the nonspecific nature of symptoms and the rarity of the infection
in many regions can contribute to misdiagnosis or delayed diagnosis. Distinguishing
between F. buski and F. hepatica can be intricate, necessitating advanced diagnostic
techniques and experience. In cases of biliary obstruction or severe complications,
surgical intervention may be necessary. However, determining the optimal timing for
surgery and ensuring appropriate postoperative care present additional challenges.
These challenges underscore the importance of multidisciplinary collaboration and
access to specialized care in the management of fasciolopsiasis.
Slide 3: Fasciolopsiasis, while rare in certain regions, remains a significant public health
concern in endemic areas, particularly in Asia. The potential for severe complications
underscores the importance of early detection and intervention to prevent adverse
outcomes. Enhancing diagnostic capabilities through training healthcare professionals
and improving access to diagnostic tools is essential for timely identification and
treatment. Public health efforts should focus on surveillance, control measures, and
health education to raise awareness and prevent transmission in endemic regions.
Collaborative initiatives involving healthcare providers, public health authorities, and
community stakeholders are vital for effective control and prevention of fasciolopsiasis.
Conclusion:
Fasciolopsis buski infections are uncommon nowadays, particularly those involving
heavy worm loads or in particular location (ileocecal, biliary tract, etc.). Through the
patients history living in endemic area and diagnosis test such as physical examination,
abdominal examination, routine blood examination, routine liver function tests, routine
occult blood test, and fecalysis report the diagnosis can be determined. Furthermore,
sufficient doses of oral praziquantel are effective for patients. However, in regard to
situations that endanger the patient’s life or seriously affect the quality of life, early
surgical intervention is an important therapy. It can even be preferred as the first choice
in some cases, such as when the diagnostic evidence is insufficient, similar to our case.

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695077/ - case study itself

• Essentials of Medical Parasitology (2nd Edition)

• Paniker’s Textbook of Medical Technology (8th Edition)

Complications: https://studymicrobio.com/fasciolopsis-buski-classification-morphology-
manifestation-transmission/
https://www.cdc.gov/parasites/fasciolopsis/faqs.html#:~:text=With%20heavy%20i
nfections%20Fasciolopsis%20flukes,and%20anemia%20may%20be%20present.
Parasite Images and Life Cyle: https://www.cdc.gov/dpdx/fasciolopsiasis/index.html
Clinical Manifestations: https://www.sciencedirect.com/topics/medicine-and-
dentistry/fasciolopsiasis