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Natural History, Clinicoradiologic Correlates, and Response to Triclabendazole in Acute Massive Fascioliasis

Fascioliasis is highly endemic in the Andean region of South America. Newer serological assays have improved our ability to diagnose acute fascioliasis. The diagnosis was established by Fasciola hepatica serology (Fas2-ELISA or Western blot) in 10 patients. Identifiable exposure included ingestion of watercress (N = 8), alfalfa juice (N = 5), and lettuce (N = 1). Computed tomography of the abdomen showed hepatomegaly (N = 9), track-like hypodense lesions with subcapsular location (N = 8), and subcapsular hematoma (N = 2). Radiologic sequelae included cyst calcifications detectable at least 3 years after treatment. Stool examinations were negative for F. hepatica eggs; serology was positive (Arc II [N = 2], Fas2-ELISA [N = 6], Western blot [N = 2]). The syndrome of eosinophilia, fever, and right upper quadrant pain, elevated transaminases without jaundice, hypodense liver lesions on CT, and an appropriate exposure history suggests acute fascioliasis. Fascioliasis is specifically treatable with a single dose of triclabendazole.

Received July 20, 2007. Accepted for publication October 15, 2007.

Acknowledgments: This project was partially supported by U.S. Public Health service grants K24AI068q03, "Patient-Oriented Research in Tropical Infectious Diseases" and D43TW007120, "Endemic Infectious Diseases of the Peruvian Amazon. " The American Committee on Clinical Tropical Medicine and Travelers’ Health (ACCTMTH) assisted with publication expenses.

^* Address correspondence to Luis A. Marcos, Instituto de Medicine Tropical Alexander von Humboldt, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres AP 4314, Lima 100, Perú. E-mail: Luis.A.Marcos{at}uth.tmc.edu

Authors’ addresses: Luis A. Marcos, Martin Tagle, Angelica Terashima, Alejandro Bussalleu, Luis Valdez, and Eduardo Gotuzzo, Instituto de Medicine Tropical Alexander von Humboldt, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres AP 4314, Lima 100, Perú, Telephone: 511-3821021, E-mail: Luis.A.Marcos{at}uth.tmc.edu. Martin Tagle, Alejandro Bussalleu, and Jorge Huerta-Mercado, Gastroenterology Service, Hospital Nacional Cayetano Heredia, Lima, Perú. Cesar Ramirez and Carlos Carrasco, Radiology Service, Hospital Nacional Cayetano Heredia, Lima, Perú. David O. Freedman, University of Alabama at Birmingham, Birmingham, AL. Joseph M. Vinetz, Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA.

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