Human Fascioliasis a Silent Menace: Case Report With Review of Literature

Abstract

Fascioliasis is a tropical zoonotic disease caused by liver flukes (Fasciola hepatica and Fasciola gigantica) mostly in sheep, goats, and cattle. It is a prevalent infection in developing countries like Bolivia, Peru, and Egypt, affecting both humans and livestock. It remains under-reported due to lack of awareness. Humans accidentally acquire it by consuming contaminated watercress or water contaminated with infective metacercaria. It affects the hepatobiliary system, manifesting as tender hepatomegaly, bile duct obstruction, liver fibrosis, and secondary cholangitis. Diagnosing fascioliasis is a challenge as it presents with nonspecific symptoms like prolonged fever, anorexia, ascites, and with limited availability of testing. Triclabendazole, currently the only approved drug, is unavailable in India. Fascioliasis has been reported only in reports from India. We here report a case of a 4-year-old patient who presented with fever and tender hepatomegaly. Hepatobiliary imaging showed infiltrative liver disease with small cystic lesions and periportal thickening. Liver biopsy showed microabscesses with eosinophilic infiltration. The patient was tested for Fasciola IgG antibody, which was positive. Triclabendazole was procured from Geneva for treatment. Through this report, we highlight this neglected parasitic infection that presented in a nonendemic region that needs improved diagnostic tools, increased awareness, and control measures to mitigate the disease.