Hepatobiliary fascioliasis: A neglected re-emerging threat, its diagnostic and management challenges.

Alaa Ismail, Mohamed Ayman Abdelsalam, Mustafa H Shahin, Yusuf Ahmed, Ibrahim Halil Bahcecioglu, Mehmet Yalniz, Ahmed Tawheed
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Abstract

Hepatobiliary fascioliasis is a neglected but re-emerging parasitic disease caused by Fasciola hepatica. Humans become infected by consuming contaminated water or aquatic plants, allowing the parasite to enter the digestive tract. From there, immature flukes penetrate the intestinal wall and migrate through the liver, triggering inflammation, fibrosis, and biliary complications. Over time, this can lead to cholangitis, biliary obstruction, and long-term liver damage. Due to its vague clinical symptoms and the limitations of current diagnostic methods, fascioliasis could be easily missed. Stool analysis is still used to detect eggs in diagnosis. However, this method is unreliable due to the inconsistency of the egg shedding. Also, serological tests are often linked to false positives due to the cross-reactions with other parasites. Imaging techniques such as ultrasound, computed tomography, and magnetic resonance imaging can reveal its complications, especially in the biliary phase, yet this is not specific. Molecular tests like polymerase chain reaction (PCR) have higher sensitivity and specificity and allow earlier diagnosis, but they are still not widely available, especially in low-resource settings. Triclabendazole is the only recommended medical treatment, yet it is not widely available. In addition, the emerging reports of resistance represent a potential threat in managing this infection. Other modalities could be needed in addition to triclabendazole, such as endoscopic retrograde cholangiopancreatography in patients with biliary complications. All the previously mentioned challenges necessitate the urgent need to make the newly developed diagnostic methods, such as PCR, available, especially in areas where fascioliasis is endemic. Additionally, new medical treatments and therapeutic options should be considered to provide a second line of management, particularly in light of emerging reports of resistance.

肝胆筋膜吸虫病:一个被忽视的重新出现的威胁,其诊断和管理的挑战。
肝胆片吸虫病是由肝片吸虫病引起的一种被忽视但又重新出现的寄生虫病。人类通过饮用被污染的水或水生植物而感染,从而使寄生虫进入消化道。从那里,未成熟的吸虫穿透肠壁,通过肝脏迁移,引发炎症、纤维化和胆道并发症。随着时间的推移,这会导致胆管炎、胆道阻塞和长期肝损伤。由于其临床症状不明确和现有诊断方法的限制,片吸虫病很容易被忽视。粪便分析在诊断中仍用于检测卵子。然而,由于卵子脱落的不一致性,这种方法是不可靠的。此外,由于与其他寄生虫的交叉反应,血清学测试往往与假阳性有关。成像技术如超声、计算机断层扫描和磁共振成像可以显示其并发症,特别是在胆道期,但这不是特异性的。像聚合酶链反应(PCR)这样的分子检测具有更高的灵敏度和特异性,并允许早期诊断,但它们仍然没有广泛使用,特别是在资源匮乏的环境中。三氯苯达唑是唯一推荐的药物治疗,但它并没有广泛使用。此外,新出现的耐药性报告对管理这种感染构成了潜在威胁。除了三氯苯达唑外,还需要其他方式,如胆道并发症患者的内窥镜逆行胆管胰胆管造影。所有前面提到的挑战都迫切需要提供新开发的诊断方法,例如聚合酶链反应,特别是在片形吸虫病流行的地区。此外,应考虑新的医疗方法和治疗方案,特别是考虑到新出现的耐药性报告,以提供第二线管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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