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Fascioliasis, only foodborne trematodiasis of worldwide distribution, is caused by Fasciola hepatica and F. gigantica, liver flukes transmitted by freshwater snails. Southern and southeastern Asia is an emerging hot spot of F. gigantica, despite its hitherto less involvement in human infection. In Vietnam, increasing cases have been reported since 1995, whereas only sixteen throughout 1800-1994. A database was created to include epidemiological data of fascioliasis patients from the 63 Vietnam provinces throughout 1995-2019. Case profiles were based on serology, symptoms, eosinophilia, imaging techniques, stool egg finding, and post-specific-treatment recovery. Radio broadcasting about symptoms and costless diagnosis/treatment led patients to hospitals after symptom onset. Yearly case numbers were modelled and spatio-temporally analyzed. Missing data and confounders were assessed. The countrywide spread has no precedent. It started in the central coast, including 53,109 patients, mostly adults and females. Seasonality, linked to vegetable consumption, peaks in June, although the intensity of this peak differs according to relief/climatic zones. Incidence data and logistic regression curves are obtained for the first time in human fascioliasis. Fasciolid hybrids accompanying the spreading F. gigantica flukes, and climate change assessed by risk index correlations, are both ruled out as outbreak causes. Human-guided movements of livestock from an original area prove to be the way used by fasciolids and lymnaeid vectors to expand geographically. Radix viridis, a highly efficient transmitting and colonizing vector, played a decisive role in the spread. The use of irrigated crop fields, widely inhabited by R. viridis, for livestock grazing facilitated the transmission and spread of the disease. General physician awareness and diagnostic capacity improvement proved the successful impact of such knowledge transfer in facilitating and increasing patient infection detection. Information, education and communication to the public by radio broadcasting demonstrated to be very helpful. Fasciola gigantica is able to cause epidemic and endemic situations similar to F. hepatica. The magnitude of the human outbreak in Vietnam is a health wake-up call for southern and southeastern countries of Asia which present the highest human population densities with increasing food demands, uncontrolled livestock inter-country exchange, foreign import practices, and monsoon's increasing climate change impact.
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BACKGROUND: Bovine fascioliasis is a parasitic disease that affects cattle. It leads to direct and indirect great economic loss due to animal mortalities, growth retardation and expenditure on anthelmintics, reduction livestock productivity and essentially condemnation of infected liver by inspection service. The study was carried out to determine the seasonal prevalence and estimated financial losses of fascioliasis in cattle in the Western Highlands of Cameroon. METHODOLOGY: A total of 2167 cattle were selected. Later, the cattle, have being the carcasses, were dissected, and the livers were dissected and carefully examined for adult liver flukes. Faeces were collected immediately after the cattle were killed and examined using the formol-ether concentration technique. Condemned livers were weighted to estimate the financial losses using the average price of a kilogram of liver. RESULTS: A total 428 of cattle were found with infected livers or egg in the faeces giving a total prevalence of 19.75%. Among the infected carcass, 18.64% had both the Fasciola eggs in the faeces and flukes in the liver while 1.10% had only flukes in the liver. Results revealed that prevalence of Fasciola spp. was significantly higher during the rainy season (23.48%) than 16% in the dry season (p = 0.00). A significantly (p = 0.000) higher prevalence was also observed in females (33.9%) than in males (13.1%). Age range showed significant (p = 0.000) influence with the animals of 8-10 years old recorded the highest prevalence of 39.3%. Furthermore, 433.1 kg of liver was condemned giving a direct financial loss of 1221,550 FCFA (2049.64 USD) and an annual financial loss due to liver condemnation estimated to 1814,775 (3045.01 USD). CONCLUSION: Findings of this study indicated that bovine fascioliasis is prevalent in cattle in the Western Highlands of Cameroon, and it leads to an important financial loss particularly in the rainy season.
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Mataderos , Enfermedades de los Bovinos , Fascioliasis , Animales , Bovinos , Camerún/epidemiología , Enfermedades de los Bovinos/epidemiología , Enfermedades de los Bovinos/economía , Enfermedades de los Bovinos/parasitología , Fascioliasis/veterinaria , Fascioliasis/epidemiología , Fascioliasis/economía , Prevalencia , Mataderos/estadística & datos numéricos , Masculino , Femenino , Estaciones del Año , Heces/parasitología , Costo de EnfermedadRESUMEN
Human fascioliasis, caused by Fasciola hepatica and Fasciolagigantica, is a neglected tropical disease of increasing public health significance. Reported cases are rare, with only one serologically confirmed instance in Ethiopia to date. We present the case of a male patient in his late twenties, without identified risk factors, who presented with bilateral upper quadrant pain persisting for a year and a history of repeated treatment for H. pylori gastritis. Initial ultrasound findings prompted further investigation with abdominal CT, contrast-enhanced MRI, and MRCP, leading to a diagnostic shift confirmed by a positive enzyme-linked assay for Fasciola hepatica. This case highlights the diagnostic challenges and the critical role of radiological imaging-ultrasound, CT, and MRIin identifying key features such as biliary dilation and parenchymal abnormalities, crucial for early detection and effective management of human fascioliasis.
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Parasitic liver diseases can be caused by trematodes, cestodes, nematodes, and protozoa. This pathology is significant because millions of people in different parts of the world have liver parasites, which can manifest themselves in the development of inflammation, liver cysts, cholecystitis, cholelithiasis, pancreatitis and liver cirrhosis that are often threatening their lives. The International Agency for Research on Cancer considers three species of trematodes, Schistosoma haematobium, Opisthorchis viverrini and Clonorchis sinensis, to be carcinogens. Complex modern examination methods, in some cases including extensive screening of large populations, are required for diagnosing liver parasites. Treatment of parasitic liver diseases is differentiated and can involve a combination of surgical and therapeutic measures. There is no doubt that the clinical and epidemiological scale allows one to regard parasitic liver diseases as a global healthcare problem.
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Parasitosis Hepáticas , Humanos , Animales , Parasitosis Hepáticas/epidemiología , Parasitosis Hepáticas/diagnóstico , Parasitosis Hepáticas/terapia , Parasitosis Hepáticas/parasitología , Hígado/parasitología , Hígado/patología , Salud GlobalRESUMEN
Background: Hepatobiliary fascioliasis has two phases, each requiring specific management approaches. Triclabendazole has been widely effective in treating the two phases of clinical fascioliasis and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary phase. We aimed to characterize presentations of hepatobiliary fascioliasis and highlight the role of ERCP in management. Subjects and methods: This retrospective cohort includes patients diagnosed with clinical hepatobiliary fascioliasis between January 2013 and December 2022. Demographic data, clinical presentation, laboratory and radiological investigations, treatment, and endoscopy reports were collected from the records of 62 participants. Patients were divided into two groups: acute hepatic and chronic biliary phases. Results: Thirty-six patients were in the biliary phase, and 26 were in the hepatic phase. All patients were from rural areas, and females were predominant (76%). Hypereosinophilia was detected in 92% of acute cases and 58% of chronic biliary cases. In chronic biliary cases, the levels of liver biochemicals, including alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and bilirubin, were higher at levels of 189 ± 76, 127 ± 47, 268 ± 77, and 2.4 ± 0.7 respectively, compared to acute hepatic cases, 35.6 ± 8.2, 32.7 ± 4.3, 69.2 ± 45.45, and 0.58 ± 0.01. The corresponding P-values were 0.003, 0.001, <0.001, and <0.001, respectively. Triclabendazole effectively cured 93.5% of patients and was used in combination with ERCP in biliary-phase cases where the fluke was extracted from the biliary system in 34 patients (94.4%). Three patients (8.8%) were diagnosed with post-ERCP pancreatitis. None of the patients experienced bleeding, perforation, or required biliary stenting. Conclusion: Clinical fascioliasis could manifest in acute hepatic or chronic biliary phases. Hypereosinophilia was more evident in the hepatic phases, while ALT, AST, GGT, and bilirubin were higher in the biliary phase. Triclabendazole is effective in the hepatic phase and when combined with ERCP in the biliary phase. ERCP is highly effective for relieving obstruction and treating biliary fascioliasis.
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Fascioliasis is one of the most common foodborne zoonotic infection of ruminants in Bangladesh. To estimate the prevalence and associated risk factors of fascioliasis and extent of liver damage, 825 livers of sheep and goats were randomly inspected during onsite slaughterhouse visiting in Naogaon, Natore, Rajshahi and Joypurhat districts. The overall prevalence of fascioliasis was 25.09% and significantly (P = 0.008) higher in goats (26.11%) than sheep (24.00%). During gross inspection, Fasciola infected livers were increased in size, fibrosed, fatty, multiple white or reddish necrotic foci on the parietal surface, hard to cut, calcified, and numerous mature and immature flukes were also observed. In histoarchitecture, inflammatory cell infiltration in the hepatic parenchyma and periportal area, fibrous connective tissue proliferation around necrotic area, hyperplastic bile duct, congestion, and primary biliary cirrhosis were seen in acute and chronic fascioliasis. Epidemiological investigations revealed that fascioliasis was higher in goats than sheep. Age, sex, BCS and season were found to have statistically significant associations with fascioliasis in goats. In case of sheep, age (OR = 5.8671; 95% CI: 2.9482-11.6757, P < 0.0001), sex (OR = 3.7317; 95% CI: 1.9052-7.3094, p < 0.0001), BCS (OR = 6.0346; 95% CI: 1.7986-20.2472, p < .0001), and season (OR = 8.2308; 95% CI: 3.9922-16.9693, p = < .0001) were also found to have statistically significant associations with fascioliasis. Results of the study can help for molecular epidemiology of fascioliasis in small ruminants to plan fluke control programs for safe food production.
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The freshwater amphibious snail Orientogalba viridis commonly occurs in eastern Asia, on certain Pacific islands and more importantly has recently dispersed into Europe. Since this snail is now considered an invasive species, its distribution is of growing parasitological interest as an alien intermediate host for various trematodes, particularly liver flukes. As part of ongoing surveillance for snail-borne diseases in Malawi, a population of O. viridis was first observed in May 2023, alongside an alarming presence of a human schistosome cercaria. This snail population later underwent detailed morphological characterisation with both snail and parasite identities confirmed upon DNA barcoding. This seminal observation triggered more extensive local snail surveys, finding 3 further populations in separated rice paddies, with further field-caught snails (n = 465) screened for infection and a selection used for repeated experimental challenges with miracidia from Schistosoma haematobium and Schistosoma mattheei. Although no field-caught (and experimentally exposed) snail was seen to shed schistosome cercariae, molecular xenomonitoring for schistosomiasis provided tangible evidence of putative transmission potential. Our first report of O. viridis here in Malawi, and more broadly in Africa, flags a need for increased vigilance for this invasive species alongside local clarification(s) of its transmission potential for trematodiases of either medical and/or veterinary importance.
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Non-viral infections of the liver are rare to very rare compared to viral infections. They can be caused by various bacteria, helminths, protozoa, and fungi, often leading to liver involvement during dissemination. Some of these infections affect in particular immunocompromised individuals, while others need to be considered in the differential diagnostic work-up in patients returning from tropical countries. In cases where the infection occurs through oral ingestion of eggs, such as in cystic and alveolar echinococcosis, the liver is often the most commonly affected organ. Due to the diversity of non-viral liver infections and their varied clinical manifestations, a comprehensive discussion of all potential pathogens and their effects is not within the scope of this article. Therefore, only a few of these conditions will be discussed in more detail.
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Equinococosis , Virosis , Humanos , HígadoRESUMEN
PURPOSE: Fascioliasis is a common parasitic disease in humans and herbivores which is caused by Fasciola hepatica and Fasciola gigantica and has a worldwide distribution. Serological tests such as the enzyme-linked immunosorbent assay (ELISA) technique play a prominent role in the fast diagnosis of the disease. However, there are diagnostic limitations, including cross-reactivity with other worms, which decline the specificity of the results. This study aimed to evaluate the structure of a recombinant multi-epitope antigen produced from linear and conformational B-cell epitopes of three parasitic proteins with sera of individuals with fasciolosis, healthy controls, and those with other diseases to gain accurate sensitivity and specificity. METHODS: After designing the multi-epitope structure of cathepsin L1, FhTP16.5, and SAP-2 antigens and then synthesizing, cloning, and expressing, the extracted purified protein was evaluated by indirect ELISA to detect IgG antibodies against Fasciola hepatica parasite among the sera of 39 serum samples of Fasciola hepatica, 35 healthy individual samples, and 20 samples of other types of parasitic diseases. The synthesized multi-epitope produced from cathepsin L1, FhTP16.5, and SAP-2 antigens was evaluated using the indirect ELISA. RESULTS: The analysis of the samples mentioned for IgG antibody diagnosis against Fasciola hepatica showed 97.43% (95% confidence interval, 94.23-100%) sensitivity and 100% (95% confidence interval, 97-100%) specificity. CONCLUSION: The recombinant B-cell multi-epitope with high antigenic potency may increase the specificity of epitopic peptides and ultimately help improve and develop indirect ELISA commercial kits for the diagnosis of fascioliasis in humans.
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Anticuerpos Antihelmínticos , Antígenos Helmínticos , Ensayo de Inmunoadsorción Enzimática , Fasciola hepatica , Fascioliasis , Inmunoglobulina G , Proteínas Recombinantes , Sensibilidad y Especificidad , Pruebas Serológicas , Fascioliasis/diagnóstico , Fascioliasis/inmunología , Animales , Humanos , Antígenos Helmínticos/inmunología , Antígenos Helmínticos/genética , Ensayo de Inmunoadsorción Enzimática/métodos , Fasciola hepatica/inmunología , Fasciola hepatica/genética , Anticuerpos Antihelmínticos/sangre , Pruebas Serológicas/métodos , Proteínas Recombinantes/inmunología , Proteínas Recombinantes/genética , Inmunoglobulina G/sangre , Epítopos de Linfocito B/inmunología , Epítopos de Linfocito B/genética , Proteínas del Helminto/inmunología , Proteínas del Helminto/genética , Epítopos/inmunología , Catepsina L/inmunología , Catepsina L/genéticaRESUMEN
Background: The potential molluscicidal extracts, obtained from indigenous plants Cannabis sativa, Acacia nilotica, and Tinospora cordifolia, were tested for toxicity against freshwater pulmonate snail Lymnaea acuminata, an intermediate host of Fasciola hepatica. The organic extracts had a significant effect on young snails. Materials and Methods: All organic extracts and column-purified fractions gave median lethal concentrations (19-100.05 mg/L; 24 h) that fell well within the threshold level of 100 mg/L, set for a potential molluscicide by the World Health Organization. Results: The toxicity of T. cordifolia stem acetone extract (96 h LC50: 16.08 mg/L) was more pronounced compared with C. sativa leaf ethanol extract (96 h LC50: 16.32 mg/L) and A. nilotica leaf ethanol extract (96 h LC50: 24.78 mg/L). ß-caryophyllene, gallic acid, and berberine were characterized and identified as active molluscicidal components. Co-migration of ß-caryophyllene (retardation factor [Rf] 0.95), gallic acid (Rf 0.30), and berberine (Rf 0.23) with column-purified parts of Cannabis sativa, Acacia nilotica, and Tinospora cordifolia on thin-layer chromatography demonstrates same Rf value, that is, 0.95, 0.30, and 0.23, respectively. Conclusion: This study indicates that these extracts thus represent potential plant-derived molluscicides that are worthy of further investigations.
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Acacia , Cannabis , Moluscocidas , Extractos Vegetales , Tinospora , Animales , Tinospora/química , Extractos Vegetales/farmacología , Extractos Vegetales/química , Acacia/química , Moluscocidas/farmacología , Cannabis/química , Hojas de la Planta/química , Lymnaea/efectos de los fármacos , Fasciola/efectos de los fármacos , Caracoles/parasitología , Caracoles/efectos de los fármacosRESUMEN
(1) Background: Human fascioliasis is considered an endemic and hyper-endemic disease in the Peruvian Andean valleys. Our objective was to determine variations in the composition of the gut microbiota among children with Fasciola hepatica and children who do not have this parasitosis. (2) Method: A secondary analysis was performed using fecal samples stored in our biobank. The samples were collected as part of an epidemiological Fasciola hepatica cross-sectional study in children from 4 through 14 years old from a community in Cajamarca, Peru. (3) Results: In a comparison of the bacterial genera that make up the intestinal microbiota between the F. hepatica positive and negative groups, it was found that there are significant differences in the determination of Lactobacillus (p = 0.010, CI: 8.5-61.4), Bacteroides (p = 0.020, CI: 18.5-61.4), Clostridium (p < 0.001, CI: 3.5-36.0), and Bifidobacterium (p = 0.018, CI: 1.1-28.3), with each of these genera being less frequent in children parasitized with F. hepatica. (4) Conclusions: These results show that F. hepatica may be associated with direct or indirect changes in the bacterial population of the intestinal microbiota, particularly affecting three bacterial genera.
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Fascioliasis, a prevalent disease in livestock globally, is primarily caused by the trematode parasites Fasciola hepatica and Fasciola gigantica. This parasitic infection leads to significant economic repercussions. In this study, our objective was to gain insight into the pathophysiological consequences of Fascioliasis in cattle through the evaluation of metabolic, oxidative stress, and histological parameters. A thorough investigation was carried out on the liver of 197 bovines after their slaughter, which unveiled the occurrence of Fascioliasis, with a prevalence rate of 13.2% observed. The bovine that were infected exhibited notable increase in serum transaminases (ALT, AST, and ALP) and malondialdehyde (MDA) and catalase (CAT) while the decrease in glutathione (GSH) and superoxide dismutase (SOD) levels. The lipid profile analysis of infected cattle revealed alterations in the cholesterol and triglyceride levels. Moreover, the histopathological examination revealed a range of hepatic lesions associated with Fascioliasis, including necrosis, inflammation, fibrosis, and proliferative alterations. The bile ducts also displayed distinct pathological changes, including hyperplasia, thickening, and edema, and harbored various developmental stages of Fasciola spp. highlighting the parasitic infestation's effects on the biliary system. These results highlight the serious effects of Fascioliasis on lipid metabolism and the oxidative damage that is induced in the livers of cattle. Thus, Fasciola infestation in bovine causes alteration in biochemical and antioxidant activities, which are considered as important factors in the diagnosis of Fascioliasis.
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Enfermedades de los Bovinos , Fasciola hepatica , Fasciola , Fascioliasis , Bovinos , Animales , Fascioliasis/veterinaria , Estrés OxidativoRESUMEN
Fascioliasis, a zoonotic helminthiasis, occurs sporadically in Japan. In this report, we describe a case of fascioliasis that was initially difficult to diagnose because the fecal examination method was negative for the Fasciola sp. eggs. A 64-year-old man living in Shimonoseki City, Japan, presented with fatigue and anorexia. Laboratory tests showed hepatic dysfunction and eosinophilia. Abdominal dynamic contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography suggested intrahepatic biliary cysts. Thereafter, fever and night sweats persisted, and positron emission tomography and biopsy of the porta hepatis lymph node were performed on suspicion of malignancy. However, histopathological diagnosis found non-specific inflammation. As fascioliasis was suspected due to eosinophilia and the multiple hepatic masses, fecal egg examination was performed by an external private laboratory, which adopted the flotation method and reported the absence of parasite eggs. However, fecal examination was retried in our laboratory using the formalin-ether concentration method, and we detected Fasciola sp. eggs. This case suggests that misdiagnosis may occur depending on the fecal examination method; thus, it is necessary to choose a suitable method for certain parasite species.
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Eosinofilia , Fascioliasis , Masculino , Humanos , Persona de Mediana Edad , Fascioliasis/diagnóstico , Fascioliasis/tratamiento farmacológico , Fascioliasis/parasitología , Diagnóstico Tardío , Eosinofilia/etiología , Tomografía Computarizada por Rayos XRESUMEN
Introduction: Trematodiases cause significant financial losses to livestock worldwide and some of which are zoonotic, raising public health concerns. In Rwanda, information on the prevalence of bovine trematodiases is scanty, and this hampers efforts to control and prevent them in the country. Methods: This cross-sectional study aimed to determine the prevalence of bovine trematodiases in Nyagatare district and associated risk factors. One hundred cattle were randomly selected for this study and faecal samples were collected directly from the rectum to identify trematode eggs using a simple sedimentation technique. To analyze the data, frequencies, chi-square test, and binary logistic regression were computed. Results: Overall, the prevalence of bovine trematodiases was 69%, and Paramphistomum spp. predominated (69%), followed by Dicrocoelium spp. (23%), Fasciola spp. (20%), and Echinostoma spp. (1.0%). The study also recorded mixed paramphistomiasis, fascioliasis and dicrocoeliasis (11.6%), paramphistomiasis and fascioliasis (15.9%) as well as paramphistomiasis and dicrocoeliasis (20.3%). The odds of having trematodiasis (mono or mixed fascioliasis and dicrocoeliasis) for the cow located in Barija cell (AOR = 0.143; 95% C.I. 0.026-0.793) were 14% lower compared to those of developing such parasitosis for the cow located in Bushoga cell. Conclusion: Taken together, the study shows that trematodes are a significant contributor to lowering livestock production and productivity and pose a threat to human health. Different approaches should be applied to prevent and control the trematodiases in cows and other livestock (sheep and goats) and reduce the risk of contracting fascioliasis and echinostomiasis in humans in Nyagatare district, Rwanda.
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PURPOSE: Fascioliasis is caused by Fasciola hepatica of almost worldwide distribution and F. gigantica in wide regions of Asia and Africa. Their adult stage develops in the biliary canals and gallbladder. Infection follows an initial, 3-4 month long invasive, migratory or acute phase, and a several year-long biliary, chronic or obstructive phase. METHODS: The unexpected finding of a fasciolid inside the gallbladder during a cholecystectomy for obstructive lithiasis suspicion in a patient is reported from an area of Iran where human infection had been never reported before and studies on fascioliasis in livestock are absent. RESULTS: The fluke obtained was phenotypically classified as F. hepatica by morphometry and genotypically as F. gigantica by mtDNA cox1 fragment sequencing, although with F. hepatica scattered mutations in species-differing nucleotide positions. The clinical, radiological, and biological signs observed at the acute and chronic phases often lead to some misdiagnosis. Serological methods may be useful in cases of negative coprology. Diagnostic techniques with insufficient resolution leading to unnecessary invasive interventions are analyzed. The way to avoid unnecessary surgery is described, including analyses to be made, diagnostic tools to be used, and aspects to be considered. CONCLUSION: Reaching a correct diagnosis in the confusing presentations avoids procedure delays and unnecessary surgery. A correct drug treatment may be sufficient. Except in extreme pathological presentations, lesions decrease in number and size and finally disappear or calcify after a successful treatment. Finally, the need to increase awareness of physicians about fascioliasis is highlighted, mainly in non-human endemic areas.
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Fasciola hepatica , Fasciola , Fascioliasis , Animales , Adulto , Humanos , Fascioliasis/diagnóstico , Fascioliasis/epidemiología , Fasciola/genética , Fasciola hepatica/genética , Asia , ColecistectomíaRESUMEN
The gastropod Pseudosuccinea columella participates in the dissemination of Fasciola hepatica in the environment, acting as the main intermediate host of this parasite in Brazil. The present study sought to elucidate the possible pathogenic effects of the entomopathogenic nematode (EPN) Heterorhabditis bacteriophora on P. columella, by evaluating the influence of infection on alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as well as the concentrations of total protein, uric acid, and urea in the snail's hemolymph. For this, the snails were exposed to EPNs for 24 and 48 h, and for each exposure time, 20 snails were dissected after 7, 14 and 21 days for hemolymph collection. The primary findings suggest a significant proteolysis alongside elevated levels of uric acid and urea in P. columella infected individuals. These findings reveal that H. bacteriophora HP88 infection induced serious changes in the snail's metabolism, triggering important deleterious effects.
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Rabdítidos , Animales , Ácido Úrico , Caracoles/parasitología , UreaRESUMEN
BACKGROUND: The association of fever, focal hepatic lesions and peripheral hyper-eosinophilia (FHLH) can be observed in both infectious and non-infectious conditions. Fascioliasis, capillariasis, toxocariasis, all causes of visceral larva migrans (VLM), represent most of the former, whilst lymphomas, eosinophilic leukemias and mastocytosis belong in the non-infectious conditions. METHODS: We prospectively followed a young patient presenting with FHLH in the Tuscany region of Italy. RESULTS: The patient was subject to serological and parasitological examination in an attempt to clarify the origin of the lesions. Serologies for both Fasciola hepatica and Toxocara spp. were positive, with the latter presenting a higher index. We opted for treatment with a prolonged course of albendazole due to the serological results and being toxocariasis more frequent in our setting. The patient was then subject to radiological follow-up. The patient responded to treatment with albendazole as shown by a decrease in eosinophils, seronegativization for Toxocara spp., clinical and radiological improvement. Toxocariasis was hence considered the most likely diagnosis. CONCLUSIONS: Parasitic infections cannot be disregarded in the presence of FHLH. Differential diagnosis between these parasitic infections can be challenging due to the presence of similar clinical presentations and serological cross-reactions, and follow-up of the patient is needed to ensure optimal treatment outcomes.