RESUMO
Here we report a rare case of living Fasciola hepatica in biliary tract. The patient was in acute phase of infection and treated successfully with 10 mg/kg oral triclabendazole after the fluke was extracted using endoscopic retrograde cholangiopancreatography (ERCP).
Assuntos
Sistema Biliar/parasitologia , Fasciola hepatica/isolamento & purificação , Fasciola hepatica/fisiologia , Fasciolíase/diagnóstico , Adulto , Animais , Anti-Helmínticos/uso terapêutico , Benzimidazóis/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica , Terapia Combinada , Fasciolíase/tratamento farmacológico , Fasciolíase/cirurgia , Feminino , Humanos , Resultado do Tratamento , TriclabendazolRESUMO
PURPOSE OF REVIEW: Hepatobiliary flukes--Fasciola, Opisthorchis, Clonorchis- are a major public health problem in east Asia, east Europe, Africa and Latin America. The present review focuses on current knowledge of clinical, diagnostic and treatment aspects caused by hepatobiliary flukes that can be applied to current protocols in endemic areas. RECENT FINDINGS: Specific risk factors and geographic areas for these flukes have been heavily reported recently, with millions of people infected worldwide. Human cases in nonendemic areas, related to immigration and the international food trade (i.e. raw vegetables and fish), have also been reported. Diagnostic imaging changes include track-like lesions that are a characteristic feature of acute fascioliasis on computed tomography scanning of the liver. Newly available diagnostic serological tests may detect early infection and, therefore, help reduce severe clinical complications such as recurrent cholangitis, cholecystitis, hepatic tumours, cysts, calcification, cholelithiasis, pancreatitis, most importantly, cholangiocarcinoma related to Opisthorchis viverrini and possibly Clonorchis sinensis, and liver fibrosis associated with Fasciola hepatica infections. Highly effective antiparasitic treatment is available for all flukes. SUMMARY: There is a better understanding of risk factors, clinical manifestations and complications, novel diagnosis tests and effective treatment, which together should help reduce the morbidity and mortality of these infections.
Assuntos
Sistema Biliar/parasitologia , Clonorquíase/parasitologia , Opistorquíase/parasitologia , Infecções por Trematódeos/tratamento farmacológico , Infecções por Trematódeos/parasitologia , Animais , Sistema Biliar/patologia , Clonorquíase/diagnóstico , Clonorquíase/tratamento farmacológico , Clonorquíase/epidemiologia , Equinostomíase/parasitologia , Fasciolíase/diagnóstico , Fasciolíase/tratamento farmacológico , Humanos , Opistorquíase/diagnóstico , Opistorquíase/tratamento farmacológico , Opistorquíase/epidemiologia , Trematódeos , Infecções por Trematódeos/etiologiaRESUMO
Ascariasis is one of the most common helminthic diseases. Its most feared complication is migration into the biliary tree. Some authors recommend immediate duodenoscopy in all cases of biliary migration, with sphincterotomy for the extraction of the parasites, and surgical extraction in case of intrahepatic ascariasis. We followed prospectively 69 patients with ultrasonographical evidence of migration. Initial treatment consisted of intravenous analgesics and antispasmodics, and albendazole 800 mg by mouth. Only patients with persisting symptoms or with high amylasaemia underwent duodenoscopy, with extraction in case of a visible worm. Surgery was limited to cases with persistent or progressive complications. In 97% of our cases the worms disappeared with noninvasive therapy alone. A duodenoscopy was done in 30 (42%) cases; in 10 (14%) a worm was found in the ampulla of Vater and extracted without sphincterotomy. In none of the 6 cases with A. lumbricoides in the intrahepatic biliary tree did the parasite persist. Only one patient required surgical intervention. Treatment of A. lumbricoides migration to the biliary tract should be principally medical. Duodenoscopy with extraction of a visible worm should be limited to cases with persisting pain and/or hyperamylasaemia. Invasive methods like sphincterotomy and surgery should be restricted to patients who do not respond to conservative treatment.
Assuntos
Ascaríase/parasitologia , Ascaríase/terapia , Ascaris lumbricoides/fisiologia , Doenças Biliares/parasitologia , Doenças Biliares/terapia , Adulto , Albendazol/uso terapêutico , Ampola Hepatopancreática/parasitologia , Ampola Hepatopancreática/cirurgia , Animais , Anti-Helmínticos/uso terapêutico , Ascaríase/diagnóstico por imagem , Ascaris lumbricoides/isolamento & purificação , Sistema Biliar/diagnóstico por imagem , Sistema Biliar/parasitologia , Doenças Biliares/diagnóstico por imagem , Duodenoscopia , Equador , Feminino , Hidratação , Humanos , Higiene , Masculino , Ácidos Mandélicos/uso terapêutico , Estudos Prospectivos , Esfincterotomia Transduodenal , UltrassonografiaRESUMO
Ultrasonography (USG) has recently contributed much to the diagnostic of hepatic cystic echinococcosis (CE). The use of portable ultrasonograph allowed us to perform a community survey among 9482 people living in a high risk area for CE in the Florida Department (Uruguay). Positive USG results were found in 123 asymptomatic patients. 48 out of 51 USG positive cases were surgically confirmed and 3 were found to be false positive. The results of this survey allowed us to propose a new classification of the echographic imaging based on the parasite's various evolutive and involutive stages. The Echinococcus granulosus cyst size was compared with the parasite's evolutive stages. The cyst's segmentary topography and the related risk of CE is evaluated. The importance of cystic-biliary communication is pointed out and its rational surgical treatment described. Finally, an algorithm is presented facilitating the choice of a rational treatment.