see also:

• parasites
• the febrile returned traveller

• fasciola is a liver fluke (a type of parasitic worm) that can infect the liver and bile duct of exposed people and animals
• two species can infect people:
  • Fasciola hepatica: the main species that infects people.
    • AKA “the common liver fluke” and “the sheep liver fluke”
    • occurs on all continents except Antarctica, especially where there are sheep, cattle or goats, although human infections are rare in USA and Australia
  • Fasciola gigantica: a related species that primarily affects domestic and wild animals but can also infect people but only occurs in parts of Africa and Asia
• most infections occur after eating raw watercress or freshwater plants contaminated by larvae, vegetables washed by contaminated water, or drinking contaminated water
• it is not contagious from one person to another

• may be asymptomatic
• features are similar in acute and chronic phases:
  • malaise
  • fever
  • nausea +/- vomiting
  • abdominal pains
  • altered bowel habits +/- diarrhoea
  • eosinophilia
  • hepatomegaly
  • abnormal LFTs

• incubation period is 4-7 days and symptoms can last several weeks or months
• occurs when immature flukes are passing from intestine through the abdominal cavity and liver

• starts months after infection
• mature flukes migrate to the bile ducts

• stool microscopy to see the eggs
• biliary USS or CT abdo may show dilated bile ducts containing the flukes

• oral triclabendazole - two doses usually suffice ¹⁾