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Z Gastroenterol 2015; 53(04): 285-290
DOI: 10.1055/s-0034-1385728
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Fasciolosis

Fasziolose
C. F. Dietrich
1   Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim
,
A. Kabaalioglu
2   Akdeniz University Hospital, Department of Radiology, Antalya-Turkey
,
E. Brunetti
3   Division of Infectious and Tropical Diseases, San Matteo Hospital Foundation, University of Pavia
,
J. Richter
4   Tropenmedizinische Ambulanz, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich-Heine Universität Düsseldorf
› Author Affiliations
Further Information

Publication History

07 August 2014

10 November 2014

Publication Date:
10 April 2015 (online)

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Abstract

Fasciolosis is a zoonosis affecting ruminants, caused by the liver flukes Fasciola (F.) hepatica, and F. gigantica, which infect at least 2.4 million people worldwide. This disease may occur in cluster or family infections or after travel in high-risk areas such as the Nile Delta in Egypt, Iran, Turkey, South-East Asia, Mexico, the Caribbean and the Andean Altiplano. In Europe, fasciolosis occurs more frequently in Portugal, Spain and France, although autochthonous infections have also been reported from Ireland and Germany. Infectious metacercariae are ingested with contaminated water or raw or undercooked vegetables. During their larval stage immature flukes migrate through the liver producing an acute febrile syndrome some weeks after infection, followed by a chronic-latent stage which may last for years or decades. Acute fasciolosis is characterized by fever, high eosinophilia and hepatosplenomegaly. At this stage ova are usually not yet produced. Diagnosis relies on the detection of specific antibodies and/or antigens in serum. Typical imaging features include multiple, ill-defined, fleeting hypodense or hypoechoic areas in the liver. Intraabdominal bleeding due to fluke’s penetration of the bowel wall or liver capsule, may occur. In chronic latent fasciolosis the diagnosis is achieved by specific serology tests, detection of eggs in bile and parasitological examinations of multiple enriched stools samples. Ultrasonography may sometimes reveal a dilated and thickened common bile duct or crescent-like parasites in the gallbladder or bile ducts. Some patients exhibit sludge which typically does not sediment. Triclabendazole at a single dose of 10 mg/kg body weight is the treatment of choice.

Zusammenfassung

Die Fasziolose ist eine Plattwurminfektion von Wiederkäuern, die durch Fasciola (F.) hepatica, und F. gigantica hervorgerufen wird. F. hepatica ist mitteleuropäischen Ursprungs und wurde in Steinzeitfunden nachgewiesen. Durch Viehexporte wurde diese Wurminfektion weltweit verbreitet. Diese Zoonose betrifft 2,4 bis 17 Millionen Menschen. Der klinische Verdacht beruht auf einer entsprechenden Reise- und Expositionsanamnese. Betroffen sind besonders Bewohner armer Regionen im Nildelta in Ägypten, im Iran, der Türkei, in Südostasien, Mexiko, der Karibik und in den Anden. In Europa tritt die Fasziolose besonders in Portugal, Spanien und Frankreich auf, Familien- und Cluster-Infektionen wurden aber auch in Deutschland beschrieben, nachdem durch Tierfaeces kontaminierte Wildkräuter oder Brunnenkresse konsumiert wurden. Auf den Pflanzen befinden sich infektiöse Wurmlarven (Metazerkarien), die nach Infektion zur Leber gelangen und dann durch die Leber wandern, wo sie eosinophile (Mikro-)Abszesse produzieren. Diese akute Phase kann je nach Wurmlast oligosymptomatisch oder hochakut febril mit einer hohen Eosinophilie verlaufen. Die Bildgebung kann eine unspezifische Hepatosplenomegalie und abdominelle Lymphadenopathie zeigen. Charakteristisch aber inkonstant sind hypodense abszedierende Areale, die im zeitlichen Verlauf die Leber durchwandern. Die Diagnose erfolgt serologisch, da in diesem Krankheitsstadium normalerweise noch keine Eier produziert werden. Im weiteren Verlauf wachsen im Gallensystem die unreifen Würmer zu Adultwürmern heran. Sie führen zu intermittierenden Gallenkoliken und können zu Cholezystitis, Cholangitis, Ulzerationen und Cholezystolithiasis führen. In der Bildgebung können mitunter spontan bewegliche 1,5 bis 3,5 cm lange Fasziolen im Gallensystem dargestellt werden. Hinweisend ist auch geformter Sludge, der nicht nach unten sedimentiert. Sonografische Kontrollen nach Therapie, insbesondere während Gallenkoliken, erhöhen die Sensitivität des Nachweises von Würmern. Die Diagnose beruht auf dem Nachweis der Wurmeier in wiederholten Stuhluntersuchungen, im Gallensaft und/oder serologisch. Die Therapie der Wahl ist Triclabendazol (Egaten®, Novartis), das aus der Schweiz importiert werden muss. Die Dosis beträgt 10 mg/kg einmalig zu einer fetthaltigen Mahlzeit und kann ggf. wiederholt werden.

Schlüsselwörter

Ultraschall - Kontrastmittel-Ultraschall - Fasciola spp. - Fasciola hepatica - Fasciola gigantica - Plattwürmer - Leber - akute febrile Eosinophilie

Key words

ultrasound - contrast ultrasound - Fasciola spp. - Faciola hepatica - Fasciola gigantica - flukes - liver - acute febrile eosinophilia
 

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