Human hepatic fascioliasis treated with triclabendazole

Abstract

Fascioliasis is a parasitic disease that usually affects herbivores. Human infestation occurs through the ingestion of
contaminated water or plants. The authors describe four
patients from the Republic of Cabo Verde, who presented with prolonged fever, weight loss, tender hepatomegaly,
anaemia, hypereosinophilia, an erytrocyte sedimentation
rate over 100, low albumin, hypergammaglobulinemia, high
alkaline phosphatase and high gama-GT. Fasciola sp. eggs
were found in the faeces together with positive serology.
Abdominal CT scans revealed hepatomegaly with multiple
focal liver lesions not enhanced by contrast and in one of
the cases described as “tracking” lesions. The patients were
treated with triclabendazole, approved only for veterinary
use, but already successfully used in humans without side effects in Europe and Latin America.
This treatment was well tolerated and resulted in a good
clinical, laboratory and radiological response. The authors
propose that triclabendazole should be the treatment of
choice in hepatic fascioliasis especially in the light of the
known therapeutic failures and multiple side-effects associated with the use of bithionol, emetine, albendazole
and praziquantel, the recommended treatment to date of fascioliasis.