关键词: 片形吸虫病, 病理, 三氯苯达唑, 预后

Abstract:

Objective To analyze the general clinical features and manifestations, treatment and prognosis of fascioliasis. Methods The data of 15 patients diagnosed as fascioliasis and hospitalized at the First Affiliated Hospital of Dali University from July 2017 to March 2018 were collected. The general clinical features including manifestations, treatment and prognosis were analyzed. Results Total 15 patients were diagnosed as fascioliasis from July 2017 to March 2018. The patients came from different areas of Yunnan Province including 3 from Pu’er, 6 from Dali, 5 from Lincang and 1 from Lijiang. Four of them were males and 11 females. The first clinical symptoms were mainly abdominal pain (11 cases), fever (8 cases), abdominal bloating (5 cases), fatigue (3 cases), weight loss (4 cases), loss of appetite (2 cases), nausea (2 cases), vomiting (2 cases), etc.. The course of disease ranged from 1 d to 2 years with 8 cases happened in autumn, 4 cases in winter, 2 cases in summer, and 1 case in spring. Blood examination showed an increase in the percentage of eosinophils in 12 of 15 cases, 9 cases with decreased percentage of neutrophils, 7 cases with decreased lymphocyte count, 7 cases with increased platelet count and 6 cases with increased white blood cells count. In liver function tests, 10 cases showed an increase in alkaline phosphatase activity; 10 cases with increased γ-glutamyl transpeptidase. C-reactive protein was detected in 6 of 12 cases with the highest value of 154 mg/L. Most of the cases (11/12) had the elevated erythrocyte sedimentation rate with the highest of 120 mm/h. The eggs of Fasciola spp. were only found in the feces of 2 patients, however, all patients showed antibody positive in the ELISA test against Fasciola antigen. CT examination showed the diffuse multiple nodules and patchy lesions in the liver. Abdominal ultrasound showed liver heterogeneous echo mass. Histopathological examination of liver biopsy in 2 patients showed serious eosinophil infiltration, lymphocyte and eosinophilic abscess and local necrosis. Skin biopsy in one patient showed a large amount of eosinophil infiltration. Total 11 of 15 patients were misdiagnosed as liver abscess (2 cases), liver occupying lesions (2 cases), cholangio-carcinoma (2 cases), liver cancer (1 case), enteritis (1 case), connective tissue disease (1 case), acidophilic bacterial pneumonia (1 case), abdominal tuberculosis (1 case) in other hospitals. After being diagnosed as fascioliasis all 15 patients were treated with triclabendazole 10 mg/（kg·d) for successive two days. Symptoms improved significantly after treatment. The patients were followed up by telephone for 6 months, 10 patients with response showed good prognosis. Conclusion There still are cases of human infection with Fasciola spp. sporadically around Dali areas. More cases were seen in autumn and winter seasons. The clinical manifestations of fascioliasis are not specific and the infection is easily misdiagnosed. The immunological test with positive antibody is important for the diagnosis of fascioliasis. Triclabendazole is the first line of therapeutic drugs for fascioliasis.

Key words: Fascioliasis, Pathology, Triclabendazole, Prognosis