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For further information, see CMDT Part 35-16: Intestinal Flukes

Key Features

  • Fasciolopsis buski is a common parasite of pigs and humans in eastern and southern Asia

  • Eggs shed in stools and hatch in fresh water, followed by infection of snails and release of cercariae that encyst on aquatic plants

  • Humans are infected by eating uncooked plants, including water chestnuts, bamboo shoots, and watercress

  • Adult flukes mature in about 3 months and live in the small intestine attached to the mucosa, leading to local inflammation and ulceration

  • Other intestinal flukes causing similar syndromes include two transmitted by undercooked freshwater fish

    • Heterophyes (North Africa and Turkey) species

    • Metagonimus (East Asia) species

Clinical Findings

  • Infection is often asymptomatic, but eosinophilia may be marked

  • In symptomatic cases, after an incubation period of 1–2 mo, manifestations include epigastric pain and diarrhea

  • Uncommon findings

    • Other gastrointestinal symptoms

    • Ileus

    • Edema

    • Ascites

Diagnosis

  • Diagnosis depends on finding characteristic eggs or, occasionally, adult flukes in the stools

  • Moderate eosinophilia is common

  • Illness > 6 months after travel to endemic area is unlikely

Treatment

  • Praziquantel

    • Drug of choice

    • 25 mg/kg as a single dose

  • Triclabendazole and niclosamide are alternatives (for most species)

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