CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2024; 14(01): 020-023
DOI: 10.1055/s-0044-1786718
Case Report

Eosinophilia in an Indian Patient with Helminthic Infection Unresponsive to Albendazole and Diethylcarbamazine: An Enigmatic Case of Human Fascioliasis

Debadrita Ray
1   Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Ganesh C. P.
1   Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Yogendra Kumar
1   Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Deba Prasad Dhibar
2   Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Abhishek Mewara
1   Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Arka De
1   Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations
Funding None.

Abstract

Human fascioliasis is a zoonosis caused by Fasciola hepatica and Fasciola gigantica. Population migration, globalization of food trade, climate change, and drug resistance are contributing to the re-emergence of Fasciola infection in several countries with increased recognition even in nonendemic regions. Helminthic infections are prevalent in India and are a common cause of eosinophilia in Indian patients who are often empirically treated with antihelminthic agents. However, human fascioliasis is rarely reported in India and does not respond to commonly used antihelminthic agents like albendazole, mebendazole, praziquantel, and diethylcarbamazine (DEC). We report a case of a young female with abdominal pain and eosinophilia who did not respond to empirical treatment with albendazole and DEC. She was diagnosed with Fasciola hepatica on endoscopic retrograde cholangiopancreatography and was treated with nitazoxanide that led to complete resolution of symptoms and normalization of eosinophil counts.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.


Ethical Statement

The authors followed applicable EQUATOR Network (www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report.


Author Contributions

D.R. helped in manuscript writing; G.C.P. contributed to data collection and manuscript writing; Y.K. was involved in data collection; D.P.D. helped in data collection and critical revision; A.M. contributed to parasitological analysis, data collection, and critical revision; A.D. helped in manuscript writing, data collection, and critical review. The manuscript has been read and approved by all the authors, and each author believes that the manuscript represents honest work.


Note

The case was presented at the 31st annual conference of the Indian National Association for Study of the Liver (INASL), August 3–6, 2023.




Publication History

Received: 29 January 2024

Accepted: 28 March 2024

Article published online:
29 May 2024

© 2024. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Thomsen GN, Christoffersen MN, Lindegaard HM. et al. The multidisciplinary approach to eosinophilia. Front Oncol 2023; 13: 1193730
  • 2 Fürst T, Keiser J, Utzinger J. Global burden of human food-borne trematodiasis: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12 (03) 210-221
  • 3 Caravedo MA, Cabada MM. Human fascioliasis: current epidemiological status and strategies for diagnosis, treatment, and control. Res Rep Trop Med 2020; 11: 149-158
  • 4 Jha AK, Goenka MK, Goenka U, Chakrabarti A. Hepatobiliary fascioliasis in non-endemic zones: a surprise diagnosis. Arab J Gastroenterol 2013; 14 (01) 29-30
  • 5 Goenka MK, Majumder S, Sethy PK, Kumar S, Goenka U. Hepatobiliary fascioliasis treated at endoscopic retrograde cholangiopancreatography. Endoscopy 2010; 42 (Suppl. 02) E103
  • 6 Yattoo GN, Dar GA, Jan K. et al. Human fascioliasis: report of two cases from Kashmir valley. J Clin Exp Hepatol 2021; 11 (06) 747-750
  • 7 Ramachandran J, Ajjampur SS, Chandramohan A, Varghese GM. Cases of human fascioliasis in India: tip of the iceberg. J Postgrad Med 2012; 58 (02) 150-152
  • 8 Bargues DM, Artigas P, Varghese GM. et al. Human fascioliasis emergence in southern Asia: complete nuclear rDNA spacer and mtDNA gene sequences prove Indian patient infection related to fluke hybridization in northeastern India and Bangladesh. One Health 2024; 18: 100675
  • 9 Ramanan RV, Dhus U, Ramamurthy A, Parameswaran SA, Piramanayagam P, Gopalakrishnan R. Human fascioliasis: diagnosis by typical computed tomography features and response to nitazoxanide in 16 patients from India. Trop Gastroenterol 2018; 39 (03) 149-176
  • 10 Lalrinkima H, Lalchhandama C, Jacob SS, Raina OK, Lallianchhunga MC. Fasciolosis in India: an overview. Exp Parasitol 2021; 222: 108066
  • 11 Mas-Coma S, Valero MA, Bargues MD. Human and animal fascioliasis: origins and worldwide evolving scenario. Clin Microbiol Rev 2022; 35 (04) e0008819
  • 12 Qureshi AW, Zeb A, Mansoor A, Hayat A, Mas-Coma S. Fasciola hepatica infection in children actively detected in a survey in rural areas of Mardan district, Khyber Pakhtunkhawa province, northern Pakistan. Parasitol Int 2019; 69: 39-46
  • 13 Valero MA, Bargues MD, Khoubbane M. et al. Higher physiopathogenicity by Fasciola gigantica than by the genetically close F. hepatica: experimental long-term follow-up of biochemical markers. Trans R Soc Trop Med Hyg 2016; 110 (01) 55-66
  • 14 Favennec L, Jave Ortiz J, Gargala G, Lopez Chegne N, Ayoub A, Rossignol JF. Double-blind, randomized, placebo-controlled study of nitazoxanide in the treatment of fascioliasis in adults and children from northern Peru. Aliment Pharmacol Ther 2003; 17 (02) 265-270
  • 15 Zumaquero-Ríos JL, Sarracent-Pérez J, Rojas-García R. et al. Fascioliasis and intestinal parasitoses affecting schoolchildren in Atlixco, Puebla State, Mexico: epidemiology and treatment with nitazoxanide. PLoS Negl Trop Dis 2013; 7 (11) e2553