Fascioliasis Hepatica: A Single-center Retrospective Analysis Of 25 Cases In Yunnan

Objective: The aim of this study was to understand the incidence and analyze the epidemiological and clinical characteristics,and treatment methods of Fascioliasis hepaticain Yunnan,China.This study also provides the basis for the diagnosis,treatment,and prevention of Fascioliasis hepatica.Methods: From January 2013 to August 2019,the First People’s Hospital of Yunnan Province admitted 25 patients with Fascioliasis hepatica.We analyzed the general information,clinical manifestations,results of auxiliary examinations,diagnostic strategies,and treatment experience of these cases,and followed up the patients for at least six months.Results: The incidence of male and female patients was similar.The most represented ethnicities were the Han and Bai nationalities,with 36% and 16%,respectively.In Yunnan,the most represented prefectures were Puer City,Chuxiong,and Dali,with 44%,20%,and 16%,respectively.Forty percent of the patients are farmers.In the patients with risk factors,most patients have a history of eating lettuce,including Oenanthe javanica,Houttuynia cordata Thunb,etc.In addition,some families use cooking utensils that have processed raw meat to process cooked food.Like other parasitic diseases,the onset of Fascioliasis hepatica is insidious,and latent patients(about 8% of our cases)were asymptomatic and signs free.The most common symptoms of acute stage patients are abdominal pain(about 76% of our disease),followed by fever(about 36% of our disease).The most prominent sign was abdominal tenderness(about 76% of our cases),which was also evident under the xiphoid process,followed by the right upper abdomen.Eighty percentage of the patients had eosinophil count increased.Eighty percentage of the patients had abnormal liver enzymes by serological examination.Of all patients,68% had elevated glutamyltransferase(GGT),60% had elevated alkaline phosphatase(ALP),20% had elevated alanine aminotransferase(ALT),8% had elevated aspartate aminotransferase(AST).Hypoproteinemia occurred in nine patients,of which eight patients had a slight decrease(30 < albumin(ALB)< 35g/L),and one patient had a significant decrease(ALB < 25g/L).Eggs were found in the stool of 16% of the patients,and occult blood was positive in the stool of 8% of the patients.Pathological biopsy of the lesion revealed inflammatory cell infiltration,Charcot-Leyden crystallization,granuloma and small bile duct hyperplasia.Parasites could be seen in typical pathological sections.The main imaging manifestations of abdominal ultrasonography,mainly cystic,Schistose or Patchy mixed echo,hypoechoic or solid echo lesions.The main imaging manifestations of enhanced CT were cystic quasi-circular(about 24%),Schistose or Patchy or fused into patchy(about 72%)low-density shadows,accompanied by mixed density shadows(about 8%)and high-density calcification(about 20%).The lesions were mainly near the hepatic capsule(about 80%).They could also be distributed along the portal vein(about 12%)or bile duct(about 4%)or located in the intrahepatic and extrahepatic bile ducts(about 4%).The borders of all lesions were blurred and unclear.Eighty-eight percentage of the lesions were enhanced in the contrast-enhanced scan,mainly in progressive enhancement,venous enhancement or delayed enhancement.Enhancement is mainly at the edge of the lesion.Some patients had hepatic capsule involvement,bileduct dilatation,gallbladder lesions and intraperitoneal lymphadenopathy.The cure rate of trichlorobenzopyrazole were 90%.Conclusion: The main distribution areas of Fascioliasis hepatica in Yunnan include Puer,Chuxiong and Dali.The clinical manifestations of sporadic patients in Yunnan,have no obvious specificity.Early diagnosis of Fascioliasis hepatica is difficult.We suggest that in actual clinical work,patients with abdominal pain,fever and eosinophilia from the endemic area should be highly suspected of Fascioliasis hepatica.If the patient’s enhanced CT or enhanced MRI shows characteristic changes,the disease can be diagnosed.When the patient’s imaging performance is not typical,it should be distinguished from other liver-occupying lesions,and if necessary,liver pathological biopsy should be performed to confirm the diagnosis.The low cure rate of praziquantel treatment of this disease is clinical evidence.Trichlorobenzodiazole is still the first choice for the treatment of the disease,and its side effects are fewer than those of other drugs.A high proportion of patients cured by this drug.