Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
The Queens Medical Center, Honolulu, HI.
Hawaii J Health Soc Welf. 2021 Sep;80(9):212-217.
Fascioliasis is a foodborne zoonotic infection caused by the trematode liver flukes: Fasciola hepatica and Fasciola gigantica (F. gigantica). Infections may cause acute and chronic hepatobiliary tract diseases in herbivore animals and humans. Fascioliasis is present worldwide, particularly in regions where sheep and cattle are raised. The global burden of human fascioliasis is estimated to be 2.7 million. Human infections are rare in the United States, and most infections were acquired abroad. In the 1950s, several human cases of F. gigantica infection were reported from Hawai'i, but no subsequent cases have been reported until the case described here. This case report describes a man from Hawai'i Island who ate raw wild watercress, and 22 days later, developed acute phase fascioliasis with fever, acute hepatitis, peripheral eosinophilia, and hypodense lesions seen on liver diagnostic imaging. Immunodiagnostic tests were positive for Fasciola species. Based on earlier reports from Hawai'i, F. gigantica infection was likely. Clinical abnormalities resolved after treatment with triclabendazole. Physicians should consider fascioliasis in immigrants and travelers from endemic areas with acute hepatitis and eosinophilia after eating raw wild watercress or chronic hepatobiliary disease. Hepatobiliary imaging and serological testing are useful for diagnosis. Oral triclabendazole is the preferred treatment. Animal fascioliasis appears to be spreading in the United States, and the popularly perceived health benefits of eating raw wild watercress and other aquatic plants may lead to more human infections. The rarity of human infections in Hawai'i suggests that it is safe to eat commercially grown watercress cultivated in Hawai'i.
片形吸虫病是一种食源性病原体感染，由肝片吸虫和巨片形吸虫（F. gigantica）引起。感染可导致草食动物和人类的急性和慢性肝胆道疾病。片形吸虫病在全球范围内存在，特别是在绵羊和牛养殖地区。据估计，全球人类片形吸虫病的负担为 270 万例。在美国，人类感染较为罕见，大多数感染都是在国外获得的。20 世纪 50 年代，夏威夷曾报告过几例巨片形吸虫感染病例，但此后直到本例报告之前，再无后续病例。本病例报告描述了一位来自夏威夷岛的男性，他食用了生的野生豆瓣菜，22 天后，出现发热、急性肝炎、外周血嗜酸性粒细胞增多和肝脏诊断影像学上的低密度病变等急性期片形吸虫病。免疫诊断检测对片形吸虫属呈阳性。根据夏威夷之前的报告，可能是巨片形吸虫感染。在接受三氯苯达唑治疗后，临床异常得到缓解。医生应该考虑在食用生的野生豆瓣菜或慢性肝胆疾病后出现急性肝炎和嗜酸性粒细胞增多的来自流行地区的移民和旅行者中是否患有片形吸虫病。肝胆影像学和血清学检测对诊断有用。口服三氯苯达唑是首选治疗方法。在美国，动物片形吸虫病似乎正在蔓延，人们普遍认为食用生的野生豆瓣菜和其他水生植物对健康有益，这可能导致更多的人类感染。夏威夷人类感染的罕见性表明，食用在夏威夷种植的商业化豆瓣菜是安全的。
