Fasciola hepatica infestation in Turkish children

BACKGROUND: The data on childhood fascioliasis are limited. We aimed to heighten physicians' awareness of Fasciola Hepatica by presenting 14 cases in this paper. METHODS: The medical records of pediatric patients treated for F. Hepatica infection within the last 2 years were reviewed. ELISA method with a cut-off level of 10 was used as the serological test, in which an absorbance level of >11 DU/mL was considered positive. RESULTS: Ten (71.4%) patients were female. Complaints at presentation were abdominal pain (N.=14; 100%) and loss of appetite (N.=12; 85.7%). Twelve (85.7%) patients were from rural areas. All patients had an elevated eosinophil count (mean: 3885.6/mm(3), minimum: 566/mm(3),maximum: 18687/mm(3)). Six patients had a leucocyte count >10.000 cells/mm(3) and 8 (57%) patients had an ESR>20 mm/h. Gamma-glutamyt transferase (GGT) was normal in all but 1 patient presenting with cholangitis. In hepatobiliary ultrasonography (USG) the most common finding was a heterogeneous solid lesion found in 11 patients. Advanced imaging methods revealed multiple cystic lesions in 10 patients and magnetic resonance imaging (MRI) showed hypo-hyperintense hepatic parenchymal changes in 9 patients. The patients were started on Triclabendazole 10 mg/kg/dose. Clinical, laboratory, and radiological findings of the patients were improved after the therapy. CONCLUSIONS: Fascioliasis should be suspected in children from endemic regions presenting with abdominal pain, weight loss, and fever, which are accompanied by eosinophilia, elevation in transaminases, and cystic/solid lesions in liver, particularly in bile ducts or parenchyma. Triclabendazole is very effective for treatment of this disease.