Differential Diagnoses

Workup

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Media Gallery

Life cycle of Fasciola hepatica. Immature Fasciola eggs are discharged in the biliary ducts and in the stool (1). Eggs become embryonated in water (2), eggs release miracidia (3), which invade a suitable snail intermediate host (4), including the genera Galba, Fossaria and Pseudosuccinea. In the snail, the parasites undergo several developmental stages (sporocysts (4a), rediae (4b), and cercariae (4c)). The cercariae are released from the snail (5) and encyst as metacercariae on aquatic vegetation or other surfaces. Mammals acquire the infection by eating vegetation containing metacercariae. Humans can become infected by ingesting metacercariae-containing freshwater plants, especially watercress (6). After ingestion, the metacercariae excyst in the duodenum (7) and migrate through the intestinal wall, the peritoneal cavity, and the liver parenchyma into the biliary ducts, where they develop into adult flukes (8). Courtesy of the CDC's DPDx, Division of Parasitic Diseases and Malaria.
Adult Fasciola hepatica fluke stained with carmine (30 mm by 13 mm). Courtesy of the CDC's DPDx, Division of Parasitic Diseases and Malaria.
Fossaria bulamoides, a snail host for F hepatica in the western United States. Courtesy of the CDC's DPDx, Division of Parasitic Diseases and Malaria (Conchology, Inc, Mactan Island, Philippines).
Fasciola hepatica egg in an unstained wet mount (400x magnification). F hepatica eggs are broadly ellipsoidal, operculated, and measure 130-150 μm by 60-90 μm. Courtesy of the CDC's DPDx, Division of Parasitic Diseases and Malaria.
Adult of F hepatica observed with ERCP imaging in the common bile duct of a human patient. Courtesy of the CDC's DPDx, Division of Parasitic Diseases and Malaria (Dr. Subhash Agal, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India).

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Author

Harbir Singh Arora, MD Fellow in Pediatric Infectious Diseases, Children’s Hospital of Michigan

Harbir Singh Arora, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jocelyn Y Ang, MD, FAAP, FIDSA, FPIDS Clinical Professor of Pediatrics, Wayne State University School of Medicine; Professor of Pediatrics, Central Michigan University College of Medicine; Consulting Staff, Division of Infectious Diseases, Children's Hospital of Michigan

Jocelyn Y Ang, MD, FAAP, FIDSA, FPIDS is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Glenn Fennelly, MD, MPH Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

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