Parasites and Biliary stones

Fascioliasis ١٤
(Acuna-Soto and Braun-Roth, 1987). This ectopic migration is not seen
in other liver fluke diseases (Jones et al., 1977).
Pathology:
Fascioliasis can be characterized by three distinct phases: invasive
(acute) phase; latent phase, and chronic phase.
The invasive phase corresponds to the penetration and migration of
the juvenile, immature parasites through the liver parenchyma with
production of tissue necrosis, acute inflammation and hemorrhages
leading to severe anemia (Kayabali et al., 1992).
The chronic phase is established when the flukes gain access to
biliary system. The fasciola produces biliary epithelial hyperplasia.
Thickening and dilatation of the ducts and the gallbladder wall occur.
Other complications of long-standing fascioliasis in humans have been
reported, including portal and biliary fibrosis, cirrhosis and portal
hypertension (Rivero and Marcial, 1989).
Diagnosis:
Clinical manifestations of F. hepatica have different presentations,
according to the phase of infection (Kayabali et al., 1992). The acute
phase may be severe but more commonly it passes without significant
symptoms. In symptomatic patients, the invasive phase usually begins
with a transitory period of dyspepsia, followed by high temperature (39–
40°C), abdominal pain and tenderness. The clinical symptoms can also
include urticaria and respiratory symptoms.Marked eosinophilia (40%)
may be present (Balci, 1975). There may also be marked leukocytosis and
hypergammaglobulinemia (Espina et al., 1987). No ova are present in
the stool, making the diagnosis of acute fascioliasis difficult. The