A finding of live Fasciolopsis buski in an ileostomy opening
Rakesh K. Mahajan1, Shalini Duggal2, Niraj K. Biswas3, Nandini Duggal1, Charoo Hans1 1Department of Microbiology, Dr Ram Manohar Lohia Hospital, New Delhi, India
2Department of Microbiology, Dr B. L. Kapur Memorial Hospital, Delhi, India
3Jhalawar Medical College, Jhalawar, Rajasthan, India
A pair of live Fasciolopsis buski
wriggled their way out through the ileostomy opening in a young adult male who had recently migrated to
Delhi and had met with a road traffic accident. Finding this parasite in the national capital, a non endemic area for Fasciolopsiasis, prompted
us to emphasize the importance of changes in the ecology, human demography, and human behaviour that may provide an environment
conducive to their adaptability to the new geographical requirements. Awareness of Fasciolopsiasis, which is endemic in some regions of
India, especially in rural settings, is an important issue because early diagnosis is essential. Hence, a surveillance mechanism among the
migratory population to institute preventive interventions is necessary.
endemic, intestinal trematode, plant-borne, migratory population
J Infect Dev Ctries
(Received 3 July 2009 – Accepted 30 November 2009)
Copyright 2010 Mahajan et al
. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited. Introduction
), also called giant
give history of passing greenish yellow, extremely
intestinal fluke, is a duodenal digenetic trematode, of
malodorous stools and there may be associated
the Fasciolidae family. It was described for the first
edema of the face and limbs, generalized abdominal
time by Busk in the duodenum of a sailor in 1843 in
pain, ascitis and even death . Adult worms at the
London and its life cycle in humans was first
site of attachment cause deep inflammatory
described by Barlow in 1925 . F. buski
ulcerations and their metabolites on absorption may
mainly in southeast Asian countries including India.
also induce toxic and sensitization reactions.
It seems to be restricted to areas where water plants
The present case is first of its kind where an
such as water chestnut, water caltrops, water bamboo,
ileostomy opening acted as a corridor for the escape
etc. are cultivated and in communities that consume
of adult Fasciolopsis buski
these water plants uncooked.
Aquatic snails act as intermediate host for the
parasite and harbor the infective metacercariae that
An 18-year-old boy fell down from a moving
encyst on water plants after being released into the
vehicle and was brought to the surgical emergency of
water. The mature fluke develops and starts laying
our hospital. In the accident, he sustained a fracture at
eggs within three to four months after infective
the neck of the femur as well as a blunt injury to the
metacercariae have been ingested . Two species of
abdomen, resulting in peritonitis. Ultrasonography
the snails, Segmentina (Polypylis) hemisphaerula
abdomen revealed a significant amount of free fluid
Segmentina (Trochorbis) trochoides
, have been
in the peritoneal cavity.
particularly found to play an important role in disease
The patient was taken for an exploratory
transmission. Though pigs and humans both act as
laparotomy. About a 20 cm length of ileum was
definitive hosts, pigs appear to be the only reservoir
found gangrenous and an ileostomy was undertaken
of infection .
after resecting the dead portion. About 500 ml of
Clinically, fasciolopsiasis may present with
fecal fluid was also removed.
occasional loose stools, loss of weight and abdominal
About one month after the surgery, while
pain. As the worm burden increases, the patient may
replacing the ileostomy bag with a fresh one, the
Mahajan et al. - Fasciolopsis buski in an ileostomy opening
J Infect Dev Ctries 2010; 4(6):401-403.
Figure 1. Adult worm of Fasciolopsis buski recovered
Figure 2: Ova of Fasciolopsis buski recovered from
from the ileostomy opening.
contents of ileostomy bag.
patient felt two large fleshy structures crawling on
needle to release the ova, which were again
the abdominal wall around the ileostomy opening.
visualized on microscopy.
Immediately, he called for the resident doctor on
Other laboratory investigations revealed Hb 7.2
duty, who collected them in a glass container and
gm%, TLC 13,500/cu mm, DLC: P 78L13E9. Absolute
referred the contents immediately to
Microbiology Department for identification and
immunoglobulin profile showed elevated levels of
IgA at 602.0 mg/dL (reference range 90-310 mg/dL).
When transferred to a petri dish, the contents
To de-worm, the patient was given Nitazoxanide
proved to be two large, fleshy worms whose leaf
 500 mg BD for five days. After taking just two
shape doubtlessly pointed to their lineage of Flukes.
doses of the drug, the patient passed five more worms
This is the first report of fasciolopsiasis from our
through the ileostomy opening. Three more stool
tertiary care hospital and also the very first case
samples were examined over the next week and none
where live F. buski pushed their way out through an
of them showed any evidence of ova/cyst. Thereafter,
the patient did not complain of any such findings and
The worms were dorsoventrally flattened, non
was discharged after his wound healed.
segmented and reddish brown in color. Absence of a
cephalic cone ruled out the probability of the parasite
as being Fasciola hepatica. One of them measured
Though fasciolopsiasis appears to be attracting
about 36 mm × 24mm and the other about 40 mm ×
research interest, not much literature is available on
20mm in size. The ventral sucker was prominent in
the subject topic. F. buski infestation has been
both, while the oral sucker was clear in only one of
reported in India from mainly from Bihar , Uttar
them. The worms had morphology classical of
Pradesh, and Maharashtra but also sporadically from
Fasciolopsis buski (Figure 1).
other states . It appears to be affecting mainly rural
To further assess further whether the patient was
areas where certain water plants are eaten raw. This
harboring more of F. buski or some other parasites,
particular case migrated to Delhi just five days before
contents of the ileostomy bag were examined macro-
the accident from eastern Uttar Pradesh where he
as well as microscopically. Formol ether
worked as an agriculture farm laborer. There was a
concentration of the sample showed a number of
freshwater pond in his native village that has aquatic
large, ovoid bile-stained ova morphologically
plants such as water chestnut, and he gave history of
resembling those of F. buski (Figure 2), though it was
eating raw water chestnuts and vegetables washed in
not possible to differentiate them from ova of F.
the pond water. Snails abound in that pond and the
hepatica. The parasites were fixed in formalin, and
surrounding damp area. The patient had a significant
their unbranched intestinal caeca and uterine segment
past history of vague abdominal pain and passing
examined under 40X. These were teased with a 25 G
Mahajan et al. - Fasciolopsis buski in an ileostomy opening
J Infect Dev Ctries 2010; 4(6):401-403.
Delhi, the national capital, is emerging as a hot
fertilizer etc. Such measures could go a long way in
favorite for migrants in anticipation of some job
preventing and controlling a battery of infectious
opportunities. The migrant population is bringing
diseases including fasciolopsiasis. Furthermore, the
with them certain problems that have historically
importance of continuing medical education to
been endemic problems of their native areas. The
medical personnel in areas of emerging and re-
Yamuna River, which traverses practically the whole
emerging problems in tropical countries to sensitize
city, has certain sectors where edible water plants and
them to current issues of public health cannot be
snails are plenty; this situation can play a significant
role in providing epidemiological support allowing
this parasite to establish in this geographical area.
This report of fasciolopsiasis from an area that is
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(Lankester, 1857) in Thailand. Am J Trop Med Hyg 19:
whether Nitazoxanide can be included in the
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of the drug caused expulsion of five more worms
treatment of Fasciolopsis buski infection in children: A
after the initial two that were removed. Although the
comparison of thiabendazole, mebendazole, levamisole,
drug of choice is Praziquantel, the patient in this case
pyrantel pamoate, hexaresorcinol and tetrachloroethylene. Trans R Soc Trop Med Hyg 79: 513-15.
was treated with Nitazoxanide, a novel agent that has
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gastrointestinal pathogens, as these cases may have
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multiple parasitic infestations [5,6]. Use of
6. Rai S, Wadhwa V, Kharbanda P, Uppal B (2007) A case of
poly-parasitism involving a trematode and four different
Nitazoxanide would definitely need more scientific
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support since some other unknown mechanism might
have been operative in this subject case
7. CD Alert. Food borne trematode (Fluke) infections: A
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Given that the present distribution of parasitic
diseases reflects the success of hygiene and control
measures in the more developed parts of the world
rather than any clear geographical or ecological
Department of Microbiology
restriction, it becomes extremely pertinent to stress
B.L.Kapur Memorial Hospital
the need to disseminate health education at the
Delhi, India [email protected]
community level focused on measures such as the
importance of properly cleaning and processing vegetables, discouraging the use of night soil as
Conflict of interests: No conflict of interests is declared.
PREVENCION E INTERVENCION CONTRA EL ACOSO ESCOLAR Capacitación del Empleado de la Corporación Escolar sobre la PrevenciónFuente: Departamento de Educación de Indiana Según la Asociación Nacional de Psicólogos Escolares, 160,000 estudiantes por día faltan a la escuela cada día a causa del acoso escolar (bullying) (Fried & Fried, 2003).
Schizophrenia Research 63 (2003) 63 – 71 Source distribution of neuromagnetic slow-wave activity in schizophrenic patients—effects of activation Thorsten Fehr, Johanna Kissler, Christian Wienbruch, Stephan Moratti, Thomas Elbert, Hans Watzl, Brigitte Rockstroh * Department of Psychology, University of Konstanz, P.O. Box D23, D-78457 Konstanz, Germany Center for Psychiatry Reichenau, D-78467 Reichenau, Germany