Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

910 Liver Flukes

management

What to Do First

■Assess severity of disease, including possible ectopic flukes.

General Measures

■Determine source of infestation; educate patient on prevention.

specific therapy

Indications

■All patients

Treatment Options

■Bithional, on alternate days for 10–15 doses (must be obtained from

the CDC)

■Triclabendazole once (available only as a veterinary preparation in

U.S. Excellent record of efficacy and safety in reports)

Side Effects & Complications

■Bithional: vomiting, diarrhea, abdominal pain, urticaria, photosen-

sitivity. Occasionally hepatitis, leukopenia.

■Triclabendazole: so far well tolerated

■Contraindications to treatment: absolute: allergy to medications

■Contraindications to treatment: relative: light infection, asymp-

tomatic

follow-up

During Treatment

■Monitor liver function, clinical course.

Routine

■Repeat stool exams 2–4 weeks after treatment, retreat if needed

(bithional cures about 50% in one course).

complications and prognosis

■Biliary obstruction, syndromes due to ectopic worms that migrate

to abdominal cavity, heart, brain. Prognosis of hepatic infection is

good if treated. Prognosis of ectopic worms depends on location and

possible surgical complications.