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Medications: Occasional gastrointestinal side effects
Prevention and Hygiene: Wash bed linens and night clothes in hot water to destroy eggs.
No Improvement/Deterioration: Referral for evaluation
Follow-up Actions
Return evaluation: As needed
Consultation Criteria: Failure to improve
ID: Fasciolopsiasis
LTC Glenn Wortmann, MC, USAIntroduction: Fasciolopsiasis is caused by the giant intestinal fluke, Fasciolopsis buski, found in the Far East
and Southeast Asia. Humans are infected by eating raw water plants (e.g., water chestnut/water bamboo) onto
which the organism has attached. The parasite eggs can be found about 3 months after ingestion.
Subjective: Symptoms
Usually asymptomatic, although infection may cause diarrhea and abdominal cramping, with vomiting and
anorexia.
Focused History: Have you noticed diarrhea? (most infections are asymptomatic, but diarrhea may occur)
Have you eaten any raw water plants, such as water chestnuts, in the previous few months? (typical exposure)
How long ago did you eat a water plant? (Symptoms usually occur several months after ingestion)
Objective: Signs
Using Basic Tools: Diarrhea. Massive infection can cause intestinal obstruction, edema of face/legs and
ascites.
Using Advanced Tools: Lab: O&P of stool: Identification of the F. buski eggs or large flukes in the stool.
Assessment:
Differential Diagnosis: There are many potential causes of diarrhea. Clues to fasciolopsiasis are travel to an
endemic region and diarrhea developing several months after the ingestion of raw water plants.
Plan:
Treatment: Praziquantel 25 mg/kg tid x 1 day
Patient Education
General: Avoid ingestion of raw water plants
Activity: As tolerated
Diet: As tolerated
Medications: Occasional nausea with praziquantel
Prevention and Hygiene: Avoid foods that may be contaminated
No Improvement/Deterioration: Return for reevaluation.
Follow-up Actions
Return evaluation: Investigate for other possible causes of diarrhea
Consultation Criteria: Failure to improve
ID: Fascioliasis
LTC Glenn Wortmann, MC, USAIntroduction: Fasciola hepatica infections are seen in sheep- and cattle-raising areas worldwide, with most