PNEUMOTHORAX A RARITY IN FASCIOLASIS

M. Aghajanzadeh MD*, A. Sarshad MD**, R. Ebrahimian MD*

Departments of * Surgery and ** Infectious Disease, Razi Medical Center, Rasht, Iran

Introduction

A 30 year-old tall and slender female housewife from Gilan north of Iran was admitted to emergency ward with sever dyspnea and chest pain. In her physical examination a decrease in right lung sounds was evident. Her chest X-Ray revealed a total right lung collapse with a mediastinal shift to left. A chest tube was inserted for the patient and her respiratory condition improved, but the air leakage continued and the lung did not re-expand totally. In her third day of hospitalization a WBC count of 13,000 with a 67% predominance of eosinophils was detected. Seven days after chest tube insertion she went under thoracotomy. During exploration a 3 centmeter superficial air-leaking nodule in her left inferior lobe was found. The nodule was resected with some safe margin. Twenty four hours after the repair and pleural abrasion the lung reexpanded.

The microscopic examination of the nodule revealed fasciolasis. Hepato-biliary ultrasound was performed but no abnormality was detected.

She was treated with Triclabendasole and her 4 month follow-up revealed no complication.

The sheep liver fluke, F. hepatica, is a common parasite with cosmopolitan distribution.¹ Human Outbreaks have been reported from France, England and Cuba ^1,3. Gilan province in northern Iran has suffered two outbreaks in 1989 and 1999 during the recent years. Many Fasciola infections are asymptomatic but symptomatic fasciolasis displays acute, chronic and ectopic forms. In the acute or larval migratory, phase patients might complain of severe productive or non-productive coughs and other respiratory complaints. These symptoms are sometimes mistakenly treated as asthma and other allergic reactions. ^{1, 3, 4}

In the chronic phase there may be pain in the right hypochondrium and epigastrium, various gastrointestinal complaints and eventually jaundice and choledocholithiasis. In the ectopic forms the parasite migrates via blood, lymph or direct invasion to the lung, heart, brain, and skin where nodules or absccses may be formed.

As far as we know, no case of pure pneumothorax due to fasciola has been reported. A case of pyopneumothorax has appeared in French literature. ⁵The management of pneumothorax due to fasciola is comparable to instances due to other etiologies; chest tube installation accompanied by treatment of underlying disease. Triclobendazole is an effective treatment against F.hepatica and is becoming the drug of choice. A single dose eliminates the infestation in about ¾ of the cases.^6-8 Two separately administered doses almost totally eliminates the parasite.^6,8

It is concluded that due to the high prevalence of F.hepatica in some northern regions should by considered even in the differential diagnosis of pulmonary complaints especially case not matching with classical symptoms or responding to standard treatments.

Reference

1. Markell EK, Voge M, John DT. Medical Parasitology 7^th ed. Philadeiphia: WB Saunders, 1992.
2. Bunnage D, Harinasuta KT. Liver fluke disease. In: Goldsmith R, Heyneman D, eds. Tropical Medicine and Parasitology. London: Prentice-Hall, 1989.
3. Harinasuta T, Bunnag D. liver, lung, and intestinal trematodiasis. In: Warren K S, Mahmoud AAF, eds.
4. Tropical and Geographical Medicine. 2^nd ed. New York: Mc Graw-Hill, 1990.
5. Flores M, Merino-Angula J, Aguirre Errasti C Pulmonary infiltrates as first sign of infection by Fasciola hepatica. Eur J Respir Dis 1982; 63: 231-3.
6. Vivesl, Gaillemin C, Recco P, Seguela JP. Pyopneumothorax as the first and main manifestation of Fasciola hepatica distomatosis. Nour Presse Med 1980; 9(1): 48.
7. Human fascioliasis in Egyptian children: successful treatment with triclabendazole. El-Karaksy H, Hassanein B, Okasha S, Behairy B, Gadallah I. J Trop Padiatr 1999. 45(3): 135-8.
8. Trematode infections. Opisthorchiasis, fascioliasis, and paragnoimiasis Harinasuta T, Pungpak S, Keystone JS. Infect Dis Clin North Am 1993 7(3): 699-716.
9. Treatment of human chronic fascioliasis with triclabendazole: drug efficacy and serologic response. Apt W, Aguilera X, Vega I, et al. Am J Trop Med Hyg 1995; 52: 532-5.

AIM Home|Table of Contents