The life cylce for the fluke:
(1) eggs are passed in the stool of an infected ruminant
(2) land snails ingest the eggs and excrete cercaria in mucus balls
(3) ants eat the mucus balls and develop metacercariae
(4) an infected ant is eaten by a ruminant or human, accidentally (eating vegetation or drinking contaminated water) or intentionally
(5) the metacercariae develop into adults and migrate to the bile duct
Clinical features of an infection with Dicrocoelium dendriticum:
(1) chronic diarrhea or constipation (altered bowel habits)
(2) right upper quadrant pain or biliary colic
(3) other abdominal discomfort
(4) vomiting
(5) allergic pharyngitis (Halzoun syndrome)
(6) urticaria
Laboratory findings:
(1) eosinophilia
(2) elevated serum IgE concentration
(2) excretion of small, thick-walled eggs in the stool (40 x 20 mm)
The diagnosis is supported by:
(1) absence of alternative explanations for symptoms
(2) therapy with albendazole or other suitable agent results in disappearance of eggs in stool and clinical improvement
A pseudo-infection can occur in a person who eats raw liver from an infected animal. Eggs from the raw liver may be excreted in the stool but the person is not infected. In this case the eggs disappear after avoiding raw liver for several days.
