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Episternal abscess due to fascioliasis in an Etesot in Uganda
417 TRANSACTIONS OF TNE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE, VOL. 74, No. 3, 1980
Correspondence To the Editor
Episternal
abscess due to fascioliasis in an Etesot in Uganda SIR-Human fascioliasis has been reported from many parts of the world (FACEY & MARSDEN, 1960; NORTON & MONROE, 1961; FAUST et al., 1970). However, human ectopicfascioliasis is rare and there are only a few recorded cases (NEGHME & OSSANDON, 1943; FATTAH et al., 1964; CATCHPOLE & SNOW, 1952). In this paper a case of ectopic fascioliasis is reported from Eastern Uganda. The subject was a male patient aged 17 years who presented with an anterior swelling on the upper third of the sternum at Aturtur Hospital, Eastern Uganda. The swellinrr had been gradual in onset and was of two months duration. On examination it was fluctuant but not fixed to the bone. On incision there was pus and a fluke which was brought to the parasitology laboratory of the Institute of Public Health for identification. The fluke measured 16 mm; oral and ventral suckers were clearly demarcated, with a very short cephalic cone. The oesophagus and branched caeca could all be seen. Two dendritic testes lay one behind the other in the middle sector. The cirrus pouch, lying close to the ventral sucker contained a seminal vesicle and a cirrus organ. The vitellaria were in the lateral fields and branched. The ovary which was dendritic was anterior to the anterior testis. Laurer’s canal and a mass of Mehlis’ glands were visible. There was a short uterus containing eggs, most of which were immature, typical of Fasciola, i.e. ovoid, operculate and yellowish-brown in colour, but less than the mean size (140 pm by 75 urn) (FAUST et al.. 1970). The snecimen was therefore identified as an immature Fasciola gigantica, as F. hepatica has not been reported from this country. Fasciola spp. are essentially parasites of the biliary tracts. Although from the available literature there is no record of ectopic human fascioliasis in this country, elsewhere there have been reports of the fluke being found lodged in blood vessels, lungs, subcutaneous tissues (abscess pockets), ventricles of the brain and the orbit (NEGHME & OSSANDON, 1943; FATTAH et al., 1964). GODQUINE et al. (1972) reported a case in which there were intramuscular calcifications due to ectopic fascioliasis. PERRY al. (1972) reported a case of hepatic abscess due to fascioliasis, typical ova even being recovered from the aspirate of the abscess. The earliest recorded case of ectopic human fascioliasis is perhaps that reported by LEUCKART (1863), more than a century ago, in which the parasite was found lodged in the trunk of the portal vein. Ectopic manifestations in fascioliasis are quite plausible when one considers the migratory route of the parasite. THORPE (1965) using albino rats I
I\
et
demonstrated that the early migratory route almost certainly involved traversing the peritoneal cavity. I am. etc.. V. ‘L. &G~M Institute of Public Health Makerere”University P.O. Box 7072, Kampala, Uganda
References Catchpole, B. N. & Snow, D. (1952). Human ectopic fascioliasis. Lancet, ii, 711-712. Facey, R. V. & Marsden, P. D. (1960). Fascioliasis in man: an outbreak in Hampshire. British Medical Journal, ii, 619-625. Fattah, F. N., Babero, B. B., Karaghouli, A. A. & Shaheen, A. S. (1964). The zoonosis of animal parasites in Iraq. X. A confirmed case of human fascioliasis. AmericanJournal of Tropical Medicine and Hygiene, 13, 291-294. Faust, E. C., Russell, P. F. & Jung, R. C. (1970). Clinical Parasitology (8th edition). Philadelphia: Lee & Febiger. Godquine, G., Lamy, Y., Blanchard, J. & Bernard, P. (1972). Distomatose hepatique et calcifications intramusculaires. Chirurgie (Paris), 98, 611-613. Leuckart, R. (1863). Die menschlichen Parasiten und die von ihnen herruhrenden Krankheiten, I. p. 582. Neghme, A. & Ossandon, M. (1943). Ectopic and hepatic human fascioliasis. American Journal of Tropical
Medicine,
23, 545-550.
Norton,
R. A. & Monroe, L. (1961). Infection by Fasciola hepatica acquired in California. Gastroenterology, 41, 46-48. Perry, W., Goldsmid, J. M. & Gelfand, M. (1972). Human fascioliasis in Rhodesia. Report of a case with liver abscess. Journal of Tropical Medicine and Hygiene,
75, 221-223.
Thorpe, E. (1965). The pathology of experimental fascioliasis in the albino rat. Journal of Comparative
Accepted
Pathology,
for
publication
letter was unfortunately the post.)
An outbreak
75, 39-44.
27th
March,
1978.
(This
delayed for 18 months in
of Rift Valley fever in the Sudan -1976 SIR-Rift Valley fever (RVF) is an arthropod-borne viral disease primarily affecting domestic animals with occasional involvement of man (DAUBNEY et al., 1931). Before 1977, the disease was geo-
Correspondence To the Editor
Episternal
abscess due to fascioliasis in an Etesot in Uganda SIR-Human fascioliasis has been reported from many parts of the world (FACEY & MARSDEN, 1960; NORTON & MONROE, 1961; FAUST et al., 1970). However, human ectopicfascioliasis is rare and there are only a few recorded cases (NEGHME & OSSANDON, 1943; FATTAH et al., 1964; CATCHPOLE & SNOW, 1952). In this paper a case of ectopic fascioliasis is reported from Eastern Uganda. The subject was a male patient aged 17 years who presented with an anterior swelling on the upper third of the sternum at Aturtur Hospital, Eastern Uganda. The swellinrr had been gradual in onset and was of two months duration. On examination it was fluctuant but not fixed to the bone. On incision there was pus and a fluke which was brought to the parasitology laboratory of the Institute of Public Health for identification. The fluke measured 16 mm; oral and ventral suckers were clearly demarcated, with a very short cephalic cone. The oesophagus and branched caeca could all be seen. Two dendritic testes lay one behind the other in the middle sector. The cirrus pouch, lying close to the ventral sucker contained a seminal vesicle and a cirrus organ. The vitellaria were in the lateral fields and branched. The ovary which was dendritic was anterior to the anterior testis. Laurer’s canal and a mass of Mehlis’ glands were visible. There was a short uterus containing eggs, most of which were immature, typical of Fasciola, i.e. ovoid, operculate and yellowish-brown in colour, but less than the mean size (140 pm by 75 urn) (FAUST et al.. 1970). The snecimen was therefore identified as an immature Fasciola gigantica, as F. hepatica has not been reported from this country. Fasciola spp. are essentially parasites of the biliary tracts. Although from the available literature there is no record of ectopic human fascioliasis in this country, elsewhere there have been reports of the fluke being found lodged in blood vessels, lungs, subcutaneous tissues (abscess pockets), ventricles of the brain and the orbit (NEGHME & OSSANDON, 1943; FATTAH et al., 1964). GODQUINE et al. (1972) reported a case in which there were intramuscular calcifications due to ectopic fascioliasis. PERRY al. (1972) reported a case of hepatic abscess due to fascioliasis, typical ova even being recovered from the aspirate of the abscess. The earliest recorded case of ectopic human fascioliasis is perhaps that reported by LEUCKART (1863), more than a century ago, in which the parasite was found lodged in the trunk of the portal vein. Ectopic manifestations in fascioliasis are quite plausible when one considers the migratory route of the parasite. THORPE (1965) using albino rats I
I\
et
demonstrated that the early migratory route almost certainly involved traversing the peritoneal cavity. I am. etc.. V. ‘L. &G~M Institute of Public Health Makerere”University P.O. Box 7072, Kampala, Uganda
References Catchpole, B. N. & Snow, D. (1952). Human ectopic fascioliasis. Lancet, ii, 711-712. Facey, R. V. & Marsden, P. D. (1960). Fascioliasis in man: an outbreak in Hampshire. British Medical Journal, ii, 619-625. Fattah, F. N., Babero, B. B., Karaghouli, A. A. & Shaheen, A. S. (1964). The zoonosis of animal parasites in Iraq. X. A confirmed case of human fascioliasis. AmericanJournal of Tropical Medicine and Hygiene, 13, 291-294. Faust, E. C., Russell, P. F. & Jung, R. C. (1970). Clinical Parasitology (8th edition). Philadelphia: Lee & Febiger. Godquine, G., Lamy, Y., Blanchard, J. & Bernard, P. (1972). Distomatose hepatique et calcifications intramusculaires. Chirurgie (Paris), 98, 611-613. Leuckart, R. (1863). Die menschlichen Parasiten und die von ihnen herruhrenden Krankheiten, I. p. 582. Neghme, A. & Ossandon, M. (1943). Ectopic and hepatic human fascioliasis. American Journal of Tropical
Medicine,
23, 545-550.
Norton,
R. A. & Monroe, L. (1961). Infection by Fasciola hepatica acquired in California. Gastroenterology, 41, 46-48. Perry, W., Goldsmid, J. M. & Gelfand, M. (1972). Human fascioliasis in Rhodesia. Report of a case with liver abscess. Journal of Tropical Medicine and Hygiene,
75, 221-223.
Thorpe, E. (1965). The pathology of experimental fascioliasis in the albino rat. Journal of Comparative
Accepted
Pathology,
for
publication
letter was unfortunately the post.)
An outbreak
75, 39-44.
27th
March,
1978.
(This
delayed for 18 months in
of Rift Valley fever in the Sudan -1976 SIR-Rift Valley fever (RVF) is an arthropod-borne viral disease primarily affecting domestic animals with occasional involvement of man (DAUBNEY et al., 1931). Before 1977, the disease was geo-