What are the other Names for this Condition? (Also known as/Synonyms)

• Dicrocoelium Dendriticum Infection
• Lanceolate Liver Fluke Infection
• Lancet Liver Fluke Infection

What is Dicrocoeliasis? (Definition/Background Information)

• Dicrocoeliasis is a condition that results when a parasitic flatworm, known as the lancet liver fluke (specifically Dicrocoelium dendriticum), infects the intestine and bile duct
• The lancet liver fluke often resides in the bile ducts of their human hosts, absorbing nutrients to multiply and propagate. These parasites are known to infect grazing mammals such as cows, sheep, and goats
• However, such an infection/infestation normally results only in mild symptoms that disturb the digestive system. This may include diarrhea and bloating
• A healthcare provider typically diagnoses Dicrocoeliasis upon examination of the stool, bile, or intestinal fluid for the presence of parasitic eggs
• Anthelmintic (anti-parasitic) medication may be prescribed towards treating the infection. The prognosis of Dicrocoeliasis is generally good following appropriate treatment

Who gets Dicrocoeliasis? (Age and Sex Distribution)

• Individuals of all ages, racial and ethnic groups, and both male and female genders are susceptible to Dicrocoeliasis
• Geographically, areas that foster the intermediate hosts of Dicrocoelium dendriticum tend to have a higher frequency of infection in the human population. These areas include Central Europe, Middle East and Asia, North and South America, etc.

What are the Risk Factors for Dicrocoeliasis? (Predisposing Factors)

• A major risk factor for Dicrocoeliasis is the frequent ingestion/consumption of undercooked, raw liver of grazing mammals such as cows, sheep, and goats

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Dicrocoeliasis? (Etiology)

Dicrocoeliasis is caused by the infestation of a parasite known as Dicrocoelium dendriticum. The condition is also known as Lancet Liver Fluke Infection. These parasites find their way into human hosts through multiple intermediate hosts. They spread infection after being consumed (often unintentionally).

• D. dendriticum is classified as a trematode (fluke) parasite, which have a life cycle characteristic of other trematode parasites
• The host that directly passes the parasite to humans is most often the ant, whose behavior patterns are affected by the parasite so as to make it more susceptible to being unintentionally eaten by mammals or humans
  • Once the ant has been ingested, the parasite excysts (activates) from the ant in the small intestine
  • The worms then travel from the small intestine to the bile duct, where they grow and mature into adult D. dendriticum by feeding off host material in the bile duct
• The infection can also spread from eating raw or undercooked liver of infected animals
• The presence of the parasite in the bile duct is the cause of most symptoms associated with Dicrocoeliasis

What are the Signs and Symptoms of Dicrocoeliasis?

The signs and symptoms of Dicrocoeliasis vary in occurrence and severity depending on the duration and magnitude of infestation by D. dendriticum. Symptoms that are common for most mild cases of infection include:

• Bloating
• Diarrhea
• Dehydration

If infestations are severe (in rare cases), a consequential enlargement of the bile ducts can cause the following: 

• Hepatomegaly or enlargement of the liver
• Cirrhosis or inflammation/low function of the liver, which can be associated with liver abscesses and pain in the upper abdominal area
• Cholecystitis or swelling of the gallbladder

How is Dicrocoeliasis Diagnosed?

The diagnosis of Dicrocoeliasis is made using the following tests and exams:

• A complete physical examination and a thorough assessment of symptoms
• Evaluation of the affected individual’s medical history
• An examination of stool for the presence of eggs of the parasite
  • However, the presence of eggs in the feces may be a false positive indicator of Dicrocoeliasis
  • Since, it is possible that the ingestion of raw, infected liver of animals may result in eggs being present in the stool, even when the parasite has not infected the body
• The examination of bile or intestinal fluid for the presence of eggs, is a more accurate indicator of infection

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Dicrocoeliasis?

The potential complications of Dicrocoeliasis may include the following:

• Inflammation and damage to the liver with severe infections; liver failure 
• High blood pressure in the liver
• Swelling of the abdomen/legs 
• Easy bruising or bleeding
• Jaundice
• Formation of gallstones
• Severe itching of skin
• Sensitivity to medicine
• Swelling of the gallbladder: This may irritate other tissues and cause injury to the bile ducts, inhibiting the drainage of the liver and causing additional injury. The gallbladder itself can become perforated requiring its surgical removal 

How is Dicrocoeliasis Treated?

Treatment of Dicrocoeliasis may include the following:

• Prescription of anthelmintics: These are a class of medication that kill parasitic tapeworms in the body (without interfering with essential bodily functions). They do so by either paralyzing or starving the tapeworms until they die. The dead tapeworms then detach from the tissue and are excreted from the body
• Electrolyte therapy for rehydration, to treat secondary symptoms in the affected individuals, particularly children

How can Dicrocoeliasis be Prevented?

Prevention of Dicrocoeliasis may be possible by:

• Avoiding raw liver consumption: This greatly decreases one’s risk for infection, as the main mode of Dicrocoeliasis transmission is through the ingestion of raw, contaminated liver
• Always drinking filtered and safe water

What is the Prognosis of Dicrocoeliasis? (Outcomes/Resolutions)

• The prognosis of Dicrocoeliasis is often good with proper administration of medication in a timely manner. Anthelmintic drugs are very effective and they are known to eliminate D. dendriticum from the body
• If left untreated, the infection may lead to certain complications, which can be detrimental to major organs of the body, such as the liver

Additional and Relevant Useful Information for Dicrocoeliasis:

• D. Dendriticum belongs to the same family as the D. hospes trematode
• Mild infections are more commonly reported than severe infections, because the long/narrow morphology of the D. dendriticum often results in the parasite residing in regions further out from the bile ducts (and therefore in less clinically significant regions)
• D. dendriticum belong to the flatworm family known as flukes. They have characteristically dark brown eggs that are easily identifiable by a healthcare provider under microscope