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Abstract: The patient in this case is a 25-year-old guy. The patient reported that he had intermittent weakness, abdominal distension, loss of appetite and discomfort in the liver area 2 months ago, and was very apprehensive when a checkup revealed abnormal liver function. We learned from communication that the patient occasionally drank beer in small amounts, but liked to eat raw fish made of river fish. Through routine blood and egg tests, he was diagnosed with schistosomiasis. The patient’s clinical symptoms disappeared and the indexes returned to normal, and he was clinically cured.
Basic information】Male, 25 years old
Disease Type】Testicular schistosomiasis
Hospital】The Second Hospital of Harbin Medical University
Time of consultation】February 2019
Treatment plan】Medication (albendazole tablets, compound glycopyrrolate tablets, glutathione tablets)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The patient’s clinical symptoms disappeared, and the indexes returned to normal, and the patient was clinically cured.
I. Initial consultation
Two months ago, the patient had intermittent symptoms of weakness, abdominal distension, loss of appetite and discomfort in the liver area. The patient reported that he had never had hepatitis before and occasionally drank beer in small amounts, but he liked to eat raw fish made from river fish. Considering the characteristics of the patient’s diet, it was likely that he was infected with liver fluke (Toxoplasma gondii) or hepatitis A and E. The hepatitis A, B, C and E tests were found to be normal through the hepatitis series. The routine blood test showed that the eosinophil percentage was significantly increased to 28.9%. The egg test revealed: Schistosoma chinensis eggs. Ultrasound of liver, spleen and gallbladder showed thickening of intrahepatic bile duct wall. Considering that viral hepatitis was excluded, and that the patient did not drink a lot of alcohol and was not an alcoholic liver, and that the eosinophils were so high and the eggs were positive, Schistosoma chinensis was considered.
II. Treatment history
There are many causes of liver injury, such as hepatophilic virus infection, alcohol, non-alcoholic fatty liver disease, drugs, parasites, autoimmune and so on, or multiple factors superimposed. The choice of treatment plan should be based on the cause. Routine blood and stool tests revealed a high percentage of eosinophils, which is often associated with allergies, parasitic infections, and eosinophilic leukemia, but the patient had a clear preference for raw fish, and the treatment was directed to schistosomiasis, and eggs were detected in the stool. At present, praziquantel tablets and albendazole tablets can be used. We gave the patient albendazole tablets for 1 week, and also gave the patient compound glycyrrhizin tablets and glutathione tablets for liver protection, and paid attention to observe whether there is any drug allergy performance.
III. Treatment effect
After the treatment, the patient’s liver function abnormalities recovered significantly, and the glutathione transaminase and glutathione transaminase soon returned to the normal range. Gastrointestinal symptoms such as abdominal distension and loss of appetite were relieved. There was also a relatively significant decrease in the percentage of routine blood eosinophils after the use of albendazole. After 1 week of treatment, the stool egg test was negative. 1 month later, he returned to the hospital and the results of liver function and routine blood tests were normal and negative for stool eggs. There was no abdominal distension or loss of appetite. In conclusion, the patient was hospitalized for 7 days and followed up in outpatient clinic after 1 month. The patient’s clinical symptoms disappeared and the indexes returned to normal, and he was clinically cured.
IV. Notes
The patient was cured through the treatment and relieved the tension, so we are sincerely happy for him. After treatment, patients should still keep their mouths shut and not forget about their illness when they see such delicacies. In daily life, pay attention to dietary hygiene, imported food must be thoroughly cleaned, and also pay attention to whether the kitchen utensils are contaminated, and the chopping board where raw fish has been cut should be scrubbed. Avoid eating raw fish and other seafood afterwards. Do not drink water that may be contaminated, and eat food that is cooked as well as possible. Eat more vitamin-rich foods, such as fresh fruits and vegetables. After treatment, you also need to review liver function, ultrasound, blood and stool routine and other indicators regularly to ensure healing.
V. Personal insight
The infection has a lot to do with dietary habits, mostly related to eating raw freshwater fish and shrimps, such as the temptation to kill raw fish, drunken shrimps and other delicacies, and the lack of immunity of the human body to T. burgdorferi. Some people may never know they are infected. Even some doctors may lack knowledge of the disease and fail to diagnose the condition in time, resulting in delays and, over time, can cause cirrhosis and liver cancer. So there should also be more awareness and prevention. Do not eat raw freshwater fish and shrimp, animal liver, boil untreated water, and separate raw from cooked. Prompt treatment is needed after diagnosis. The overall deworming treatment is not expensive and the side effects of the drugs are not significant.