Fascioliasis is a food-borne parasitic disease caused by the trematode species Fasciola hepatica, distributed worldwide, and Fasciola gigantica, restricted to given regions of Africa and Asia. This disease in humans shows an increasing importance, which relies on its recent widespread emergence related to climate and global changes and also on its pathogenicity in the invasive, biliary, and advanced chronic phases in the human endemic areas, mainly of developing countries. In spite of the large neurological affection capacity of Fasciola, this important pathogenic aspect of the disease has been pronouncedly overlooked in the past decades and has not even appear within the numerous reviews on the parasitic diseases of the central nervous system. The aim of this wide retrospective review is an in-depth analysis of the characteristics of neurological and ocular fascioliasis caused by these two fasciolid species. The terms of neurofascioliasis and ophthalmofascioliasis are restricted to cases in which the direct affection of the central nervous system or the eye by a migrant ectopic fasciolid fluke is demonstrated by an aetiological diagnosis of recovered flukes after surgery or spontaneous moving-out of the fluke through the orbit. Cases in which the ectopic fluke is not recovered and the symptoms cannot be explained by an indirect affection at distance may also be included in these terms. Neurofascioliasis and ophthalmofascioliasis cases are reviewed and discussed. With regard to fascioliasis infection giving an indirect rise to neurological affection, the distribution and frequency of cases are analysed according to geography, sex, and age. Minor symptoms and major manifestations are discussed. Three main types of cases are distinguished depending on the characteristics of their manifestations: genuine neurological, meningeal, and psychiatric or neuropsychic. The impressive symptoms and signs appearing in each type of these cases are included. Brain examination techniques and neuroimaging useful for the diagnosis of neurological cases are exposed. Within fascioliasis infection indirectly causing ocular manifestations, case distribution and frequency are similarly analysed. A short analysis is devoted to clarify the first reports of a human eye infection. The affection of related and close organs is discussed by differentiating between cases of the dorsal spine, pulmonary manifestations, heart and vessel affection, findings in blood vessels, skin and dermatologic reactions, cases of ectopic mature flukes, and upper body locations. The clinical complexity of the puzzling polymorphisms, the disconcerting multifocality of the manifestations, and their changes along the evolution of the disease in the same patient, as well as the differences between the clinical pictures shown by different patients, are highlighted. The many syndromes involved are enumerated. The pathogenic and physiological mechanisms underlying neurofascioliasis and ophthalmofascioliasis caused by ectopic flukes and the physiopathogenic processes indirectly affecting the central nervous system and causing genuine neurological, meningeal, psychiatric, and ocular manifestations are discussed. The diagnosis of neurological and ophthalmologic fascioliasis is analysed in depth, including clinical and paraclinical diagnosis, eosinophilia in the blood and cerebrospinal fluid, differential diagnosis from other parasitic infections such as helminthiases and myiases, an update of human fascioliasis diagnosis, and fluke and/or fluke egg recovery by surgery. Diagnostic analyses with faecal and blood samples for fascioliasis patients are updated. Therapy for patients with major neurological manifestations includes both antiparasitic treatments and anti-inflammatory therapeutics. Prognosis in fascioliasis patients with neurological manifestations is discussed, with emphasis on sequelae and fatal cases, and the care of patients with ophthalmologic manifestations is added. Conclusions indicate that neurological cases are overlooked in human fascioliasis endemic areas and also in developing countries in general. In remote zones, rural health centres and small hospitals in or near the human endemic areas do not dispose of the appropriate equipments for neurological analyses. Moreover, physicians may not be aware about the potential relationship between liver fluke infection and neurological implications, and such cases may therefore remain misdiagnosed, even in developed countries. Priority should henceforth be given to the consideration of neurological and ocular affection in human endemic areas, and efforts should be implemented to assess their characteristics and frequency. Their impact should also be considered when estimating the global burden of fascioliasis.

Neurological and Ocular Fascioliasis in Humans

Conjunctivitis due to the trematode Philophthalmus in a 13-year-old Israeli girl is described. A single worm, probably a mature Philophthalmus palpebrarum, was detected on the palpebral conjunctiva of the upper eyelid of the right eye. Removal of the worm resulted in rapid abatement of the ocular symptoms. This is the first documentation of human philophthalmosis in Israel.

A first instance of human philophthalmosis in Israel.

Species of Philophthalmus parasitize primarily the eyes of wild and domestic birds. A variety of mammals, including humans, occasionally serve as the intermediate as well as the definitive hosts for this parasite, although human cases are extremely rare. Here, we report a case of human conjunctivitis caused by an infection with Philophthalmus sp. in Mexico. The patient was a 31-yr-old male who visited an ophthalmologist in Los Mochis, Sinaloa, Mexico, because of a foreign-body sensation in his left eye for 2 mo. A small live parasite was found in the connective tissue of the bulbar conjunctiva and was removed surgically under local anesthesia under ophthalmoscopic observation. The parasite was identified morphologically as Philophthalmus lacrimosus Braun, 1902. This is the first case of human philophthalmosis in Mexico and, to our knowledge, the first human case of P. lacrimosus infection in the world.

https://bioone.org/journals/Journal-of-Parasitology/volume-89/issue-1/0022-3395(2003)089[0183:TFHCIM]2.0.CO;2/The-First-Human-Case-in-Mexico-of-Conjunctivitis-Caused-by/10.1645/0022-3395(2003)089[0183:TFHCIM]2.0.CO;2.pdf

The First Human Case in Mexico of Conjunctivitis Caused by the Avian Parasite, Philophthalmus lacrimosus

Human Conjunctivitis Caused by the Bird Parasite Philophthalmus

Trematodes of the genus Philophthalmus are cosmopolitan parasites that infect the eyes of birds and mammals. They have the potential to affect the survival of their hosts and a few cases of human philophthalmiasis have occurred worldwide. Adults of known Philophthalmus species have never been recorded from bird hosts in New Zealand, despite their cercarial stage being a focus of various studies. Here, we describe a new species of Philophthalmus infecting New Zealand red-billed and black-backed gulls, Philophthalmus attenuatus n. sp. It is distinguished from other marine species of Philophthalmus by its long, thin body shape, consistently longer vitelline field on the left, and its body reflexed at the ventral sucker. We use molecular methods to complete the life cycle of this species, matching it with the larval stage infecting the mud whelk, Zeacumantus subcarinatus, and present a preliminary cox1 phylogeny. In addition, we comment on the validity of some taxonomic characters used to differentiate species of this genus, discuss potential colonisation routes to New Zealand and comment on the potential for zoonotic infection.

Morphology and molecules resolve the identity and life cycle of an eye trematode, Philophthalmus attenuatus n. sp. (Trematoda: Philophthalmidae) infecting gulls in New Zealand

A living mature eye fluke of the genus Philophthalmus was removed from under the conjunctiva of a man from the north of Sri Lanka. This is the third report on infection of a human by Philophthalmus sp., the second with subconjunctival infection by cercaria is discussed.

[Mature avian eye fluke (Philophthalmus sp.) under the human conjunctiva (author's transl)].

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[Mature avian eye fluke (Philophthalmus sp.) under the human conjunctiva (author's transl)].