An unhealthy holiday on Lake Bolsena

A 70-year old man (OL) was hospitalized due to fever (up to 40°C) associated with malaise and abdominal pain. Tests showed hypereosinophilic syndrome, and increased liver and inflammation indexes. Abdominal echography showed a nonhomogeneous liver and the spleen was enlarged. Abdominal computed tomography showed multiple abscesses on the liver. The patient reported that he had recently gone on holiday to Lake Bolsena where he had eaten raw fish. A specialist in infectious diseases confirmed that in that area there is an infestation of Opisthorchis felineus. Analysis of blood and stool samples confirmed the presence of this parasite. The patient was treated with praziquantel with resolution of fever and improvement in clinical tests and general condition. Opisthorchis felineus is a parasite that commonly infects dogs and cats. Infection is sometimes transmitted to man and is usually related to eating raw fish. The parasite enters the liver and its eggs are found in the patient's stool samples. Acute symptoms are: fever, diarrhea, abdominal pain, and malaise. Hypereosinophilic syndrome and increase in liver index are typical. Chronic infection could result in cholangiocarcinoma. Presence of the parasite is confirmed through specific analysis of blood and stool. Therapy consists of praziquantel or, as second choice, abendazol. In the 20th century, there were 4 epidemics in Italy, on Lakes Trasimeno and Bolsena in Central Italy. The latest epidemic was reported in that area in summer 2012.