Hepatobiliary fascioliasis: A neglected re-emerging threat, its diagnostic and management challenges

Table 1 Challenges in fascioliasis diagnostics and emerging techniques

Method		Strengths	Challenges	Emerging solutions/comments
Stool analysis		Direct detection of eggs in stool samples confirms active infection	Does not allow the differentiation between F. gigantica and F. hepatica due to morphological similarities, delay in detection (only positive 3-4 months post-infection), intermittent egg output, low or absent egg shedding in light infections, chronic cases, ectopic infections, or false positives from ingested infected liver tissue	Necessitates alternative or adjunct diagnostic methods due to limited sensitivity in early and complex cases
Serology	Serological tests using excretory/secretory Antigens[29,30]	ELISA-based tests using purified or recombinant antigens (e.g., cysteine proteinases produced in yeasts[29] or in E. coli[30]) offer high sensitivity and specificity, particularly for F. hepatica and F. gigantica	May suffer from cross-reactivity with antibodies against other helminths; delayed seroconversion in the acute phase; cannot differentiate between species in regions where both coexist	Recombinant antigens produced in yeast or E. coli have been successfully incorporated into ELISA protocols, improving diagnostic performance
	MM3 coproantigen-detection test[31]	Provides high sensitivity and specificity; suitable for large-scale screening, early detection in chronic infections, and monitoring treatment outcomes	Limited in its ability to quantify fluke burden on its own, which is crucial for determining appropriate treatment doses and assessing disease intensity	The use of a new preservative/diluent (CoproGuard™) has enhanced coproantigen extraction and antigen stability, potentially improving the test's diagnostic yield[32]
	Commercial F. hepatica IgG ELISA[26]	High sensitivity and high negative predictive value, making it useful for ruling out infection when combined with a compatible clinical history	Exhibits a low positive predictive value and lacks correlation with egg output, necessitating confirmation with additional diagnostic methods to avoid misclassification, particularly in areas with potential cross-reactive helminth infections	Considered promising for individual diagnosis and large-scale epidemiological studies, provided it is supplemented by other diagnostic tests to confirm positive results
	SeroFluke Lateral Flow Test[33]	Offers maximal specificity and sensitivity; applicable to both serum and whole-blood samples; user-friendly and suitable for point-of-care testing in both hospital settings and endemic regions	While promising, further validation is required to fully assess its performance across diverse clinical settings and to ensure its reliability in routine diagnostic practice	Represents a significant step forward in rapid, field-friendly diagnostics, potentially addressing the shortcomings of more invasive or technically demanding methods