Liver Fluke

LIVER FLUKE
(an often-misidentified worm that's lethal if not treated for properly)
Update 12/08
by Sue Reith.

SYMPTOMS
Liver fluke damage is generally rather slow in appearing in mature goats... In a reasonably healthy goat, it can take years of gradual decline before the owner is even aware that Liver fluke is present.  Symptoms are some, if not always all, of the following: Gradual increase in unthriftiness (dry coat, guard hairs sticking up, ribbiness, pale eye membranes (indicating anemia caused by the worm's activity), a swelling under the jaw (that has erroneously been considered among the veterinary community to be symptomatic of resistance to treatment for Haemonchus contortus), and, eventually, a possibly sub-normal temp (less than 102 degrees), a distended belly (symptomatic of last-stage liver disease), and fecal pellets that are almost black in color and shriveled up with pointy ends on them.
Often the victim goat is one that has been wormed routinely, and yet still continues its gradual decline. The problem is that there's only one wormer on the market that will wipe out Liver fluke properly, Ivomec PLUS, (the PLUS part being clorsulon, specifically for eradication of Liver fluke) and many owners don't even know this wormer exists! Sadly, even when the owner finally learns about it and starts treatment, by that time there has often already been too much damage to the goat's liver for it to be saved even after proper worming.
BTW: While Liver fluke damage is often found in otherwise well-managed mature goats that despite good care continue to decline in appearance, in my experience this sudden appearance of anemia and weakness with either normal, or subnormal, temp (and sometimes swelling under the jaw as well) is not at all unusual to discover in young ruminants within the first few months of life as well.  At that age it commonly shows up when they're heavily exposed to it in pastures containing wet areas,  before their immune systems can get up and going to protect them. In fact, it's not uncommon for these young victims to die so fast they hardly have time to be sick.¹ This is especially true if there are any clostridial (Entero) organisms present in them, since they multiply and secrete their toxins fast in the already damaged, poorly oxygenated liver tissue .¹ 

TREATMENT:
I'm not one to quit without at least doing my best to save the goat... So if a goat of mine were affected with Liver Fluke I'd start it immediately on Ivomec Plus, using the appropriate worming approach as follows: All wormer packages note on the packaging that the product kills off ONLY the adult stages. So in order to get the worm load in the host down to a low enough level so that the immune system can take over and keep the problem under control, you need to worm 3X, with 10 days between wormings. The first dose will wipe out the adults already in there,  the second dose will wipe out the larvae that were in the gut, but not affected by the first worming, as they become adults (but before they can start laying eggs of their own), and the third dose kills off any eggs that were left over after you started the worming regimen,when they've passed thru the larval stage, when they, too, have become adults.

And as soon as you've begun the repair process by giving the first dose of Ivomec Plus, the next step would be to immediately start the goat on subcutaneous injections of Ferrodex 200 (each 1 ml dose of which delivers 200 mg of elemental iron... BTW: If the Ferrodex 200 isn't easily accessible, go to the local Rite Aid or other drug store and buy a bottle of Iron tablets (Ferrous Sulfate, ~321% or 65mg, crush them, and feed with yogurt) (1 Ferrous Sulfate tablet is equivalent to 1/3/ dose of Ferrodex200, so 3 iron tablets would be the equivalent of 1 daily dose provided in Ferrodex200), to restore the liver's red cells, the loss of which was the cause of  have caused the anemia and the blackened, shriveled, pointy-ended fecal pellets. And at this very critical time, as adjunct (supportive) therapy, I'd give it subcutaneous doses daily of 'Fortified' B-complex' (a combination of B vitamins needed for proper body function that has everything but B-12), essential because every time the patient urinates, it's losing all of those vitamins that are needed to maintenance of its body functions, and BoSe (to support his stressed immune system so that the goat can help itself to get well from inside, while I work on it from the outside), and Banamine (to reduce the goat's pain and cut the inflammation caused by the worm damage) which, once given, will encourage the goat to want to eat once again! And last but not least, I'd give the goat a preventative doe of C&D antitoxin (to prevent entero from taking this opportunity to sneak in and finish the poor victim off because while it's down its stomach is not digesting food and moving it out of its body as it should.)
BACKGROUND :
Liver fluke is  found in most of the US, but it's especially common in the Southern states due to the lack of good frosts to wipe out eggs and larvae in winter. We see it often up here in the Northern states as well, but because we have colder winters, the numbers, fortunately, are somewhat lower.  However during the rainy season, no matter what part of the country the goat lives in, the Liver Fluke problem becomes particularly pervasive each year!
Today, by far the most difficult problem that we as owners face with Liver fluke treatment/control is that the veterinary community in general isn't even aware that it's there.  As a result, they're unable to recommend proper treatment for it. This is because the egg of the Liver fluke (Fasciola hepatica)² looks so similar to that of the Barberpole worm (Haemonchus contortus)² that when it shows up on the slide in the Vet's office it's routinely misidentified to BE that of the Haemonchus contortus (or perhaps by some general term like strongyles, stomach worms, et al).  And this is despite the fact that the Merck Veterinary Manual (8th Ed. Pp.197-198)³, which, BTW, is not a text used in Vet Schools, but in fact is instead a text available to Veterinarians and Goat owners as well, in discussing its prevelance, notes:  "Fasciola hepatic, the most important trematode of domestic ruminants, is the common cause of Liver Fluke disease in the USA and other temperate areas of the world. It's endemic along the Gulf Coast, the West Coast, the Rocky Mountain Region, and other areas... IT is present in Eastern Canada, British Columbia, and South America... etc and so forth.. They have even found it in Europe, Australia,in NEw Zealand, Africa and Asia, and it's been reported in Hawaii as well"...
Until just a few years ago the veterinarian, seeing what was thought to be Haemonchus contortus eggs on the slide, would recommend Ivomec to the owner as the wormer of choice to eradicate it. And rightly so, because the moment Ivomec appeared on the scene back in the early 1980's, it was recognized as the most effective general wormer to show up ever! And frankly it  remains, in my view, still the best and most efficacious general wormer on the market today.
And largely because the real Haemonchus contortus has always responded very well to Ivomec, veterinarians, misidentifying Liver fluke eggs as those of Haemonchus contortus, quite logically continued recommending Ivomec for treatment. When the Liver fluke failed to respond to the Ivomec treatment, unfortunately the loss of the animal in question was assumed to be a sign of the Haemonchus contortus having developed 'resistance' to the Ivomec! This notion has now become so pervasive that the veterinary community in general believes these days that the worms affecting livestock have developed a resistance to Ivomec, the result being a recommendation to their clients that they (1) increase the doses, and (2) turn to other wormers.  Neither approach has even slowed down the deaths being caused, in fact, by Liver fluke. Since neither of those suggestions are working, the most recent approach has been to set up Famacha classes to instruct owners and veterinarians alike in how to check the eyelids of the downed animals to see if they're anemic. If the animals have pale eyelids, indicating they're anemic, owners are sometimes advised to destroy the victim, fearing that if it lives, the 'resistance to wormers' will spread even further.
Sadly, neither plain Ivomec, nor Panacur, nor any of the other general wormers on the market today, are effective against Liver fluke.  The fact is, this parasite can ONLY be eradicated efficiently by using a product called Ivomec Plus .  It's not the Ivomec itself, but the PLUS part of the combined wormer, which is actually 'clorsulon' , that effectively wipes out Liver fluke.. And (very critically) since it only kills the ADULT of the species, clorsulon (just as all wormers) must be used at regular doses, 3 X in a row, 10 days apart, to wipe out all stages of the worm. ¹
And it will no doubt be of particular interest for those owners who are worried about using milk from does being treated with Ivomec Plus that the Pharmaceutical companies have now run the required tests on those two products that officially clears them for use in lactating ruminants! 
So in my view, these days (particularly if the reader is having a hard time controlling internal parasites in his/her animals) Ivomec Plus (instead of plain Ivomec) should ALWAYS be used for general worming, 'just in case'!  Just like regular Ivomec, it can be given orally although it's actually an injectable. But since right now Ivomec itself is less readily being used by people (most of whom have never even heard of Liver fluke, and many of  whom have their vets ID their goats' fecal samples as well) Ivomec Plus, while its importance is gradually growing among goat owners, may not yet be available in your local feed store... However it is readily available in livestock catalogs.