Aksoy DY, Kerimolu U, Oto A, Ergven S, Arslan S, Unal S, Batman F, Bayraktar Y. Fasciola hepatica infection: clinical and computerized tomographic findings of ten patients. [10], The outer surface of the fluke is called the tegument. During the early phase of the infection (usually referred to as the acute phase; also, the migratory, invasive, hepatic, parenchymal, or larval phase), the period when the larval fluke is migrating from the intestines and through the liver parenchyma, larval migration can be associated with inflammation, tissue destruction, and toxic/allergic reactions. The drug is administered at a dose of 10 mg/kg for 1 or 2 days, and it is well-tolerated. A growing degree-day model for determination of. Efforts are being made to develop an effective vaccine for livestock. Because of the chronic inflammation, the thickened walls of the extrahepatic ducts and gallbladder are visible on abdominal CT examination[1,5,6]. Accessibility [PMC free . Omissions? Cabada et al in a study testing a limited number of stool samples reported that a single RPA had a sensitivity of 88% and specificity of 100% when tested in stool samples of children with and without fascioliasis and with other parasites. Let us know if you have suggestions to improve this article (requires login). i Fascioliasis (Liver Fluke Disease) Etiology Liver flukes are an important cause of acute and chronic disease in grazing sheep and cattle. [34], Humans become infected by eating watercress or by drinking 'Emoliente', a Peruvian drink that uses drops of watercress juice. However, reports of resistant infections in livestock and human threaten the clinical care and control of the infection in endemic areas. It infects the livers of various mammals, including humans, and is transmitted by sheep and cattle to humans the world over. Platelet counts were normal in all patients. Adult flukes in the extrahepatic bile ducts are visualized as a filling defect on cholangiogram[1,6,9,10]. [18], The alimentary canal of F. hepatica has a single mouth which leads into the blind gut; it has no anus. Currently in Canada the parasite occurs only in cattle and is restricted to dairy cattle around Quebec City and an isolated and inexplicable focus in central Alberta. The two species of trematodes that cause fascioliasis (Fasciola hepatica and F. gigantica) are leaf-shaped worms, large enough to be visible to the naked eye (adult F. hepatica measure 20-30 mm x 13 mm; adult F. gigantica measure 25-75 mm x 12 mm). The symptoms of fascioliasis in humans are fever, sweating, loss of weight, abdominal pain, anemia, and sometimes a fleeting rash. [38] In cattle and sheep, classic signs of fasciolosis include persistent diarrhea, chronic weight loss, anemia, and reduced milk production. Khademvatan S, Majidiani H, Khalkhali H, Taghipour A, Asadi N, Yousefi E. Prevalence of fasciolosis in livestock and humans: a systematic review and meta-analysis in Iran. From here, a short oviduct passes to the vitelline duct. The common liver fluke, also known as the sheep liver fluke (Fasciola hepatica), is a trematode parasite that infects a wide range of hosts, including ruminants, horses, rabbits and humans [].It causes the parasitic disease fasciolosis and occurs worldwide [1, 2[. A large study by Parkinson et al in the Bolivian Altiplano involving almost 8000 subjects of all ages failed to find a significant association with sex.49 However, studies in other areas have suggested a higher prevalence in females especially among children.57 Curtale et al in a study including over 21,000 children in Egypt reported that females had a significantly higher prevalence of fascioliasis and passed more eggs in the stool than males.58. Fascioliasis is an infection caused by a trematode of the liver. Endoscopic management of biliary parasitic diseases. Standard precautions apply for the processing of stool, serum, and tissue specimens. Drug toxicity evaluation in dogs found the potential for QTc interval prolongation at high doses. Fascioliasis in the asymptomatic, acute, and chronic forms is associated with short- and long-term impacts on human health. [12] It is leaf-shaped, pointed at the back (posteriorly), and wide in the front (anteriorly). Human fasciolasis and gastrointestinal compromise: study of 277 patients in the Cayetano Heredia National Hospital (19702002). In addition, the RPA was able to detect DNA in 47% of samples from patients with fascioliasis and negative microscopy testing.76 Ghodsian et al reported on LAMP tests with a limit of detection of five eggs per gram of stool using spiked stool samples.77 Despite the promising results of these isothermal techniques, none of these tests have been evaluated in field conditions and most of these studies do not consider issues related to sample preparation and manipulation as a potential source for false negative and false-positive results, respectively. In humans, maturation from metacercariae into adult flukes usually takes about 34 months; development of F. gigantica may take somewhat longer than F. hepatica. This study had a limited number of samples and found a sensitivity of 43% and specificity of 100%.72 Further evaluation of the Fas2 IgM ELISA targeting subjects with acute or recent infection may provide a useful diagnostic tool in the future. Rodrguez-Ulloa C, Rivera-Jacinto M, Del Valle-Mendoza J, et al. Twenty-four (80%) patients were female, and all of them were home-working, suggesting that the females had more contact with watercress than the men. Sexually mature parasites established in the bile ducts cause the chronic phase of the infection that can last more than 10 years and is characterized by inflammation of the biliary tree and obstructive symptoms such as intermittent abdominal pain and jaundice. The FLOTAC and mini-FLOTAC devices (University of Naples, Naples, Italy) combined with flotation solutions with specific gravities adjusted for Fasciola eggs are considered more sensitive than direct smear, Kato Katz, formalin-ether, and simple flotation techniques.68 The Flukefinder (Soda Springs, ID) device consists of a series of sieves to concentrate fluke eggs and is commercialized in the veterinary market. In Peru, initial efforts for a school-based mass drug administration program was piloted in the Northern highlands but was not fully implemented in the rest of the country.66 Bolivia applied a mass drug administration program that consistently provided yearly triclabendazole doses to populations living in hyperendemic areas near Lake Titicaca. [19] F. hepatica relies on extracellular digestion which occurs within the intestine of the host. [21], F. hepatica's excretory system contains a network of tubules surrounding one main excretory canal. In our patients with hepatic phase fascioliasis, the common clinical signs and symptoms were right upper abdominal pain, intermittent fever, right upper quadrant tenderness and hepatomegaly. [7] Intermediate hosts of F. hepatica are air-breathing freshwater snails from the family Lymnaeidae. fascioliasis, infection of humans and grass-grazing animals caused by the liver fluke Fasciola hepatica, a small parasitic flatworm that lives in the bile ducts and causes a condition known as liver rot. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Right: Fossaria bulamoides, a snail host for F. hepatica in the western United States. Esteban JG, Flores A, Angles R, Mas-Coma S. High endemicity of human fascioliasis between Lake Titicaca and La Paz valley, Bolivia. Although F. hepatica and F. gigantica are distinct species, intermediate forms that are thought to represent hybrids of the two species have been found in parts of Asia and Africa where both species are endemic. The disease cannot be ruled out by a negative stool examination[3,5,8]. Parkinson M, ONeill SM, Dalton JP. The presence of risk factors such as exposure to endemic areas, raw water plants, or untreated water may raise the clinical suspicion.63 The signs and symptoms of fascioliasis are not specific but certain combinations of these may suggest the infection. [26] The genome is contained in 10 pairs of chromosomes. Live and mobil Fasciola hepatica removed from the choledochus by balloon catheter during endoscopic retrograde cholangiopancreatography. These findings suggest that fever in hepatic phase fascioliasis is not a prominent finding. None of the patients with hepatic phase was administered antibiotics. Migrating larval flukes may be detected in histologic sections. Ghodsian S, Rouhani S, Fallahi S, Seyyed-Tabaei SJ, Taghipour N. Keiser J, Engels D, Bscher G, Utzinger J. Triclabendazole for the treatment of fascioliasis and paragonimiasis. Twenty-two (73%) patients had hepatic phase fascioliasis, 5 patients had biliary phase, and 3 patients had biliary phase associated with acute pancreatitis. However, once diagnosed, all the forms of the infection warrant treatment. National Library of Medicine (CDC Photo: DPDx) The standard way to be sure a person is infected with Fasciola is by seeing the parasite. [14][15] On the surface of the tegument are also small spines. fascioliasis, infection of humans and grass-grazing animals caused by the liver fluke Fasciola hepatica, a small parasitic flatworm that lives in the bile ducts and causes a condition known as liver rot. Abdominal pain was reported by all patients, fever in 2 (25%), nausea in 3 (38%), and weight loss in 1 (13%) patient. From this junction, the uterus opens into the genital atrium; this opening is surrounded by Mehlis glands. The genital atrium is an ectodermal sac which opens up to the outside of the fluke via a genital pore. Fasciola hepatica infection should be considered in the differential diagnosis of patients with hepatic or biliary disease and/or acute pancreatitis associated with eosinophilia. [43][44] For humans, the type of control depends on the setting. The https:// ensures that you are connecting to the [5][8][6] Several other lymnaeid snails may be naturally or experimentally infected with F. hepatica, but their role in transmission of the fluke is low. The seropositivity was significantly lower in the group between 5 and 15 years compared to the other age groups (4.9% vs >8.9%, p < 0.05).60 In the Cusco region of Peru, we identified 253 children ages 3 to 16 years old with positive serology and/or stool microscopy for fascioliasis among 2513 children studied. Anemia was present in 6 (27%) patients, leukocytosis in 11 (50%), eosinophilia in 22 (100%) and elevations in the erythrocyte sedimentation rate (ESR) in 18 (82%) patients, alanine aminotransferase (ALT) in 6 (27%), aspartate aminotransferase (AST) in 2 (9%), alkaline phosphatase (ALP) in 13 (59%) , glutamyl transferase (GGT) in 13 (59%), and total bilirubin in 1 (5%) patient. [20] [10] In humans, the time taken for F. hepatica to mature from metacercariae into an adult fluke is roughly 3 to 4 months. The hepatic phase is characterized by fever with chills, upper abdominal pain, hepatomegaly, mild hepatitis, weight loss and prominent eosinophilia[6-8,14]. Echenique-Elizondo M, Amondarain J, Lirn de Robles C. Fascioliasis: an exceptional cause of acute pancreatitis. [19] Flukes migrate into smaller capillaries and bile ducts when feeding within the host. 2003, 2005 ). Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants in endemic area. 2 Department of Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco. Muhsin Kaya, Remzi Beta, Department of Gastroenterology, Dicle University School of Medicine, Diyarbakr 21280, Turkey, Sedat etin, Department of Internal Medicine, Dicle University School of Medicine, Diyarbakr 21280, Turkey. Chang Wong MR, Pinto Elera JOA, Guzman Rojas P, Terashima Iwashita A, Samalvides Cuba F. Demographic and clinical aspects of hepatic fascioliasis between 20132010 in National Hospital Cayetano Heredia, Lima, Peru, Case report: hepatic fascioliasis in a young afghani woman with severe wheezing, high-grade peripheral Eosinophilia, and liver lesions: a brief literature review. are in the family Lymnaeidae, particularly species in the genera Lymnaea, Galba, Fossaria, and Pseudosuccinea. The full terms of this license are available at. Nonspecific symptoms/signs (e.g., abdominal pain, nausea, vomiting, hepatomegaly, malaise, fever, cough) and laboratory abnormalities (e.g., peripheral eosinophilia, elevated transaminase levels) may develop. Two accepted species, Fasciola hepatica and Fasciola gigantica, infect a wide range of mammals including livestock and humans. Inflammation of the pancreas may also occur. Cattle and sheep are infected when they consume the infectious stage of the parasite from low-lying, marshy pasture. Ko Z, Ulusan S, Tokmak N. Hepatobiliary fascioliasis: imaging characteristics with a new finding. Panel (A) Abdominal computed tomography scan with contrast showing hypodense and track-like lesions (white arrow heads) in a patient with acute fascioliasis. sharing sensitive information, make sure youre on a federal This disease is rarely seen with jaundice caused by obstruction of the biliary tree. official website and that any information you provide is encrypted An official website of the United States government. Asymptomatic or mildly symptomatic subjects in the community should also receive treatment to prevent the potential chronic effects of the infection, especially in children. People usually become infected by eating raw watercress or other water plants contaminated with immature parasite larvae. During tissue migration, the parasites do not produce eggs and diagnosis relies on antibody detection. Today, triclabendazole is the drug of choice for its effectiveness against both adult and immature worms[7,13,21]. Micic D, Oto A, Charlton MR, Benoit J-L, Siegler M, Solomon CG. Dominguez MF, Gonzlez-Miguel J, Carmona C, et al. In addition, research on alternative drugs to treat human infection and/or overcome triclabendazole resistance is urgently needed. Fasciolosis is a parasitic worm infection caused by the common liver fluke Fasciola hepatica as well as by Fasciola gigantica. These serious public health scenarios appear mainly linked to . are broadly ellipsoidal, are operculated, measure 130150 m long by 6090 m wide, and are passed unembryonated in feces. A 19-year-old female patient presented with right upper abdominal pain and fever lasting 3 wk. Marcos L, Maco V, Terashima A, Samalvides F, Espinoza JR, Gotuzzo E. Fascioliasis in relatives of patients with, Approaches to the control of fasciolosis in ruminants. This canal leads to the excretory pore at the posterior end of the fluke. Fascioliasis is an emerging neglected zoonotic infection affecting the health and wellbeing of human populations. Previous research . Centers for Disease Control and Prevention. The highest chronic infection rate documented was 70% in the 811 years age group in the Bolivian Altiplano.49 An epidemiologic study in the highlands of Cusco in Peru showed that older age of the child was an independent risk factor for fascioliasis with infected children having a mean age of 11 years.36 De van et al recently reported a case series of Fasciola infection among infants and toddlers in Vietnam.59 This report documented acute and chronic fascioliasis in 5 very young children and reviewed 38 additional cases of children under 4-years old reported in the literature between the years 1856 and 2016.59 The same group published a report on the seroprevalence of fascioliasis among 1120 patients referred to Hanoi Medical University Hospital. Due to this, the prevalence, along with the intensity of infection, of F. hepatica is primarily dependent on rainfall levels and temperature. In the continental U.S., Fasciola hepatica infections are primarily seen in southeastern and western states. In the blood there is an increase in white blood cells of the type called eosinophils, a common finding in worm infections. All patients were followed until complete clinical and laboratory response or until 6 mo after treatment discontinuation. They also had acute edematous pancreatitis and were treated by extraction of live Fasciola hepatica by balloon during ERCP and conservative management. Initially, these spines are single-pointed, then, just prior to the fluke entering the bile ducts, they become multipointed. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Snail species may differ with respect to their suitability to serve as intermediate hosts for F. hepatica versus F. gigantica; host ranges for both Fasciola spp. Azab M el-S, el Zayat EA. In the patient whose pre-treatment computerized tomographic image is shown in Figure Figure1,1, abdominal computerized tomographic examination showed residual lesions (arrow) and minimally enlarged spleen 6 mo after treatment with triclabendazole. A positive reaction is defined as the presence of a band at ~38 kDa. Fascioliasis can be presented as various clinical manifestation from mild to severe in nature. Marcos LA, Maco V, Castillo M, Terashima A, Zerpa R, Gotuzzo E. Report of cases of human fascioliosis in the specialized Childrens Health Institute, Lima, Peru (19882003). The role of serology in the clinical follow up of subjects with acute and chronic fascioliasis is unclear and may depend on the method. At the posterior end, one pair of nerves becomes thicker than the others; these are known as the lateral nerve cords. Mass drug administration of Triclabendazole for, Pharmacokinetic evaluation of different generic triclabendazole formulations in heifers. Device-based concentration techniques achieve the highest sensitivity but are expensive, difficult to use in large surveys, and not widely available. In this study, fascioliasis caused losses of USD 750 million a year, with the largest impact on the dairy and meat cattle industries.25 The estimated cost of nematode resistance to medications accounted for an additional USD 45 million, but no estimate was provided for resistance in Fasciola. The consumption of wild watercress that grows near livestock grazing areas is reported in most cases of sporadic transmission.15,40,41,43,44,61 However, other leafy vegetables and vegetables that grow at the ground level such as radish have also been associated with transmission.61,62 Drinking untreated water has been associated with a higher likelihood of Fasciola infection in several studies from the highlands of Peru.21,62 Drinks prepared with contaminated water or raw vegetables may lead to inadvertent transmission. Received 2011 Apr 8; Revised 2011 Jun 15; Accepted 2011 Jun 22. The lack of supporting information from large epidemiologic studies and the particularities of the distribution of fascioliasis significantly hinder the estimation of the number of infected people and disease burden. gigantica).64,65 The Kato Katz test is a quantitative microscopy test recommended by WHO in areas with a high prevalence and intensity of infection.66 The Kato Katz test alone may miss a third of the infections and combining it with methods that concentrate eggs provides a better sensitivity. Inclusion in an NLM database does not imply endorsement of, or agreement with, Fasciola Species introgression: just a fluke or something more? Glycogen taken from within the host is broken down by glycolysis to produce carbon dioxide and fatty acids. The mammalian host then eats this vegetation and can become infected. School-age children are disproportionately affected by Fasciola infection in highly endemic countries. Fascioliasis is a rare parasitic infection primarily of the hepatobiliary system caused by one of 2 digenean flatworms, Fasciola hepatica or Fasciola gigantica, which are commonly referred to as liver flukes. Mailles A, Capek I, Ajana F, Schepens C, Ilef D, Vaillant V. Commercial watercress as an emerging source of fascioliasis in Northern France in 2002: results from an outbreak investigation. Regardless of the presentation, fascioliasis can be associated with long-term complications such as anemia and malnutrition. From the duodenum, they burrow through the lining of the intestine and into the peritoneal cavity. Antibodies against Fasciola may take 2 to 4 weeks to become detectable after the initial infection and should remain positive through the chronic phase. [39] Some remain asymptomatic. Our editors will review what youve submitted and determine whether to revise the article. Cabada MM, Lopez M, Cruz M, Delgado JR, Hill V, White ACJ. and transmitted securely. High prevalence rates of fascioliasis has been repeatedly reported in the Andean region of South America. Carolus H, Muzarabani KC, Hammoud C, et al. The Fasciola MM3-Coproantigen ELISA is a highly sensitive test commercialized in veterinary medicine that can detect very low burdens of infection (one parasite) in cattle.73, Detection of Fasciola DNA in stool samples using polymerase chain reaction (PCR) tests have an overall high sensitivity and specificity. Three patients were sisters and were admitted to the hospital on the same day. Bethesda, MD 20894, Web Policies To receive email updates about this page, enter your email address: For Healthcare Providers, Emergency Consultations, and General Public. This is particularly important in highly endemic areas. Barbosa R, Pinto C, Garcia P, Rodrigues A. Fasciola hepatica is found on all inhabited continents, in more than 70 countries, particularly where sheep or cattle are raised.
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