Fascioliasis

Shahid Beheshti University of

medical sciences
2005
Hatami H. MD. MPH
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ELISA

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Clinical
epidemiology
of fascioliasis
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1- Definition and importance

Disease of the liver caused by a
large trematode that is a natural
parasite of sheep
Man is an accidental host
Economic impacts
Health impacts
It has now become an important
emerging foodborne
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2 Etiologic agents

1- Fasciola hepatica
2- Fasciola gigantica
Fasciola is a well known parasite of
herbivorous animals
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2 Etiologic agents

Ova - average 145 x 80 uM large, yellowbrown,

Adult fluke - 2 - 3 cm, flat, leaf shaped
1O in liver; bile passages, gall bladder
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Clinical epidemiology of infectious diseases

Definition and public health importance
Etiologic agents
1)
2)
3)
4)
5)
6)
7)
8)
9)

Incubation period
Natural course
Geographical distribution
Timeline trend
Age, Gender, Occupation, Social situation
Predisposing factors
Susceptibility & Resistance
Secondary attack rate
Modes of transmission, period of communicability

Prevention : primary, secondary, tertiary

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1- Incubation period
Variable (~ 3 months)

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2- Natural course

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Clinical Features
In the acute phase

Abdominal pain,
Hepatomegaly,
Fever,
Vomiting,
Diarrhea,
Urticaria
Eosinophilia,

Can last for months

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Clinical Features
In the chronic phase

Reflect intermittent biliary

obstruction
Biliary inflammation
Ectopic locations of infection can
occur.
Complications ???
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Fascioliasis in Kermanshah
Symptoms
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RUQ

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40
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18 18 18 18 18
12 12 12

50

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Fascioliasis in Kermanshah
Signs
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70
60
50
40

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3- Geographical distribution
It has a worldwide distribution
in the animal reservoir host
A large variety of animals, such
as sheep, goats, cattle, buffalo,
horses and rabbits show
infection rates that may reach
90% in some areas
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Geographical distribution
Infection of the human host was
very sporadic
Outbreaks were reported
It has now become an important
emerging foodborne
The estimated number of people
infected is 2.4 million in 61 countries
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Geographical distribution
The number at risk is more than
180 million throughout the world
The largest numbers of infected
people have been reported from :
Bolivia, China, Ecuador, Egypt,
France, Iran, Peru and Portugal

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In Iran
The first human case was diagnosed
surgically in 1955
In the recent past, up to 100 cases have
been diagnosed per year
In 1988, an outbreak, considered the
biggest in the world, occurred in the Gilan
province
It began in February 1988, lasted for 18
months
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In Iran
About 10000 people were
infected
The outbreak was related to an
increased consumption of local
green aquatic vegetables in the
province
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In Iran
Isfahan in the central part of the
country
The population at risk in these
provinces is estimated to be 6 million
Studies in Iran have revealed the
following characteristics of infection:

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In Iran
With regard to age, sex,
clustering of cases and social class,
the data are similar to those in
Egypt.
The peak of transmission is from
February to June (Bahman to
Khordad).
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In Iran
The vehicles for metacercariae
are the green aquatic vegetables,
mainly water cress, lettuce and
khali-vash
Patients in the outbreak were
treated with triclabendazole and
the cure rate was 90%.
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In Iran
Fascioliasis is becoming an
increasing threat to public health
There is still a lack of awareness
of this emerging problem in
countries in the region

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In Iran
An urgent priority is to carry
out surveillance studies to
determine the risk of infection
It is expected that the true
prevalence is higher than that
reported
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Fascioliasis in Iran

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Fascioliasis in Kermanshah

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4- Timeline trend
(Pandemics)
(Epidemics)
(Outbreaks)
(Duration)
(Seasonality)

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5- Age, sex, occupation

The disease affects all ages, both
sexes, all social classes and
professions, particularly inhabitants
of rural areas
The prevalence is lowest in children
under 5 years of age
Females are more commonly
infected, the sex ratio being 1.4:1.
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Fascioliasis in Kermanshah
Age distribution

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6- predisposing factors

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7- susceptibility and resistance

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8- Secondary attack rate

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Life Cycle:

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Life Cycle:
Eggs are discharged in the biliary
ducts and in the stool
Eggs become embryonated in
water
Eggs release miracidia, which
invade a suitable snail including
many species of the genus Lymnae.
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Life Cycle:
The cercariae are released from the snail
and encyst as metacercariae on aquatic
vegetation or other surfaces
Mammals acquire the infection by eating
vegetation containing metacercariae
Humans can become infected by ingesting
metacercariae-containing freshwater plants,
especially watercress
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Life Cycle:
After ingestion, the metacercariae
excyst in the duodenum and
migrate through the intestinal
wall, the peritoneal cavity, and
the liver parenchyma into the
biliary ducts, where they develop
into adults
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Life Cycle:
In humans, maturation from
metacercariae into adult flukes
takes approximately
3 to 4 months
The adult flukes reside in the
large biliary ducts of the
mammalian host
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Prevention & control

Primary Prevention:

Prevention of disease in well

individuals

Secondary Prevention:

Identification and intervention in

early stages of disease

Tertiary Prevention:
Prevention of further deterioration,
reduction in complications
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1- Primary prevention
Mass treatment of the animal
reservoir
Proper diagnosis and treatment of
patients, using triclabendazole
Snail control
Plantation of salad vegetables in
safe areas
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prevention and control

Health education and
orientation towards:
Proper washing of salad
vegetables,
Using either 6% vinegar (100
ml/l) or potassium permanganate
(24 mg/l) for 5 to 10 minutes
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prevention and control

A control programme has begun for
mass chemotherapy of animals, and
snail control is carried out using
molluscicides.
In order to prevent human infection,
health education and activities to raise
awareness about the mode of
transmission are the strategies being
used at present
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2- Secondary prevention
Diagnosis
Microscopic identification of eggs
is useful in the chronic (adult) stage
Antibody detection tests are useful
especially in the early invasive
stages, when the eggs are not yet
apparent in the stools, or in ectopic
fascioliasis.
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Secondary prevention
Treatment
Drug of choice is triclabendazole
10 mg / kg / oral/ once
In severe cases, 2 x 10 mg/kg body
weight, 12 hours apart
The drug comes in scored 250 mg
tablets
It is effective against both adult and
immature worms.

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3- Tertiary prevention
Surgery

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Sources
Human fascioliasis in some countries of the Eastern
Mediterranean Region
WHO, Fact Sheet N 191 April 1998
TRICLABENDAZOLE AND FASCIOLIASIS - A
NEW DRUG TO COMBAT AN AGE-OLD DISEASE
Hatami H., Assmar M., Massoud J., Aryaii Far S.H.,
Mansouri F., Fatemi M., Shahrezaii A., Rezaii R.,
Namdari Tabar H.: The first report of human
Fascioliasis outbreak in Kermanshah province. J.
Modaress. Med. Sci. 2000, 2(2): 79-87.

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