Common Liver Fluke Response Plan 2016

Medical Plan for

Common Liver Fluke (fascioliasis)
Background
The common liver fluke, as known as "the sheep liver fluke," is a parasitic trematode
which infects the liver of mammals. The disease caused by the common liver fluke is called the
Fascioliasis, is an infection due to the food and watercress. Fascioliasis also recognized as an
infection of the bile ducts and liver, but infection in other parts of the body can occur. It is found
in over 50 countries, most commonly found in places where sheep are located mainly in
south-eastern Australia. This disease costs millions of dollars each year in lost production, stock
deaths, and costs of treatment and prevention. Moreover, the estimated 91.1 million humans at
risk for infection worldwide, as many as 17 million may be infected. Certain areas of the world
bear the burden of the highest prevalence of infection. This medical plan is created to stop
infection, reduce the number of patients and prevent people from getting infected in the current
outbreak in Northern Thailand.

Causes
 The figure above shows the cause of the infection of the common liver fluke which is
called Fascioliasis. It is caused by accidentally ingesting the parasite, eating raw watercress and
eating undercooked sheep or goat liver that contained immature forms of the parasite. The cycle
of common liver fluke starts with the adult fluke produced eggs in bile and flow into intestine
and finally passed to sheep faeces. Eggs hatch in watercress that growth in pasture area. When
the temperature reach over 10C, larvae is able to get into the snail (most commonly Lymnaea
tomentosa) to develop its body. After the fluke growth to cercaria stage, its leave the snail and
swim until they find plant that could encysted it. It forms metacercariae (infective stage) after
developed itself in vegetation. Metacercariae ingested by human or animal that eat those plants
which allow immature fluke in small intestine. Then, it goes to the liver and liver tissue for 6-7
weeks before migrate again to bile and finally become adult fluke.

Symptom (prognosis)
Most of the people that are infected by this parasite will have no symptoms, but some
severe cases, the patient may feel discomfort and exhausted, and if it is a long-term infection, it
may cause stone formation in the bile duct and maybe in the gallbladder. Moreover, there are
also several other symptoms at different times during the infection such as fever, nausea,
vomiting and diarrhea, malaise and weight lost. Initially, patients of the disease will have
episodic fever but usually discontinues. Their body temperature can raise up to 40 celsius or
about 104 fahrenheit and if there is an obstruction to biliary system that affected by liver fluke
also cause fever. Secondly, patients could also have nausea, vomiting and diarrhea after get
infected by the common liver fluke. These symptoms will showed up after early week to month.
In some cases, fascioliasis can cause skin to turn yellowish and led to reduction of weight.
Thirdly, it may cause hives and mostly occur in early of the illness. Fourthly, the malaise, liver
fluke cause malaise and It will occur later in the illness. Generally patients will feel unwell and
uncomfortable. Lastly, that patient can have a declined appetite and also weight loss due to the
infection of the common liver fluke. The infection with liver fluke, especially Fasciola hepatica
can cause liver cirrhosis after many years
Medication/ treatment
Fascioliasis can be treated easily. Triclabendazole is a drug of which can killed the
common liver fluke inside our body. It is given by mouth, usually in one or two doses. The drug
is designed to treat infections by Fasciola hepatica for both immature and adult liver flukes,
roundworms and ectoparasites and high efficacy against both immature and adult liver flukes.

Current situation

The graphs above are the prediction graph for the next three month. If we not prevent it
now, there will be a rise in the number of patients and new cases may approach 89 cases in
october.
 Figure 1 : If we prevent it now, new cases will start to decline in April and total cases will
be stable after July. For the cost of the patients, if 1000 baht per person, the total cost will be
253000 baht.

Figure 2: If we prevent in next three months, the number of new cases will be uplift until
July and begin to reduce. Then, in March the new case will become zero and the total cases
remain constant. For the total cost of this time of prevention, it will be 650000 baht.
To summarize, both time of prevention can stop the liver fluke. However, if we prevent it now,
we can stop number of total cases from increasing and also lower the cost to prevent it.

Prevention Plan
Since this rural area is mostly a farm, fluke can be easily develop and spread really fast.
Firstly, to stop the spreading of the disease, we must control the growth and sale of watercress
and other edible water plant by making sure that the water we use is sanitized. Secondly, it can
also prevent by changing eating behavior on a regular basis such as eating more food that are
heated instead of eating raw meat or food that are not cooked well enough such as eating well
steak instead of rare steak since most of the common liver fluke are located in the middle layer of
raw meat, it is very important to cooked that part to make the common liver fluke disappear. To
make sure that the prevention is working we can test by liver fluke egg counts, using fecal
samples, or an antibody test (ELISA) using blood samples or, in the case of dairy cattle, milk
samples.

Cost
The cost of treatment is approximately 1000 baht per person
Total cost: Now : 253000 baht
The next 3 months : 650000 baht
In addition : Triclabendazole 35 Euro

Summary
If the plan is followed and act now, the outbreak would be approximately in August and if the
plan is intervene in 3 months the outbreak would be over in March. We highly recommend doing
now due to time and economics.
 Reference

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October 03, 2016, from http://www.uptodate.com/contents/liver-flukes-fascioliasis

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http://www.cdc.gov/dpdx/fascioliasis/dx.html

Price, T. A., Tuazon, C. U., & Simon, G. L. (1993, February 26). Fascioliasis: Case

Reports and Review. Retrieved October 4, 2016, from

Fasciola FAQs. (2013, January 10). Retrieved October 03, 2016, from

http://www.cdc.gov/parasites/fasciola/gen_info/faqs.html

Health Topics. (2014, March 31). Retrieved October 03, 2016, from

http://www.paho.org/hq/index.php?option=com_content

Tewoderos, S. D. (n.d.). Prevention. Retrieved October 03, 2016, from

http://web.stanford.edu/group/parasites/ParaSites2006/Fascioliasis/prevention.htm

St. John, T. M., Dr. (2015, October 08). Human Liver Fluke Symptoms. Retrieved

October 03, 2016, from http://www.livestrong.com/article/102360-human-liver-fluke-symptoms/

A. (n.d.). Liver Fluke. Retrieved October 03, 2016, from

https://www.liverdoctor.com/liver-problems/liver-fluke/