Fasciolopsis buski medical plan

By
Natcha Thanasumpunth (Cartoon)
Phanita Tangsiriwattanakul (Pat)
Phimchanok Eakkaparksawat (Praewa)
Pitchayapa Vichitvigrom (Eian)

Section 1108 & 1110

Presenting
Mr. Andrew Filipczak
Executive Summary

Recently, Northern Thailand has faced the outbreak of Fasciolopsis or the Giant intestinal
fluke. Therefore, a medical plan is constructed in order to reduce the number of parasite-infected
people by taking an account of all the possible transmission and environmental factors within the
area.
During the diagnosis stage, while symptomatic patients are examined with the process of
stool examination, the asymptomatic patients are diagnosed by blood tests. This process allows
doctors to determine the number of patients and prepare for treatment.
Medicine recommended for this parasitic disease consists of Praziquantel and
Tetrachloroethylene. While Praziquantel is highly effective for adults, Tetrachloroethylene is
recommended for children. However, each of them also have side effects depending on the
condition of patients.
Although the treatment will reduce the number of infected people, a number of
restrictions must be applied to stop the spread of the disease. For immediate actions, we
suggested restrictions, chemical control, and food supply to reduce the amount of infected cases.
Food and clean water would be provided until the construction of water treatment systems are
completed. The construction of the water systems must begin as soon as possible. Moreover,
actions such as encouraging education in order to stimulate awareness among local people,
acknowledging them about the restraints, implementing constraints to control people's actions,
and constructing facilities is required to limit and control the parasites as well as prevent the
same parasitic outbreak in the future.
If the plan is applied immediately, the number of infected people would reduce by 15
cases per month. However, if the plan is applied within the next 3 months, the number of
infected people would fall down by 10 cases per month.
Overview
The situation:
The outbreak is located in the Northern part of Thailand. The infected area is a rural area,
away from the big city. However​, ​as the towns are all interconnected with the total population of
10,000 people the number of infected people might be higher than expected. Even though there
is a limited amount of public transportations between the area, people are still able to operate
around the towns. The region is full of forests and has lots of different species of animals
including mammal, reptile, and mollusk. Some animals that can easily be found in the region are
rats, mice, bats, snakes, skinks, freshwater fish, mollusks, and snails. There are also freshwater
rivers and streams which is crucial for people and animals within the area in terms of drinking.
The forests and rivers around there are where people utilize their food. Around ⅓ of the local
people depend on agriculture as their main source of income, for example, raising farm animals
such as cows, pigs, and sheep. Furthermore, the products from agriculture in the area are also
transported to all major cities. Although the infected area is a rural area that has no system for
sanitation, there is a local hospital that can accommodate a small number of people within that
area. The implementation of the law is good and people respect rules.
The first case of a Platyhelminthes parasite was reported in September. After that, the
number of new cases has increased rapidly, so the total cases also have increased. The latest
record is in April, it shows that there are 47 new cases, 202 total cases and 34 deaths.

Record table (new cases and total cases by month)

Month New cases Total cases

September 1 1

October 3 4

November 10 14

December 25 39

January 29 68

February 35 103

March 52 155

April 47 202
 From the line graphs and table above, the number of new cases would rapidly increase
after 2 months from the first-month case, and then slow the rate of infection for one month while
the trend of the total cases continually increases. For example, the number of new cases between
September and November has risen up an average below 10 cases per month, but between
November to December, the number of cases has risen up above 10 cases and then between
December and February, it has risen below 10 cases again.
We can suspend that the number of people who are infected would be over 400 people if
they don’t launch the medical response plan. Moreover, the infection would spread out from this
area due to the river where the source of Giant internal fluke passes through other towns; people
also rely on this river. Thus, the same situation would occur in other towns which cause the
amount of new cases and total cases to increase.
The line graphs and table below will show the number of total and new cases that we
expect after 3 months.
Month New cases Total cases

September 1 1

October 3 4

November 10 14

December 25 39

January 29 68

February 35 103

March 52 155

April 47 202

May 54 256

June 70 326

July 75 401
Health effects:
Fasciolopsiasis Buski or as we normally call it a giant intestinal fluke are considered as
one of the largest nematodes that infect humans. People who are exposed to the parasite may not
appear to have any signs or symptoms within a few hours. However, diarrhea and abdominal
pain can occur within a month or two after the infection. Early symptoms after 30-60 days of
infection may appear with epigastric pain, diarrhea, nausea, hunger, and mimicking peptic ulcer
disease (breaking of inner lining of stomach or small intestine). Heavy infection that may be
found in some patients is ​acute intestinal obstruction and ileus. In addition, the symptoms can
range from mild such as fever, anorexia, vomiting to severe cases with malnutrition including
vitamin B12 deficiency and eosinophilia. Most importantly, patients who developed peripheral
edema, anasarca, or ascites may appear to be hypersensitive to the worm metabolites or having
hypoalbuminemia condition due to malabsorption is also possible.
Long standing can be fatal which will normally present with oedema, abdominal pain,
diarrhea, ​ascites, ​anaemia and vomiting. The attachment of parasites on the small intestine can
lower down the amount of eosinophilia, a type of white blood cells. Having low eosinophils
causes mechanical injury which leads to ulcer formation. In some conditions, bleeding or
hemorrhaging may occur from the ulcer due to capillary damage which petechial bleeding and
formation of intestinal abscesses may be found. If left untreated, intestinal ulceration may disrupt
the working of the intestine due to the infection. Therefore, the presence of severe malnutrition
(especially B12), wasting and oedema are expected. In the long term malnutrition will cause the
decrease in ​albumin (a substance found in blood which is a transporter of various molecules)
resulting in hypoalbuminemia. ​Moreover, patients may pass light yellow stools containing
undigested materials. This will then lead to ​cachexia (a complex change in body causing extreme
weight loss and muscle wasting) and death.

Overview of the fluke life cycle

The Fasciolopsis buski is also known as the
giant intestinal fluke. It is the largest known parasite to
parasitise humans, with its body being able to grow up
to 7.5 centimeters in length and 2.5 centimeters in
width. The Fasciolopsis buski inhibits the small
intestine of humans and pigs and leads to intestinal
disorders such as diarrhea, abdominal pain, abdominal
obstruction, and fever. This parasite is a common
parasite that is prevalent in eastern Asia and southwest
Pacific. The place with the highest reported cases is
eastern China.
Immature eggs from the feces of infected pigs or humans are released into the water and
is embryoted. Miracidias hatch from the eggs and friends a suitable intermediate host. These are
usually snails. In the snail, the miracidia matures through three stages called: sporocysts, rediae,
and cercariae respectively. Cercanias leave the snails and settle on water plants such as water
chestnut, water caltrop, water bamboo, and lotus as metacercariae. Mammals, mostly humans
and pigs, that ingest raw infected water plants become the next host. The parasite settles down in
the duodenum, the upper part of the small intestine, and attaches itself to the intestinal wall. It
takes an average of three months for the parasite to develop into an adult, and an adult fluke has
a lifespan of around one year. The eggs of these flukes are then released with the host’s feces.
Diagnosis
There are multiple ways to diagnose patients with Fasciolopsis buski, each with different
levels of difficulties. The easiest way is to look and observe for symptoms. Even though most
infections are asymptomatic, the fluke can lead to many severe symptoms such as diarrhea,
abdominal pain, fever, intestinal obstruction, etc. In case of patients with symptoms, it is highly
possible that the patients’ vomits or feces may contain eggs of the parasite. In order to find eggs
within these body wastes, they have to go through a process called
a fecal examination which is commonly used for laboratory
diagnosis. However, the differentiation of Fasciolopsis buski
(figure 2) and Fasciola hepatica (figure 1) is difficult due to the
similarity in both shape and size of the ova. Therefore, dietary,
clinical history, and living conditions should highly be
considered.
On the other hand, in case of asymptomatic patients. The
easiest way and most accessible for rural areas is by blood tests.
Eosinophils are a type of white blood cells in which the percent
of eosinophils in the human body often indicate a parasitic
infection, allergic reaction to even cancer. In normal blood
samples, the number of eosinophils is usually 0.0 to 6.0 percent
of human blood. Yet, the exact amount is counted by the
percentage of eosinophils multiplied by the amount of white
blood cells. For a normal range, the count is approximately
between 30 to 350 cells per microliter of blood. However, the
attachment of parasites on the duodenal or jejunal wall can
cause low measurement of eosinophilia, the level of eosinophils
for patients with Fasciolopsis buski is less than 35 cells per
microliter of blood. After all the local people in the area have their blood samples taken, the
people will be categorized into 2 groups. The first group is the group with normal levels of
eosinophils and another group with abnormal levels of eosinophils. Moreover, the second group
or the group with abnormal needs to be interviewed and categorized further as the amount of
eosinophils can vary due to the patient’s behaviors. A lower-than-normal eosinophil count can be
due to alcohol intoxication and overproduction of certain steroids in the body. This is an
important point to address as in the northern region of Thailand, illegal steroid mixed substances
are easily accessible. After the interview and the categorization of patients, the patient with no
use of steroid and alcohol intoxication will be examined further by endoscopic retrograde
cholangiopancreatography. This method can be used to observe, diagnose, and manage biliary
system parasites. If the final diagnosis was made and inspection of a flat, fleshy, ovate trematode
that has a length of 2 to 7.5 cm are made, then further treatment will be proceeded.
 To conclude, all the steps and possible methods mentioned above have to be done as fast
as possible because once the parasite parasites escape from a cyst stage of their life cycle, the
larva can develop into mature adults within 3 months and produce approximately 10,000 to
25,000 eggs per worm/day.

Treatment
There are many medications that could be a useful source to cure patients with
Falscioopsiasis Buski. However, side effects and limitations may be asked to follow strictly
throughout the use.
When it comes to intestinal fluke, prescription of Praziquantel is common nowadays. The
drug was used world widely for the treatment of schistosomiasis and was approved by the FDA
among adults and children's over 4 years old. The use of this medication will help prevent newly
hatched worms from growing and dividing themselves. The Average dose given to the patients is
25 mg/kg, 3 times a day for 1 day. Nevertheless, there's a scale given for each age group where
adults would consume 20 mg/kg orally 3 times a day for one day within every 4-6 hours gap. For
children the age of 4 or older will be prescribed 20 mg/kg orally 3 times per day for one day in a
gap of 4-6 hours as well. For the case of mothers with newborns, it is to be said that Praziquantel
could enter the breast milk. Therefore, patients do not nurse on the day of taking the drugs but if
breastfeeding would need an addition of 72 hours. During the pregnancy, patients are able to be
given Praziquantel but should be strictly under doctor’s care. Praziquantel contains various
possible side effects which could range from mild to severe symptoms. The following symptoms
may not be experienced in all patients, depending on the patient's body whether they can handle
it or not. The side effects may include mainly fever, headache, abdominal pain, allergic reaction.
Moving on, Niclosamide is considered as one of the effective treatment choices for
patients with certain conditions. The absorption of the drugs by the gastrointestinal tract are quite
slow and not as effective as Praziquantel. Side effects that may appear would include diarrhea,
loss appetite, vomiting and abdominal pain. Moreover, the drugs can be used in children age 2
and above, it is tested that no side effects were found in childrens like they were in adults. Also,
there is minimal risk for infants that may be breastfeed by women who're under this medication
(... ). The doses may depend on the patient's condition, strength of medicine and amount of dose
per day. However, it is to be said that compared with other available treatments Niclosamide are
considered as the least effective one.
Tetrachloroethylene is known as another deworming drug and could be fastly absorbed
by the body. The side effects of these drugs are more serious than other available medicine, it is
hepatotoxic, neurotoxic, pulmonary edema (in the form of inhalation) anf renal damage.
However, many sources mentioned the use of drugs in childrens. In addition, an experiment has
been conducted on a group of 17 and 49 childrens that are directly infected with Fasciolopsis
buski. The result came out pretty well where 99% of feces count were reduced and large amounts
of worms were expelled out of the host. Nevertheless, possible reactions in patients are severe
anaphylactic reactions (serious allergic reactions that can be fatal) which doctors will normally
prevent by prior treatment with antihistamines.
In conclusion, treatments that are effective include Tetrachloroethylene, Praziquantel and
Niclosamide. However, drugs that were used but considered ineffective in some cases were
anthelmintics which included Thiabendazole, mebendazole, levamisole and pyrantel pamoate.

Immediate actions
To solve the ongoing outbreak, some immediate actions must be taken to reduce the
damage of the outbreak and limit the outbreak from infecting even more people.

Treatments
The recommended treatment would be Praziquantel and Tetrachloroethylene.
Praziquantel will be recommended to adults while Tetrachloroethylene will be recommended to
childrens.

Construction
The construction of water treatment systems must begin as soon as possible.

Temporary restrictions
A temporary restriction should be implemented by preventing people’s access to the river
in order to control the outbreak. The restriction should last until the construction of a water
treatment system is ready for use.

Food and water shelters

Due to the temporary restriction of access to the river, people will not be able to access
water or resources from the river. Therefore, for the meantime, food and water should be
provided to the people until the water treatment system is ready for use. Approximately, the
water treatment takes 8 months both to plan and build. There should be a shelter to provide food
and clean water in each town to ensure everyone receives the supplies.

Chemical controls
One of the ways to reduce the number of flukes in the river and reduce the risk of being
infected is to control the population of snails, one of the hosts for the Giant Intestinal fluke. This
would reduce the chances of miracidias being able to find a host and continue its life cycle to
develop to a stage that could infect and harm humans. One of the methods used to control the
population of snails is the introduction of chemicals. Multiple chemicals can be used as
molluscicides. One of these includes niclosamide. Niclosamide is a type of molluscicide that
could be used to control the population of snails as well as cercariae in water. It disrupts oxygen
processes by interfering with the process of oxygen intake. Although niclosamide has a short half
life in water and is quickly metabolized in water, it can affect organisms that are not targeted,
particularly fishes as it is highly toxic to them. However, after dilution, it is not toxic to water
plants and crops, and fishes killed by the mullusticide can be safely eaten by humans. Therefore,
with its effects on the environment taken into account and its high price, the introduction of
chemicals into rivers should be used sparingly and seasonally when there is a spike in the
number of infected people to reduce the negative impacts on the environment.
The molluscicide should be in contact with the snails and cercariae for a certain period of
time, with eight hours being the ideal period of time, to be effective. Since in flowing water
molluscicides would be washed away as soon as applied, a drip-feed technique using a drum
dispenser is required. The technique would deliver a
constant flow of molluscicide into the stream for a
certain period of time to assure the target species
are exposed to the chemical long enough. It should
be set up at a narrow part of the stream to ensure all
the chemicals and water have mixed then spread
throughout the system. The solution applied on the
stream should contain enough chemicals to ensure
the concentration would be high enough to kill the
target species. Furthermore, the dispenser should
have a tap to control how much should be
discharged per second, and the barrel must be
frequently stirred to stop the chemicals from sedimenting.
The type of niclosamide used should be a 70 percent wettable powder, a homogeneous
mixture of niclosamide and is in the form of fine powder, at 1mg/l. To calculate the amount of
molluscicide needed, the total volume of water (m3/s) that needs to be treated must first be
calculated. This can be calculated by multiplying the water velocity, average water depth (m),
and the average width of the stream. The water velocity can be estimated by recording the
velocity of a floating object on the stream. The amount of molluscicide can then be calculated as
the total water volume (m3/s) x 100/70 x 60 x 60 x 8. Furthermore, the discharge from the head
or the dispenser (liters/s), denoted as F in this equation, can be calculated as: [Q (m3/s) × 100/70
(g/m3)]/F(l/s) = 100/70 × Q/F (g/l), where Q is the total amount of molluscicide needed.
Since this method leads to many negative impacts to the environment and could
potentially affect the economy of the local area due to their heavy reliance on resources from the
river, this method is not recommended to be used in the long term. However, the use of
chemicals would lead to an immediate result, thus is fit to be used as an immediate action to
control the population and outbreak of the flukes. Whenever there is a surge in the number of
those who are infected or a trend is seen where the number of those who are infected increases in
certain months and is seasonal, this method can be applied and used in conservative amounts.

Drash tents
In order to solve the problem, few
systems or buildings must be considered to be
constructed. The first problem is local
hospitals don’t have enough capacity for all
patients. We don’t recommend building a new
hospital because it uses large space and
money. Instead of building new hospitals, we
should use DRASH or Deployable Rapid
Assembly Shelter. DRASH is important for this outbreak time because it is only setting up
within one minute without using special tools. Thus, it provides temporary space for infected
patients to cure during outbreak time. Medical workers like doctors are also important in medical
treatment, but the local area usually lacks them. Therefore, the local hospitals should be one spot
that medical volunteers can work with because we need as many doctors as possible to treat
infected people, and then the situation will be solved faster.

Supplies
1. Blood test kits
2. Equipment required to perform stool examination
3. Medications
3.1. Praziquantel
3.2. Tetrachloroethylene
3.3. General drugs to milden symptoms of the patients with side effects from the
intake of medication or the infection.
4. Medical tents (drash tents)
5. Water and food supplies
6. Niclosamide 70% wettable powder
7. Chlorine
8. Supplies for the construction of water systems nanofilters, wastewater stabilization
ponds, and pig farm elevation.
Long term actions
In order to prevent such outbreaks in the future, certain controls and measures should be
implemented. Major changes must be made in order to reduce the chances of the outbreak of the
Fasciolopsis buski in the future.

Education and restraints

Many of the actions that must be done include the changes in people’s behaviors and
actions. One of the first things that must be taught to the people is the basic understanding of
Fasciolopsis buski. This should include but not be limited to: its life cycle, the way it transmits to
humans, as well as the symptoms of fascioliasis. Doing so, the locals would understand the
measures that are taken to prevent the outbreak, allowing them to better cooperate with the
process of prevention.
People should prevent ingesting raw or untreated water based plants. People should be
advised to cook the aquatic plants for one to two minutes in boiling water to kill the
metacercariae. Prevention could also be accomplished by thoroughly cleaning the plants with
running water before ingesting to remove the metacercariae on the plants. Feeding pigs raw and
untreated aquatic plants should also be prevented.
Furthermore, people should be instructed to avoid submerging the aquatic plants in water
to preserve its freshness. This is because metacercariae are found to be very sensitive to dryness.
Therefore, keeping the plants damp would only allow the ​metacercariae to survive longer.
Moreover, a time elapse between the harvesting of the plants and selling it in the market should
be highly recommended to decrease the chances of metacercariae being alive.
Additionally, people should be instructed not to drink water straight from the river or
give untreated water to pigs. This is because around 3.6 percent of the total encysted cercariae
are found floating on the water surface. Furthermore, 10.3-12.8 percent of people as well as
35.1-40 percent of pigs infected with the F. buski were possibly infected by drinking water
straight from the river.
Instead, the use of fermented silage should
be suggested. This is a type of diet for pigs and
cattles produced through the fermentation of crops.
There are a total of six phases of silage
fermentation and storage. This process of
fermentation causes the silage to go through a high
temperature ensuring all the eggs of the parasite is
killed. Thus, the chances of pigs getting infected
would drop. Furthermore, silage has a higher
amount of nutrients and allows food to be kept longer. However, nitrogen dioxide produced in
the process is harmful as it could cause irritation to the nose and lead to inflammation of the
lungs. Exposure to high concentrations of the gas could cause the person to collapse and lead to
death within minutes. Thus, there should be safety measures implemented and taught to the
people along with the methods of operating the silo. Some of these measures could include
making sure there is good ventilation around the area of the silo and making sure there is not too
close to livestocks and people’s houses as gas could leak and to the area around it. The dangers
of the silo should be clearly stated to the locals to prevent them from dangerous areas or doing
something dangerous. The silos must also be surrounded by fences and contain locks to prevent
people, specifically kids, from entering dangerous areas. Furthermore, entering the silo during a
phase where fermentation is occurring should be prohibited. However, if it is required for
someone to do so, they should use a self-contained breathing apparatus (SCBA) to protect them
from the harmful gases. Other protections like dust masks or chemical cartridge respirators
would not be able to provide the necessary protection.
The information and knowledge as stated above should be delivered to the locals through
courses that should be held at least two times annually. This would increase the awareness about
the fluke, as well as educate and remind locals of the actions they should follow to prevent or
decrease their chances of getting infected.

Constraints implemented
Certain actions must be prevented by law as it would increase the efficiency and certainty
of the measure being followed by the locals. A restriction must be implemented to instruct that
wastes, sludge, and feces from both households and agricultural farms should be treated through
the water treatment system before being released into the river. By treating the wastes before
releasing it into the river, the eggs can be reduced, consequently decreasing the number of flukes
in the water and the infection rate. If violated, the action must be punished accordingly.

Constructing Facilities
Water is the main source of this area, so most local
people use a lot of it for many purposes. This is a major
risk which causes people to get infection because water
contains a lot of Giant intestinal flukes. When people
directly use water from the river, it isn't clean enough and
easy to get inside the human body. To deal with this
problem, we should build two systems which are water
treatment and wastewater stabilisation ponds (WSPs).
Water treatment is normally found in many cities around
the world. The process in conventional water treatments
eliminates most of the bacteria in water, but unfortunately it
doesn’t kill viruses and parasites which include helminth,
and protozoa. Therefore, we will change some structures of water treatment, in part of filtration
to not allow protozoan cyst, and helminth eggs passing through by using nanofiltration. The
water treatment has 4 main steps; coagulation and flocculation, sedimentation, filtration, and
disinfection.
Next, we should build a waste stabilization pond (WSP) for treated wastewater before
releasing it back to the river. The size of stabilization and cost depends on the area. Moreover, it
is a simple process and doesn't need much control. For example in Thailand there will be Phitchit
and Hat Yai. The most significant point is it can remove intestinal helminth eggs from
wastewater. There are 3 types of ponds; anaerobic, facultative and aerobic (maturation).

Last thing we suggest to be built are pig houses.

Pigs can easily be infected by Giant intestinal fluke such as
accidentally drinking water from the river or eating the soil
directly. The local people should build an appropriate pig
house to reduce parasite infection. The side of a pig house
depends on how large the farm-scale is in that area, but it
should be a closed area. Addition to the pig house, the floor
should be made in order to not allow pigs contact with soil.
We can build wooden poles, or wooden bridges, or cement
floors or husks to cover the soil.
Projection
The latest records portray that the number of new cases and total cases are increasing
each month. To start our plan, we can be divided into two periods. First period is intervening
now, it will start in May and end in July. The number of new cases will reduce by 15 cases per
month until 0 cases. Second period is waiting for 3 months then intervenes, so it will start in
August and end in March next year. The number of new cases will fall by 10 cases per month.

(1.1) The graph show the new cases if we intervene now

(1.2) The graph shows the total cases if we intervene now

(2.1) The graph illustrates new cases if we wait for 3 months, and then intervene

(2.2) The graph illustrates total cases if we wait for 3 months, and then intervene
 References

Bhargava, H. D. (2020, January 07). Eosinophils and Eosinophil Count Test (EOS Blood Test).

Retrieved from https://www.webmd.com/asthma/eosinophil-count-facts#2

CDC - Fasciolopsiasis - Frequently Asked Questions (FAQs). (2014, April 01). Retrieved from

https://www.cdc.gov/parasites/fasciolopsis/faqs.html#:~:text=What are the signs

and,nausea, vomiting, and fever.

Clinical Infectious Diseases. (n.d.). Retrieved from

https://books.google.co.th/books?id=zvCOpighJggC&pg=PA387&lpg=PA387&dq=How

to treat Fasciolopsis buski in children under. 4 years

old&source=bl&ots=9zH0pcW7ZF&sig=ACfU3U3B9HN9DX3OfFmist0gIlLcEYZLfg&

hl=th&sa=X&ved=2ahUKEwjQjPasl9PpAhUTX30KHfyeCJkQ6AEwAnoECAcQAQ#v=

onepage&q=How to treat Fasciolopsis buski in children under. 4 years old&f=false

DRASH® M Series Shelter. (2016, October 04). Retrieved from

http://www.hdtglobal.com/product/drash-m-series-shelter/

Disinfection with Chlorine. (2015, June 22). Retrieved from

https://www.cdc.gov/healthywater/drinking/public/chlorine-disinfection.html

Eosinophil count - absolute. (n.d.). Retrieved from

https://www.mountsinai.org/health-library/tests/eosinophil-count-absolute

Eosinophilia. (n.d.). Retrieved from

https://www.sciencedirect.com/topics/medicine-and-dentistry/eosinophilia

Fasciolopsiasis - Explain Medicine: Medical Joyworks. (n.d.). Retrieved from

https://www.medicaljoyworks.com/explain-medicine/catalog/Infectious-diseases/Fasciolop
 siasis

Fasciolopsis Buski. (n.d.). Retrieved from

https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-scien

ce/fasciolopsis-buski

Fasciolopsis Buski. (n.d.). Retrieved from

https://www.sciencedirect.com/topics/immunology-and-microbiology/fasciolopsis-buski#:

~:text=Fasciolopsis buski (Intestinal Fluke)&text=The adult is a flat,small operculum at

one end.

Fasciolopsis Buski. (n.d.). Retrieved from

https://www.sciencedirect.com/topics/immunology-and-microbiology/fasciolopsis-buski

How to farm pigs: Housing. (2020, June 08). Retrieved from

https://thepigsite.com/articles/how-to-farm-pigs-housing

Murphy, D. (2020, May 26). Silo Gases - the Hidden Danger. Retrieved from

https://extension.psu.edu/silo-gases-the-hidden-danger#:~:text=Dangers of Silo Gases,to

inflammation of the lungs.&text=Very high concentrations of gas,collapsing and dying

within minutes

Nanofilters. (n.d.). Retrieved from https://www.sciencedirect.com/topics/engineering/nanofilters

Niclosamide. (n.d.). Retrieved from https://www.drugbank.ca/drugs/DB06803

Niclosamide Advanced Patient Information. (n.d.). Retrieved from

https://www.drugs.com/cons/niclosamide.html

Paniker's Textbook of Medical Parasitology. (n.d.). Retrieved from

https://books.google.co.th/books?id=JrpEDwAAQBAJ&pg=PA153&lpg=PA153&dq=ho
 w+to+use+endoscopic+retrograde+cholangiopancreatography+to+detect+Fasciolopsis+bu

ski&source=bl&ots=_zbemmTfEq&sig=ACfU3U2OVk3RnYTsU32kjAoCgNSACLD78

A&hl=en&sa=X&ved=2ahUKEwi7r9a1g97pAhXVILcAHR5FCgoQ6AEwAHoECAUQ

AQ#v=onepage&q=how to use endoscopic retrograde cholangiopancreatography to detect

Fasciolopsis buski&f=false

Praziquantel in Children Under Age 4 - Full Text View. (n.d.). Retrieved from

https://clinicaltrials.gov/ct2/show/NCT03640377

Praziquantel: Side Effects, Dosages, Treatment, Interactions, Warnings. (2017, July 24).

Retrieved from

https://www.rxlist.com/consumer_praziquantel_biltricide/drugs-condition.htm

Spuhler, D., & Swiss Federal Institute of Aquatic Science and Technology. (2019, June 03).

Waste Stabilisation Ponds: SSWM - Find tools for sustainable sanitation and water

management! Retrieved from https://sswm.info/factsheet/waste-stabilisation-ponds

Weng YL;Zhuang ZL;Jiang HP;Lin GR;Lin JJ;. (n.d.). [Studies on Ecology of Fasciolopsis

Buski and Control Strategy of Fasciolopsiasis]. Retrieved from

https://pubmed.ncbi.nlm.nih.gov/2805255/

Yılmaz, S., Akıcı, M., Şimşek, M., Okur, N., Erşen, O., & Tuncer, A. A. (2018, January 03).

Endoscopic retrograde cholangiopancreatography for biliary system parasites. Retrieved

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340658/