Fasciolopsiasis

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Fasciolopsiasis
Other names: Fasciolopsis buski infection[1]
  • Top:Fasciolopsis buski life cycle[2]
  • Bottom: Fasciolopsis buski
SpecialtyInfectious disease
SymptomsAbdominal pain, diarrhea, nausea, vomiting, fever[3]
ComplicationsIntestinal obstruction, anemia[4][5]
CausesFasciolopsis buski [2]
Diagnostic methodStool exam[2]
Differential diagnosisChronic gastritis, Ascariasis, Eosinophilia, Giardiasis, Inflammatory bowel disease[6]
MedicationPraziquantel[7]
FrequencySouth and southeastern Asia[8]

Fasciolopsiasis results from an infection by the trematode Fasciolopsis buski,[9] the largest intestinal fluke of humans (up to 7.5 cm in length).

Most infections are light and asymptomatic.Fasciolopsiasis can be treated with medications such as praziquantel, levamisole, mebendazole, and thiabendazole[7]

Fasciolopsiasis is most often seen in south and southeastern Asia[8]

Signs and symptoms

Most infections are light, almost asymptomatic. In heavy infections, symptoms can include abdominal pain, chronic diarrhea, ascites, toxemia, allergic responses, sensitization caused by the absorption of the worms' allergenic metabolites can lead to complications that may eventually cause death of the patient.[3]

Complications

Anemia

As to the complications of Fasciolopsiasis we find the following:[5][4]

  • Malabsorption

Cause

The parasite infects an amphibic snail (Segmentina nitidella, Segmentina hemisphaerula, Hippeutis schmackerie, Gyraulus, Lymnaea, Pila, Planorbis (Indoplanorbis)) after being released by infected mammalian feces; metacercaria released from this intermediate host encyst on aquatic plants like water spinach, which are eaten raw by pigs and humans. [10]

Water itself can also be infective when drunk unboiled ("Encysted cercariae exist not only on aquatic plants, but also on the surface of the water.")[11]

Mechanism

In terms of the life cycle we find that the eggs, originally from excreted stool,hatch in water, releasing miracidia, which invade a snail intermediate host.The parasites undergo several developmental stages in the snail.The cercariae are released from the snail and encyst on aquatic plants.Mammalian hosts(humans), become infected by ingesting these metacercariae on aquatic plants.After ingestion, the metacercariae excyst in the duodenum and attach to the intestinal wall. They develop into adult flukes over approximately three months[2]

Diagnosis

Microscopic identification of eggs, or more rarely of the adult flukes, in the stool or vomitus is the basis of specific diagnosis. The eggs are indistinguishable from those of the very closely related Fasciola hepatica liver fluke, but that is largely inconsequential since treatment is essentially identical for both.[2][12]

High number of ascaris worms are filling the duodenum

Differential diagnosis

The DDx of Fasciolopsiasis in an affected individual is as follows:[6]

Prevention

Infection can be prevented by immersing vegetables in boiling water for a few seconds to kill the infective metacercariae, avoiding the use of untreated feces as a fertilizer, and maintenance of proper sanitation and good hygiene. Additionally, snail control should be attempted.[4]

Treatment

Praziquantel

Praziquantel is the drug of choice for treatment. Treatment is effective in early or light infections. Heavy infections are more difficult to treat. [13]

Studies of the effectiveness of various drugs for treatment of children with F. buski have shown tetrachloroethylene as capable of reducing faecal egg counts by up to 99%. [13]

Other anthelmintics that can be used include thiabendazole, mebendazole, levamisole and pyrantel pamoate.[13] Oxyclozanide, hexachlorophene and nitroxynil are also highly effective.[14]

Epidemiology

F. buski is endemic in Asia including China, Taiwan, Southeast Asia, Indonesia, Malaysia, and India. It has an up to 60% prevalence in worst-affected communities in southern and eastern India and mainland China and has an estimated 10 million human infections. Infections occur most often in school-aged children or in impoverished areas with a lack of proper sanitation systems.[8]

A study from 1950s found that F. buski was endemic in central Thailand, affecting about 2,936 people due to infected aquatic plants called water caltrops and the snail hosts which were associated with them. The infection, or the eggs which hatch in the aquatic environment, were correlated with the water pollution in different districts of Thailand such as Ayuthaya Province. The high incidence of infection was prevalent in females and children ages 10–14 years of age.[15]

  • Global distribution of fasciolopsiasis[16]

    Global distribution of fasciolopsiasis[16]

  • Distribution of Fasciolopsis buski

    Distribution of Fasciolopsis buski

History

George Busk MD

In terms of history we find that Fasciolopsiasis is caused by the giant intestinal fluke, Fasciolopsis buski, which was first described by English surgeon George Busk in 1843[17]

The term "liver rot" was used in sheep as a description in a French work in the year 1379. This disease is rather common among humans and is a prime concern in veterinary medicine.[17]

In 1925 the life cycle in humans was ascertained by Claude Heman Barlow[18]

Research

Vaccination against trematode infection like fasciolopsiasis is still an area of ongoing research. For fasciolopsiasis, researchers have been working on an epitope-based vaccine ensemble using in silico methods. This approach aims to identify key molecules involved in biology, toxicity, and virulence of the parasite Fasciolopsis buski. Some results are encouraging, however validation is needed before a vaccine is available.[19]

References

  1. ↑ Wu, Xinglang; Wang, Weimin; Li, Qujin; Xue, Qiang; Li, Yue; Li, Shengwei (December 2020). "Case Report: Surgical Intervention for Fasciolopsis buski Infection: A Literature Review". The American Journal of Tropical Medicine and Hygiene. 103 (6): 2282–2287. doi:10.4269/ajtmh.20-0572. ISSN 1476-1645. PMC 7695077. PMID 32959769.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 "CDC - DPDx - Fasciolopsiasis". www.cdc.gov. 5 June 2024. Archived from the original on 25 July 2024. Retrieved 16 February 2025.
  3. ↑ 3.0 3.1 Bhattacharjee HK, Yadav D, Bagga D (2001). "Fasciolopsiasis presenting as intestinal perforation: a case report". Trop Gastroenterol. 30 (1): 40–1. PMID 19624087.
  4. ↑ 4.0 4.1 4.2 "About Fasciolopsis". Fasciolopsis. 25 April 2024. Archived from the original on 12 February 2025. Retrieved 21 February 2025.
  5. ↑ 5.0 5.1 "Fasciolopsiasis - Infectious Diseases". Merck Manual Professional Edition. Archived from the original on 2 April 2024. Retrieved 14 February 2025.
  6. ↑ 6.0 6.1 "Intestinal Flukes Differential Diagnoses". emedicine.medscape.com. Archived from the original on 24 November 2024. Retrieved 13 February 2025.
  7. ↑ 7.0 7.1 Siles-Lucas, Mar; Becerro-Recio, David; Serrat, Judit; González-Miguel, Javier (1 January 2021). "Fascioliasis and fasciolopsiasis: Current knowledge and future trends". Research in Veterinary Science. 134: 27–35. doi:10.1016/j.rvsc.2020.10.011. ISSN 0034-5288. PMID 33278757. Retrieved 19 February 2025.
  8. ↑ 8.0 8.1 8.2 Keiser J, Utzinger J (2009). "Food-borne trematodiases". Clin Microbiol Rev. 22 (3): 466–83. doi:10.1128/CMR.00012-09. PMC 2708390. PMID 19597009.
  9. ↑ Lankester, E.; Küchenmeister, F. (1857). "Appendix B: On the occurrence of species of Distoma in the human body". On animal and vegetable parasites of the human body: a manual of their natural history, diagnosis, and treatment. Vol. 1. Sydenham society. pp. 433–7.
    Odhner TH (1902). "Fasciolopsis Buski (Lank.)[= Distomum crassum Cobb.], ein bisher wenig bekannter Parasit des Menschen in Ostasien". Centr. Bakt. U. Par. XXXI.
  10. ↑ Mas-Coma, S.; Bargues, M.D.; Valero, M.A. (October 2005). "Fascioliasis and other plant-borne trematode zoonoses". International Journal for Parasitology. 35 (11–12): 1255–1278. doi:10.1016/j.ijpara.2005.07.010. PMID 16150452.
  11. ↑ Weng YL, Zhuang ZL, Jiang HP, Lin GR, Lin JJ (1989). "Studies on ecology of Fasciolopsis buski and control strategy of fasciolopsiasis". Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi (in 中文). 7 (2): 108–11. PMID 2805255.
  12. ↑ "Fasciolopsiasis - Infectious Diseases". MSD Manual Professional Edition. Archived from the original on 2 April 2024. Retrieved 25 February 2025.
  13. ↑ 13.0 13.1 13.2 Rabbani GH, Gilman RH, Kabir I, Mondel G (1985). "The treatment of Fasciolopsis buski infection in children: a comparison of thiabendazole, mebendazole, levamisole, pyrantel pamoate, hexylresorcinol and tetrachloroethylene". Trans R Soc Trop Med Hyg. 79 (4): 513–5. doi:10.1016/0035-9203(85)90081-1. PMID 4082261.
  14. ↑ Probert AJ, Sharma RK, Singh K, Saxena R (1981). "The effect of five fasciolicides on malate dehydrogenase activity and mortality of Fasciola gigantica, Fasciolopsis buski and Paramphistomum explanatum". J Helminthol. 55 (2): 115–22. doi:10.1017/S0022149X0002558X. PMID 7264272.
  15. ↑ Sadun EH, Maiphoom C (1953). "Studies on the epidemiology of the human intestinal fluke, Fasciolopsis Buski in Central Thailand". American Journal of Tropical Medicine and Hygiene. 2 (6): 1070–84. doi:10.4269/ajtmh.1953.2.1070. PMID 13104816.
  16. ↑ Lu, Xiao-Ting; Gu, Qiu-Yun; Limpanont, Yanin; Song, Lan-Gui; Wu, Zhong-Dao; Okanurak, Kamolnetr; Lv, Zhi-Yue (9 April 2018). "Snail-borne parasitic diseases: an update on global epidemiological distribution, transmission interruption and control methods". Infectious Diseases of Poverty. 7 (1): 28. doi:10.1186/s40249-018-0414-7. ISSN 2049-9957. PMC 5890347. PMID 29628017.
  17. ↑ 17.0 17.1 Patterson, K. David (1993). "Fascioliasis". The Cambridge World History of Human Disease. Cambridge University Press. p. 721. ISBN 978-1-139-05351-8.
  18. ↑ Barlow, Claude Heman (1925). "The Life Cycle of the Human Intestinal Fluke Fasciolopsis Buski (Lankester)". American Journal of Hygiene: 98.
  19. ↑ Konhar, Ruchishree; Das, Kanhu Charan; Nongrum, Aiboklang; Samal, Rohan Raj; Sarangi, Shailesh Kumar; Biswal, Devendra Kumar (22 January 2025). "In silico design of an epitope-based vaccine ensemble for fasliolopsiasis". Frontiers in Genetics. 15. doi:10.3389/fgene.2024.1451853. ISSN 1664-8021. PMC 11794225. PMID 39911308.

Further reading

DOI:10.4103/ijmm.IJMM_17_7

External links

Classification
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