Fasciolopsiasis results from an

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

by the

trematode Trematoda is a Class (biology), class of flatworms known as trematodes, and commonly as flukes. They are obligate parasite, obligate Endoparasites, internal parasites with a complex biological life cycle, life cycle requiring at least two Host ( ...

'' Fasciolopsis buski'', the largest intestinal fluke of

human Humans (''Homo sapiens'') or modern humans are the most common and widespread species of primate, and the last surviving species of the genus ''Homo''. They are Hominidae, great apes characterized by their Prehistory of nakedness and clothing ...

s, growing up to long.

Signs and symptoms

Most infections are light, almost

asymptomatic Asymptomatic (or clinically silent) is an adjective categorising the medical conditions (i.e., injuries or diseases) that patients carry but without experiencing their symptoms, despite an explicit diagnosis (e.g., a positive medical test). P ...

. In heavy infections, symptoms can include

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given th ...

, chronic

diarrhea Diarrhea (American English), also spelled diarrhoea or diarrhœa (British English), is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration d ...

anemia Anemia (also spelt anaemia in British English) is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin availabl ...

ascites Ascites (; , meaning "bag" or "sac") is the abnormal build-up of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdo ...

, toxemia, allergic responses, sensitization caused by the absorption of the worms' allergenic metabolites can lead to intestinal obstruction and may eventually cause death of the patient.

Cause

The parasite infects an amphibic

snail A snail is a shelled gastropod. The name is most often applied to land snails, terrestrial molluscs, terrestrial pulmonate gastropod molluscs. However, the common name ''snail'' is also used for most of the members of the molluscan class Gas ...

('' Segmentina nitidella, Segmentina hemisphaerula, Hippeutis schmackerie, Gyraulus,

Lymnaea ''Lymnaea'' is a genus of small to large-sized air-breathing freshwater snails, aquatic pulmonate gastropod mollusks in the subfamily Lymnaeinae of the family Lymnaeidae, the pond snails.Bouchet, P.; Rosenberg, G. (2013). Lymnaea Lamarck, 1799. ...

, Pila, Planorbis'' ('' Indoplanorbis'')) after being released by infected mammalian feces; metacercaria released from this

intermediate host In biology and medicine, a host is a larger organism that harbours a smaller organism; whether a parasitic, a mutualistic, or a commensalist ''guest'' (symbiont). The guest is typically provided with nourishment and shelter. Examples include ...

encyst on

aquatic plant Aquatic plants, also referred to as hydrophytes, are vascular plants and Non-vascular plant, non-vascular plants that have adapted to live in aquatic ecosystem, aquatic environments (marine ecosystem, saltwater or freshwater ecosystem, freshwater ...

s like water spinach, which are eaten raw by pigs and humans. Water itself can also be infective when drunk unboiled ("Encysted cercariae exist not only on

s, but also on the surface of the water.")

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 ''Fasciola hepatica'', also known as the common liver fluke or sheep liver fluke, is a parasitism, parasitic trematode (fluke (flatworm), fluke or flatworm, a type of helminth) of the class (biology), class Trematoda, phylum Platyhelminthes. It ...

'' liver fluke, but that is largely inconsequential since treatment is essentially identical for both.

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 ("nightsoil") as a fertilizer, and maintenance of proper sanitation and good hygiene. Additionally,

control should be attempted.

Treatment

Praziquantel Praziquantel, sold under the brandname Biltricide among others, is a medication used to treat a number of types of parasitic worm infections in mammals, birds, amphibians, reptiles, and fish. In humans specifically, it is used to treat schist ...

is the

drug A drug is any chemical substance other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect. Consumption of drugs can be via insufflation (medicine), inhalation, drug i ...

of choice for treatment. Treatment is effective in early or light infections. Heavy infections are more difficult to treat. Studies of the effectiveness of various drugs for treatment of children with ''F. buski'' have shown

tetrachloroethylene Tetrachloroethylene, also known as perchloroethylene or under the systematic name tetrachloroethene, and abbreviations such as perc (or PERC), and PCE, is a chlorocarbon with the formula . It is a non-flammable, stable, colorless and heavy liqu ...

as capable of reducing faecal egg counts by up to 99%. Other

anthelmintics Anthelmintics or antihelminthics are a group of antiparasitic drugs that expel parasitic worms ( helminths) and other internal parasites from the body by either stunning or killing them without causing significant damage to the host. They may als ...

that can be used include

thiabendazole Tiabendazole (International Nonproprietary Name, INN, British Approved Name, BAN), also known as thiabendazole (Australian Approved Name, AAN, United States Adopted Name, USAN) or TBZ and the trade names Mintezol, Tresaderm, and Arbotect, is a pr ...

, mebendazole,

levamisole Levamisole, sold under the brand name Ergamisol among others, is a medication used to treat parasitic worm infections, specifically ascariasis and hookworm infections. It is taken by mouth. Side effects may include abdominal pain, vomiting, ...

and pyrantel pamoate. Oxyclozanide,

hexachlorophene Hexachlorophene, also known as Nabac, is an organochlorine compound that was once widely used as a disinfectant. The compound occurs as a white odorless solid, although commercial samples can be off-white and possess a slightly phenolic odor. It ...

and nitroxynil are also highly effective.

Epidemiology

''F. buski'' is endemic in

Asia Asia ( , ) is the largest continent in the world by both land area and population. It covers an area of more than 44 million square kilometres, about 30% of Earth's total land area and 8% of Earth's total surface area. The continent, which ...

including

China China, officially the People's Republic of China (PRC), is a country in East Asia. With population of China, a population exceeding 1.4 billion, it is the list of countries by population (United Nations), second-most populous country after ...

Taiwan Taiwan, officially the Republic of China (ROC), is a country in East Asia. The main geography of Taiwan, island of Taiwan, also known as ''Formosa'', lies between the East China Sea, East and South China Seas in the northwestern Pacific Ocea ...

Southeast Asia Southeast Asia is the geographical United Nations geoscheme for Asia#South-eastern Asia, southeastern region of Asia, consisting of the regions that are situated south of China, east of the Indian subcontinent, and northwest of the Mainland Au ...

Indonesia Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania, between the Indian Ocean, Indian and Pacific Ocean, Pacific oceans. Comprising over List of islands of Indonesia, 17,000 islands, including Sumatra, ...

Malaysia Malaysia is a country in Southeast Asia. Featuring the Tanjung Piai, southernmost point of continental Eurasia, it is a federation, federal constitutional monarchy consisting of States and federal territories of Malaysia, 13 states and thre ...

, and

India India, officially the Republic of India, is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area; the List of countries by population (United Nations), most populous country since ...

. It has an up to 60% prevalence in worst-affected communities in southern and eastern

and mainland

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. 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.

References

External links

{{Helminthiases Helminthiases Fasciolidae Zoonotic parasitic diseases cs:Fasciolopsis buski