Case Report: Surgical Intervention for Fasciolopsis buski Infection: A Literature Review.

Fasciolopsis buski, also called the giant intestinal fluke, is the largest intestinal fluke of the zoonotic trematode parasites and found mainly in Southeast Asian countries, including China. Fasciolopsis buski infection was formerly a common health problem in many countries, but it is now rare. Typically, it can be cured by oral drugs, but some infected patients need surgical intervention because of the severity of their condition or because of an unclear diagnosis or even misdiagnosis. Here, we report a case of a 15-year-old girl from Guizhou Province, China, presenting with recurrent upper-middle abdominal pain that was misdiagnosed as a choledochal cyst. Through laparotomy combined with postoperative histopathological examination, the source of the pain was proven to be mechanical biliary obstruction caused by F. buski infection. In the past, mechanical obstruction, especially biliary obstruction, caused by F. buski infection leading to surgery was not uncommon, but it is very rare in modern society. Moreover, delayed treatment and misdiagnosis of parasitic infection can lead to severe consequences. Therefore, we reviewed the previous literature on F. buski infection treated by surgical operation and summarized the characteristics and therapeutic strategies of these cases to raise clinicians' awareness of this rare infection.

Adaptive Radiation of the Flukes of the Family Fasciolidae Inferred from Genome-Wide Comparisons of Key Species.

Liver and intestinal flukes of the family Fasciolidae cause zoonotic food-borne infections that impact both agriculture and human health throughout the world. Their evolutionary history and the genetic basis underlying their phenotypic and ecological diversity are not well understood. To close that knowledge gap, we compared the whole genomes of Fasciola hepatica, Fasciola gigantica, and Fasciolopsis buski and determined that the split between Fasciolopsis and Fasciola took place ∼90 Ma in the late Cretaceous period, and that between 65 and 50 Ma an intermediate host switch and a shift from intestinal to hepatic habitats occurred in the Fasciola lineage. The rapid climatic and ecological changes occurring during this period may have contributed to the adaptive radiation of these flukes. Expansion of cathepsins, fatty-acid-binding proteins, protein disulfide-isomerases, and molecular chaperones in the genus Fasciola highlights the significance of excretory-secretory proteins in these liver-dwelling flukes. Fasciola hepatica and Fasciola gigantica diverged ∼5 Ma near the Miocene-Pliocene boundary that coincides with reduced faunal exchange between Africa and Eurasia. Severe decrease in the effective population size ∼10 ka in Fasciola is consistent with a founder effect associated with its recent global spread through ruminant domestication. G-protein-coupled receptors may have key roles in adaptation of physiology and behavior to new ecological niches. This study has provided novel insights about the genome evolution of these important pathogens, has generated genomic resources to enable development of improved interventions and diagnosis, and has laid a solid foundation for genomic epidemiology to trace drug resistance and to aid surveillance.

An Autochthonous Human Case of Fasciolopsiasis in Nepal.

Fasciolopsiasis is rarely known as the parasitic disease in Nepal. Herein, we report a case of fasciolopsiasis in a 22-year-old man who was admitted in the hospital with abdominal pain, distension and loss of appetite for a month. He had previously diagnosed with acute viral hepatitis but, his abdominal pain was not resolving despite improvement in his liver function and general condition. During endoscopy an adult digenean worm was seen in the first part of the duodenum. After isolation, the worm was identified morphologically as Fasciolopsis buski. Microscogic examination of the patient's stool revealed eggs with a morphology consistent with F. buski. Eggs were yellow-brown, ellipsoidal, unembmbryonated, operculated, filled with yolk cells, with thin shell and ranging 118-130 µm in length and 60-69 µm in width. The abdominal pain of the patient was resolved after treatment with praziquantel. By the present study, it was confirmed for the first time that fasciolopsiasis is indigenously transmitted in Nepal. Accordingly, the epidemiological studies in humans and reservoir host animals should be performed intensively in near future.

Norma técnica de salud para la vigilancia, prevención y control de la fasciolosis humana en el Perú / Technical health standard for the surveillance, prevention and control of human fasciolosis in Peru

La norma técnica contiene: finalidad y justificación técnica, ámbito de aplicación, base legal, disposiciones generales y específicas para la vigilancia, prevención y control de la fasciolosis humana en el Perú.

Fasciolopsiasis in children: Clinical, sociodemographic profile and outcome.

PURPOSE: To describe the clinical and sociodemographic profile of fasciolopsiasis in children. MATERIALS AND METHODS: A chart review of 56 children presenting with the passage of adult Fasciolopsis buski per stool from February 2015 to January 2016 was done for their clinical profile and risk factors for acquiring fasciolopsiasis in the Paediatric Unit of a medical college of Northern India. RESULTS: The mean age of presentation was 8.2 years (2-14 years age group). Persistent diarrhoea (85.71%) was the most common presentation, whereas anaemia (71.42%) was the most common sign. Protein-energy malnutrition (PEM) and tuberculosis were well-associated comorbid conditions in this study. Polyparasitism was an important finding, Hymenolepis nana being the most common associated parasite. Patients were treated either with praziquantel or nitazoxanide. CONCLUSION: All patients recovered well except one who died due to severe PEM and disseminated tuberculosis and two cases presented with relapse. Most of the cases of polyparasitism were associated with tuberculosis.

DIAGNOSIS AND THERAPY OF LIVER FLUKE (FASCIOLOIDES MAGNA) INFECTION IN FALLOW DEER (DAMA DAMA) IN SERBIA.

Giant liver fluke ( Fascioloides magna ) infection is an important health problem of cervids in southeastern Europe. We measured the prevalence and intensity of infection with F. magna in a fenced area near the Danube River in the South Backa District of Serbia. Parasitologic, pathomorphologic, and histopathologic examinations were conducted from November 2007 to February 2008, beginning with a population of 127 adult fallow deer ( Dama dama ). After a positive diagnosis, therapy with triclabendazole-medicated corn was applied. Deer were treated at four baiting stations, using medicated feed providing triclabendazole at an estimated dose of 10-14 mg/kg of body weight per deer. Treatment lasted for 7 d in early February 2008 and an additional 7 d 2 wk later. For the complete success of pharmacotherapy it was necessary to prevent any contact of deer with the snail intermediate host ( Galba truncatula ). Intervention in the habitat, removing grass and low vegetation, and draining ponds reduces the possibility of contact. Six months after the treatment, livers of hunted deer were reddish, with fibrous tracks; pigmentation and cysts in the parenchyma were surrounded by a fibrous capsule and their fecal samples contained no eggs of F. magna . Over the following years, livers of hunted deer were negative, and the last control cull in March 2015 confirmed complete absence of infection. We reconfirmed the presence of giant liver flukes in fallow deer in Serbia, apparently the result of natural spread across the Danube from Hungary and Croatia. We also report that the treatment of deer with triclabendazole-medicated corn is an effective method for administration of therapeutic doses of drug in semicaptive deer. Interventions in the environment are necessary to prevent recontact of deer with habitats used by the snail intermediate host, and enable the success of the therapy.

Fasciolopsiasis: Endemic focus of a neglected parasitic disease in Bihar.

PURPOSE: To describe a newly discovered, previously unreported endemic focus of fasciolopsiasis in the Phulwaria village, under tehsil Sugauli, East Champaran, Bihar. MATERIALS AND METHODS: A study was conducted at village Phulwaria, following diagnosis of fasciolopsiasis in three children from the village. A total of 120 individuals, including all the children and adults who gave history of recent passage of red fleshy masses in their stool, were included in the study. The cases of fasciolopsiasis were treated with Praziquantel 25 mg/kg, three doses a day. Risk factors for the transmission of the parasite in the village were also studied. RESULTS: Questionnaire revealed majority of the population suffering from abdominal discomfort and passage of red fleshy masses in stool. These fleshy masses were identified as Fasciolopsis buski. One hundred and eighteen individuals were presumably considered as cases of the parasitic infection. After treatment with Praziquantel, all of them passed the parasite in their stool for the next 2-3 days. On investigating, it was observed that all the conditions required for effective continuation of the life cycle of the parasite were present in this village. CONCLUSION: This study draws attention to a new endemic focus of fasciolopsiasis in Bihar, with a very high prevalence due to poverty, the lack of awareness about the parasite in villagers as well as ignorance among local medical practitioners. There is an urgent need for mass campaign around the region for its effective control.

Rare cause of appendicitis: Mechanical obstruction due to Fasciolopsis buski infestation.

This study aimed to improve the understanding of the clinical characteristics of patients with fasciolopsiasis and thus reduce misdiagnosis and inappropriate treatment. We retrospectively analyzed the clinical data of two patients with fasciolopsiasis which caused appendicitis. Fasciolopsis buski infestation as a cause of appendicitis is very rarely seen in the clinic. The clinical characteristics, clinical manifestations, diagnostic methods and the principles of treatment in these two patients were analyzed.

The role of hepatic myofibroblasts in liver cirrhosis in fallow deer (Dama dama) naturally infected with giant liver fluke (Fascioloides magna).

BACKGROUND: This paper describes liver cirrhosis in 35 fallow deer infected with the giant liver fluke, as well as the distribution, origin, and role of myofibroblasts in its development. RESULTS: In liver of infected deer, stripes of connective tissue are wound around groups of degenerated and regenerated liver lobuli. In the connective tissue, lymphocytes and macrophages which often contain parasite hematin are also present. The walls of the bile ducts are thickened, the epithelium multiplied with mucous metaplasia, and desquamated cells, parasite eggs and brown pigment are present in their lumen.In the livers with cirrhosis, immunopositivity to α-SMA and desmin was observed in cells in portal and septal spaces, at the edge between fibrotic septa and the surrounding parenchyma and in perisinusoidal spaces. These cells vary in size, they are round, oval, spindle-shaped or irregular in shape, similar to vascular smooth muscle cells. The derangement of epithelial-mesenchymal interactions detected in chronic cholangiopathies is most probably the pro-fibrogenic mechanism in liver cirrhosis of fallow deer (Dama dama) infected with the giant liver fluke (Fascioloides magna). CONCLUSION: Myofibroblasts, especially hepatic stellate cells (HSCs), play an important role in the synthesis of extracellular matrix components in the development of parasitic fibrosis and cirrhosis in the liver of fallow deer.

Intestinal infestation with Fasciolopsis buski leading to acute kidney injury.

Fasciolopsis buski is the largest intestinal fluke infecting human beings. This trematode is endemic in certain parts of the country. Migration poses the risk of spread of the worm to other parts of the country. We report fasciolopsis buski in a migrant from Bihar working in Coimbatore, Tamil Nadu. Acute kidney injury following intestinal obstruction occurred in this case which was never described before.

Fasciolopsiasis presenting as intestinal perforation: a case report.

Infestation by the zoonotic trematode Fasciolopsis buski (fasciolopsiasis) is seen in several parts of South-East Asia. Abdominal pain, diarrhoea, mucosal ulceration, intestinal obstruction, anasarca, and even fatality are described following heavy infestation. We present here the case of a 10-year-old boy from the Barabanki district of Uttar Pradesh, India with heavy infestation by Fasciolopsis buski causing intestinal perforation. Fasciolopsiasis is by no means rare but its presentation as a case of intestinal perforation is extraordinary.

Fasciolopsiasis: a first case report from Malaysia.

Fasciolopsiasis is a disease caused by the largest intestinal fluke, Fasciolopsis buski. The disease is endemic in the Far East and Southeast Asia. Human acquires the infection after eating raw freshwater plants contaminated with the infective metacercariae. There has been no report of fasciolopsiasis either in man or in animal in Malaysia. We are reporting the first case of fasciolopsiasis in Malaysia in a 39-year-old female farmer, a native of Sabah (East Malaysia). This patient complained of cough and fever for a duration of two weeks, associated with loss of appetite and loss of weight. She had no history of traveling overseas. Physical examination showed pallor, multiple cervical and inguinal lymph nodes and hepatosplenomegaly. Laboratory investigations showed that she had iron deficiency anemia. There was leukocytosis and a raised ESR. Lymph node biopsy revealed a caseating granuloma. Stool examination was positive for the eggs of Fasciolopsis buski. The eggs measure 140 x 72.5 microm and are operculated. In this case, the patient did not present with symptoms suggestive of any intestinal parasitic infections. Detection of Fasciolopsis buski eggs in the stool was an incidental finding. She was diagnosed as a case of disseminated tuberculosis with fasciolopsiasis and was treated with antituberculosis drugs and praziquantel, respectively.

Case report: unusual presentation of Fasciolopsis buski in a Vietnamese child.

A Vietnamese child presented with a history of abdominal pain. Shortly afterwards, he vomited eight live trematode flukes that were collected and morphologically identified as Fasciolopsis buski. The identification was confirmed by DNA analysis. Adult worms of F. buski from humans are very rarely seen except at autopsy, and this is the first such report from Vietnam.

Liver and intestinal flukes.

A number of trematodes besides schistosomes parasitize humans and domesticated animals. Although they do not have as great a public health impact as schistosomiasis, they are prevalent in Southeast Asia as well as among the greater than 1 million immigrants from this region to North America. The human biliary flukes include C. sinensis, O. viverrini, and O. felineus. These chronic infections are often asymptomatic but over time may cause biliary thickening, cholangitis, and a predisposition to cholangiocarcinoma. Zoonotic trematode infections include the sheep liver fluke F. hepatica and the intestinal flukes Fasciolopsis, Echinostoma, Heterophyes, and Metagonimus.

A western blot and ELISA assay for the diagnosis of Taenia solium infection in pigs.

An enzyme-linked immunoelectrotransfer blot (EITB) was developed using soluble Taenia solium metacestode antigen preparation for immunodiagnosis of porcine cysticercosis and compared with an enzyme-linked immunosorbent assay (ELISA). Sera from 20 pigs with parasitologically confirmed cysticercosis were tested by both EITB and ELISA assays. Specificity of the tests was examined by testing 25 serum samples from the UK, where cysticercosis is not endemic and sera from pigs with Echinococcus granulosus (15), Fasciolopsis buski (six), or Trichinella spiralis (five) infections. All but two of the samples from cases of confirmed cysticercosis were positive by EITB and none of the samples from healthy controls or heterologous infections reacted to any of the diagnostic bands. Thus, the test was 90% sensitive and 100% specific. The sensitivity of the ELISA was 70% with 73% specificity, cross-reactions occurring with sera from E. granulosus infected pigs. Four polypeptides (8, 11, 16 and 23 kDa) were identified by SDS-PAGE and EITB that were specifically recognized by pigs with confirmed cysticercosis.