Fasciola hepatica hijacks host macrophage miRNA machinery to modulate early innate immune responses.

Fasciola hepatica, a global worm parasite of humans and their livestock, regulates host innate immune responses within hours of infection. Host macrophages, essential to the first-line defence mechanisms, are quickly restricted in their ability to initiate a classic protective pro-inflammatory immune response. We found that macrophages from infected animals are enriched with parasite-derived micro(mi)RNAs. The most abundant of these miRNAs, fhe-miR-125b, is released by the parasite via exosomes and is homologous to a mammalian miRNA, hsa-miR-125b, that is known to regulate the activation of pro-inflammatory M1 macrophages. We show that the parasite fhe-miR-125b loads onto the mammalian Argonaut protein (Ago-2) within macrophages during infection and, therefore, propose that it mimics host miR-125b to negatively regulate the production of inflammatory cytokines. The hijacking of the miRNA machinery controlling innate cell function could be a fundamental mechanism by which worm parasites disarm the early immune responses of their host to ensure successful infection.

Autochthonous Human Fascioliasis, Belgium.

We report 2 cases of human fascioliasis (HF) in Belgium, likely caused by consumption of vegetables from a garden that was flooded by pasture runoff. Because autochthonous HF is rare and the route of transmission was unusual, HF was not diagnosed until 6 months after symptom onset in both cases.

[Fasciola hepatica infection acquired in Denmark].

In this case report, a 64-year-old woman with symptoms of lethargy, nausea, fluctuating temperature, and weight loss was suspected of a disease of cardiological or haematological aetiology. She was diagnosed with liver fluke infection based on serological evidence, eosinophilia, relevant exposure, and clinical presentation. High-dose triclabendazole led to symptom resolution. On several occasions, she had been eating watercress from a meadow with grazing sheep. The tendency of eating raw watercress and other green plants collected in nature confers an increased risk of developing liver fluke infections.

Risk factors for human fascioliasis in schoolchildren in Baños del Inca, Cajamarca, Peru.

Background: The aim of the investigation was to determine the risk factors for human fascioliasis in schoolchildren in five localities of the Baños del Inca district in Cajamarca, Peru. Secondarily, the prevalence of infection among this population was also studied. Methods: A questionnaire was applied to 270 schoolchildren from 6-12 years of age and to their parents with the aim of collecting information related to risk factors predisposing the children to Fasciola hepatica infection. Faecal samples from all the children were tested for F. hepatica using the modified rapid sedimentation method of Lumbreras and the technique of Kato-Katz for egg counts. Results: Risk factors were identified as follows-raising cattle, consumption of radishes and chewing grass. The prevalence of F. hepatica in Baños del Inca was 6.30%; there was no significant difference by sex or age. Conclusion: Risk factors associated with this parasitosis in children in this area of Cajamarca were the raising of cattle, the consumption of radish and the habit of chewing grass. The prevalence results in this district suggest a mesoendemic level of infection, with local variations between meso- and hyper-endemic levels.

The Battle of Worldviews: A Case Study of Liver Fluke Infection in Khon Kaen, Thailand.

Control efforts to reduce infection from the parasitic flatworm Opisthorchis viverrini have progressed through understanding the epidemiology of Opisthorchis viverrini, antiparasitic drug developments, technological innovations, health education promoting cooking of fish, and improved hygienic defecation. Yet the problem persists. The case study method was used to examine the fundamental cause of the liver fluke infection problem. Evidence shows that the liver fluke-infected population does not care about living a long life. For them, suffering and death are simply a part of life, and expected. Thus, the cause(s) leading to death is not important. They believe morally bad actions, and predetermined fate associated with kamma in Buddhism, play a big role whether or not one is infected with the liver fluke. Health interventions may be made more effective if they take into account the liver fluke-infected population's worldviews about ethics, morality, life, and death. We researchers should not feel concerned only about medically determined causes of death.

[Epidemiological investigation on fascioliasis and its risk factors in population of Binchuan County, Yunnan Province].

OBJECTIVE: To understand the infection status of Fasciola and related risk factors in population of Binchuan County, Yunnan Province. METHODS: In February and March, 2014, 6 natural villages from 2 administrative villages in Zhoucheng Town were selected as investigated sites, and the permanent residents aged ≥ 5 years were examined by ELISA for the serum antibody detection, and then the positive ones were examined by Kato-Katz technique and the hatching method for Fasciola egg detection. Meanwhile, the fascioliasis cases that checked out by the above methods were further surveyed, and the residents who with the same gender, similar age and negative results in the blood examination were selected as the controls, then the risk factors were explored through a case control study. RESULTS: Totally 1 207 people were included in the blood examination, and 36 positives were found with a positive rate of 2.98%. Though the differences between the positive rates of the serum antibody in people with different genders and age were not statistically significant (χ2 = 1.686, 7.106, both P > 0.05) , those between the rates of people in different administrative villages and natural villages were statistically significant (χ2 = 4.103, 13.181, both P < 0.05). Two cases were determined as positives in fecal examinations with a positive rate of 6.45% (2/31), among which, 1 case was newly discovered. The case control study showed that OR values of eating out- purchased cold dish (4.30), raw mint (1.22) , raw leek (4.30) and drinking unboiled-water (3.75) were relatively higher, but all of them were not statistically significant (χ2 = 0.524, 0.046, 0.524, 1.571, all P > 0.05). CONCLUSIONS: There is still sporadic Fasciola infection in Binchuan County. Eating raw vegetables and drinking unboiled water which are contaminated by Fasciola metacercariae may be the infection routes of local people, and to find out the exact entrance way is the key points for the infection control.

Impact of climate change and man-made irrigation systems on the transmission risk, long-term trend and seasonality of human and animal fascioliasis in Pakistan.

Large areas of the province of Punjab, Pakistan are endemic for fascioliasis, resulting in high economic losses due to livestock infection but also affecting humans directly. The prevalence in livestock varies pronouncedly in space and time (1-70%). Climatic factors influencing fascioliasis presence and potential spread were analysed based on data from five meteorological stations during 1990-2010. Variables such as wet days (Mt), water-budget-based system (Wb-bs) indices and the normalized difference vegetation index (NDVI), were obtained and correlated with geographical distribution, seasonality patterns and the two-decade evolution of fascioliasis in livestock throughout the province. The combined approach by these three indices proved to furnish a useful tool to analyse the complex epidemiology that includes (i) sheep-goats and cattlebuffaloes presenting different immunological responses to fasciolids; (ii) overlap of Fasciola hepatica and F. gigantica; (iii) co-existence of highlands and lowlands in the area studied; and (iv) disease transmission following bi-seasonality with one peak related to natural rainfall and another peak related to man-made irrigation. Results suggest a human infection situation of concern and illustrate how climate and anthropogenic environment modifications influence both geographical distribution and seasonality of fascioliasis risks. Increased fascioliasis risk throughout the Punjab plain and its decrease in the northern highlands of the province became evident during the study period. The high risk in the lowlands is worrying given that Punjab province largely consists of low-altitude, highly irrigated plains. The importance of livestock in this province makes it essential to prioritise adequate control measures. An annual treatment scheme to control the disease is recommended to be applied throughout the whole province.

Pesticides, fresh water fish, liver flukes and nitrosamines: A story of cholangiocarcinoma development in Thailand.

Cholangiocarcinoma is a common hepatobiliary carcinoma in Thailand. It is believed that both chronic exposure to liver fluke infestation and nitrosamine exposure are the two main underlying factors leading to the carcinogenesis. Here, the author further extrapolates and proposes a new hypothesis based on the environmental ecological data that the stimulation of fresh water fish by contaminated pesticide in water reservoirs might be a possible background of the high prevalence of cholangiocarcinoma in Thailand.

Epidemiological review of human and animal fascioliasis in Egypt.

One of the neglected food-borne-diseases in the international public health arena is fascioliasis. It is a serious infectious parasitic disease infecting humans and animals worldwide and tops all the zoonotic helminthes. Human cases are being increasingly reported from Europe, the Americas, Oceania, Africa and Asia. Hence, human fascioliasis is considered now as a zoonosis of major global and regional importance. In Egypt, animal and human fascioliasis is an endemic clinical and epidemiological health problem. Doubtless, understanding the epidemiology of the parasitic diseases and factors affecting their incidence provides the foundation upon which effective prevention and control programs should be established. This article reviews the history, life cycles, transmission, incidence, geographical distribution, and environmental and human determinants that contribute to the epidemiological picture of fascioliasis with special reference to Egypt.

Multiple brain hemorrhages and hematomas associated with ectopic fascioliasis in brain and eye.

BACKGROUND: Fascioliasis is a parasitic infection caused by Fasciola hepatica. Human beings can be infected accidentally by an ingestion of the metacercariae; and the parasite exists almost persistently in the bile ducts, but rarely in other organs. We report an interesting case of ectopic fascioliasis in both the brain and the right eye of a school-aged boy, which was associated with 2 unruptured intracranial aneurysms. To our knowledge, no case report such as this has been found in the medical literature. CASE DESCRIPTION: After an ingestion of Potamon denticulata (a fresh crab) for 4 months, a 10-year-old boy presented with neurologic manifestations caused by 5 episodes of intracranial hemorrhages and hematomas. The boy simultaneously suffered repeated affliction in the right eye accompanied by headache, vomiting, ophthalmalgia, exophthalmos, and abducens nerve palsy. Digital subtraction angiography revealed 2 unruptured intracranial aneurysms. The definitive diagnosis of this case had been confirmed by an observation of the parasite moving out of the patient's swelling conjunctiva and by the results of the laboratory tests. The patient was treated with praziquantel and completely recovered. The 2 aneurysms were not surgically treated but underwent a long-term follow-up. The follow-up DSA revealed that one aneurysm disappeared but the other remained unchanged. CONCLUSIONS: Multiple brain hemorrhages and hematomas can be associated with ectopic fascioliasis in brain and eyes. An intracranial infection occasionally caused by F hepatica or other parasites can be indicated by a fever of unknown origin, eosinophilia, and iterative intracranial hemorrhages. Ingestion of P denticulata may be an uncommon transmission route of fascioliasis. Fascioliasis can be successfully treated.

Hepatic fascioliasis due to Fasciola hepatica: a two-case report.

Two cases of hepatic fascioliasis due to Fasciola hepatica were retrieved from our surgical-pathology file since the hospital's foundation in 1969 up to 2005. The diagnosis of hepatic fascioliasis was based on detection of one live fluke in a large cystic lesion in the lobectomized liver specimen in one case and of deposited eggs in the large liver specimen obtained from open biopsy in the other Hepatic fascioliasis is rather rare and almost worldwide in distribution including Thailand. The diagnosis should be considered in the patient from endemic areas consisting of the northern, northeastern and upper-central regions of the country, with a history of ingesting fresh water plants or drinking untreated water and having fever right-upper-quadrant pain or intrahepatic cystic lesion(s) together with absolute peripheral blood eosinophilia.

[A focus study from a case of human fascioliasis in Neuquén]. / Estudio del foco en un caso de fasciolosis humana en Neuquén.

An epidemiological focal study was performed in Loncopué, Neuquén, Argentina, in November 2002 to detect the origin of the infection in a human case of fascioliasis confirmed by an indirect-ELISA test, six months before the study. Thirty five individual fecal samples were taken from domestic livestock, and watercress plants and snails were collected from the irrigation ditches connected to a main canal in the surroundings of the patient's house. A new blood sample was taken from the already recovered patient. The patient was still seropositive to Fasciola hepatica antigens. No metacercariae were found in the 222 watercress leaves checked. All the snails collected (n=130) were identified as Lymnaea viatrix and two out of 101 (2%) were infected with F. hepatica larvae. Coprological analysis showed F. hepatica eggs in 100% of goats (10/10), 82% of sheep (9/11) and 86% of bovines (6/7). The number of eggs per gram shed by positive goats (median=20.7, Q1=6.2, Q3=34.5) and sheep (4, 1.8, 13) was significantly higher than in cows (0.3, 0.3, 1.7) (p < 0.01). Local veterinary control programs were apparently not effective in this case. Anthelmintics used and treatment schedule should be revised and small herds raised at households should also be included and treated.

Chronic liver fluke disease with dyspepsia: a case report.

BACKGROUND: Chronic liver fluke disease with dyspepsia is rarely seen clinically. In this study, we assessed the etiological factors, symptoms, physical signs and diadynamic methods in a case of chronic liver fluke disease with dyspepsia. METHODS: Physical examination, laboratory studies, ultrasonography and CT scan were performed before pathogen examination. The eggs of fluke found with the inverted sedimentation method were also observed under a microscopy. They were diagnosed as the eggs of Clonorchis sinensis. RESULTS: The patient was diagnosed as having chronic liver fluke disease, and his appetite recovered after three courses of treatment with praziquantel. CONCLUSION: Eating fresh fish and shrimp might cause liver fluke disease. The symptoms of this disease with dyspepsia can be anorexia, abdominal distention, bellyache, and loose stools.

Fasciolasis hepatica: reporte de un caso y revisión de la literatura / Hepatic fasciolasis: report of a case and review of the literature

La fasciolasis humana es una zoonosis causada por la Fasciola hepática, trematodo que en su vida adulta afecta principalmente el ganado ovino y bovino, siendo el hombre huésped accidental. La dificultad en el diagnóstico clínico, dada su variada sintomatología, muchas veces requerirá del apoyo imagenológico, por lo que el radiólogo debe estar preparado y conocer la epidemiología de este patógeno, especialmente en aquellas zonas endémicas (Latinoamérica, zonas de Asia y el Norte de Africa). Es importante considerarla dentro del diagnóstico diferencial de lesiones focales hepáticas, especialmente en el contexto clínico de eosinofilia.