Summary about Disease
Fasciolopsiasis is an intestinal parasitic infection caused by the trematode Fasciolopsis buski, commonly known as the giant intestinal fluke. It primarily affects humans and pigs in Southeast Asia and the Indian subcontinent. Infection occurs through ingestion of metacercariae (the infective larval stage) encysted on aquatic plants, particularly water chestnuts, water caltrop, and water bamboo. The flukes mature in the small intestine, where they attach to the intestinal wall and can cause inflammation, ulceration, and malabsorption. Heavy infections can lead to significant morbidity.
Symptoms
Symptoms can vary depending on the worm burden. Light infections may be asymptomatic. As the worm burden increases, symptoms can include:
Abdominal pain
Diarrhea (sometimes with mucus)
Anorexia (loss of appetite)
Nausea
Vomiting
Edema (swelling), particularly of the face and abdomen, due to protein loss
Ascites (fluid accumulation in the abdominal cavity)
Intestinal obstruction (in severe cases)
Eosinophilia (elevated eosinophil count in the blood)
Causes
Fasciolopsiasis is caused by ingesting metacercariae of Fasciolopsis buski that are attached to aquatic plants. The life cycle involves: 1. Adult flukes reside in the small intestine of humans and pigs. 2. Eggs are passed in feces. 3. In water, eggs hatch and release miracidia (free-swimming larvae). 4. Miracidia infect snails (the first intermediate host). 5. Inside the snail, miracidia develop into cercariae (another larval stage). 6. Cercariae are released from the snail and encyst as metacercariae on aquatic plants. 7. Humans or pigs become infected by eating raw or undercooked aquatic plants containing metacercariae. 8. The metacercariae excyst in the duodenum and mature into adult flukes in the small intestine.
Medicine Used
4. Medicine used The primary medication used to treat fasciolopsiasis is:
Praziquantel: This is the drug of choice and is highly effective. A single dose or a short course of treatment is typically sufficient. Dosage depends on the weight of the individual.
Is Communicable
Fasciolopsiasis is not directly communicable from person to person. The infection is acquired through the ingestion of metacercariae on aquatic plants that have been contaminated in the life cycle of the parasite. The eggs must go through a snail host and contaminate vegetation to be infectious.
Precautions
Preventive measures include:
Thoroughly wash and cook aquatic plants before consumption.
Avoid eating raw or undercooked aquatic plants, especially in endemic areas.
Improve sanitation to prevent fecal contamination of water sources.
Control snail populations in areas where aquatic plants are grown.
Treat infected individuals and animals to reduce the number of eggs released into the environment.
Education of communities about the life cycle of the parasite and preventive measures.
How long does an outbreak last?
The duration of an outbreak depends on factors such as the extent of contamination of aquatic plants, the implementation of control measures, and the behavior of the affected population. Outbreaks can last for weeks or months if the source of contamination is not identified and controlled. Effective control measures (e.g., plant washing, sanitation improvements, treatment of infected individuals) can shorten the duration.
How is it diagnosed?
Diagnosis typically involves:
Stool examination: Microscopic identification of Fasciolopsis buski eggs in stool samples. Multiple stool samples may be needed to increase the likelihood of detection.
Duodenal aspiration: In some cases, eggs can be found in aspirates of the duodenal contents.
Serological tests: Antibody detection tests may be available in some research settings, but they are not widely used for routine diagnosis.
Clinical presentation: Symptoms suggestive of fasciolopsiasis can raise suspicion, especially in individuals from endemic areas.
Timeline of Symptoms
9. Timeline of symptoms
Incubation period: After ingestion of metacercariae, the incubation period (time until symptoms appear) can range from a few weeks to several months.
Early symptoms: Initial symptoms may be mild and nonspecific, such as abdominal discomfort or diarrhea.
Progressive symptoms: As the worm burden increases, symptoms become more pronounced, including more severe abdominal pain, diarrhea, edema, and other complications.
Chronic infection: Untreated infections can persist for years, leading to chronic malnutrition and other health problems.
Important Considerations
Endemic areas: Fasciolopsiasis is primarily a problem in Southeast Asia and the Indian subcontinent. Travelers to these regions should be aware of the risk and take preventive measures.
Misdiagnosis: The symptoms of fasciolopsiasis can overlap with other intestinal parasitic infections or gastrointestinal disorders, leading to misdiagnosis. Proper laboratory testing is essential.
Co-infections: Individuals with fasciolopsiasis may also be infected with other parasites or pathogens. Screening for other infections may be warranted.
Public health importance: Fasciolopsiasis is considered a neglected tropical disease (NTD). Control efforts focus on improving sanitation, promoting safe food handling practices, and providing access to treatment.