Emerging Cases of Fascioliasis in Lorestan Province, Western Iran: Case Series Report
Fascioliasis is a zoonotic disease caused by Fasciola spp. We report five serologically and molecularly confirmed cases in an emerging region in Iran. A retrospective, case series study, performed in Lorestan Province, west of Iran between January 2015 and June 2016. From 1256 patients examined, 16 patients had positive serum ELISA. Five cases were approved as infected with fasciolosis using stool exam and PCR. Age ranged from 24 to 80 yr with mean age of 45 years. All of patients were adults and four of them had abdominal and back pain. Other symptoms included fever and chills, coughing and sore throat, weight loss, cutaneous manifestations. All patients lived in the rural environment, and four reported the ingestion of raw aquatic plants such as watercress. In fecal examination for fluke eggs, four samples were positive for F. hepatica eggs. Conventional PCR analysis showed that five human stools were positive for F. hepatica. All of 5 patients were treated with the usual dose of triclabendazole. A history of recent consumption of raw aquatic plants (in 4 out of 5 patients) is an important finding, but in one patient the source of infection remained unclear. Lorestan should be considered as an emerging region for this disease and further research in this province should be carried out.
2. Cotruvo JA, Dufour A, Rees G, et al (2004). Waterborne zoonoses. ed. Iwa Publishing.
3. Kaya M, Beştaş R, Çetin S (2011). Clinical presentation and management of Fasciola hepatica infection: single-center experience. World J Gastroenterol, 17(44):4899-904.
4. Mas-Coma S (2004). Human fascioliasis: epidemiological patterns in human endemic areas of South America, Africa and Asia. Southeast Asian J Trop Med Public Health, 35:1-11.
5. Mowlavi Gh, Mamishi S, Rokni MB, Mobedi I, Gharaguzlo M, Ashrafi K, Mas-Coma S (2010). Neglected human fascioliasis case in a visceral leishmaniasis endemic area, north-Western Iran. Iran J Public Health, 39(3):129-131.
6. Kheirandish F, Kayedi MH, Ezatpour B, Anbari K, Rouzbahani HRK, Sharafi AC, Zendehdel A, Bizhani N, Rokni MB (2016). Seroprevalence of Human Fasciolosis in Pirabad, Lorestan Province, Western Iran. Iran J Parasitol, 11 (1): 24-29.
7. Asadian S, Mohebali M, Moudi M, Kia E, Heidari Z, Asgari M, Aryaeipour M, Radi S, Rokni MB (2013). Seroprevalence of human fascioliasis in Meshkin-Shahr district, Ardabil Province, northwestern Iran in 2012. Iran J Parasitol, 8 (4): 516-521.
8. Moghaddam AS, Massoud J, Mahmoodi M, Mahvi A, Periago M, Artigas P, Fuentes M, Bargues M, Mas-Coma S (2004). Human and animal fascioliasis in Mazandaran province, northern Iran. Parasitol Res, 94(1):61-69.
9. Orlandi PA, Chu D-MT, Bier JW, Jackson GJ (2002). Parasites and the food supply. Food Technology-Champaign Then Chicago-, 56:72-79.
10. Mas-Coma S, Bargues MD, Valero M (2005). Fascioliasis and other plant-borne trematode zoonoses. Int J Parasitol, 35(11-12):1255-1278.
11. Ashrafi K (2015). The status of human and animal Fascioliasis in Iran: A narrative review article. Iran J Parasitol, 10 (3): 306-328.
12. Heydarian P, Ashrafi K, Mohebali M, Kia EB, Aryaeipour M, SHARAFI AC, Mokhayeri H, Bozorgomid A, Rokni MB (2017). Seroprevalence of human fasciolosis in Lorestan Province, western Iran, in 2015–16. Iran J Parasitol, 12 (3): 389-397.
13. Gaucher P, Thelu J, Bigard M, Champigneulle B, Brucker P (1981). Hématome sous-capsulaire du foie et distomatose hépatique. Nouv Presse Med.
14. Ashrafi K, Valero M, Forghan-Parast K, Rezaeian M, Shahtaheri S, Hadiani M, Bargues M, Mas-Coma S (2006). Potential transmission of human fascioliasis through traditional local foods, in northern Iran. Iran J Public Health, 35:49-56.
15. Ashrafi K, Valero MA, Massoud J, Sobhani A, Solaymani-Mohammadi S, Conde P, Khoubbane M, Bargues MD, Mas-Coma S (2006). Plant-borne human contamination by fascioliasis. Am J Trop Med Hyg, 75(2):295-302.
16. Salahimogadam A. Epidemiologic survey of human and animal fascioliasis and relation between parasite and lymnaeid snails in Mazandaran province, northern Iran [PhD thesis]. Medical parasitology, Health Faculty of Tehran Medical Sciences University, Iran;2004.
17. Sarkari B, Ghobakhloo N, Moshfea A, Eilami O (2012). Seroprevalence of human fasciolosis in a new-emerging focus of fasciolosis in Yasuj district, southwest of Iran. Iran J Parasitol, 7(2):15-20.
18. SALAHI MA (2009). Epidemiology of human fascioliasis in Iran. J Arch Military Med, 1(1): 6–12.
19. Happich FA, Boray JC (1969). Quantitative Diagnosis of Chronic Fasciolosis: 1. Comparative Studies on Quantitative Faecal Examinations for Chronic Fasciola hepatica Infection in Sheep. Aust Vet J, 45(7):326-328.
20. Mas-Coma S, Bargues M (1997). Human liver flukes: a review. Res Rev Parasitol, 57:145-218.
21. Rokni M, Aminian B (2006). Evaluation of the enzyme-linked immuno-Electro Transfer Blot (EITB) technique using hydatid cyst antigens B/5 and total lgG antibodies in lab. diagnosis of human hydatidosis. Pak J Med Sci, 22:127-131.
22. López-Vélez R, Domínguez-Castellano A, Garron C (1999). Successful treatment of human fascioliasis with triclabendazole. Eur J Clin Microbiol Infect Dis, 18(17):525-526.
23. Marcos LA, Tagle M, Terashima A, et al (2008). Natural history, clinicoradiologic correlates, and response to triclabendazole in acute massive fascioliasis. Am J Trop Med Hyg, 78(2):222-227.
24. Stitt AW, Fairweather I (1994). The effect of the sulphoxide metabolite of triclabendazole (‘Fasinex’) on the tegument of mature and immature stages of the liver fluke, Fasciola hepatica. Parasitology, 108 (Pt 5):555-567.
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