Original Article

Clinical Features, Diagnosis and Management of Patients with Suspicion of Fascioliasis in Kohgiluyeh and Boyer-Ahmad Province, Southwestern Iran

Abstract

Background: In the current study, we described the epidemiological features, clinical presentation, diagnosis and management of patients with suspicion of fascioliasis in Kohgiluyeh and Boyer-Ahmad Province in southwest of Iran.   
Methods: Overall, 56 patients with suspicion of fascioliasis, based on their clinical signs and symptoms that referred to Clinic of Internal Medicine in Yasuj city, from 2014 to 2016 were enrolled. Demographic data, history of eating aquatic local plants, the chief complains, and laboratory findings were recorded for each patient. Stool samples were obtained from each case for detection of Fasciola eggs. Moreover, blood samples were taken from each patient and evaluated for detection of anti-Fasciola antibodies by an indirect ELISA. Patients who defined as having fascioliasis were treated with triclabendazole and were followed for at least three months for clinical improvement.
Results: Serological test was positive in 5 patients. Of these 5 cases, three cases had a history of ingesting raw aquatic vegetables. The main clinical signs and symptoms in positive cases were; abdominal pain (60%), epigastric pain (40%), anemia (60%), and dermal pruritus (20%). Hypereosinophilia was seen in all of 5 positive cases. No Fasciola egg was found in stool specimens of any of the patients. The fascioliasis cases were treated by triclabendazole and clinical symptoms disappeared in all of 5 cases.
Conclusion: Our observation further confirmed Yasuj district as a human endemic area for fascioliasis in Iran. The study also highlighted the importance of clinical features together with eosinophilia, as key parameters, in the diagnosis of human fascioliasis. Clinicians need to be aware of this disease and should keep in mind fascioliasis when hypereosinophilia present in patients in such endemic areas.

1. Mas-Coma S, Valero MA, Bargues MD. Chapter 2. Fasciola, lymnaeids and human fascioliasis, with a global overview on disease transmission, epidemiology, evolutionary genetics, molecular epidemiology and control. Adv Parasitol. 2009; 69:41-146.
2. Ashrafi K, Bargues MD, O'Neill S, Mas-Coma S. Fascioliasis: a worldwide parasitic disease of importance in travel medicine. Travel Med Infect Dis. 2014; 12:636-649.
3. Ashrafi K, Saadat F, O'Neill S et al. The endemicity of human fascioliasis in Guilan Province, Northern Iran: the baseline for implementation of control strategies. Iran J Public Health. 2015; 44:501-511.
4. Hosseini G, Sarkari B, Moshfe A et al. Epidemiology of human fascioliasis and intestinal helminthes in rural areas of Boyer-Ahmad Township, Southwest Iran; A population based study. Iran J Public Health. 2015; 44:1520-1525.
5. Sarkari B, Ghobakhloo N, Moshfea A, Eilami O. Seroprevalence of human fasciolosis in a new-emerging focus of fasciolosis in Yasuj district, southwest of Iran. Iran J Parasitol. 2012; 7:15-20.
6. Haseeb AN, El-Shazly AM, Arafa MA, Morsy AT. Clinical, laboratory and ultrasonography features of proven human fascioliasis. J Egypt Soc Parasitol. 2003; 33:397-412.
7. Karadag-Oncel E, Ozsurekci Y, Ozkaya-Parlakay A et al. Fasciola hepatica infection: clinical and radiological findings in pediatric patients. Turk J Pediatr. 2012; 54:362-367.
8. Shafiei R, Sarkari B, Sadjjadi SM. Performance of a 27 kDa Fasciola hepatica antigen in the diagnosis of human fascioliasis. J Lab Physicians. 2015; 7:17-20.
9. Lukambagire AH, McHaile DN, Nyindo M. Diagnosis of human fascioliasis in Arusha region, northern Tanzania by microscopy and clinical manifestations in patients. BMC Infect Dis. 2015; 15:578.
10. Mas-Coma S, Bargues MD, Valero MA. Diagnosis of human fascioliasis by stool and blood techniques: update for the present global scenario. Parasitology. 2014; 141:1918-1946.
11. Abdolahi Khabisi S, Sarkari B, Moshfe A, Jalali S. Production of monoclonal antibody against excretory-secretory antigen of Fasciola hepatica and evaluation of its efficacy in the diagnosis of fascioliasis. Monoclon Antib Immunodiagn Immunother. 2017; 36:8-14.
12. Sarkari B, Khabisi SA. Immunodiagnosis of human fascioliasis: an update of concepts and performances of the serological assays. J Clin Diagn Res. 2017; 11:Oe05-oe10.
13. Sarkari B, Parhoode M, Abdolahi Khabisi S et al. Genetic diversity of Fasciola spp. isolates from northern part of Iran: comparison with southwestern isolates. J Parasit Dis. 2017; 41:768-772.
14. Shafiei R, Sarkari B, Sadjjadi SM et al. Molecular and morphological characterization of Fasciola spp. isolated from different host species in a newly emerging focus of human fascioliasis in Iran. Vet Med Int. 2014; 2014:405740.
15. Shafiei R, Sarkari B, Moshfe A. A Consistent PCR-RFLP assay based on ITS-2 ribosomal DNA for differentiation of Fasciola species. Iran J Basic Med Sci. 2013; 16:1266-1269.
16. Oner Vatan A, Mete B, Yemisen M et al. A case of Fasciola hepatica mimicking sepsis without eosinophilia. Turkiye Parazitol Derg. 2014; 38:131-134.
17. Abdolahi Khabisi S, Sarkari B. Detection of Fasciola hepatica and Fasciola gigantica common and uncommon antigens, using rabbit hyper immune serum raised against their excretory-secretory and somatic antigens. J Parasit Dis. 2016; 40:1552-1557.
18. Sarkari B, Hosseini G, Motazedian MH et al. Prevalence and risk factors of intestinal protozoan infections: a population-based study in rural areas of Boyer-Ahmad district, Southwestern Iran. BMC Infect Dis. 2016; 16:703.
19. Sarkari B, Pedram N, Mohebali M et al. Seroepidemiological study of visceral leishmaniasis in Booyerahmad district, south-west Islamic Republic of Iran. East Mediterr Health J. 2010; 16:1133-1136.
20. Sarkari B, Sadjjadi SM, Beheshtian MM, et al. Human cystic echinococcosis in Yasuj District in Southwest of Iran: an epidemiological study of seroprevalence and surgical cases over a ten-year period. Zoonoses Public Health. 2010; 57:146-150.
21. Abdolali M, Rezaei Nasrabad SA, Cheraghzadeh SR, et al. Study on prevalence of fascioliasis in ruminants in Dasht Room County in spring and summer of 2013. Animal Vet Sci. 2016; 4:15-18.
22. Karahocagil MK, Akdeniz H, Sunnetcioglu M et al. A familial outbreak of fascioliasis in Eastern Anatolia: a report with review of literature. Acta Trop. 2011; 118:177-183.
23. Hatami H, Asmar M, Masoud J et al. The first epidemic and new-emerging human fascioliasis in Kermanshah (western Iran) and a ten-year follow up, 1998-2008. Int J Prev Med. 2012; 3:266–272.
24. Figtree M, Beaman MH, Lee R et al. Fascioliasis in Australian travellers to Bali. Med J Aust. 2015; 203:186-188.
25. Rondelaud D, Dreyfuss G, Vignoles P. Clinical and biological abnormalities in patients after fasciolosis treatment. Med Mal Infect. 2006; 36:466-468.
26. Mekky MA, Tolba M, Abdel-Malek MO, Abbas WA, Zidan M. Human fascioliasis: a re-emerging disease in upper Egypt. Am J Trop Med Hyg. 2015; 93:76-79.
27. Ashrafi K, Tahbaz A, Sharifdini M, Mas-Coma S. Familial Trichostrongylus infection misdiagnosed as acute fascioliasis. Emerg Infect Dis. 2015; 21(10):1869-70.
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IssueVol 15 No 1 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijpa.v15i1.2530
Keywords
Clinical features Diagnosis Treatment Fasciolosis Iran
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How to Cite
1.
MOSHFE A, ARIA A, ERFANI N, JAMSHIDI A, SARKARI B, ABDOLAHI KHABISI S, AREFKHAH N. Clinical Features, Diagnosis and Management of Patients with Suspicion of Fascioliasis in Kohgiluyeh and Boyer-Ahmad Province, Southwestern Iran. Iran J Parasitol. 2020;15(1):84-90.