Fascioliasis (Source : http://www.who.

int/foodborne_trematode_infections/fascioliasis/en/ )
The disease
Fascioliasis is caused by two species of parasitic flatworms or trematodes that mainly affect the
liver. It belongs to the group of foodborne trematode infections and is a zoonosis, meaning an
animal infection that may be transmitted to humans.
The two species of trematodes that cause fascioliasis (Fasciola hepatica and F. gigantica) are
leaf-shaped worms, large enough to be visible to the naked eye (adult F. hepatica measure 2030
mm x 13 mm; adult F. gigantica measure 2575 mm x 12 mm). The disease they both cause is
similar.
Until recently, human cases occurred occasionally but are now increasingly reported from
Europe, the Americas and Oceania (where only F. hepatica is transmitted) and from Africa and
Asia (where the two species overlap). WHO estimates that at least 2.4 million people are infected
in more than 70 countries worldwide, with several million at risk. No continent is free from
fascioliasis, and it is likely that where animal cases are reported, human cases also exist.
Life-cycle
The life-cycle of fascioliasis is complex. It involves a final host (where the adult worm lives), an
intermediate host (where the larval stages of the worm develop) and a carrier (entailing suitable
aquatic plants).
The process starts when infected animals (cattle, sheep, buffaloes, donkeys and pigs but also
horses, goats, dromedaries, camels, llamas and other herbivores) defecate in fresh-water sources.
Since the worm lives in the bile ducts of such animals, its eggs are evacuated in faeces and hatch
into larvae that lodge in a particular type of water snail (the intermediate host).
Once in the snail, the larvae reproduce and eventually release more larvae into the water. These
larvae swim to nearby aquatic or semi-aquatic plants, where they attach to the leaves and stems
and form small cysts (metacercariae). When the plants with the small cysts attached are ingested,
they act as carriers of the infection. Watercress and water-mint are good plants for transmitting
fascioliasis, but encysted larvae may also be found on many other salad vegetables. Ingestion of
free metacercariae floating on water (possibly detached from carrier plants) may also be a
possible mode of transmission.
Symptoms and signs
After the larvae are ingested with contaminated food or water, a symptomless incubation period
starts, lasting for a few days to a few months. This is followed by an acute and a chronic clinical
phase.

Acute phase. The acute phase, lasting 2-4 months, begins when the immature worms
penetrate the intestinal wall and the peritoneum, the protective membrane surrounding the
internal organs . From here, they puncture the liver's surface and eat their way through its
tissues until they reach the bile ducts. This invasion kills the liver's cells and causes
intense internal bleeding. Typical symptoms include fever, nausea, a swollen liver, skin
rashes and extreme abdominal pain.

Chronic phase. The chronic phase begins when the worms reach the bile ducts, where
they mature and start producing eggs. These eggs are released into the bile and reach the
intestine, where they are evacuated in faeces, thereby completing the transmission cycle.
Symptoms include intermittent pain, jaundice and anaemia. Pancreatitis, gallstones and
bacterial super-infections may also occur. Patients with chronic infections experience
hardening of the liver (fibrosis) as a result of the long-term inflammation.

Both animals and humans contract fascioliasis infection in the same way.

Transmission of the infection in the environment is usually perpetuated by animals.

Humans do not typically contribute to the parasite's life-cycle; they are only occasionally
infected after failure to observe basic hygiene measures (consuming larvae-contaminated
uncooked vegetables or drinking larvae-infected water). Moreover, Fasciola worms are
not well adapted to humans and, in some cases, fail to develop into mature adult worms
and produce eggs.

In some areas, transmission to humans is constant and intense, and a geographical

aggregation of cases may be observed. This pattern is possibly explained by a human-tosnail-to-plant-to-human transmission cycle, without the involvement of any animal.
Indigenous communities in the South American highlands represent well known "hot
spots" for fascioliasis: here, highly prevalent infection has been reported and may be
explained by such transmission pathway.

Where it occurs sporadically, fascioliasis affects people from all age-groups, and there is
no specific risk group. Where the infection is highly endemic, the prevalence and
intensity of infection tend to peak in school-age children. People living in rural areas are
typically more likely to become infected; however, cases may occur anywhere and can
follow the trade routes of the carrier plants, which are part of the usual diet in many
countries.

Fascioliasis is a global disease, and human cases have been reported from more than 75
countries worldwide. Recognized areas of high transmission are the highlands of south
America, the Nile valley, the Caspian sea basin, as well as east Asia and south-east Asia.
No countries can be considered free from the risk of fascioliasis.

The epidemiological pattern of fascioliasis is quite varied: the infection usually has a
hypo-endemic pattern, with low and stable levels of prevalence among a defined
population. Sporadic outbreaks may occur among such populations: these are usually
related to sudden changes in climatic conditions that boost the life-cycle of either the
parasite or the snail, or both. Scientists have also found that the epidemiology of
fascioliasis is strictly linked to the geographical and environmental characteristics of the
area where transmission occurs, and different patterns can be distinguished: this suggests
that fascioliasis may adapt to different ecological niches.

In Africa and Asia, where both F. hepatica and F. gigantica are present, mixed infections
are possible. In Asia, hybridization among the two species occurring in co-infected
humans or animals has been described. The offspring resulting from such hybridization is
characterized by intermediate morphological characteristics between the two species as
well as by different ploidies (diploid, triploid, and mixoploid); such worms are frequently
non-fertile.