Chad Clark Kelli Rogers

Introduction Phylum: Platyhelminthes Class : Trematoda Flat Worm Infection results in a Liver Fluke Has important economic impacts around the world Rarely infects humans Causes the disease fascioliasis Hepatic means “Having to do with the liver” and is derived from the Greek word hepar meaning The Liver

Region and host Definitive host: - Sheep or cattle Intermediate host: - Fresh Water Snail (the type of snail will vary depending on region of world you are in) Accidental host: - Humans Geographical region: - Anywhere sheep and cattle are raised where fresh water snails are abundant.

Miracidia Metacercariae Cercariae Egg

Adult Fluke Will set up camp in the liver Has been described as having a “leaf shape” body - Picture below is a cross section of the adult fluke resembling a “blue pac-man” Size: - On average they are 30 mm long and 13 mm wide

Clinical Signs Abdominal Pain (Chronic) Anemia (Acute) Biliary Chollic (Chronic) Hepatic Tenderness (Acute) Hepatomegaly due to Edema (Acute) Fever (Can be moderate to severe)(Acute and Chronic) Fibrosis (Chronic) Hives (Acute) Jaundice (Chronic) Vomiting (Acute)

Pathogenesis Acute - F. hepatica larvae migrate throughout liver parenchyma - Will penetrate liver capsules and produce acute symptoms for 6-8 weeks until larvae mature and settle in the bile ducts. Chronic - Metabolic waste of adult flukes causes inflammation of bile ducts eventually leading to fibrosis - Can result in portal cirrohsis or even death Halzoun - Obtained when an individual eats raw liver - Will settle in the Pharynx causing symptoms for 10 years

Diagnosis Specific diagnosis depends on finding eggs in the stool can do a fecal egg count (directly observed) using a duodenal aspirate or a biliary aspirate An enzyme linked immunosorbent assay (ELISA) test is can also be used to determine whether F. hepatica eggs are present can detect up to five weeks earlier then the fecal egg count Can also use an ultrasound to visualize adult flukes in bile duct Can use excretory/secretory (E/S) antigens that are specific to F. hepatica

Treatment Rafoxanide - Acts by uncoupling oxidative phosphorylation in the adult fluke Triclabendazole - Most effective treatment - Take 1-2 oral doses in a 24 hour period - Many countries have yet to approve of its use (2002) In severe cases may need to undergo surgery Overall success rate for treatment of fascioliasis is %

Control Methods EDUCATE! - Wash veggies with 6% vinegar or potassium for 5 to 10 minutes to destroy the encysted metacercariae - Physicians and health workers rarely consider possibility of F. hepatica infection when treating patients, giving them an awareness of it would help greatly and reduce future infections. Keep sheep herds and cattle herds away from areas of water, if area of water present is their drinking grounds then make sure it is free of snails Molluscicides

Sources A-F/Fascioliasis/body_Fascioliasis_il5.htm A-F/Fascioliasis/body_Fascioliasis_il5.htm 001/fascioliasis/Fasciola.htm 001/fascioliasis/Fasciola.htm Foundations of Parasitology Eighth Edition Gerald D. Schmidt & Larry S. Roberts & John Janovy, Jr