Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, 41996-13769 Rasht, Guilan Province, Iran; Research Centre for Fascioliasis and Parasitic Diseases, Guilan University of Medical Sciences, Rasht, Guilan Province, Iran.
Departamento de Parasitologia, WHO Collaborating Centre on Fascioliasis and Its Snail Vectors, FAO Reference Centre for Parasitology, Facultad de Farmacia, Universidad de Valencia, Av. Vicent Andres Estelles s/n, 46100 Burjassot, Valencia, Spain.
Travel Med Infect Dis. 2014 Nov-Dec;12(6 Pt A):636-49. doi: 10.1016/j.tmaid.2014.09.006. Epub 2014 Sep 28.
Fascioliasis is a foodborne zoonotic disease caused by the two parasite species Fasciola hepatica and Fasciola gigantica. This trematodiasis has never been claimed special relevance for travellers and migrants. However, the situation has drastically changed in the last two decades, in a way that fascioliasis should today be included in the list of diseases to be enhanced in Travel Medicine. Different kind of travellers have been involved in human infection reports: business travellers, tourists, migrants, expatriated workers, military personnel, religious missionaries, and refugees. Europe is the continent where more imported cases have been reported in many countries. More cases would have been probably reported in Europe if fascioliasis would be a reportable disease. In the Americas, most of the reports concern cases diagnosed in USA. Relative few patients have been diagnosed in studies on travellers performed in Asia. In Africa, most cases were reported in Maghreb countries. Blood eosinophilia and the ingestion of watercress or any other suggestive freshwater plant in anamnesis are extremely useful in guiding towards a fascioliasis diagnosis in a developed country, although may not be so in human endemic areas of developing countries. Several suggestive clinical presentation aspects may be useful, although the clinical polymorphism may be misleading in many cases. Non-invasive techniques are helpful for the diagnosis, although images may lead to confusion. Laparoscopic visualization should assist and facilitate procurement of an accurately guided biopsy. Endoscopic retrograde cholangiopancreatography (ERCP) is the first choice in patients in the chronic phase. ERCP and sphincterotomy are used to extract parasites from the biliary tree. Fluke egg finding continues to be the gold standard and enables for burden quantification and establishing of the drug dose. Many serological and stool antigen detection tests have been developed. Immunological techniques present the advantages of being applicable during all periods of the disease, but fundamentally during the invasive or acute period, as well as to other situations in which coprological techniques may present problems. Triclabendazole is the drug of choice at present, although the spread of resistance to this drug is challenging. Prevention mainly concerns measures to avoid individual infection by considering the different human infection sources.
片形吸虫病是一种食源性病原体引起的人畜共患疾病，由两种寄生虫物种肝片形吸虫和巨片形吸虫引起。这种吸虫病从未被认为对旅行者和移民有特殊的重要性。然而，在过去的二十年中，情况发生了巨大变化，以至于片形吸虫病现在应该被列入旅行医学中需要加强的疾病之列。不同类型的旅行者都有感染报告：商务旅行者、游客、移民、外派工人、军人、宗教传教士和难民。在许多国家，欧洲是报告输入性病例最多的大陆。如果片形吸虫病是一种报告疾病，那么欧洲可能会报告更多的病例。在美洲，大多数报告的病例都涉及在美国诊断出的病例。在亚洲进行的旅行者研究中，相对较少的患者被诊断为片形吸虫病。在非洲，大多数病例发生在马格里布国家。在发达国家，血液嗜酸性粒细胞增多和摄入水芹或任何其他在病史中有提示的淡水植物对指导片形吸虫病诊断极为有用，尽管在发展中国家的片形吸虫病流行地区可能并非如此。虽然在许多情况下可能会产生误导，但有一些提示性的临床表现可能会有所帮助。非侵入性技术有助于诊断，但图像可能会导致混淆。腹腔镜可视化有助于并有助于获得准确引导的活检。在慢性期患者中，内镜逆行胰胆管造影（ERCP）是首选。ERCP 和括约肌切开术用于从胆道中提取寄生虫。找到吸虫卵仍然是金标准，并且能够进行负担量化并确定药物剂量。已经开发了许多血清学和粪便抗原检测试验。免疫技术的优点在于可以在疾病的所有阶段应用，特别是在侵袭性或急性阶段，以及在粪便检查可能存在问题的其他情况下。三氯苯达唑是目前的首选药物，尽管这种药物的耐药性传播是一个挑战。预防主要涉及通过考虑不同的人类感染源来避免个体感染的措施。
