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Epidemiology of Human Fascioliasis

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Epidemiology of Human Fascioliasis eserh ipidemiology of humn fsiolisisX review nd proposed new lssifition I P P wF F wsEgomD tFqF istenD 8 wFhF frgues he epidemiologil piture of humn fsiolisis hs hnged in reent yersF he numer of reports of humns psiol hepti hs inresed signifintly sine IWVH nd severl geogrphil res hve een infeted with desried s endemi for the disese in humnsD with prevlene nd intensity rnging from low to very highF righ prevlene of fsiolisis in humns does not neessrily our in res where fsiolisis is mjor veterinry prolemF rumn fsiolisis n no longer e onsidered merely s seondry zoonoti disese ut must e onsidered to e n importnt humn prsiti diseseF eordinglyD we present in this rtile proposed new lssifition for the epidemiology of humn fsiolisisF he following situtions re distinguishedX imported sesY utohthonousD isoltedD nononstnt sesY hypoED mesoED hyperED nd holoendemisY epidemis in res where fsiolisis is endemi in nimls ut not humnsY nd epidemis in humn endemi resF oir pge QRR le reÂsume en frnËisF in l p gin QRR figur un resumen en espnÄ olF ± severl rtiles report tht the inidene is sntrodution signifintly ggregted within fmily groups psiolisisD n infetion used y the liver fluke euse the individul memers hve shred the sme ontminted foodY psiol heptiD hs trditionlly een onsidered to e n importnt veterinry disese euse of the ± severl rtiles hve reported outreks not neessrily involving only fmily memersY nd sustntil prodution nd eonomi losses it uses in livestokD prtiulrly sheep nd ttleF sn ontrstD ± few rtiles hve reported epidemiologil surveys of lrge numer of infeted personsF humn fsiolisis hs lwys een viewed s seondry disese @ID PAF he puli helth importne of humn eent developments fsiolisis hsD howeverD inresed in reent yersD s shown y the high numer of humn ses he trditionl epidemiologil piture of humn fsiolisis hs hnged mrkedly in reent yersD s reorded over the period IWUH±WHX PSWR infeted outlined elowF persons in RP ountries loted on ll ontinents @QAF reviouslyD ses of humn fsiolisis hd lwys qeogrphil distriution een linked to ses mong livestok in the re onernedF he numers of reported linil ses of humn fsiolisis used y pF hepti s well s of infeted persons identified during epidemiologil surveys hve inresed signifintly sine IWVHF e reent ypes of humn fsiolisis review y isten et lF @RA ompiled totl of UHUI humn ses reported from SI ountries over the lst ulished mteril on humn fsiolisis flls into the PS yersD distriuted s followsX efri @RVU sesAD following rod tegories @QD RAX emeri @QPTUAD esi @QSRAD iurope @PWSIAD nd ± the mjority of rtiles del only with individul yeni @IPAF he mjor ssoited helth prolems se reportsY re found in enden ountries of outh emeriD northern efriD sslmi epuli of srnD nd western iuropeF he true numer of humn ses is undoutedly muh greter thn tht reported @RAF he epidemiologil nd trnsmission hrE teristis of fsiolisis men tht the disese hs I ghirmn nd hiretorD heprtment of rsitologyD pulty of pthy distriutionD with foi eing relted to the lol hrmyD niversity of leniD evF ient endreÂs istelleÂs sGnD distriution of intermedite snil host popultions in RTIHH furjssot±leniD pinF equests for reprints should freshwter odies s well s to generl physiogrphi e sent to rofessor hr F wsEgom t this ddressF P nd limti onditionsF st is therefore not pproprite itulr rofessorsD heprtment of rsitologyD pulty of hrmyD to refer to the hrteristis of fsiolisis t the niversity of leniD evF ient endreÂs istelleÂs sGnD RTIHH furjssot± leniD pinF ountry levelD ut rther to those in given eprint xoF SUVU physiogrphilly nd limtilly homogeneous reF 5 QRH orld relth yrgniztion IWWW fulletin of the orld relth yrgniztionD IWWWD UU @RA ipidemiology of humn fsiolisis highest levels thus fr reported @PRD PSAF sn ortoD rumn endemi res ortuglD prospetive study provided geometri urveys in severl regions indite tht there re res men level in stools of PQQ epg @rngeD PS±PIHH epgAD with true endemi humn fsiolisisD rnging from lthough most of the sujets shed IHI±QHH epg @IUAF low to very high prevlene nd intensity @SAF eent elthough in generl the prevlene nd estimtes suggest tht up to PFR million @TA or even up intensity of egg outputs re higher in hildren to IU million people @UA re infeted with pF hepti @US7D PR±RRRH epgA thn dults @RIFU7D IRR±VTR in the worldF ry @VA hs stressed the lrge helth epgAD in hyperendemi zones dults either mintin prolem used y fsiolisis in severl ountriesD the prsites they quired when young or n e nd rillyer 8 ept @WA hve underlined the sitution in newly infeted euse they live in zone of high the emerisF hese dt tke on gret importne infetion risk @PSAF euse of the reognized pronouned pthogeniity of fsiolisis in humns @QD SD IHAF qlol nlysis of the geogrphil distriution he prsite of humn ses shows tht the expeted orreltion wost of the res with high endemiity of humn etween niml nd humn fsiolisis ours only t fsiolisis involve pF heptiF roweverD in esi the si levelF e high prevlene in humns does not distriution of pF hepti nd pF gignti overlpsD nd seem to orrelte with res where fsiolisis is this mkes it diffiult to identify the prtiulr speies mjor veterinry prolem @RAF husD lssifition of involvedD whih is often referred to simply s psiol fsiolisis s one of the prinipl tropil diseses spF his espeilly ours in ghin @rovine of ppers wrrnted @IIAF iwnAD tpnD the epuli of uoreD nd the hilippines @QPAF revlene of humn fsiolisis e similr prolem ours in igyptD where heres the prevlene of humn fsiolisis n e fsiolisis hs ppered s n emerging helth negligile in res where the veterinry form of the prolem @QQA with some rurl res eing endemi disese oursD the rtes vry widely in res where nd hving prevlenes in the rnge U±IU7 @QRAF e the disese in endemi to humnsF totl of PUFU million people re t riskD with the ixmples of very low prevlenes re HFQR±QFI numer infeted eing t lest VQH HHH @VAF foth ses per IHH HHH inhitnts in fsseExormndieD pF hepti nd pF gignti s well s intermedite prne @IPD IQAY HFVQ±IFIT ses per IHH HHH forms hve een foundD thus explining why the fluke inhitnts in gorsi @IRD ISAY nd HFU7 prevlene speies involved hs not een determined in most @RI ses per SVTI sujets studiedA in the ss egion instnes @RAF of ghile @ITAF sntermedite levels re exemplified y foth the norml spermtogeneti type prevlenes of QFP7 in the inner orto regionD @eD inluding diploidD triploidD nd mixoploid ortugl @IUAY UFQ7 in the xile deltD igypt @IVAY hromosome types in whih no fertiliztion oursA VFU7 in gjmrD eru @IWAY nd IHFW7 in gorozlD nd the norml spermtogeneti type @xA of uerto io @PHAF ixmples of high prevlenes re psiol sppF hve een found in severl esin provided y ISFTR7 in the uno region @PIA nd ountriesX ghin @rovine of iwnAD sndiD xeplD QRFP7 in the wntro vlley @PPAD oth in eruF he the hilippinesD hilndD nd iet xmF e ours highest humn prevlenes hve een reported in the prtiulrly in tpn nd the epuli of uoreF folivin eltiplnoX up to TTFU7 deteted using sn southEest esiD e flukes re symptri with oprologil tehniques @PQ±PTA nd up to SQ7 x pF hepti nd x pF gigntiF sn iuropeD using immunologil methods @PQD PU±PWAY higher outh nd xorth emeriD nd yeniD where rtes of UP7 nd IHH7D respetivelyD hve een minly pF hepti oursD nd in efriD where reported y lol folivin workers @QHAF pF gignti predomintesD only x speimens hve he reltionship etween the prevlene of een found @QSAF fsiolisis nd ge differs in humn endemi nd tpnese flukes reprodue y prthenogenesis humn nonendemi resF sn high prevlene res euse of their norml gmetogenesisD regrdless hildren under IS yers of ge usully present the of whether thy re diploidD triploidD or mixoploid highest rtes @ITD IVD IWD PID PRD PSAD in ontrst to the @QTAF tudies hve distinguished vrious prthenogeE urrent sitution in humn nonendemi resF neti lines tht hve risen independently of eh otherD presumly through independent hyridizE tion etween strinsF he existene of suh hyrids rumn infetion intensities would explin the ontinuing txonomi onfusion emong humn ses low egg outputsD eFgF I±P eggs regrding the txonomi sttus of the tpnese liver per g of fees @epgA @PHA nd I±R epg @IWAD were until flukes @QTAF inzymti studies hve een unle to reently the most ommonD with n output of RRH settle this issueD perhps euse the worms epg @QIA eing onsidered rreF hese egg outputs reprodue prthenogenetillyD with the popultions reD howeverD very muh lower thn those found in exmined onsisting of desendnts of single humn endemi resF por exmpleD mong folivin individul @QUD QVAF hildrenD eggs in stools rnged from PR to SHTR epgD woleulr tehniques hveD howeverD provided with rithmeti nd geometri men levels of RUR±IHHI epg nd PHI±QHW epgD respetivelyD the n nswer to this ontroversyF iosoml hxe fulletin of the orld relth yrgniztionD IWWWD UU @RA QRI eserh suprspeifi lymneid phylogeny @RU±SHAF he @rhxeA sequene studies hve shown tht pF hepti nd pF gignti re distintD with tpnese psiol spF importne of these tehniques is evident in view hving n rhxe sequene lose to tht of pF gignti of the speifi determintion prolems in vymneiE @QVD QWAF ery reentlyD rshimoto et lF @RHA hve de snilsF woreoverD espeilly the iIHEI helix of the found tht intermedite forms from tpn my e P vrile region of the IV riosoml xe sried to pF gigntiD sed on their mitohondril @rxeA gene hs proved useful in distinguishing nd nuler hxe sequeniesF por the time eingD etween lymneid speies whih trnsmit nd whih howeverD the sitution is not ler for other esin do not trnsmit fsiolid prsitesD s well s in ountriesF distinguishing etween those speies tht trnsmit pF hepti nd those tht trnsmit
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