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Gastrodiscoidiasis, a Plant-Borne Zoonotic Disease Caused by the Intestinal Amphistome Fluke Gastrodiscoides Hominis (Trematoda: Gastrodiscidae)

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Gastrodiscoidiasis, a Plant-Borne Zoonotic Disease Caused by the Intestinal Amphistome Fluke Gastrodiscoides Hominis (Trematoda: Gastrodiscidae) 75 Gastrodiscoidiasis, a plant-borne zoonotic disease caused by the intestinal amphistome fluke Gastrodiscoides hominis (Trematoda: Gastrodiscidae). Mas-Coma, S.; Bargues, M.D. & Valero, M.A. Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Burjassot, Valencia, Spain Received: 25.11.05 Accepted: 10.12.05 Abstract: Gastrodiscoidiasis is an intestinal trematodiasis caused by the only common amphistome of man Gastrodiscoides hominis and transmitted by small freshwater snails of the species Helicorbis coenosus, belonging to the family Planorbidae. Human and animal contamination can take place when swallowing encysted metacercariae, by ingestion of vegetation (aquatic plants) or animal products, such as raw or undercooked crustaceans (crayfish), squid, molluscs, or amphibians (frogs, tadpoles). Pigs appear to be the main animal reservoir of any significance in most endemic areas. Its geographical distribution covers India (including Assam, Bengal, Bihar, Uttar Pradesh, Madhya Pradesh and Orissa), Pakistan, Burma, Thailand, Vietnam, Philippines, China, Kazakstan and Volga Delta in Russia, and has also been reported in African countries such as Zambia and Nigeria. The presence of G. hominis in Africa needs further studies, to confirm that the African amphistome in question is really that species and not a closely related African species, and to ascertain its geographical distribution in this continent. In man, this amphistome fluke causes inflammation of the mucosa of caecum and ascending colon with attendant symptoms of diarrhoea. This infection causes ill health in a large number of persons, and deaths among untreated patients, especially children. Human infection by G. hominis is easily recognisable by finding the characteristic eggs of this amphistome in faeces. Although comparative assays about the efficacy of different drugs against this amphistome are lacking, there is nothing impeding to suggest Praziquantel as the drug of choice for this trematodiasis. Control methods should include (i) prevention of human contamination, (ii) actions at human level to cut disease dissemination by humans, (iii) control the disease at animal reservoir level, and (iv) actions at the level of the intermediate molluscan host. Keywords: Gastrodiscoides hominis, Gastrodiscoidiasis, review. Resumen: La Gastrodiscoidiasis es una trematodiasis intestinal causada por el único afistómido común del hombre Gastrodiscoides hominis y transmitida por pequeños caracoles dulceaquícolas de la especie Helicorbis coenosus, perteneciente a la familia Planorbidae. La contaminación humana y animal tiene lugar por deglución de metacercarias enquistadas, al ingerir vegetación (plantas acuáticas) o productos animales, tales como crustáceos crudos o poco cocidos (cangrejos de río), calamares, moluscos, o anfibios (ranas, renacuajos). El cerdo es el principal reservorio animal, de importancia en la mayoría de áreas endémicas. Su distribución geográfica abarca la India (incluyendo Assam, Bengal, Bihar, Uttar Pradesh, Madhya Pradesh y Orissa), Pakistan, Burma, Tailandia, Vietnam, Filipinas, China, Kazakstan y el Delta del Volga en Rusia, y ha sido también citado en paises africanos como Zambia y Nigeria. La presencia de G. hominis en Africa precisa de estudios adicionales, con el fin de confirmar si el anfistómido africano en cuestión es en realidad la misma especie y no otra especie africana próxima, así como también para establecer su distribución geográfica en dicho continente. En el hombre, este trematodo anfistómido causa inflamación de la mucosa del ciego y colon ascendente, con síntomas de diarrea. La infección por este digénido origina enfermedad en un gran número de personas, e incluso la muerte en pacientes sin tratamiento, especialmente niños. La infestación humana por G. hominis es fácilmente reconocible mediante el hallazgo de los huevos característicos de este anfistómido en las heces. A pesar de que ensayos comparados sobre la eficacia de diferentes drogas contra este trematodo brillan por su ausencia, nada impide el sugerir que el Praziquantel debe ser considerado la droga de elección para esta trematodiasis. Los métodos de control deben comprender (i) prevención de la contaminación humana, (ii) acciones a nivel humano para cortar la diseminación por el hombre, (iii) controlar la enfermedad a nivel de reservorio animal, y (iv) acciones a nivel de molusco hospedador intermediario. Palabras clave: Gastrodiscoides hominis, Gastrodiscoidiasis, revisión. Corresponding author: Prof Santiago Mas-Coma 1. Introduction Departamento de Parasitologia Facultad de Farmacia At present, many trematodiases are emerging in Universidad de Valencia different regions (Keiser and Utzinger, 2005). Climate Av Vicent Andres Estelles s/n - 46100 Burjassot, Valencia, Spain and global changes appear to increasingly affect the Tel Office: +34 96-3544905; Tel Secretariat: +34 96 3544298 Tel Department: +34 96 3543093; Fax: +34 96 3544769 snail-borne helminthiases, which are pronouncedly Email: SMasComa@uves Revista Ibérica de Parasitología (2006), 66 (1-4), 75-81. © 2006 Sociedad Española de Parasitología (SEP) 76 Mas-Coma, S. et al., Gastrodiscoides hominis and gastrodiscoidiasis. dependent from the environment. Fascioliasis is a good of the discoidal portion (Ahluwalia, 1960; Kumar, 1980, example of an emerging-reemerging parasitic disease in 1999). Eggs are ovoid, measure 127-160/62-75 µm many countries as a consequence of many phenomena (mean 146/66 µm), have a pale greenish grey colour in related to both environment change and man-made fresh faecal specimens, and present the abopercular end modifications (Mas-Coma, 2004a, b, 2005; Mas-Coma generally thickened and rarely provided with a spine like et al., 2003, 2005). That is why fascioliasis and other elongation (Dutt and Srivastava, 1972). foodborne trematodiases have been very recently added The surface morphology of the tegument of the to the list of important helminthiases with high impact on huge ventral disc has a prominent pattern of convolutions human development, at the occasion of the Third Global and folds, including tubercle-like protuberances well Meeting of the Partners for Parasite Control held in WHO visible with scanning electron microscopy. Such a Headquarters Geneva on November 2004 (Anonymous, tegument characteristics extend also to the surface of the 2004). subterminal acetabulum. Along the acetabular rim there Among these trematodiases, there are diseases are conspicuous globular or cup-shaped, mini sucker- which affect millions of people, as fascioliasis, like protuberances known as suckerlets, which probably clonorchiasis and opisthorchiasis by liver flukes (Mas- aid the strong anchorage of the acetabulum to the host Coma & Bargues, 1997), fasciolopsiasis by the Giant surface of contact (Tandon and Maitra, 1983). Asian intestinal fluke (Mas-Coma et al., 2005), and paragonimiasis by lung troglotrematid species belonging 3. Definitive hosts and adult microhabitat to only one genus (Blair et al., 1999), whereas others The location of this amphistome is the caecum are considered secondary because of appearing only and colon of both pig and man (Ahluwalia, 1960; Kumar, sporadically or affecting a lower number of persons. 1980, 1999). The number of flukes in pig can reach very Among the latter, gastrodiscoidiasis is undoubtedly one of high numbers, as up to 1886 in a pig individual and the most important owing to both the number of infected with intensity averages of 227 in pig populations (Dutt subjects, its pathogenicity and its wide geographical and Srivastava, 1972), which clearly indicates that the distribution. pig may be considered the normal host species of this Concerning gastrodiscoidiasis, studies in recent trematode parasite. years have been less numerous and a recent, exhaustive Varma (1954) made a comparative study of the review of the present knowledge on this disease is needed. morphology of the adult fluke from man and pigs and In this paper, a review of gastrodiscoidiasis is included in concluded that the porcine forms differed from the human the way to offer the necessary baseline for future studies. forms in their general smaller size, characters of their genital papilla/cone, and the shape and arrangements of 2. The causal agent the testes. That is why he justifiedG. hominis from pig as The trematode species Gastrodiscoides hominis a separate variety, var. suis. However, this differentiation (Lewis et McConnell, 1876) Leiper, 1913 (Gastrodiscidae) has not been generally accepted after studies involving is the only common amphistome of man. When alive, a large number of specimens which show that those adults of G. hominis are thick, fleshy pyramidal in shape differences were not constant (Shrivastav and Shah, and bright pink in colour. Their size varies from 8.0 to 1970). 14.0 by 5.5 to 7.5 mm in fixed and pressed specimens Another definitive host species in which this (Shrivastav and Shah, 1970; Kumar, 1980). Two parts trematode has been found is wild boar, as in the Thekaddy may be distinguished in its adult body: a short and forest area in Kerala, India, where it was detected conical-cylindrical anterior portion, and a large, discoidal, infected besides the domestic pig (Easwaran et al., 2003). of up to 8.0 mm wide and ventrally excavated posterior This parasite has also been found in Napu mouse deer portion. The oral sucker is provided with a small paired (Tragulus napu) from Malaya, as well as in field rat diverticula and the oesophagus has a posterior
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