1. Fascioliasis
Rebecca Flint

2. Fascioliasis has world wide effects
WHO designated extremely neglected disease
Cases in 51 different countries
17 million people affected
WHO has designated fascioliasis as one of the extremely neglected diseases. Cases have been seen in 51 different countries in the past 25 years. The highest known rates of human infection are in the Andean highlands of Bolivia and Peru. It is the second most common trematode infection in the Middle East and North Africa. It mainly affects children in poor rural areas. The estimated number of infected people is at least 2.4 million and might be as high as 17 million.

3. Oral-fecal transmission route
Reservoir in livestock
Watercress
The fasciola is a liver fluke that is passed through the oral-fecal route. It most commonly occurs where cattle or sheep vectors contaminate water and people become infected by drinking water carrying the worm or eating raw vegetables, specifically watercress, that are exposed to the contaminated water and not cooked prior to eating.

4. 1. Unfertilized eggs are released in stool usually from cattle or sheep and fertilized in water.
2. Miracidia hatch and invade the snail intermediate host where they continue to develop
Parasite goes through 3 developmental stages in the snail, the sporocysts then rediae and last the free- swimming cercariae are released from the snail
the metacercariae encyst on water plants
5. Humans become sick by eating metacercariae that have attached to plants
6. The metacercariea move into the duodenum and migrate to the biliary ducts where they mature and eventually are excreted in the stool

5. Disease manifests in the liver
Chronic phase
Producing eggs in bile ducts
Asymptomatic
Symptomatic
Acute phase
Flukes traveling to bile ducts
Nausea, vomiting, abdominal pain
Inflammation and bleeding
Liver tissue destruction
The acute phase of the disease occurs when the flukes are traveling through the small intestinal wall into the liver and the bile duct. It usually begins 4 to 7 days after ingestion of the fasciola and may last from weeks to months. This phase is often asymptomatic, but patients who do experience symptoms may experience gastrointestinal bleeding, inflammation, abdominal pain, nausea, vomiting and diarrhea. Patients may also experience destruction of the liver tissue. The chronic disease occurs when the flukes have made it to the bile ducts and begin producing eggs. symptomatic disease causes Severe, lasting damage while many patients in the chronic phase remain asymptomatic

6. Diagnosis can be difficult
Stool ova test
ELISA or Western Blot
Liver ultrasound

7. Few drugs have been used for treatment
Bithionol
- Less effective
Triclabendazole
- 1983
- Effective against early stage parasites
- Inhibits parasitic microtubule formation
- Resistance in 1995
Bithionol causes morphological changes

8. Cathepsin L proteases vaccine testing
Fascilitate in tissue penetration, feeding, and immune system evasion
Cathepsin L1 and L2 are the major fasciola proteases
Secreted from the epithelial cells lining the gut of fasciola. Only tested in sheep and cattle

9. FhSAP2 as a potential vaccine
Potential to protect against subsequent fasciola hepatica metacercariae infections
Fluke burden
Reduced 83.3% with cDNA-FhSAP2
Reduced 60% with FhSAP2 protein
FhSAP2 is a Fasciola antigen. All vaccinated animals had less liver damage

10. Kapplan-Meier analysis to estimate the survival probability over the time after challenge in mice vaccinated with FhSAP2 or cDNA-FhSAP2 compared to positive controls. PC includes mice vaccinated with PBS in FA and vaccinated with the empty pFLAG-CMV−2 plasmid. Log-rank test determined that there are statistical differences (P<.05) between survival probability of DNA-FhSAP2-vaccinated group compared to the PC group

11. Difficulty controlling Fasciola spread
Individualized control plans
Separation of livestock and farming
Sanitation
Cooked vegetables

12. References
Farid Z, Kamal M, Woody J (1988). Treatment of acute toxemic fascioliasis. Trans R Soc Trop Med Hyg, 82, 299.
Dawes B. Some apparent effects of Bithionol (Actamer) on Fasciola hepatica. Nature –425.
Neglected tropical diseases of the Middle East and North Africa: Review of their prevalence, distribution and opportunities for control