Diagnosis of human fascioliasis in Arusha region, northern Tanzania by microscopy and clinical manifestations in patients.

Abdul-Hamid Settenda Lukambagire,Deborah N Mchaile,Mramba Nyindo

doi:10.1186/s12879-015-1326-9

Abdul-Hamid Settenda Lukambagire, Deborah N Mchaile + Show 1 more

Open Access

https://doi.org/10.1186/s12879-015-1326-9

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Abstract

BackgroundHuman fascioliasis (HF) is a zoonotic disease that has been identified in many countries worldwide. This report concerns the identification and clinical management of cases of human fascioliasis in the suburbs of Arusha city, northern Tanzania in 2013. Fascioliasis is included among the WHO’s Neglected Tropical Diseases as a plant transmitted trematode infection. Human fascioliasis has not been described before in the East Africa region, including Tanzania.MethodsPatients presenting at a primary healthcare centre in Arusha Region, northern Tanzania provided fresh stool samples for routine ova and parasite screening (saline and iodine preparations). Subsequent stool samples were preserved in 5 % formalin in saline and subjected to ether sedimentation for examination.ResultsOut of 1460 patients, 305 (21 %) were diagnosed positive for fascioliasis based on the demonstration of brownish, oval eggs with inconspicuous opercula in stool. Two distinct egg sizes were identified; large 170–212.5 by 115–150 μm (mean 194.5 by 130.5 μm) and smaller eggs 120–150 by 87.5 – 112.5 μm (mean 138.8 by 101 μm). Clinically, patients presented with fever (39 - 40 °C) and abdominal pain. Some patients had pruritis around the mouth and their lips were swollen. 3 patients were treated and cured with single dose Triclabendazole. The remaining 302 patients were treated with Nitazoxanide and 122 (40 %) were cleared of infection with a single course. Snails of the genus Lymnaea were found in the surroundings.ConclusionsThis report serves to remind medical professionals in East Africa that HF is a probable differential diagnosis in patients presenting with similar symptoms. It is possible to diagnose fascioliasis by light microscopy although specific antigen tests are required for confirmation. Human fascioliasis however, has not been described or reported in Tanzania before and begs further investigation.

Highlights

Human fascioliasis (HF) is a zoonotic disease that has been identified in many countries worldwide
The challenges associated with a definitive diagnosis of human fascioliasis, especially at the clinical level are many: First, eggs are never passed in stool during the acute phase of the disease, patients presenting clinically are likely to be missed on routine stool screening especially if only a single sample is examined without concentration
We examined at least 2 samples per patient, we used only a qualitative concentration/sedimentation method as these screenings were not prejudiced towards the detection of Fasciola eggs alone

Summary

Introduction

Human fascioliasis (HF) is a zoonotic disease that has been identified in many countries worldwide. Following the penetration of the capsule the immature flukes migrate through the liver tissues for about 6–8 weeks in the case of F. hepatica and up to 12–14 weeks for F. gigantica, entering the bile ducts where they mature and begin egg production [3, 4]. Human fascioliasis (HF) is usually asymptomatic, though symptoms may occur early on in the infection when immature flukes migrate from the intestine through the abdominal cavity and liver. The symptoms of chronic disease may last for months to years after infection, usually resulting from inflammation and blockage of bile ducts. This is usually complicated by biliary colic, cholestasis or cholangitis in untreated patients [5, 6]

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