Abstract
Fascioliasis is a zoonotic trematode infection that is endemic in the highlands of Peru. Chronic fascioliasis can be asymptomatic and remain undiagnosed for years. Chronic malnutrition in children, as manifested by stunting, leads to delayed cognitive development and lost productivity. We hypothesized that fascioliasis is among the factors associated with stunting in children from endemic areas. We conducted a cross-sectional study among children attending pre-school and school in 26 communities in the Anta province in the Cusco region of Peru. We conducted interviews to collect information on demographic, socioeconomic, and medical history. Blood was collected and tested for complete cell count and FAS2 ELISA for Fasciola antibodies. Three stool samples per participant were tested for parasites by Kato-Katz and Lumbreras rapid sedimentation methods. Chronic fascioliasis was determined by the presence of ova in stool. Children’s height, weight, and age were recorded and used to calculate height for age Z scores (HAZ). Three thousand children participated in the study. Nine percent (264) of children had at least one positive test for Fasciola infection, 6% (164) had chronic fascioliasis, and 3% (102) had only positive antibody tests. The median HAZ was -1.41 (IQR: -2.03 to -0.81) and was similar in males and females. Twenty six percent (776) of children had stunting with HAZ < -2. Children with chronic fascioliasis had a lower median HAZ than children without Fasciola (-1.54 vs. -1.4, p = 0.014). History of treatment for malnutrition, history of treatment for anemia, having other helminths in stool, lower socioeconomic score, living at a higher elevation, and fewer years of schooling of both parents were associated with a lower HAZ score. In a multiple regression analysis, older age and a lower socioeconomic score were associated with a lower HAZ score. While fascioliasis and other helminths were associated with lower HAZ, they were not independent of the socioeconomic score.
Highlights
Fascioliasis, caused by the liver flukes Fasciola hepatica and Fasciola gigantica, is a zoonotic parasitic infection with worldwide distribution and high prevalence in some areas of South America, Africa, the Middle East, and Asia [1,2,3]
Fasciola infection is endemic in the highlands of Peru
The effect of chronic fascioliasis on children’s long-term health and development, the impact on nutrition, is not well defined. In this large epidemiologic study, we evaluated the association of chronic Fasciola infection with chronic malnutrition
Summary
Fascioliasis, caused by the liver flukes Fasciola hepatica and Fasciola gigantica, is a zoonotic parasitic infection with worldwide distribution and high prevalence in some areas of South America, Africa, the Middle East, and Asia [1,2,3]. Fascioliasis can present as an acute infection during the parasites’ migration through the liver and as a chronic disease, which occurs once the adult flukes have established in the biliary tract [13,14]. Chronic Fasciola has been associated with anemia and weight loss. A study in Peru showed that children with chronic Fasciola infection were three times more likely to have anemia than uninfected children of similar age, gender, and other parasite infections [15]. A study in Egypt showed that 62% of subjects diagnosed with chronic Fasciola infection had normocytic normochromic anemia [16]. A hospital-based case series from Lima in Peru reported weight loss in 48% of those presenting with acute infection and 37% of those with chronic infection [17]
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