Fascioliasis

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Overview

Fascioliasis is a parasitic infection typically caused by Fasciola hepatica, which is also known as “the common liver fluke” or “the sheep liver fluke.” A related parasite, Fasciola gigantica, also can infect people. Fascioliasis is found in all continents except Antarctica, in over 70 countries,  especially where there are sheep or cattle. People usually become infected by eating raw watercress or other water plants contaminated with immature parasite larvae. The young worms move through the intestinal wall, the abdominal cavity, and the liver tissue, into the bile ducts, where they develop into mature adult flukes that produce eggs. The pathology typically is most pronounced in the bile ducts and liver.

Fascioliasis is a waterborne and foodborne zoonotic disease caused by two parasites of class Trematoda, genus Fasciola; namely Fhepatica and Fgigantica. Humans are incidental hosts and become infected by ingesting contaminated watercress or water.

Symptoms

In children, signs and symptoms of epiglottitis may develop within a matter of hours, including:


Fever

Severe sore throat

Abnormal, high-pitched sound when breathing in (stridor)

Difficult and painful swallowing

Drooling

Anxious, restless behavior

Feeling better when sitting up or leaning forward

Symptoms in adults

For adults, signs and symptoms may develop more slowly, over days rather than hours. Signs and symptoms may include:


Severe sore throat

Fever

A muffled or hoarse voice

Abnormal, high-pitched sound when breathing in (stridor)

Difficulty breathing

Difficulty swallowing

Drooling

Causes

Epiglottitis is caused by an infection or an injury.


Infection

In the past, a common cause of swelling and inflammation of the epiglottis and surrounding tissues was infection with Haemophilus influenzae type b (Hib) bacteria. Hib is responsible for a number of serious conditions, the most common of which is meningitis. Hib is now much less common in developed countries due to Hib immunization in children.


Hib spreads through infected droplets coughed or sneezed into the air. It's possible to harbor Hib in your nose and throat without becoming sick — though you still can spread the bacteria to others.


In adults, other bacteria and viruses also can cause inflammation of the epiglottis, including:


Streptococcus pneumoniae (pneumococcus), another bacterium that can cause meningitis, pneumonia, ear infection and blood infection (septicemia)

Streptococcus A, B and C, a group of bacteria that can cause diseases ranging from strep throat to blood infection

Staphylococcus aureus, a bacterium that causes skin infections and other diseases including pneumonia and toxic shock syndrome

Injury

Physical injury, such as a direct blow to the throat, can cause epiglottitis. So can burns from drinking very hot or caustic liquids.


You also may develop signs and symptoms similar to those of epiglottitis if you:


Swallow a chemical that burns your throat

Swallow a foreign object

Smoke drugs, such as crack cocaine


Risk factors

Certain factors increase the risk of developing epiglottitis, including:


Being male. Epiglottitis affects more males than females.

Having a weakened immune system. If your immune system has been weakened by illness or medication, you're more susceptible to the bacterial infections that may cause epiglottitis.

Lacking adequate vaccination. Delayed or skipped immunizations can leave a child vulnerable to Hib and increases the risk of epiglottitis.

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Complications

In chronic infection beyond the latent phase, clinical manifestations are those of the complications of fascioliasis, namely: ascending cholangitis; cholelithiasis; cholecystitis; pancreatitis; biliary cirrhosis; and hepatic fibrosis.

Epiglottitis can cause a number of complications, including:


Respiratory failure. The epiglottis is a small, movable "lid" just above the larynx that prevents food and drink from entering your windpipe. But if the epiglottis becomes swollen — either from infection or from injury — the airway narrows and may become completely blocked. This can lead to respiratory failure — a life-threatening condition in which the level of oxygen in the blood drops dangerously low or the level of carbon dioxide becomes excessively high.

Spreading infection. Sometimes the bacteria that cause epiglottitis cause infections elsewhere in the body, such as pneumonia, meningitis or a bloodstream infection.


Prevention

People can protect themselves by not eating raw watercress and other water plants, especially from endemic grazing areas. As always, travelers to areas with poor sanitation should avoid food and water that might be contaminated.

Ensuring that freshwater fish and watercress are thoroughly cooked before consuming them is the most effective way to prevent a liver fluke infection. People who are travelling to areas with poor sanitation should certainly avoid food and water that could potentially be contaminated with the parasites.