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      An Outbreak of Human Fascioliasis gigantica in Southwest China

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          Abstract

          Fascioliasis is a common parasitic disease in livestock in China. However, human fascioliasis is rarely reported in the country. Here we describe an outbreak of human fascioliasis in Yunnan province. We reviewed the complete clinical records of 29 patients and performed an epidemiological investigation on the general human population and animals in the outbreak locality. Our findings support an outbreak due to Fasciola gigantica with a peak in late November, 2011. The most common symptoms were remittent fever, epigastric tenderness, and hepatalgia. Eosinophilia and tunnel-like lesions in ultrasound imaging in the liver were also commonly seen. Significant improvement of patients’ condition was achieved by administration of triclabendazole®. Fasciola spp. were discovered in local cattle (28.6%) and goats (26.0%). Molecular evidence showed a coexistence of F. gigantica and F. hepatica. However, all eggs seen in humans were confirmed to be F. gigantica. Herb ( Houttuynia cordata) was most likely the source of infections. Our findings indicate that human fascioliasis is a neglected disease in China. The distribution of triclabendazole®, the only efficacious drug against human fascioliasis, should be promoted.

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          Most cited references21

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          Factors in the emergence of infectious diseases.

          "Emerging" infectious diseases can be defined as infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range. Among recent examples are HIV/AIDS, hantavirus pulmonary syndrome, Lyme disease, and hemolytic uremic syndrome (a foodborne infection caused by certain strains of Escherichia coli). Specific factors precipitating disease emergence can be identified in virtually all cases. These include ecological, environmental, or demographic factors that place people at increased contact with a previously unfamiliar microbe or its natural host or promote dissemination. These factors are increasing in prevalence; this increase, together with the ongoing evolution of viral and microbial variants and selection for drug resistance, suggests that infections will continue to emerge and probably increase and emphasizes the urgent need for effective surveillance and control. Dr. David Satcher's article and this overview inaugurate Perspectives, a regular section in this journal intended to present and develop unifying concepts and strategies for considering emerging infections and their underlying factors. The editors welcome, as contributions to the Perspectives section, overviews, syntheses, and case studies that shed light on how and why infections emerge, and how they may be anticipated and prevented.
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            Genetic variants within the genus Echinococcus identified by mitochondrial DNA sequencing.

            The pattern of species and strain variation within the genus Echinococcus is complex and controversial. In an attempt to characterise objectively the various species and strains, the sequence of a region of the mitochondrial cytochrome c oxidase subunit I (CO1) gene was determined for 56 Echinococcus isolates. Eleven different genotypes were detected, including 7 within Echinococcus granulosus, and these were used to categorise the isolates. The 4 generally accepted Echinococcus species were clearly distinguishable using this approach. In addition, the consensus view of the strain pattern within E. granulosus, based on a variety of criteria of differentiation, was broadly upheld. Very little variation was detected within Echinococcus multilocularis. Remarkable intra-strain homogeneity was found at the DNA sequence level. This region of the rapidly evolving mitochondrial genome is useful as a marker of species and strain identity and as a preliminary indication of evolutionary divergence within the genus Echinococcus.
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              Fascioliasis and other plant-borne trematode zoonoses.

              Fascioliasis and other food-borne trematodiases are included in the list of important helminthiases with a great impact on human development. Six plant-borne trematode species have been found to affect humans: Fasciola hepatica, Fasciola gigantica and Fasciolopsis buski (Fasciolidae), Gastrodiscoides hominis (Gastrodiscidae), Watsonius watsoni and Fischoederius elongatus (Paramphistomidae). Whereas F. hepatica and F. gigantica are hepatic, the other four species are intestinal parasites. The fasciolids and the gastrodiscid cause important zoonoses distributed throughout many countries, while W. watsoni and F. elongatus have been only accidentally detected in humans. Present climate and global changes appear to increasingly affect snail-borne helminthiases, which are strongly dependent on environmental factors. Fascioliasis is a good example of an emerging/re-emerging parasitic disease in many countries as a consequence of many phenomena related to environmental changes as well as man-made modifications. The ability of F. hepatica to spread is related to its capacity to colonise and adapt to new hosts and environments, even at the extreme inhospitality of very high altitude. Moreover, the spread of F. hepatica from its original European range to other continents is related to the geographic expansion of its original European lymnaeid intermediate host species Galba truncatula, the American species Pseudosuccinea columella, and its adaptation to other lymnaeid species authochthonous in the newly colonised areas. Although fasciolopsiasis and gastrodiscoidiasis can be controlled along with other food-borne parasitoses, fasciolopsiasis still remains a public health problem in many endemic areas despite sustained WHO control programmes. Fasciolopsiasis has become a re-emerging infection in recent years and gastrodiscoidiasis, initially supposed to be restricted to Asian countries, is now being reported in African countries.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                8 August 2013
                : 8
                : 8
                : e71520
                Affiliations
                [1 ]The National Institute of Parasitic Diseases, Shanghai, the People’s Republic of China
                [2 ]Key Laboratory on Biology of Parasite and Vector, Ministry of Health, People’s Republic of China, WHO Collaborating Center for Malaria, Schistosomiasis and Filariasis, Shanghai, People’s Republic of China
                [3 ]The Affiliated Hospital of Dali University, Dali, the People’s Republic of China
                [4 ]The People’s Hospital of Dali Prefecture, Dali, the People’s Republic of China
                [5 ]Dali Institute of Schistosomiasis Control, Dali, the People’s Republic of China
                The Australian National University, Australia
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: JXC MXC LA SL XNZ. Performed the experiments: JXC MXC LA SL XNX JMJ TJZ HYS WZ JJL YHG. Analyzed the data: JXC MXC LA SL XNX YHG XNZ. Contributed reagents/materials/analysis tools: JXC MXC LA SL XNX TJZ WZ YHG. Wrote the paper: JXC MXC LA SL XNZ.

                Article
                PONE-D-13-08603
                10.1371/journal.pone.0071520
                3738520
                23951181
                f28196b3-61a9-4ed0-9b0c-ffeeccedaf6e
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 27 February 2013
                : 28 June 2013
                Page count
                Pages: 10
                Funding
                The Program for the International Development Research Centre, Canada (Project No. 105509-00001002), National S & T Major Program (grant nos. 2012ZX10004-220, 2008ZX10004-011, 2009ZX10004-302 and 2009ZX10004-201), National Key Technology R & D Program (Grant No. 2008BAI56B03), and China Postdoctoral Science Foundation (Grant No. 2012M520353), Shanghai Postdoctoral Sustentation Fund (Grant No. 12R21416500). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology
                Microbiology
                Parasitology
                Population Biology
                Epidemiology
                Infectious Disease Epidemiology
                Zoology
                Parasitology
                Medicine
                Epidemiology
                Infectious Disease Epidemiology
                Infectious Diseases
                Neglected Tropical Diseases
                Fascioliasis
                Parasitic Diseases
                Fasciolosis
                Infectious Disease Control
                Veterinary Science
                Veterinary Diseases
                Veterinary Parasitology

                Uncategorized
                Uncategorized

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