Background: The public health importance of human fascioliasis has increased during last few decades due to the appearance of new emerging and re-emerging foci in many countries. Iran, as the most important focus of human disease in Asia, has been included among six countries known to have a serious problem with fascio­liasis by WHO. Various aspects of the disease in Iran are discussed in this review. Methods: This narrative review covers all information about human and animal fascioliasis in Iran, which has been published in local and international journals from 1960 to 2014 using various databases including PubMed, SID, Google Scholar, Scopus, Science Direct. Results: During the period of the study the infection rates of 0.1% to 91.4% was noted in various livestock. Despite the higher infection rates of livestock in south­ern areas in past decades, human disease has been mostly encountered in northern Provinces especially in Guilan. Recent studies indicate noticeable decrease in preva­lence rates of veterinary fascioliasis in Iran, however the prevalence rates of fascio­liasis in livestock in northern Provinces of Guilan and Mazandaran seem to remain at a higher level in comparison to other parts. New foci of the disease have also been reported recently.  Conclusion: While the prevalence of animal fascioliasis has decreased during last decades, human fascioliasis emerged as a public health problem in the country. The validity of new foci of human fascioliasis needs complementary standard studies.

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The Status of Human and Animal Fascioliasis in Iran: A Narrative Review Article.

Human Fascioliasis (HF) is a foodborne neglected parasitic disease caused by Fasciola hepatica and Fasciola gigantica. New epidemiological data suggest that the endemic areas of the disease are expanding and HF is being reported from areas where it was previously not observed. Diagnosis of HF is challenging. Performances of parasitological approaches, based on the detection of parasite's egg in the stool, are not satisfactory. Currently serological methods for the diagnosis of HF are mainly based on detection of anti-Fasciola antibodies in serum. Although, there have been some improvement in the development of immunological diagnostic tests for the diagnosis of HF, yet these tests suffer from insufficiency in sensitivity or/and specificity. Detection of antigens, rather than antibodies, seems to be a suitable approach in the diagnosis of HF. Antigen can be detected in sera or stool of the fascioliasis patients. Circulating antigen in serum disappears within a short time and most of the circulating antigens are in immune complex forms which are not freely available to be detected. Therefore, antigenemia might not be an appropriate method for the diagnosis of HF. Detection of antigen in stool (coproantigens) seems to be a suitable alternative method for the diagnosis of HF. Recent data provided convincing evidence that detection of coproantigen improved and simplified the diagnosis of HF. The present review highlights the new achievements in designing and improvement of diagnostic approaches for the immunodiagnosis of HF. Moreover, current status of the available immunodiagnostic techniques for the diagnosis of HF, their strengths and weaknesses has been discussed.

Immunodiagnosis of Human Fascioliasis: An Update of Concepts and Performances of the Serological Assays.

Background: The largest global outbreaks of liver fluke disease (Fascioliasis) in humans, caused by species of the genus Fasciola, have occurred in Guilan Province of Iran, affecting more than 15000 people. Although, different aspects of fascioliasis have been the subject of various researches during last two decades, nevertheless no community-based study has been performed in endemic regions of Guilan. The aim of present study was to obtain the basic information needed to develop future control strategies. Methods: Fecal and blood samples were collected from 1,984 volunteers in the Bandar-Anzali district, the region where previous epidemics occurred. Fecal samples were examined by Kato-Katz and formalin-ether methods for the presence of Fasciola eggs. Sera samples were analyzed by ELISA to detect anti-cathepsin L antibodies. Results: Twenty-seven (1.36%) individuals were seropositive, 9 (0.45%) individuals were egg positive (mean egg count 50.7 (±30.36) eggs per gram of faeces) and 30 individuals (1.51%) were positive using both methods. No statistical association was observed between infection and age, gender, location, occupation, educational status and dietary habits. The prevalence of intestinal parasites is also included. Conclusion: Human fascioliasis is hypoendemic in this region and recommends a passive case-finding approach, effective primary prevention measures, health education through mass media and effective veterinary public health measures for control of human disease.

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The Endemicity of Human Fascioliasis in Guilan Province, Northern Iran: the Baseline for Implementation of Control Strategies

Background: The aim of this study was to detect the seroprevalence of human fascioliasis in Isfahan County, central Iran in 2013. Methods: Overall, 471 sera samples were collected from people recalled randomly to 20 health centers in the city of Isfahan and 10 related villages in 2014. Sera were examined using ELISA test. A questionnaire was filled out for each participant. Results: Altogether eight cases (1.7%) were seropositive which had the OD absorbance in ELISA test more than the calculated cutoff of 0.36. All of them were female. One positive subject had a history of consuming Delar (Local dish) and three seropositive cases with history of eating Zeitoon-Parvadeh (Proceeded olive). Conclusion: Isfahan County might be considered as one area apt for fascioliasis.More studies in terms of veterinary investigation and verifying the risk factors are necessary.

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Seroprevalence of human fascioliasis using indirect ELISA in isfahan district, central iran in 2013.

Background: The aim of this study was the seroepidemiological survey for detecting
the status of human fasciolosis in Lorestan Province, western Iran.
Methods: This cross-sectional study was conducted in 2015-16. Based on statistical
estimations, 1256 serum samples were collected from different parts of Lorestan
Province, western Iran, and stored at -20 °C until use. The collected serum samples
were analyzed at Tehran University of Medical Sciences, Tehran, Iran using indirect
ELISA method.
Results: Anti-Fasciola antibodies were detected in 16 (1.3%) individuals. Regarding
the seropositivity to fasciolosis, no significant differences were found between age
groups, sex, level of education and occupation; however significant differences
were observed regarding location, consuming local freshwater plants and water resources
(P<0.02.)
Conclusion: Local freshwater plants and unfiltered water resources were probably
the main sources of the infection. Health education by local health centers to elevate
awareness of people, and providing facilities for safer drinking water, especially
in rural areas may help decrease the risk of fasciolosis infection in this region

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Seroprevalence of Human Fasciolosis in Lorestan Province, Western Iran, in 2015-16.

Background: Fascioliasis is one of the most common zoonotic diseases in Iran and other parts of the world. Although the largest epidemic of this disease has occurred in northern provinces of Iran (Guilan) during the past two decades and a few cases have also been reported in Tehran and the other provinces, there has been no evidence of its’ occurrence in western provinces of Iran such as Kermanshah before the outbreak which is being reported. Methods: The study was conducted by teamwork of infectious disease specialist, parasitologist, general practitioner, entomologist, and laboratory technician. It is an “epidemic investigation” and a cross sectional descriptive one. Clinical data and para‑clinical changes are recorded considering all of the population of a village in Kangavar, one of the suburbs of Kermanshah (western Iran). Results: The mean age was 21.65, (SD=12.44). Fifty three percent were female, and all of them were farmers. Eighty two percent had a history of watercress ingestion in a period of 1‑2 months before the admission and 18% consumed other vegetables. The average of eosinophils was 32.35% (SD=26). The patients’ Enzyme Linked Immunosorbent Assay (ELISA) and Counter Current Immuno‑electrophoresis (CCIE) serological tests were reported positive by the department of parasitology, Pasteur Institute of Iran. Treatment response to triclabendazole was excellent. A ten‑year clinical and laboratory follow‑up revealed no evidence of abnormality in treated patients. Conclusions: It was the first case of human fascioliasis in west Iran and was a real epidemic and an emerging infectious disease for this area at that time. The clinical symptoms were less severe compared with other reports. Health education to inhabitants and health care workers can lead to rapid detection of such outbreaks. Keywords: Epidemic, eosinophilia, fascioliasis, new‑emerging, watercress

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Mahdi Asmar

Papers

The First Epidemic and New-emerging Human Fascioliasis in Kermanshah (Western Iran) and a Ten-year Follow Up, 1998-2008