In a first, two patients have tested positive for fascioliasis, at Shere-i-Kashmir Institute of Medical Sciences (SKIMS) Soura, doctors said on Tuesday.
The first case, a young male patient is from Sunderwani Pakherpora area of Budgam and was referred to Gastroenterology unit of SKIMS as a liver cancer patient. The patient was treated endoscopically (ERCP) by removing hundreds of live liver flukes from the bile duct.
Fascioliasis also known as fasciolosis, distomatosis and liver rot is a parasitic worm infection caused by two species of parasitic flatworms, Fasciola hepatica and Fasciola gigantica that affects the liver.
“Before reaching to our unit, he had visited many doctors for treatment where the patient was given all sorts of antibiotics and even anti-tubercular but that did not give him any relief,” head department of Gastroenterology SKIMS Dr GN Yattoo told Rising Kashmir.
Following the first detection, the doctor visited the area and it was for the first time he treated such patient.
“First he came as a cancer patient. It was for the first time I saw such a patient in Kashmir. I had never read about the disease. He is following the treatment,” he said, adding that earlier they believed that the disease did not exist in Kashmir.
The second patient is a 20-year-old girl from Handwara and was admitted to the hospital in March last year in the department of surgery with fewer and multiple abscesses in the liver.
”She was upset and left the hospital and went to a private doctor who referred her to outside the state to a private physician for liver biopsy and for which her parents spent around 6 lakh rupees with no improvement,” Dr Yattoo said.
The fascioliasis disease affected the girl after a lot of cattle died in their village and two in their home in the past.
“I had not thought I would get another such patient. We admitted her and once I saw all the records I remembered the first patient. She said once she started illness lot of cattle had died there. This gave me a clue that possibility it could be another fascioliasis patient,” he said.
The doctors got the triclobedazole (a medication used to treat liver flukes) from a veterinary to get them treated.
About the symptoms of the disease, Dr Yattoo said there are two main stages, one is when the parasitic worm infection caused by the common liver fluke (Fasciola hepatica) goes into the liver it causes weight loss, fever, and loss of appetite and pain in the right abdomen.
“It is very rampant among cattle and sheep. Humans get accidentally infected by ingestion of contaminated water and water grown vegetables,” said the doctor.
With the ingestion of such contaminated food items, the larval stage of parasite penetrates the duodenal wall and then reaches the liver by passing through peritoneal cavity.
He also said it pierces the liver capsule and traversing through liver tissue finally reaches into Bile duct, where it grows into the adult and remains permanently there unless treated.
“Fascioliasis has two phases one liver phase, when it passes through liver during this phase patient cam get pain in abdomen, fever, anorexia, and nausea. The liver tissue reacts to this larval stage of the parasite by an intense inflammatory reaction which can look like multiple liver abscesses on ultrasound/CT-Scan/MRI ,” said Dr Yattoo.
Another phase is bile duct phase. In this phase, the parasite can remain silently for years together.
He said that the government should provide education to the people and appeal them not to take contaminated water mainly from marshy land.
“We advise public to avoid eating raw vegetables grown in the water like Nadru (Lotus stick), Pumbash (lotus) and Chestnuts. There might be other vegetables also which are not yet known,” he said.
The disease did not exist here and It is for first time this disease has been discovered. Triclobedazole is effective for it and treatment in hospital may be required. The disease is a plant-borne trematode zoonosis and is classified as a neglected tropical disease (NTD).