J. Bjorland et al., AN OUTBREAK OF ACUTE FASCIOLIASIS AMONG AYMARA INDIANS IN THE BOLIVIAN ALTIPLANO, Clinical infectious diseases, 21(5), 1995, pp. 1228-1233
Fasciola hepatica is a common and important parasite of sheep, cattle,
and other ruminants. In May 1991, 30 persons with possible acute fasc
ioliasis were identified by health care providers at a district hospit
al in the Bolivian Altiplano, and two deaths were associated with this
illness. A cross-sectional survey of a random sample of 30 (20%) of t
he 148 households in the community and a case-control study were perfo
rmed to determine the extent of the outbreak and the vehicle of transm
ission, Ninety-one members from 23 of the 30 selected families partici
pated in the cross-sectional survey, Twenty-one of the 91 members met
the case definition for acute fascioliasis (illness since 16 February
1991 that was characterized by fever and abdominal pain plus serum IgG
antibodies to F. hepatica), and 38 (49%) of 78 members had serum IgG
antibodies to F. hepatica. If this rate is extrapolated to the entire
community, an estimated 116 individuals (23% of 504) would have acute
fascioliasis and 247 individuals (49% of 504) would have evidence of c
urrent or previous infection. Case-control analysis indicated that the
only factor associated with illness was eating kjosco (an aquatic pla
nt) while tending animals in the fields; 27 (52%) of the 52 case-patie
nts vs. 9 (14%) of the 66 controls ate kjosco (OR = 6.84; 95% CI = 2.6
0, 18.44). The cause of the two deaths attributed to fascioliasis coul
d not be firmly established. Fascioliasis is a significant human healt
h problem and is highly endemic in the Aymara Indian community in the
Bolivian Altiplano. Efforts to prevent fascioliasis should include edu
cating people to avoid eating uncooked aquatic plants such as kjosco.