> Date: Tue, 26 Sep 2006 17:18:14 -0400 (EDT)
> From: ProMED-mail <promed@promed.isid.harvard.edu>
> Subject: PRO/AH/EDR> Heterophyiasis - Philippines (Bukidnon)
>
> HETEROPHYIASIS - PHILIPPINES (BUKIDNON)
> ***********************************
> A ProMED-mail post
> <http://www.promedmail.org>
> ProMED-mail is a program of the
> International Society for Infectious Diseases
> <http://www.isid.org>
>
> Tue, 26 Sep 2006 06:10:15 -0400
> From: A-Lan Banks, <A-Lan.Banks@thomson.com>
> Source: Minda News, Davao City, Philippines, 25 Sep 2006 [edited]
> <http://mindanews.com/index.php?option=com_content&task=view&id=941&Itemid=50>
>
>
> The Department of Health office in Bukidnon reported the emergence of
> heterophyiasis, an emerging disease in the province seen to be worse
> than schistosomiasis. [Bukidnon is a landlocked province on the
> island of Mindanao.
> <http://www.mapsofworld.com/philippines/philippines-political-map.html>
> - - CopyEd.PG]
>
> Heterophyiasis, according to Dr. Vincent C. Raguro in a statement
> given to MindaNews, is an infection of the small intestines caused by
> intestinal flukes [acquired] by eating raw or "insufficiently" cooked
> fish. He said the disease is endemic in 59 barangays from 10
> municipalities and 2 cities in the province.
>
> As of August 2006, the DOH identified 592 individuals who turned out
> to be positive of the disease out of the 2739 examined in the endemic
> areas. "But the real situation is yet to be determined," Raguro said
> in a statement, adding that what they are seeing is just the "tip of
> the iceberg."
>
> Treatment officer Nestor Sotelo said they are constrained by lack of
> funds for fuel and other operating expenses to conduct tests all over
> the province. He said they have so far monitored only 2 cases out of
> the 3 fatalities this year, in San Jose in Malaybalay City and in New
> Kidapawan in Kibawe.
>
> Ingestion of insufficiently cooked or raw fish is the only [way to
> acquire] heterophyiasis, according to the DOH. Adult worms and eggs
> of the intestinal flukes thrive in the intestines and will also
> spread to other organs like the brain, spinal cord, and the heart.
>
> The DOH statement said those infected suffer from upper abdominal
> discomfort or pain, gurgling abdomen, colicky abdominal pain, and
> diarrhea. Tissue reactions may lead to cardiac arrest for those with
> heart problems and also cause intra-cerebral hemorrhage in the brain.
> The statement said if it reaches the spinal cord, the disease may
> result in loss of motor and sensory functions where lesions are
> located. The DOH said diagnosis may be clinical due to similarity
> with peptic ulcer disease (PUD) and acid peptic disease (ACD),
> history of bowel disturbance and consumption of raw or improperly cooked fish.
>
> Sotelo said definitive tests could only be done in the laboratory to
> check parasite eggs using fecal or stool analysis. Sotelo said the
> disease is even more dangerous because, unlike schistosomiasis, which
> [may be contracted] through skin contact with unsanitary areas, the
> general public is at risk with the disease. "Because infection is
> through eating raw fish, it could infect anyone. If somebody eats
> uncooked fish that became host to the fluke, he could also be
> infected," he said.
>
> Sotelo identified fish from both pond and brackish water or estuarine
> waters as susceptible to become hosts to the fluke. He said among the
> long list is bangus, tilapia, "mol-mol", kitong, lapu-lapu and hito.
> He also warned [that] those who eat farmed frogs [are also] at risk.
>
> Sotelo said those who tested positive could [be given medication to
> cure] schistosomiasis. He warned those who have the lifestyle of
> eating raw fish to take the test in health centers. The DOH advised
> proper or thorough cooking of fish as preventive measure.
>
> They have also called for control measures, calling local health
> authorities to educate the population regarding proper eating habits.
> They also called for the banning of fish pond seeding using human and
> animal waste. The DOH also warned of feeding fish [scraps] and [of
> giving] water used to clean fish to animals like dogs, cats, poultry and hogs.
>
> On 29 Sep 2006, medical technologists around Bukidnon will meet to
> study the disease. But Sotelo said the disease is not limited to
> Bukidnon. He said they have learned from experiences shared by health
> authorities in Davao City.
>
> [Byline: Walter I. Balana]
>
> - --
> ProMED-mail
> <promed@promemail.org>
>
> [Heterophyiasis is an infection of the small bowel by minute
> intestinal flukes of the genus Heterophyes or related members of the
> family Heterophyidae. A stool survey conducted in Monkayo, Compostela
> Valley, the Philippines found that 36 percent of patients with
> history of bowel disturbance (abdominal discomfort/pain and/or
> diarrhea) in the past 4 weeks were found to have heterophyidiasis.
> All age groups were infected, with the youngest patient being 1 year
> 7 months of age, while the oldest patient was 73 years of age.
>
> Prevalence was highest in the age group 15-30 years at 55.3 percent
> (Belizario et al. Intestinal heterophyidiasis: an emerging food-borne
> parasitic zoonosis in southern Philippines. Southeast Asian J Trop
> Med Public Health. 2001;32 Suppl 2:36-42). The main symptoms are
> intestinal, but occasionally the eggs may migrate to the heart,
> resulting in potentially fatal myocardial and valvular damage, and to
> other organs (e.g., brain).
>
> A description of the lifecycle is found at
> <http://www.dpd.cdc.gov/dpdx/HTML/heterophyiasis.htm>.
>
> Fish that live in fresh or brackish water are the 2nd intermediary
> host, and the information in the posting that frogs may serve as
> intermediate host is most probably wrong. There is no risk of
> infection from saltwater fish, and infection can be prevented by
> cooking fish adequately. - Mod.EP]
> ...............ep/pg/mpp
>
-- Liz Brown Assistant Professor Alaska Sea Grant Marine Advisory Program School of Fisheries and Ocean Sciences University of Alaska Fairbanks PO Box 1549 Dillingham, Alaska 99576 907-842-1265 fax 907-842-3202 http://seagrant.uaf.edu/map
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