Intended for healthcare professionals

Clinical Review

Manifestation, diagnosis, and management of foodborne trematodiasis

BMJ 2012; 344 doi: (Published 26 June 2012) Cite this as: BMJ 2012;344:e4093
  1. Thomas Fürst, research fellow12,
  2. Somphou Sayasone, research fellow3,
  3. Peter Odermatt, associate professor and research group leader12,
  4. Jennifer Keiser, professor and head of the helminth drug development unit24,
  5. Jürg Utzinger, professor and head of the ecosystem health sciences unit12
  1. 1Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, PO Box, CH-4002 Basel, Switzerland
  2. 2University of Basel, Basel, Switzerland
  3. 3National Institute of Public Health, Ministry of Health, Vientiane, Lao People’s Democratic Republic
  4. 4Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
  1. Correspondence to: J Utzinger juerg.utzinger{at}
  • Accepted 19 April 2012

Summary points

  • Foodborne trematodiasis is a cluster of zoonotic infections caused by parasitic trematodes ingested in undercooked, mainly aquatic, food

  • Prevalence is increasing because of the growth of inland fish production; most cases are in Asia and Latin America, but infections in migrants and returning travellers are reported elsewhere, including Europe and North America

  • Foodborne trematodes are grouped as liver, lung, and intestinal flukes and—depending on the species, the duration and intensity of infection, and host susceptibility—inflammatory lesions and damage to tissues and organs occur with various clinical manifestations

  • The most serious clinical consequences are cancer of the bile duct (in clonorchiasis and opisthorchiasis) and ectopic infections (mainly in paragonimiasis, but also in fascioliasis and intestinal fluke infections)

  • Direct parasitological diagnosis via the detection of eggs in faeces (all flukes) and sputum (lung flukes only) is the most common approach

  • Praziquantel and triclabendazole are safe and efficacious treatments but other drugs are being investigated

Foodborne trematodiasis is a cluster of zoonotic infections caused by parasitic worms (class: trematoda; also known as flukes), which are transmitted via the ingestion of contaminated, mainly aquatic, food. More than one billion people are at risk of infection according to a systematic review from 2005.1 Another systematic review and meta-analysis suggests that 56 million people were infected in 2005, mainly in Asia and Latin America, with a global burden of 665 000 disability adjusted life years.2

Depending on the fluke species, foodborne trematodiasis is associated with a variety of signs, symptoms, and pathological consequences. The non-specificity of the clinical manifestations, the wide range of fluke species, and shortcomings in current diagnostic techniques are some of the reasons why foodborne trematodiasis is underestimated.3 4

This review introduces the most important foodborne trematode species and describes their geographical distribution. It also discusses pathological consequences, clinical manifestations, diagnosis, …

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