Report of the First Epidemic of Human Fascioliasis in Kermanshah (Iran)

Fascioliasis is one of the common zoonotic diseases in Iran and other parts of the world. Although the largest epidemic of this disease (with 10000 cases) has occured in northern provinces of Iran (Guilan) during the past ten years and a few cases have also been reported in Tehran (being originaly from Isfahan, and East Azarbaijan), there has been no evidence of it's occurrence in western provinces of Iran such as Kermanshah before the recent epidemic. So we have been faced with the first epidemic and have reported it here.The youngest patient was a 4 years old child and the oldest one was a 49 years old patient, (mean=21.65, SD=12.44). 53% of the patients were female and the rest were male, and all of them were farmers. 82% of them had a history of watercress ingestion in a period of 1-2 months before the admission and 18% used unvegetables. Weight loss and weakness were the most common symptoms and ta and hepatosplenomegalia were the most common signs. 54% of patients had leukocytosis and 6% of them had leukopenia. The average of their peripheral blood eosinophills was 32.35 (SD=26) and the hemoglobin was less than 12 g per deciliter in 41% of them. The patient's ELISA and CCIE serologic tests were reported positive and in 50% of them IFA test was positive. Treatment response to triclabendazole was excellent with a well-being sense within 5 days, also anemia was corrected after one month and eosinophill count was decreased within 2 months. The clinical symptoms in these patients were similar to that of Guilanian patients but totally with a less severity compared to them. It is necessary to say that there was no sign and symptom of the I disease in the patients after nine months of therapy and all of them were well. CBC count an hemoglobin concenteration were completely normal but a mild to moderate eosinophilia was found in half of them. In many of the patients ELISA test was positive, but CCIE test was negative in most of them,