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Melinda B Tanabe,1 Maria A Caravedo,1 A Clinton White Jr,1,2 Miguel M Cabada1,2 1Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA; 2Cusco Branch – Alexander von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, PeruCorrespondence: Miguel M Cabada, University of Texas Medical Branch, 301 University Blvd RT 0435, Galveston, TX, 77555, USA, Tel +1 409-747-0236, Fax +1 409-772-6527, Email micabada@utmb.eduAbstract: Fasciola hepatica is a trematode parasite distributed worldwide. It is known to cause disease in mammals, producing significant economic loses to livestock industry and burden to human health. After ingestion, the parasites migrate through the liver and mature in the bile ducts. A better understanding of the parasite’s immunopathogenesis would help to develop efficacious therapeutics and vaccines. Currently, much of our knowledge comes from in vitro and in vivo studies in animal models. Relatively little is known about the host-parasite interactions in humans. Here, we provide a narrative review of what is currently know about the pathogenesis and host immune responses to F. hepatica summarizing the evidence available from the multiple hosts that this parasite infects.Keywords: Fasciola spp, pathogenesis, infection, immunological response

Maria Alejandra Caravedo,1 Miguel Mauricio Cabada1,2 1Division of Infectious Diseases Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA; 2Cusco Branch – Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, PeruCorrespondence: Miguel Mauricio CabadaDivision of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, 301 University Boulevard RT 0435, Galveston, TX 77555, USATel +1 409 747 0223Email micabada@utmb.eduPurpose of the Review: This review aims to critically assess current knowledge about the epidemiology, diagnosis, and management of Fasciola infection in humans.Recent Findings: Fascioliasis is an emerging neglected zoonotic infection affecting the health and wellbeing of human populations. The burden of infection is unclear, and studies have shown the geographic expansion of fascioliasis in human and livestock likely related to climate change. The infection can be asymptomatic or present in acute or chronic forms. Regardless of the presentation, fascioliasis can be associated with long-term complications such as anemia and malnutrition. Early in the infection, antibody testing is the only tool available for diagnosis confirmation. In the chronic forms serology and stool microscopy are helpful. Other tests such as antigen detection and PCR-based methods including isothermal tests have shown promising results. Triclabendazole is the only drug available to treat Fasciola infection. However, reports of resistant infections in livestock and human threaten the clinical care and control of the infection in endemic areas.Summary: Fascioliasis is an emerging infection around the world with an uncertain burden. Lack of standardization of diagnostic testing and treatment alternatives hinder treatment and control of the infection.Keywords: Fasciola hepatica, Fasciola gigantica, diagnosis, treatment, epidemiology, triclabendazole

Background: Cuzco, a Peruvian city of historical interest located 3,326 m above sea level, is a frequent destination for tourists. We conducted a descriptive study to assess the extent and sources of pretravel health advice received by international travelers before their arrival to Cuzco.Methods: Data were collected as part of a health survey among travelers. Between August and November 2002, travelers between 15 and 65 years old were invited to fill out a questionnaire in the departing area of Cuzco's international airport.Results: A total of 5,988 travelers participated. The mean age was 35.4 years (SD 11.4 yr); 50.6% were female and 50.8% were single. Tourism was the reason for traveling in 90.2% of the participants, and 89.3% of them were traveling with companions. Pretravel health information was received by 93.6%. The median number of information sources was two, with books (41.5%), travel medicine clinics (38.8%), the Internet (23.3%), and general practitioners (22.7%) as the main sources. Most frequently received recommendations were about safe food and water consumption (85%), use of insect repellents (66.0%), sunburn protection (64.4%), and condom use (22%). Only 16.5% took medication to prevent altitude sickness, and 14.2% took medication to prevent traveler's diarrhea. Variables independently associated with receiving pretravel health information from a health care professional were female gender, country of residence other than the United States, length of stay in Cuzco > 7 days, length of stay in other Peruvian cities > 7 days, tourism as the main reason for visiting Cuzco, traveling with companions, and consulting of more than one source of information.Conclusions: Most travelers arriving to Cuzco had received pretravel health information, and the majority obtained it from more than one source. Recommendations addressed for specific health risks, such as altitude sickness prophylaxis, were received by few travelers. [ABSTRACT FROM AUTHOR]

Background: In South America, little is known about sexual behavior and risk factors for acquiring sexually transmitted diseases (STDs) among travelers and among local people sexually interacting with travelers. There is evidence that, in Peru, significant sexual interaction between these groups exists.Method: An anonymous written questionnaire was administered to travelers in the airport and bus stations before they left Cuzco.Results: Of the travelers,5.6% engaged in sexual activity with a new partner during their stay in Cuzco. Sexual intercourse with other travelers was most common (76/140, 54.3%), followed by sex with local partners (57/140, 40.7%), and with commercial sex workers (3/140, 2.15%). Consistent condom use was reported by 97/140 (69.3%). In the multivariate analysis, the following variables were independently associated with casual sex: male gender, single marital status, age between 15 and 35 years, non-United States travelers (NUSTs), traveling alone or with friends, length of stay more than 30 days, homosexual or bisexual orientation, and expectation of having sex before traveling. Homosexual and bisexual travelers had 3 or more new sexual partners more frequently than heterosexual travelers (4/8, 18/129, OR=6.17 (1.16Conclusion: Travelers visiting Cuzco engage in sexual activities that put them at risk of acquiring STD and transmitting it, both in their home country and in Peru. We recommend the inclusion of Peru and possibly other Latin American countries in the list of destinations where there is substantial risk of transmission of STD and the provision of pretravel advice regarding this issue to travelers to Peru. [ABSTRACT FROM AUTHOR]