first epidemic and new-emerging human fascioliasis in Kermanshah [western Iran] and a ten-year follow up, 1998-2008

Fascioliasis is one of the most common zoonotic diseases in Iran and other parts of the world. Although the largest epidemic of this disease has occurred in northern provinces of Iran [Guilan] during the past two decades and a few cases have also been reported in Tehran and the other provinces, there has been no evidence of its' occurrence in western provinces of Iran such as Kermanshah before the outbreak which is being reported. The study was conducted by teamwork of infectious disease specialist, parasitologist, general practitioner, entomologist, and laboratory technician. It is an "epidemic investigation" and a cross sectional descriptive one. Clinical data and para-clinical changes are recorded considering all of the population of a village in Kangavar, one of the suburbs of Kermanshah [western Iran]. The mean age was 21.65, [SD=12.44]. Fifty three percent were female, and all of them were farmers. Eighty two percent had a history of watercress ingestion in a period of 1-2 months before the admission and 18% consumed other vegetables. The average of eosinophils was 32.35% [SD=26]. The patients' Enzyme Linked Immunosorbent Assay [ELISA] and Counter Current Immuno-electrophoresis [CCIE] serological tests were reported positive by the department of parasitology, Pasteur Institute of Iran. Treatment response to triclabendazole was excellent. A ten-year clinical and laboratory follow-up revealed no evidence of abnormality in treated patients. It was the first case of human fascioliasis in west Iran and was a real epidemic and an emerging infectious disease for this area at that time. The clinical symptoms were less severe compared with other reports. Health education to inhabitants and health care workers can lead to rapid detection of such outbreaks

Two cases of gastrointestinal anthrax with an unusual presentation from Kermanshah [Western Iran]

During 1988 - 1994 a total of 38 cases of human anthrax were admitted to Sina Hospital in Kermanshah [western Iran]. There were two cases of gastrointestinal anthrax [5.3%] with culture positive ascitic fluid. Among the many reported gastrointestinal signs and symptoms, unexpectedly one of our patients had only vomiting and ascites whereas the other case had only ascites. Neither had abdominal pain, tenderness, diarrhea, hematemesis, melena, or other expected signs and symptoms of anthrax. Therefore, in contrast to the available reports, these cases presented atypically and despite receiving a sufficient dose of penicillin, the drug of choice at that time, both patients died. Gastrointestinal anthrax is not as rare as reported but due to an unusual presentation it may be misdiagnosed. Paying attention to gastrointestinal anthrax in the differential diagnosis of ascites with unknown origin and other gastrointestinal presentations in endemic areas may help to diagnose more cases of anthrax. Timely appropriate management in an early stage of the disease, may increase their chances of survival