Green vegetable juice as a potential source of human fascioliasis in Korea

Fascioliasis, a food-borne helminthiasis, is primarily a disease of cattle and sheep that occasionally occurs in humans. The aquatic perennial herb water dropwort (Oenanthe javanica) has been identified as the primary source of human infections in Korea. Recently, a cluster of patients who had not ingested water dropwort, but had the use of a green vegetable delivery service in common was diagnosed with fascioliasis. Our study aimed to identify the association between the green vegetable juice delivery service and the occurrence of human fascioliasis. Patients with liver abscesses and eosinophilia were enrolled in this study. They were categorized into fascioliasis or non-fascioliasis groups according to serological test results, clinical manifestations, and computed tomography or magnetic resonance imaging findings. Patients were classified into the fascioliasis group when ova or the adult worms of the Fasciola species were detected or serological tests were positive, with compatible clinical and radiological findings. We included 30 patients in this study; 15 were assigned to the fascioliasis group and the remaining 15 to the non-fascioliasis group. The proportion of patients who utilized the juice delivery service was significantly higher in the fascioliasis group than in the non-fascioliasis group (53.3% vs. 0%, P < 0.01). Most of the other patients in the fascioliasis group had known risk factors and the intake of water dropwort or other raw vegetables. This study suggests that human fascioliasis could be transmitted by green vegetable juice produced and delivered by modern industrial systems. Further research on the product, industry and farm-level situations is required to validate these findings.