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((Short description|Species of fluke))
((Redirect|Brain worm|the parasite of ruminants known as "brainworm"|Parelaphostrongylus tenuis))
((More citations needed|date=March 2009))
((Taxobox
| image= Dicrocoelium-adult-fresh.jpg
| regnum = [[Animal]]ia
| phylum = [[Platyhelminthes]]
| classis = [[trematode|Trematoda]]
| ordo = [[Plagiorchiida]]
| familia = [[Dicrocoeliidae]]
| genus = ''[[Dicrocoelium]]''
| species = '''''D. dendriticum'''''
| binomial = ''Dicrocoelium dendriticum''
| binomial_authority = ([[Karl Rudolphi|Rudolphi]], 1819)
))

'''''Dicrocoelium dendriticum''''', the '''lancet liver fluke''', is a [[parasite]] [[Trematode|fluke]] that tends to live in [[cattle]] or other grazing mammals.<ref>((cite web|url=http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/22705.htm|title=The Merckt Veterinary Manual|year=2008|publisher=Merck & Co., Inc.|access-date=2008-07-03))</ref>

== History of discovery ==
Much of what is presently known about ''Dicrocoelium dendriticum'' is the result of the work of the naturalist [[Wendell Krull]].<ref>((cite book |last=Esch |first=Gerald |title=Parasites and Infectious Disease Discovery by Serendipity and Otherwise (Parasites and Infectious Disease) |location=New York |publisher=Cambridge UP |year=2007 |isbn=978-0-521-85882-3))((page needed|date=August 2014))</ref>  While ''D. dendriticum'' was discovered by Rudolphi in 1819 and ''D. hospes'' was discovered by Loos in 1899, the full life cycle was not known until Krull and C.R. Mapes published a series of papers from 1951-1953 detailing their observations and experiments. It was known that ''D. dendriticum'' affected sheep, but everything else was a mystery. The first link in the chain was the discovery of the first intermediate host, the land snail ''[[Cochlicopa lubrica]]'' (synonym: ''Cionella lubrica'').<ref name = Krull14887340>((cite journal |vauthors=Mapes CR, Krull WH |title=Studies on the biology of Dicrocoelium dendriticum (Rudolphi, 1819) Looss, 1899 (Trematoda: Dicrocoeliidae), including its relation to the intermediate host, ''Cionella lubrica'' (Müller). II. Collection of the snail, ''Cionella lubrica'', and its maintenance in the laboratory |journal=The Cornell Veterinarian |volume=41 |issue=4 |pages=433–44 |date=October 1951  |pmid=14887340))</ref>  Next came the discovery that the slime balls coughed up by the snails could be a potential method of transfer of the parasite.<ref name = Krull14926337>((cite journal |vauthors=Krull WH, Mapes CR |title=Studies on the biology of ''Dicrocoelium dendriticum'' (Rudolphi, 1819) Looss, 1899 (Trematoda: Dicrocoeliidae), including its relation to the intermediate host, ''Cionella lubrica'' (Müller). III. Observations on the slimeballs of ''Dicrocoelium dendriticum'' |journal=The Cornell Veterinarian |volume=42 |issue=2 |pages=253–76 |date=April 1952  |pmid=14926337))</ref>  Shortly thereafter, the ant ''[[Formica fusca]]'' was found to be the second intermediate host by which sheep were infected.<ref name = Krull12998377>((cite journal |vauthors=Krull WH, Mapes CR |title=Studies on the biology of ''Dicrocoelium dendriticum'' (Rudolphi, 1819) looss, 1899 (Trematoda: Dicrocoeliidae), including its relation to the intermediate host, ''Cionella lubrica'' (Müller). VII. The second intermediate host of ''Dicrocoelium dendriticum'' |journal=The Cornell Veterinarian |volume=42 |issue=4 |pages=603–4 |date=October 1952  |pmid=12998377))</ref> Their work is the foundation of modern understanding of the parasite.

== Clinical presentation in humans ==
''Dicrocoelium dendriticum'' along with ''[[Dicrocoelium hospes]]'' are part of a group of flukes that can infect the bile ducts of humans. Because the bodies of these parasites are long and narrow, infections are generally confined to the more distal parts of the bile ducts. As a result, most ''Dicrocoelium dendriticum'' infections of the biliary tree produce only mild symptoms.  These symptoms can include biliary colic and general digestive disturbances, including bloating and diarrhea. However, in heavier infections, bile ducts and the biliary epithelium may become enlarged in addition to the generation of fibrous tissue surrounding the ducts, and as a result, causing an enlarged liver ([[hepatomegaly]]) or inflammation of the liver ([[cirrhosis]]).<ref name="ncbi.nlm.nih.gov">((cite journal |vauthors=Cengiz ZT, Yilmaz H, Dulger AC, Cicek M |title=Human infection with Dicrocoelium dendriticum in Turkey |journal=Annals of Saudi Medicine |volume=30 |issue=2 |pages=159–61 |year=2010 |pmid=20220269 |pmc=2855070 |doi=10.4103/0256-4947.60525 |doi-access=free ))</ref> In one unique case, an infection with ''Dicrocoelium dendriticum'' was associated with a skin rash [[urticaria]].<ref>((cite journal |vauthors=Sing A, Tybus K, Fackler I |title=Acute urticaria associated with Dicrocoelium dendriticum infestation |journal=Indian Journal of Medical Microbiology |volume=26 |issue=1 |pages=97–8 |year=2008 |pmid=18227619 |doi=10.4103/0255-0857.38879|url=http://www.bioline.org.br/pdf?mb08031 <!-- direct pdf link --> |doi-access=free |hdl=1807/53557 ))</ref>

== Transmission ==
Due to the highly specific nature of this parasite's life cycle, human infections are generally rare.  Ruminants such as cows and sheep are usually the definitive host, but other herbivorous mammals and humans can also serve as definitive hosts through ingestion of infected ants.  One definitive case involved a man who ingested bottled water contaminated by infected ants.<ref>((cite journal |vauthors=Drabick JJ, Egan JE, Brown SL, Vick RG, Sandman BM, Neafie RC |title=Dicroceliasis (lancet fluke disease) in an HIV seropositive man |journal=JAMA |volume=259 |issue=4 |pages=567–8 |year=1988 |pmid=3336179 |doi=10.1001/jama.1988.03720040059028))</ref>

== Reservoirs ==
The main reservoirs for ''Dicrocoelium dendriticum'' are sheep, cows, land snails and ants. However, ''Dicrocoelium dendriticum'' has also been found in goats, pigs and even [[llama]]s and [[alpaca]]s.

== In ruminants ==
Ruminants are the main definitive host of this fluke but other herbivorous animals, carnivores, and humans can be accidental definitive host.<ref name=CDC>((cite web | url = https://www.cdc.gov/dpdx/dicrocoeliasis/ | title = Dicrocoeliasis [Dicrocoelium dendriticum] | date = 28 December 2017 | work = DPDx - Laboratory Identification of Parasites of Public Health Concern | publisher = [[Centers for Disease Control and Prevention]] |language=en-us | access-date = 13 January 2019))</ref>  Most infections, especially in cows, are asymptomatic but the effect on the liver depends on the number of flukes and the length of infection.<ref name=CDC/><ref name="fao.org">((cite web|title=2. The epidemiology of helminth parasites|url=http://www.fao.org/wairdocs/ilri/x5492e/x5492e04.htm#2.4|website=www.fao.org|access-date=2014-04-29|archive-date=2007-07-13|archive-url=https://web.archive.org/web/20070713091428/http://www.fao.org/Wairdocs/ILRI/x5492E/x5492e04.htm#2.4|url-status=dead))</ref> Since the fluke migrates up the biliary duct — but does not penetrate the gut wall or liver tissue — long infections may cause hypertrophy of the bile duct and liver lesion, even in the absence of symptoms.<ref name="fao.org"/><ref name="Otranto, D. 2002">((cite journal |last1=Otranto | first1 = D | last2 = Traversa | first2 = D |title=A review of dicrocoeliosis of ruminants including recent advances in the diagnosis and treatment |journal=Veterinary Parasitology |volume=107 |issue=4 |pages=317–35 |date=August 2002  |pmid=12163243 |doi=10.1016/s0304-4017(02)00121-8))</ref>  While infections with ''D. dendriticum'' are usually symptom free, some animals may show anemia, edema, emaciation, and liver cirrhosis.<ref name="Otranto, D. 2002"/>  However, many of the symptoms of dicroceliosis are similar to those of other gastro-, intestinal-, and lung-nematode infections.

The diagnosis of ''D. dendriticum'' flukes is mainly from the recovery of adults in liver during necropsy or detecting eggs in animal feces.<ref name="Otranto, D. 2002"/>

There is some evidence connecting decreased liver function from the trematode infection with pregnancy toxaemia and mastitis in ewes when combined with other risk factors.<ref>((cite journal |last1=Mavrogianni | first1 = VS | last2 = Papadopoulos | first2 = E | last3 = Spanos | first3 = SA |title=Trematode infections in pregnant ewes can predispose to mastitis during the subsequent lactation period |journal=Research in Veterinary Science |volume=96 |issue=1 |pages=171–9 |date=February 2014  |pmid=24331730 |doi=10.1016/j.rvsc.2013.11.009|display-authors=etal))</ref>

Treatment can be difficult due to the fluke's complex life-cycle.  Various [[Anthelmintic|antihelminths]], especially [[Netobimin]], have been shown to be effective treatment when an entire herd is infected.<ref name="Otranto, D. 2002"/> Animal husbandry practices can decrease the incidence of infection.  This includes the avoidance of animal grazing early in the day or late in the evening, when ants are more likely to climb to the top of the grass blade.<ref name="Otranto, D. 2002"/>

== Incubation period ==
The incubation period for ''Dicrocoelium dendriticum'' is currently unknown.((Citation needed|date=May 2011))

== Morphology ==
[[File:Mature Dicrocoelium dendriticum.jpg|thumb|Mature Dicrocoelium dendriticum under microscope]]
''Dicrocoelium dendriticum'' has a similar morphology to ''[[Clonorchis sinensis]]'', the Chinese liver fluke. ''Dicrocoelium dendriticum'' is distinguished by lobed testes in the anterior of the body, as opposed to ''Clonorchis sinensis'' whose testes are located in the posterior. They both are flat and have a characteristic taper at the anterior and posterior ends. The anterior is distinguished by an oral [[sucker (parasitic worms anatomy)|sucker]] at the point, an acetabulum and the testes. The posterior is where the uterus lies. In the parasite's midsection lie the vitelline glands that are involved in egg formation.

== Life cycle ==
[[Image:Dicrocoelium_LifeCycle.png|thumb|left|''Dicrocoelium dendriticum'' life cycle]]
''Dicrocoelium dendriticum'' spends its adult [[Biological life cycle|life]] inside the [[liver]] of its [[host (biology)|host]]. After mating, the eggs are excreted in the [[feces]].

The first intermediate host, the terrestrial [[snail]] (''[[Cochlicopa lubrica]]'' in the United States), consumes the feces, and becomes infected by the [[larva]]l parasites. The larvae (or [[miracidium]]) drill through the wall of the gut and settle in its digestive tract, where they develop into a juvenile stage. The snail attempts to defend itself by walling the parasites off in cysts, which it then excretes and leaves behind in the grass or substrate.

The second intermediate host, an [[ant]] (''[[Formica fusca]]'' in the United States<ref>((cite web|url=http://workforce.cup.edu/Buckelew/dicrocoelium_dendriticum_is_a_bi.htm |title=Dicrocoelium dendriticum is a bile duct fluke of ruminants such as sheep |publisher=California University of Pennsylvania |access-date=2009-01-09 |url-status=dead |archive-url=https://web.archive.org/web/20080820210738/http://workforce.cup.edu/Buckelew/dicrocoelium_dendriticum_is_a_bi.htm |archive-date=2008-08-20 ))</ref>), uses the trail of snail slime as a source of moisture.  The ant then swallows a cyst loaded with hundreds of juvenile lancet flukes. The parasites enter the gut and then drift through its body.

Most of the cercariae encyst in the haemocoel of the ant and mature into [[Miracidium|metacercariae]], but one moves to the sub-esophageal [[ganglion]] (a cluster of [[nerve cell]]s underneath the [[esophagus]]). There, the fluke takes control of the ant's actions by manipulating these nerves.<ref>((cite web|url=http://www.damninteresting.com/a-fluke-of-nature|title=A Fluke of Nature|publisher=Damn Interesting|access-date=2007-03-22))</ref> As evening approaches and the air cools, the infected ant is drawn away from other members of the colony and upward to the top of a blade of grass. Once there, it clamps its [[mandible (arthropod)|mandible]]s onto the top of the blade and stays there until dawn. Afterward, it goes back to its normal activity at the ant colony. If the host ant were to be subjected to the heat of the direct sun, it would die along with the parasite.

Night after night, the ant goes back to the top of a blade of grass until a grazing animal comes along and eats the blade, ingesting the ant along with it, thus putting lancet flukes back inside their host. They live out their adult lives inside the animal, reproducing so that the cycle begins again.<ref>((cite news|url=http://www.exile.ru/articles/detail.php?ARTICLE_ID=7145&IBLOCK_ID=35|title=Dicrocoelium Dendriticum, the Liver Fluke|date=December 12, 2003|publisher=The Exile|access-date=2008-07-03))</ref>((Unreliable source?|date=June 2010))<ref>((cite news|url=http://www.em-news.com/pt/re/emmednews/pdfhandler.00132981-200211000-00034.pdf;jsessionid=Lt8Q13cFbyTBm7WS2T3vqwtZF05Tj8HMS7Mq0ynCh21p0yJLkhFL!1798224314!181195629!8091!-1|archive-url=https://archive.today/20120729040357/http://www.em-news.com/pt/re/emmednews/pdfhandler.00132981-200211000-00034.pdf;jsessionid=Lt8Q13cFbyTBm7WS2T3vqwtZF05Tj8HMS7Mq0ynCh21p0yJLkhFL!1798224314!181195629!8091!-1|url-status=dead|archive-date=July 29, 2012|title=Infectious Madness: Disease with a Past and a Purpose: Mental illness may not be just craziness, but have a parasitic, fungal, or viral etiology|last=Callahan|first=Gerald N.|date=November 24, 2002|publisher=Emergency Medicine News|access-date=2008-07-03))</ref>((Unreliable source?|date=June 2010))<ref>((cite news|url=https://www.newscientist.com/article/mg14018983.500-evolutions-neglected-superstars-there-is-nothing-glamorousabout-fleas-flukes-or-intestinal--worms-so-why-are-they-suddenlyattracting-so-much-attention-.html|title=Evolution's neglected superstars: There is nothing glamorous about fleas, flukes or intestinal worms. So why are they suddenly attracting so much attention?|last=Holmes|first=Bob|date=November 6, 1993|publisher=New Scientist|access-date=2008-07-03))</ref> Infected ants may contain 100 metacercariae, and a high percentage of ants may be infected. Typical infections in cattle may be in the tens of thousands of adult worms.<ref>((cite web|url=http://www2.biology.ualberta.ca/parasites/ParPub/text/index/plagi02i.htm|title=University of Alberta Parasites Lab|publisher=University of Alberta|access-date=2008-11-07))</ref>

== Diagnostic tests ==
[[Image:D dendriticum egg wtmt JCG C.jpg|thumb|''Dicrocoelium dendriticum'' egg in an [[Staining|unstained]] stool [[wet mount]] slide]]
Traditionally, diagnosis for dicrocoeliasis infection involves the identification of ''Dicrocoelium dendriticum'' eggs in the [[faeces]] of a human or other animal.  However, in humans, eggs in the stool may be a result of ingesting raw infected animal liver and may not in fact indicate dicrocoeliasis.<ref name=CDC /> Therefore, examining bile or duodenal fluid for eggs is a more accurate diagnostic technique in combination with a liver-free diet.<ref name="ncbi.nlm.nih.gov"/>

In animals, diagnosis has traditionally involved stool examination or post-mortem examination of the liver.  Recently, an [[ELISA]] using a ''Dicrocoelium dendriticum'' antigen was able to identify cases of dicrocoeliasis in sheep in Italy 28 days earlier than traditional methods.<ref name="Otranto, D. 2002"/>

== Management and therapy ==
Because human infections with ''Dicrocoelium dendriticum'' are so rare, there are multiple suggestions for treatment. The standard treatment is an [[anthelmintic]] such as [[Praziquantel]], [[Triclabendazole]], or Mirazid.

== Epidemiology ==
[[Dicrocoeliasis]] is believed to be endemic or potentially endemic in 30 countries. ''Dicrocoelium dendriticum'' is found throughout Europe (former U.S.S.R., Switzerland, Italy, Germany, Spain, Turkey), the Middle East (Iran), Asia (China, Japan, Vietnam), Africa (Ghana, Nigeria, Sierra Leone) and in North and South America and Australia.  The parasite tends to be found in areas that favor the intermediate hosts, such as fields with dry, chalky and alkaline soils.

== Public health prevention strategies ==
Current public health prevention strategies have involved the condemnation of contaminated livers so as to eliminate any possibility for food-borne infection.

In addition, in 2007 the World Health Organization included ''Dicrocoelium dendriticum'' on its list of organisms to target with its Foodborne Disease Burden Epidemiology Reference Group.

In addition, a study completed in Sweden combining data about the ''Dicrocoelium dendriticum'' prevalence and landscape data to discover in which landscape the parasite thrives.  It was found that grazing land near forest areas (good for mollusks) and dry pastures with little other biodiversity (good for ants) both increased parasite prevalence.<ref>((cite journal |vauthors=Ekstam B, Johansson B, Dinnétz P, Ellström P |title=Predicting risk habitats for the transmission of the small liver fluke, Dicrocoelium dendriticum to grazing ruminants |journal=Geospatial Health |volume=6 |issue=1 |pages=125–31 |date=November 2011 |pmid=22109870 |url=http://www.geospatialhealth.unina.it/fulltext.php?f=pdf&ida=147 |doi=10.4081/gh.2011.164 |doi-access=free ))((Dead link|date=January 2024 |bot=InternetArchiveBot |fix-attempted=yes ))</ref>

== References ==
((Reflist))

== External links ==
*[https://web.archive.org/web/20070104002943/http://www.weichtiere.at/Mollusks/Schnecken/parasitismus/dicrocoelium.html Lancet Fluke (''Dicrocoelium lanceolatum'') at The Living World of Mollusks]
*[http://theoatmeal.com/comics/captain_higgins Cartoon illustration of the cycle of ''Dicrocoelium dendriticum''.]

((Helminthiases))
((Taxonbar|from=Q21053))

[[Category:Animals described in 1819]]
[[Category:Plagiorchiida]]
[[Category:Parasites of mammals]]
[[Category:Bovine diseases]]
[[Category:Suicide-inducing parasitism]]
[[Category:Veterinary helminthology]]
[[Category:Taxa named by Karl Rudolphi]]

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