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PubMed1990

Human fascioliasis: ultrastructural study on the liver before and after bithionol treatment.

The pathology of human fascioliasis was studied before and after bithionol treatment using light and transmission electron microscopy. Fine needle biopsies were taken from five patients, with established fascioliasis, before and after drug administration. By light microscope the pathology of human fascioliasis was similar to that reported in experimental fascioliasis. The ultrastructural picture revealed bile ductular hyperplasia, fibrosis of portal tracts, widening of the interhepatic spaces by many microvilli and dilated Disse space with collagen fibres. Bile ductular hyperplasia may be the initial factor to fibrinogenesis, which subsequently enhance the development of the microvilli on the surface of the hepatocytes. Both light and electron microscopic studies revealed regression of the picture of fascioliasis to normal after bithionol treatment with no sign of toxicity on the liver.

Biopsy, Needle↗
PubMed1995

Metacercarial precipitin test for diagnosis of human fascioliasis.

A metacercarial precipitin test was devised for diagnosis of human fascioliasis. The sera tested were those of cases of fascioliasis (acute and chronic), of schistosomiasis and of normal healthy individuals. Metacercariae were prepared in the laboratory from naturally infected snails. Serum dilutions of 1:5 (20%) and 1:10 (10%) were incubated with metacercariae for periods of 6, 24 and 48 hours. No precipitation was observed when the sera of healthy persons were used. With sera of fascioliasis cases a precipitate was formed which increased in amount with time. It was more rapid in its formation and greater in its quantity with sera of acute fascioliasis. When incubation was prolonged a free precipitate was seen in the medium. With sera of schistosoma cases, a precipitate was observed in a few cases only; it was negligible in amount and localized to the plug area. Metacercarial precipitin is considered a simple, sensitive and specific test for diagnosis of human fascioliasis. It is recommended to use the serum in a dilution of 1:5 (20%), to give preliminary results after 6 hours incubation and to confirm 24 hours later.

Acute Disease↗
PubMed1986

[Fractionation of antigen for ELISA of bovine fascioliasis]

In order to obtain the most specific and sensitive antigen from crude antigens of Fasciola hepatica for the immunodiagnosis of bovine fascioliasis by the enzyme linked immunosorbent assay(ELISA), phosphate buffered saline extract of F. hepatica was prepared. The crude extract was fractionated into 7 antigens using Sephadex G-100 column chromatography. Seven fractionated antigens were applied to ELISA, precipitation test and intradermal test, respectively. Results obtained are as follows: The specificity (95 per cent confidence interval in negative sera of bovine fascioliasis; Mean+2 x SD of absorbance ) of the first (MW>150,000) and the second antigens (MW 120,000) were 93.7 per cent, but those of others including crude antigen showed 100 per cen.t. The sensitivity (positive sera of bovine fascioliasis having higher values with compared to the criterion) of the first, the sixth (MW 16,000) and the seventh antigen (MW<5,000) were 91.6 per cent, 87.5 per cent and 0 per cent, respectively, but those of others showed all 100 per cent. The absorbance by ELISA using the fifth antigen (MW 26,000) was 8.43-folds higher in the positive sera than that in the negative sera. This could be used as one of the most specific antigens for the immunodiagnosis of bovine fascioliasis. In Ouchterlony test, precipitin lines were not found in the sera naturally infected with F. hepatica, but some were found in the sera of rabbits immunized with the crude antigens. The numbers of precipitin lines in the sera of rabbits were different in the different fractionated antigens. They were 6 in the crude, 2 in the second and the third antigens, 1 in the forth, the fifth and the sixth antigens and absent in the seventh antigen, respectively. The wheal size for the bovine infected with F. hepatica was 2.46+/-0.15 cm in the intradermal test antigen (saline extract of F. hepatica) supplied by the Veterinary Research Institute, Rural Development Administration, Korea. The wheal size of the first, the second and the third antigens were larger than that of intradermal test antigen, whereas those of the forth, the fifth, the sixth and the seventh antigens showed smaller than that of the intradermal test antigen. The results suggest that the fifth antigen may be specific antigen for the immunodiagnosis of bovine fascioliasis.

Journal Article↗
PubMed1999

Human Fascioliasis in The Metropolitan Area of Curitiba, Brazil Evaluation of The Foci of Infection and Report of Nine Cases Treated With Triclabendazole.

In Brazil, only 35 cases of human fascioliasis have been reported. Several drugs have been used to treat Fasciola hepatica in humans, including praziquantel, and, more recently, triclabendazole. After three patients were diagnosed as having human fascioliasis by routine stool parasitological examinations done at Hospital de Clínicas UFPR, a study was done to determine the frequency of the infection in people and cattle from the surrounding area. Stool samples from 185 people and from 20 bovines were examined. Nine bovines' exams were positive for Fasciola hepatica and six new diagnoses of human fascioliasis were made. After taking a medical history, physical examination, routine blood examinations and biliary imaging in the 9 patients, therapy was given with praziquantel 75mg/Kg daily for 5 days. After 30 and 60 days stool examinations were made to evaluate the therapy's efficacy. All patients were asymptomatic. Hematological examinations were normal, and only one patient had an abnormal biliary system on the image study (echography). In the nine patients, praziquantel did not eliminate the fasciola eggs. Triclabendazole (a benzimidazole licensed for veterinary use) was therefore tested, 10mg/Kg one oral dose. Triclabendazole was effective and well tolerated in all patients. We conclude that fascioliasis is more common in some regions of Brazil than previously reported, and that single dose triclabendazole is effective and well tolerated in treating human fascioliasis.

Journal Article↗
PubMed2003

Sonographic findings of hepatic lesions in human fascioliasis.

PURPOSE: The aim of this retrospective study was to analyze the sonographic features of hepatic lesions in patients with fascioliasis to help determine the utility of sonography in diagnosing this disorder in patients from areas in which Fasciola hepatica infestation is endemic. METHODS: Seven patients with acute-phase (hepatic) fascioliasis had been identified among a previously reported series of 37 patients with fascioliasis who had been evaluated sonographically at Donostia Hospital in San Sebastián (Guipúzcoa), Spain. The 4 men and 3 women ranged in age from 29 to 69 years (mean, 49 years). A history of ingestion of watercress had been confirmed in 6 of the patients. RESULTS: Sonographically, the hepatic lesions appeared as focal areas of increased echogenicity in the right lobe (2 cases), multiple nodular or irregular lesions of variable echogenicity, ranging from 5 to 25 mm in diameter, in both lobes (4 cases), and a single 6-cm complex mass in the right hepatic lobe (1 case). Therapy with dehydroemetine, praziquantel, or bithionol resulted in complete remission, although 2 patients required an additional treatment cycle. One patient also underwent surgery. CONCLUSIONS: Sonography can be useful in the detection and follow-up of hepatic lesions in human fascioliasis and can facilitate the diagnosis of this condition, particularly in areas where it is endemic.

Adult↗
PubMed1980

Economic importance of bovine fascioliasis in Nigeria.

An attempt was made to determine the annual economic losses due to bovine fascioliasis in Nigeria. The estimates were based on an average annual disease incidence of 2.5%, an assumed mortality rate of 1%, a total liver condemnation rate of 7%, a cattle population of 10 million and an annual slaughter rate of 10%. When the annual cost of treating and controlling fascioliasis amounting to N30,000 was added to other costs, total annual loss due to fascioliasis was estimated at some N5 million. The importance of fascioliasis as a major source of production loss in the animal industry in Nigeria is discussed.

Animals↗
PubMed2002

Trace element levels in the liver of rats with acute and chronic fascioliasis and after treatment with zinc-copper hydroxochloride mixed crystals.

Quantities of trace elements including copper, zinc, cobalt, manganese and iron were investigated in the liver tissue of rats at the acute or chronic stages of fascioliasis following treatment with zinc-copper hydroxochloride mixed crystals. Oral dosing (with food) of zinc-copper mixed crystals to healthy rats increased zinc and copper levels in the liver and decreased the iron content compared with controls. Manganese and cobalt levels did not change significantly. Significant reductions in all trace elements except manganese occurred in the liver of rats with acute or chronic fascioliasis. Manganese levels were slightly increased in rats at the acute stage and slightly decreased in rats at the chronic stage of fascioliasis. The application of mixed zinc-copper crystals at the acute or chronic stages of fascioliasis lead to a restoration of zinc and copper levels and a slight reduction in the iron levels in liver tissue of rats. The beneficial effects of applied salts were more apparent in rats chronically infected with Fasciola hepatica.

Acute Disease↗
PubMed2005

Reviewing lymnaeid vectors of fascioliasis by ribosomal DNA sequence analyses.

Snails of the family Lymnaeidae are of great parasitological importance due to the numerous helminth species they transmit, mainly trematodiases (such as fascioliasis) of considerable medical and veterinary impact. The present knowledge of the genetics and host-parasite relationships of this gastropod group is far from adequate. Fascioliasis is caused by two species, Fasciola hepatica and F. gigantica, which, as in the case of other trematodes, show a marked snail host specificity. Many lymnaeid species involved in fascioliasis transmission still show a confused systematic-taxonomic status. The need for tools to distinguish and characterize species and populations of lymnaeids is evident and the present review concerns new molecular tools developed in recent years using nuclear ribosomal DNA sequences. The small subunit or 18S gene and the internal transcribed spacers ITS-2 and ITS-1 are analysed and evaluated as markers for taxon differentiation and relationships within the Lymnaeidae from genus and species levels to subspecies and population levels. rDNA sequence differences and genetic distances, and their value for reconstructing phylogenetic trees using different methods are considered. Nuclear rDNA sequences are appropriate tools on which to base a review of the systematics and taxonomy of the family Lymnaeidae, without excluding other valuable snail characteristics already available. A reconstruction of the lymnaeid system towards a more natural classification will undoubtedly be helpful in understanding parasite transmission and epidemiological features as well the dispersion of an emerging-reemerging disease such as fascioliasis. Nomenclature for nuclear rDNA genotyping in lymnaeids includes the main rDNA sequence regions able to furnish important information on interspecific differentiation and grouping as well as intraspecific variability of lymnaeid species. The composite haplotype code includes the rDNA markers arranged in order according to their well-known usefulness, in its turn related to their respective, more or less rapid evolutionary ratios, to distinguish between different taxonomic levels, from supraspecific taxa to the species level and up to the population level.

Animals↗
PubMed2006

Eosinophil cationic protein in patients with fascioliasis: its probable effects on symptoms and signs.

Eosinophilia is 1 of the most common signs of fascioliasis especially during acute stage. In this study, our aim was to determine eosinophil cationic protein (ECP) in the sera of patients with fascioliasis and to investigate the likely relation between ECP and symptoms and signs of fascioliasis. Presence of high liver enzyme levels, eosinophilia, abdominal pain or urticaria was not found to be significantly associated with ECP positivity (p>0.05), but statistical analyses revealed that ECP positivity was significantly related to weight loss status of patients (p<0.005). In conclusion, ECP may be 1 of the likely causes of the symptoms and signs of fascioliasis.

Abdominal Pain↗
PubMed2005

Fascioliasis imported to Norway.

We report 3 cases of fascioliasis imported to Norway: a 24-y-old male Vietnamese immigrant and a 51-y-old female Vietnamese immigrant with acute fascioliasis, and a 2-y-old male Ethiopian adoptee with chronic fascioliasis. Diagnosis was confirmed by detection of specific antibodies to Fasciola hepatica in the 2 first cases and by demonstration of Fasciola hepatica eggs in stool samples in the latter case. Treatment with oral triclabendazole led to prompt cure in all 3 patients. Imported fascioliasis is rarely reported but should be suspected in patients with a travel history to endemic areas, abdominal symptoms and hypereosinophilia of the blood.

Adult↗
PubMed2006

Indirect evidence of ectopic pancreatic fascioliasis in a human.

Fascioliasis is not common in humans and, furthermore, its ectopic migration into the pancreas is extremely rare. A definitive diagnosis of ectopic fascioliasis is based on the demonstration of flukes in the affected organ. If the flukes invade the parenchyma, however, imaging studies are limited in the detection of worms and surgical identification is required. We encountered a clinical case of probable ectopic pancreatic fascioliasis diagnosed through indirect evidence. A 46-year-old Korean woman was admitted with left upper quadrant pain. She had taken praziquantel for hepatic fascioliasis, which had been diagnosed at another hospital, and then developed abdominal pain. Peripheral eosinophilia, hyperamylasemia and hyperlipasemia were documented. Abdominal computed tomography (CT) revealed multiple, hypodense foci which had coalesced, forming irregular nodules in the medial and lateral segments of the left lobe of the liver, and similar 2- to 3-cm sized, hypodense lesions in the body and isthmus of the pancreas. IgG antibody against Fasciola hepatica was positive. Bithionol was given orally, and the patient's symptoms and biochemistry then improved, with reversal of eosinophilia. Radiological studies showed normalization of the liver and pancreas at the 10th week, and the serology for Fasciola hepatica was negative at the fifth month.

Animals↗
PubMed1997

[Human fascioliasis: comparison of a fasciolicidal effect of bithionol and praziquantel].

There is no consensus about the optimal treatment for fascioliasis. Here we report 5 cases of fascioliasis and 12 cases of fascioliasis reviewed from the literature, and discuss the clinical characteristics and treatment of this parasitic disease. The diagnosis was made in 88% of all patients by the serological test and eggs in the feces were negative in all patients. The characteristic CT findings of all patients in our series were cluster of multiple abscess-like lesions in the liver. Eosinophilia was present in all patients. Bithionol was effective in all of the 13 patients and praziquantel was effective in 4 of 8 patients. Three of 4 patients, in whom praziquantel was not effective, were treated with bithionol successfully. No severe side effects were noticed in all patients. Bithionol seems to be more effective against fasciola sp. than praziquantel. Bithionol is proposed as the drug of choice for the treatment of human fascioliasis.

Aged↗
PubMed2005

Triclabendazole for the treatment of fascioliasis and paragonimiasis.

Fascioliasis and paragonimiasis, which are caused by liver flukes (Fasciola) and lung flukes (Paragonimus), are emerging public health problems. Several hundred millions of people are at risk of the two diseases that cause considerable morbidity and delay socio-economic development. Triclabendazole, a benzimidazole derivative, has been routinely used since 1983 in veterinary medicine to control infections with Fasciola spp. in domestic herbivorous animals. In 1986, a veterinary formulation of triclabendazole was first administered to two human patients with fascioliasis. Clinical data obtained thus far suggest that triclabendazole is the most efficacious and best tolerated drug for the treatment of fascioliasis. Moreover, the drug holds promise as a useful therapeutic alternative to praziquantel in the treatment of paragonimiasis. This review of triclabendazole includes an overview of the pharmacodynamics and pharmacokinetics, toxicology and efficacy against the major food-borne trematodes in laboratory animals. Data from case reports and clinical trials in humans infected with Fasciola spp. and Paragonimus spp. are summarised and the current state of triclabendazole regarding treatment of human fascioliasis and paragonimiasis is described. Efforts to facilitate broader registration of this drug should go hand-in-hand with research and development on novel drugs against food-borne trematodiasis, better access to improved sanitation, sound health education and the development of new technologies for assuring food safety.

Animals↗
PubMed1998

Cystatin capture enzyme-linked immunosorbent assay for immunodiagnosis of human paragonimiasis and fascioliasis.

An ELISA was developed using chicken cystatin as a capture agent for the immunodiagnosis of paragonimiasis and fascioliasis. The assay detected specific antibodies to fluke cysteine proteinases without the need for purified proteinases. An ELISA plate was sensitized with chicken egg white cystatin, incubated with excretory-secretory (ES) products of adult flukes, and standard ELISA procedures were then followed. The ELISA plates incubated with the ES products of Paragonimus westermani and Fasciola sp. showed high reactivity to sera from patients with paragonimiasis westermani and fascioliasis, respectively. The capture ELISA showed little cross-reactivity with sera from patients with paragonimiasis and fascioliasis, which showed immunodiagnostic cross-reactivity in a conventional ELISA using crude fluke antigens. Moreover, the capture ELISA showed little reactivity with sera from patients with five other helminth diseases and from healthy volunteers. Omitting either sensitization with cystatin or incubation with fluke ES products abolished high ELISA reactivity, as did a prior exposure of the ES products to cystatin. The addition of papain to an incubation solution of the ES products greatly reduced ELISA reactivity. Incubating the cystatin-sensitized plates with partially purified cysteine proteinases from flukes instead of the ES products also maintained a similar high ELISA reactivity. These results indicate that the cystatin capture ELISA elicits a cystatin and fluke cysteine proteinase antigen-mediated reaction and measures fluke cysteine proteinase-specific antibodies. Prior exposure to low molecular weight inhibitors of cysteine proteinases and other proteinases, such as E-64, leupeptin, aprotinin, and pepstatin, had no effect, suggesting that these inhibitors can be added to cysteine proteinase preparations to prevent autoproteolysis. This assay has good sensitivity and high specificity and is useful for the immunodiagnosis of paragonimiasis and fascioliasis.

Animals↗
PubMed1999

Analysis of climatic data and forecast indices for human fascioliasis at very high altitude.

Human infection with Fasciola hepatica has recently been recognized as an important health problem worldwide, and particularly at very high altitudes in South America. The highest prevalences and intensities of human fascioliasis known are those of the northern Bolivian Altiplano, where infected Lymnaea truncatula occur at altitudes of 3800-4100 m. In the present study, the climatic data for this area of the Altiplano, which differ markedly from those of endemic areas in the lowlands, were analysed. There is no marked seasonality in temperature but there are large variations in temperature within a daily, 24-h period. Rainfall is seasonal, with a long dry season, coinciding with the lowest minimum temperatures, and a long wet season. The rate of evapotranspiration is very high, and temporary water bodies dry out very quickly. Solar radiation at ground level is intense, not only because of the altitude but also because of the lack of trees and shrubs. Two climatic indices for forecasting fascioliasis, Mt and Wb-bs, were calculated. Modifications in these forecast indices are proposed, to reflect the environment at high altitude and low latitude. Estimates, based on climadiagrammes, of the durations of the wet and dry seasons were greatly effected by the inclusion of an aridity-index modification. The usefulness of the modified indices was examined using prevalence data for human and cattle fascioliasis collected in the neighbourhoods of the stations providing the meteorological data. Values for both indices indicated that conditions were optimum for transmission between December and March. The results were statistically significant for the modified Wb-bs index when the data for a meteorological station in which no lymnaeids were found were excluded. The modified Mt index did not appear sufficiently accurate to be useful. The values for the modified Wb-bs index permitted the study areas to be designated low-, moderate- or high-risk areas for the transmission of fascioliasis to man and domestic animals.

Altitude↗
PubMedDate not supplied

[Massive hepatobiliary fascioliasis].

UNLABELLED: Massive hepatobiliary fascioliasis. Report of two cases. INTRODUCTION: Liver fascioliasis is the most frequent parasitic disease of the biliary tract in Mexico. Massive infestation is common in sheep and bovines and rarely occurs in humans. Only two previous cases of massive fascioliasis has been reported and we present here in two additional cases. Case reports. Both cases presented in alcohol-related liver disease patients who had eaten watercress Nasturium officinalis. Upper abdominal pain, obstructive jaundice, and choledochal dilatation were the salient manifestations. Diagnosis was made by surgical exploration and adult fluke identification. One patient died due to progressive liver failure and the other, is alive and received praziquantel treatment. CONCLUSIONS: Since 1935, approximately fifty cases of massive hepatobiliary fascioliasis have been reported in Mexico, most misdiagnosed as cholelithiasis; however, a history of watercress ingestion has been recorded in most of these cases.

Aged↗
PubMedDate not supplied

[Imaging and fascioliasis of the biliary tract: report of 4 cases].

Fascioliasis is a cosmopolitan parasitic disease. The development of some diagnostic imaging methods such as ultrasonography (US) and endoscopic retrograde cholangio-pancreatography (ERCP) have provided the opportunity of detecting the presence of the parasite in the gall-bladder and in the extra-hepatic biliary tract. Four cases of fascioliasis in the biliary tract are shown, in which the ultrasonographic findings suggested a diagnosis of fascioliasis which was later confirmed by biliary drainage and/or stool culture. When there is no clinical evidence of parasitism, ultrasonography may help to assume the presence of the parasite. The ERCP is useful to confirm the location of the trematode in the extra-hepatic biliary tract. Biliary tract fascioliasis may present as a cholestatic syndrome.

Adult↗
PubMed2002

Evaluation of two serological tests in diagnosis of human cases of biliary and ectopic fascioliasis.

In the present study, sera were examined using Fasciola-IHA, F-ELISA and Schistosoma-IHA. The sero-positive schistosomal patients were subjected to rectal snip, while the sero-positive fascioliasis ones were examined radiologically by plain chest X-ray and abdominal ultrasonography. Both F-IHA and F-ELISA gave 100% sensitivity. The specificity of both testes were 90.4% and 100% respectively. With the S-IHA, the parasitologically proven schistosomal mansoni patients gave 95% positivity, while the proven fascioliasis patients gave false positive (8%) with this S-IHA. The radiological findings of the fascioliasis patients confirmed ectopic pleuro-pulmonary infection in five patients. Ascitis was detected in one patient, the pleural effusion and ascitic fluids showed high eosinophils. However, Fasciola eggs were detected in three patients only. Two patients showed hepatic nodules, and another two had hepatic cystic lesions. Three patients had immature Fasciola worms in gall bladder. For diagnosis of human fascioliasis, serological and radiological means should be done side by side with the stool examination. This is particularly true in chronic cases and in schistosomiasis mansoni endemic areas.

Adolescent↗