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[Changes in the liver lipids of rats with fascioliasis and in fascioliasis combined with protein-calorie malnutrition].

The author examined the amount of total lipids and single lipid fractions of liver in 78 female rats with fascioliasis and with facioliasis combined with energy-protein deficit on the 10th, 30th, 90th, 180th and 240th day after the parasitic invasion. The used a thin-layer chromatographic technique for separation and determination of the concentration of single lipid reactions. There was a tendency to an increase of the liver fats in fascioliasis, but to a reduction in the combination of fascioliasis with undernourishment at the acute stage. She discusses the pathogenesis of the observed changes in the lipid metabolism in connection with the course of the infectious process.

Animals↗

Studies on human fascioliasis in Egypt. 2. Serum iron and copper in chronic fascioliasis.

Twenty-three patients diagnosed as established fascioliasis were enrolled in the present study. Fasciolia cases were investigated for serum iron, copper and their carrier proteins together with haemoglobin and some blood indices. A significant reduction in serum iron was detected in the examined group. This reveals the occurrence of iron deficiency anaemia in patients with chronic fascioliasis.

Adolescent↗

Successful treatment of acute fascioliasis with bithionol.

Fascioliasis is the parasitic infestation of the liver and biliary tract related to Fasciola hepatica. Bithionol is proposed as the treatment of choice for human fascioliasis without major side effects. However, the efficacy of bithionol has been evaluated in chronic but not in acute fascioliasis. In this study we report on the success of treatment with bithionol in 10 patients with fascioliasis, 8 having acute fascioliasis. The criteria for the diagnosis of fascioliasis were hypereosinophilia, positive immunoelectrophoresis and indirect hemagglutination. Bithionol was given orally to hospitalized patients at the daily dose of 25 mg/kg body wt for 10 days. Three patients with acute fascioliasis received a second course of bithionol 2 or 3 mo after the first because of the recurrence of diarrhea and fatigue in one patient and persistent hypereosinophilia in two patients. All patients were cured. The follow-up period after the first course of treatment was between 16 and 47 mo. No major side effects were observed. We conclude that bithionol is the drug of choice for both acute and chronic fascioliasis. Moreover, its oral administration may allow treatment of fascioliasis in outpatients who do not have serious symptoms.

Acute Disease↗

A review on fascioliasis in Egypt.

Fascioliasis, caused by Fasciola species, is a disease of herbivorous animals. It has a worldwide distribution in a large variety of grass-grazing animals as sheep, goats, cattle, buffaloes, horses and rabbits. In Egypt, donkeys and camels as well, are hosts for F. gigantica. Fascioliasis may occasionally affect man. Human infection causes serious hepatic pathological sequences that add to the already known threats to the liver of the Egyptian population. Two clinical stages are recognized in human fascioliasis. An acute stage coincides with the larval migration and worm maturation in the hepatic tissue, and a chronic stage coincides with the persistence of Fasciola worms in the bile ducts. Human infection with fascioliasis was very sporadic until the last three decades where clinical cases and outbreaks were reported. The estimated the number of people currently having fascioliasis to be 360,000 in Bolivia, 20,000 in Ecuador, 830,000 in Egypt, 10,000 in Islamic Republic of Iran, 742,000 in Peru, and 37,000 in Yemen. The total estimated number of people infected is 2.4 million in 61 countries and that the number at risk is more than 180 million throughout the world. Human fascioliasis has to be differentially diagnosed from some diseases as acute hepatitis, infection with other liver flukes as schistosomiasis, visceral toxocariasis, biliary tract diseases and hepatic amoebiasis. The parasitological diagnosis is based on identification of eggs in stool, duodenal contents or bile, also by the recovery of adult worm during surgical exploration, after treatment or at autopsy. However, the eggs may be present in very small number at irregular intervals, hence difficult to be found. Besides, the eggs may be transiently present in stool after ingestion of raw or undercooked liver from infected animals. The direct methods of diagnosing the egg are usually unsatisfactory. The symptoms may be present for several weeks before eggs are recovered in stool. Thus, the serologic tests are the alternative method of confirming early and extrabiliary human fascioliasis. However, cross-reactions with other helminthic antigen may confuse the interpretation of the results.

Animals↗

An outbreak of acute fascioliasis among Aymara Indians in the Bolivian Altiplano.

Fasciola hepatica is a common and important parasite of sheep, cattle, and other ruminants. In May 1991, 30 persons with possible acute fascioliasis were identified by health care providers at a district hospital in the Bolivian Altiplano, and two deaths were associated with this illness. A cross-sectional survey of a random sample of 30 (20%) of the 148 households in the community and a case-control study were performed to determine the extent of the outbreak and the vehicle of transmission. Ninety-one members from 23 of the 30 selected families participated in the cross-sectional survey. Twenty-one of the 91 members met the case definition for acute fascioliasis (illness since 16 February 1991 that was characterized by fever and abdominal pain plus serum IgG antibodies to F. hepatica), and 38 (49%) of 78 members had serum IgG antibodies to F. hepatica. If this rate is extrapolated to the entire community, an estimated 116 individuals (23% of 504) would have acute fascioliasis and 247 individuals (49% of 504) would have evidence of current or previous infection. Case-control analysis indicated that the only factor associated with illness was eating kjosco (an aquatic plant) while tending animals in the fields; 27 (52%) of the 52 case-patients vs. 9 (14%) of the 66 controls ate kjosco (OR = 6.84; 95% CI = 2.60, 18.44). The cause of the two deaths attributed to fascioliasis could not be firmly established. Fascioliasis is a significant human health problem and is highly endemic in the Aymara Indian community in the Bolivian Altiplano. Efforts to prevent fascioliasis should include educating people to avoid eating uncooked aquatic plants such as kjosco.

Acute Disease↗

Epidemiology of human fascioliasis: a review and proposed new classification.

The epidemiological picture of human fascioliasis has changed in recent years. The number of reports of humans infected with Fasciola hepatica has increased significantly since 1980 and several geographical areas have been described as endemic for the disease in humans, with prevalence and intensity ranging from low to very high. High prevalence of fascioliasis in humans does not necessarily occur in areas where fascioliasis is a major veterinary problem. Human fascioliasis can no longer be considered merely as a secondary zoonotic disease but must be considered to be an important human parasitic disease. Accordingly, we present in this article a proposed new classification for the epidemiology of human fascioliasis. The following situations are distinguished: imported cases; autochthonous, isolated, nonconstant cases; hypo-, meso-, hyper-, and holoendemics; epidemics in areas where fascioliasis is endemic in animals but not humans; and epidemics in human endemic areas.

Animals↗

IgM and IgG cystatin capture enzyme linked immunosorbent assays: a tool for serodiagnosis and assessment of cure of acute fascioliasis after triclabendazole (TCZ; Fasinex) therapy.

This study included 71 individuals: 25 patients with confirmed acute fascioliasis, 9 patients with suspected fascioliasis, 27 patients with parasitic infections other than fascioliasis and 10 normal controls. Patients with fascioliasis were treated with TCZ as a single dose and followed up 1 and 4 months after therapy. The results showed that both IgM and IgG cystatin capture ELISAs had very high sensitivity and specificity of 100%. They were also able to diagnose early fascioliasis even before indirect haemagglutination test (IHAT) became positive. Within 4 months after treatment, only 20 patients (80%) with fascioliasis were cured as evidenced clinically, by normal eosinophil count and negative IHAT. After the first month of treatment, IgM and IgG cystatin capture ELISAs became negative in 16.6% and 83.3% of the cured cases respectively, reaching 95% for both assays after 4 months. They remained positive in 5 cases (20%) not responding to treatment.

Acute Disease↗

Fascioliasis among live and slaugthered animals in nine centers of Dakahlia Governorate.

Fascioliasis is an important zoonotic disease. Infected animals are the main source for human fascioliasis. Consequently, this work clarifies the status of animal fascioliasis in Dakahlia centers based on parasitological examination of cows, buffaloes, sheep and goats. The overall rates of infection were 12.31%, 9.73%, 17.84% and 5.40% respectively. The mean eggs per gram stool were 22, 13.6, 148.3 and 8.6 for cows, buffaloes, sheep and goats. The mean numbers of Fasciola worms/liver/animal were 69.1, 62.7 and 208.1 for cows, buffaloes and sheep respectively. The highly infected sheep was in Manzalla (23.07%), the lowest was in Mataria (6.35%). The highly infected cows was in Manzalla (20.9%), the lowest was in Sherbeen (9.43%). The highly infected buffaloes was in Manzalla (19.29%), the lowest was in Mit Ghamr (4.93%). The relatively highly infected goats was in Manzalla (12.5%) and the lowest was zero in Mit Ghamr. So, sheep are the main reservoir host for environmental pollution and human fascioliasis. On the other hand, the overall partial condemnation of liver was 3.81% (1997), 3.24% (1998), 2.66% (1999) and 2.64% (2000). Regarding the type of animal, it was 6.38% in cows, 1.74% in buffaloes and 1.0% in sheep. It seems that sheep are most susceptible to fascioliasis treatment, followed by buffaloes and lastly cows. The epidemiological role of these farm animals as source for fascioliasis infection to animals and man was discussed.

Animals↗

Radiological findings of human fascioliasis.

Fasciola hepatica is a trematode of herbivorous mammals. Humans are accidentally infected by the ingestion of water or raw aquatic vegetables contaminated with the metacercaria. Radiological findings of six patients with fascioliasis (five hepatic fascioliasis, one biliary fascioliasis) were analyzed. The diagnosis was based on serological testing and/or histopathologic findings of eosinophilic abscess in five patients and identification of the adult worm in one patient. The characteristic radiological features of hepatic fascioliasis were (1) cluster of microabscesses arranged in tract-like fashion (burrow tract), (2) subcapsular location of the hepatic lesions, and (3) very slow evolution of the lesion on follow-up examinations. In biliary fascioliasis, there were multiple conglomerated filling defects in the common bile duct. The authors believe that the demonstration of these features, together with peripheral eosinophilia or eosinophilic aspirate from the hepatic lesion, is very helpful in making the correct diagnosis.

Adolescent↗

Fascioliasis: US, CT, and MRI findings with new observations.

BACKGROUND: The purpose of this study is to describe the ultrasonographic (US), computed tomographic (CT), and magnetic resonance imaging (MRI) findings in fascioliasis and to emphasize the impact of radiology in diagnosis. METHODS: Radiologic findings in 23 consecutive patients with fascioliasis were prospectively recorded. All patients had at least one US and CT examination, and 10 of them were studied by MRI. All diagnoses were confirmed by serologic methods. In the first three cases, initial diagnosis was reached by microscopic demonstration of the parasites' eggs in bile obtained by US-guided gallbladder aspiration. RESULTS: In the hepatic phase of fascioliasis, multiple, confluent, linear, tractlike, hypodense, nonenhancing hepatic lesions were detected by CT. On US, the parasites could be clearly identified in the gallbladder or common bile duct as floating and nonshadowing echogenic particles. MRI showed the lesions as hypo- or isointense on T1-weighted images and as hyperintense on T2-weighted images. CONCLUSIONS: CT findings in the hepatic phase and US findings in the biliary phase are characteristic of fascioliasis. Because clinical and laboratory findings of fascioliasis may easily be confused with several diseases, radiologists should be familiar with the specific radiologic findings of the disease to shorten the usual long-lasting diagnostic process.

Adult↗

Immunodiagnosis of Fasciola hepatica infection (fascioliasis) in a human population in the Bolivian Altiplano using purified cathepsin L cysteine proteinase.

Cathepsin L1 (CL1), an immunogenic cysteine proteinase secreted by juvenile and adult Fasciola hepatica, was assessed for its potential as a diagnostic agent for the serologic detection of human fascioliasis. Using ELISAs, we compared the ability of liver fluke homogenates (LFH), excretory/secretory (ES) products, and CL1 to discriminate between seropositive (infected) and seronegative (noninfected) individuals within a population of 95 patients from the Bolivian Altiplano. A high prevalence of human fascioliasis has been reported in this region. The division between the seropositive and seronegative individuals was poorly defined when LFH was used as the antigen. A greater discrimination between these populations was achieved with both ES and CL1. A K-means cluster analysis using the combined ES and CL1 ELISA data identified a cluster of seropositive individuals. Cathepsin L1 detected a subset (20) of these seropositive individuals while ES detected all 26; however, ES detected nine additional individuals that were in the seronegative cluster. The ratio of the mean absorbance readings between seropositive and seronegative individuals was markedly improved by using conjugated second antibodies to IgG4, the predominant isotype elicited by infection. In these IgG4-ELISAs, CL1 again identified fewer individuals as seropositive than did ES, but improved the discrimination between the seropositive and seronegative individuals and thus provided a more conclusive diagnosis. Sera obtained from patients infected with schistosomiasis mansoni, cysticercosis, hydatidosis, and Chagas' disease were negative in these assays, which demonstrated the specificity of the IgG4-ELISA for detecting fascioliasis. Twenty of the 95 patients (21%) were seropositive for fascioliasis by the CL1 IgG4-ELISA, confirming the earlier reports of the high prevalence of disease in this region. A standardized diagnostic test for human fascioliasis, based on an ELISA that detects IgG4 responses to CL1, could be available to all diagnostic centers if sufficient quantities of recombinant CL1 can be produced.

Adolescent↗

Short report: Immunodiagnosis of human fascioliasis using recombinant Fasciola hepatica cathepsin L1 cysteine proteinase.

Our laboratory recently developed a diagnostic test (ELISA) for human fascioliasis based on the detection of serum IgG4 antibodies reactive with Fasciola hepatica cathepsin L1 (CL1). In the present study, we have used recombinant CL1, generated by functional expression of the cDNA in Saccharomyces cerevisiae, in this immunodiagnostic test and compared its performance with native CL1. Sera obtained from 64 individuals living in Cutusuma village in the northern Altiplano of Bolivia, a region with a high prevalence of human fascioliasis, were analyzed by the IgG4-ELISA. A highly statistically significant correlation (r2 = 0.751, P < 0.001) was demonstrated between the absorbances obtained using the recombinant and native proteins. These assays showed that 38 (59%) of the individuals tested were seropositive for fascioliasis, whereas only 26 of them were coprologically positive for F. hepatica eggs. All seronegative patients were also coprologically negative. Serum from individuals infected with schistosomiasis mansoni, cysticercosis, hydatidosis, and Chagas disease did not contain antibodies reactive with the recombinant or native CL1. Therefore, recombinant CL1 shows excellent potential for the development of the first standardized assay for the sensitive and specific diagnosis of human fascioliasis. Finally, our data supports earlier reports on the high prevalence of human fascioliasis in the Bolivian Altiplano, which collectively suggest that the disease has been endemic there for more than a decade.

Adolescent↗

[Clinical considerations on 2 cases of hepatic fascioliasis. Importance of the imaging examinations].

Two cases of hepatic human fascioliasis, both with antecedents of eating watercress, hepatobiliary symptoms and high eosinophilia are described. In the first one (42 year-old male), at the beginning the abdominal ecotomographical and computed tomography images suggested an hepatic tumor, but afterwards, the finding of Fasciola hepatica ova in feces and the observation of numerous typical images of the fluke in the choledochus by means of an endoscopic cholangiography, plus lesions related to a Löffler syndrome detected in a chest radiography, lead to the diagnosis of hepatic fascioliasis. The patient was treated with dehydroemetine. In the second case (52 year-old male), presented pain in the upper right abdominal quadrant; in an abdominal ecography three cystic lesions in the right liver lobe were found. Nor in the feces neither in the bile F. hepatica eggs were observed. Serological tests for fascioliasis and hydatidosis resulted positive. The endoscopic cholangiography was normal. With the presumptive diagnosis of fascioliasis the patient was treated with dehydroemetine. But as his disturbances remained during the following six months, and raising the possibility of a suppurated hydatid cyst or hepatic abscesses, he was submitted to surgery, finding F. hepatica eggs in the chocolate-like hematic liquid. In the wall and in a liver mass resected a grunuloma with eggs of the parasite was detected. The patient was treated again and cured with dehydroemetine. The existence of subcapsular hematomata and granulomas in hepatic fascioliasis, which can give raise to a diagnosis confusion due to their aspect in the ecotomography and computed tomography are commented. The cholangiographic aspect of the affection is discussed.

Adult↗

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↗