Paragonimiasis pulmonar. Reporte de caso pediátrico / Pulmonary paragonimiasis. Pediatric case report

La paragonimiasis es una parasitosis provocada por varias especies de Paragonimus, un trematodo que se transmite a través del consumo de cangrejos poco cocidos o crudos y que se ha encontrado en áreas tropicales y subtropicales de América, Asia y África. Esta infección afecta, principalmente, los pulmones y provoca manifestaciones clínicas y radiológicas muy similares a la tuberculosis pulmonar, por lo cual siempre debe incluirse dentro del diagnóstico diferencial. Se presenta el caso de una niña escolar de 7 años de edad, hospitalizada con el diagnóstico de paragonimiasis pulmonar, quien presentó evolución favorable luego de recibir tratamiento con triclabendazol.

Paragonimiasis is a parasite infection caused by several species of Paragonimus, a trematode that is transmitted through the consumption of raw or undercooked crabs and that has been found in the subtropical areas of America, Asia and Africa. This infection mainly affects the lungs, causing clinical and radiological manifestations very similar to pulmonary tuberculosis, so it should always be included in the differential diagnosis. We present the case of a 7-year-old school patient, hospitalized with the diagnosis of pulmonary paragonimiasis, who had a favorable evolution after receiving treatment with triclabendazole.

Human Cases of Fascioliasis in Fujian Province, China

Fascioliasis is a foodborne zoonotic parasitic disease. We report 4 cases occurring in the same family, in whom diagnosis of acute fascioliasis was established after series of tests. One case was hospitalized with fever, eosinophilia, and hepatic lesions. MRI showed hypodense changes in both liver lobes. The remaining 3 cases presented with the symptom of stomachache only. Stool analysis was positive for Fasciola eggs in 2 adult patients. The immunological test and molecular identification of eggs were confirmed at the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China. The results of serological detection were positive in all the 4 patients. DNA sequencing of PCR products of the eggs demonstrated 100% homology with ITS and cox1 of Fasciola hepatica. The conditions of the patients were not improved by broad-spectrum anti-parasitic drugs until administration of triclabendazole.

Fracaso de dosis única de triclabendazole para el tratamiento de fasciolosis humana / Failure of single-dose triclabendazole in the therapy of human fasciolasis

La fasciolosis humana es prevalente en zonas ganaderas del Perú. La única droga efectiva para tratar a la infección por Fasciola hepatica en la práctica clínica es el triclabendazole (TCBZ). Sin embargo, se ha reportado recientemente resistencia de la F. hepatica al TCBZ en Perú tanto en humanos como en animales. Este problema ya se sospechaba anteriormente en vista que una dosis única de triclabendazole no curaba (eliminación de huevos de Fasciola en heces) en algunos pacientes. Aquí reportamos 11 de 12 casos humanos infectados por F. hepatica que no respondieron a dosis única de TCBZ 10 mg/kg vía oral. En vista de estos resultados observados en la práctica clínica, recomendamos considerar por lo menos dos dosis de TCBZ para los infectados. Creemos que el tratamiento de fasciolosis se ha convertido en un problema emergente desde el punto de vista farmacológico. Se necesitan nuevos regímenes de terapia o drogas contra F. hepática

Human fascioliasis is prevalent in cattle raising areas in Peru. The only effective drug against Fasciola hepatica infections in clinical practice is triclabendazole (TCBZ). However, the occurrence of TCBZ-resistant F. hepatica both in humans and animals has recently been reported in Peru. This issue was previously suspected, due to treatment failure (presence of Fasciola eggs after treatment) in some patients receiving a single dose of TCBZ. Here, we report 11 of 12 human cases infected by F. hepatica who did not respond to TCBZ administered in a single 10 mg/Kg oral dose. Given these results observed in clinical practice, we recommend the use of at least two doses of TCBZ for human fascioliasis. Nowadays, the treatment for fascioliasis has become an emergent problem from the pharmacological point of view. New therapies against Fasciola are urgently needed

Evaluation of activity of triclabendazole against Taenia solium metacestode in naturally infected pigs

Objective: To assess the efficacy of triclabendazole (TCBZ) in porcine cysticercosis. Methods: Eighteen naturally infected cysticercosis pigs were divided into 3 groups of 6 individuals each. The first group was treated orally with TCBZ at a single dose of 30 mg/kg of body weight, the second group was treated orally with oxfendazole at a single dose of 30 mg/kg of body weight and the third group received a placebo (control group). All animals were kept under the same management conditions. The pigs were euthanized 17 wk post-treatment and the number of surviving cysts in muscles was assessed and compared between groups. Results: All pigs treated with oxfendazole had only degenerated cysts in their carcasses. In contrast, TCBZ had very little effect against the parasitic cysts. Cysts from pigs in the TCBZ group looked apparently normal after treatment. However, histological evaluation showed a mild to moderate degree of inflammation. Conclusions: TCBZ is not an efficacious drug against Taenia solium cysticercosis in swine using a single dose.

Evaluation of activity of triclabendazole against Taenia solium metacestode in naturally infected pigs

OBJECTIVE@#To assess the efficacy of triclabendazole (TCBZ) in porcine cysticercosis.@*METHODS@#Eighteen naturally infected cysticercosis pigs were divided into 3 groups of 6 individuals each. The first group was treated orally with TCBZ at a single dose of 30 mg/kg of body weight, the second group was treated orally with oxfendazole at a single dose of 30 mg/kg of body weight and the third group received a placebo (control group). All animals were kept under the same management conditions. The pigs were euthanized 17 wk post-treatment and the number of surviving cysts in muscles was assessed and compared between groups.@*RESULTS@#All pigs treated with oxfendazole had only degenerated cysts in their carcasses. In contrast, TCBZ had very little effect against the parasitic cysts. Cysts from pigs in the TCBZ group looked apparently normal after treatment. However, histological evaluation showed a mild to moderate degree of inflammation.@*CONCLUSIONS@#TCBZ is not an efficacious drug against Taenia solium cysticercosis in swine using a single dose.

Fascioliasis hepática humana: resistencia al tratamiento con triclabendazol / Resistant human fasciolasis: Report of four patients

Human fascioliasis is a parasitic zoonosis that affects the liver of human and herbivorous animals. In chronic cases, its diagnosis is confirmed by direct visualization of parasitic eggs in stool examination, by positive testing for Fasciola hepatica antigens in stools, or by direct observation of parasites by endoscopic retrograde cholangiography or surgery. In acute cases, serological reactions as immunoblothing or detection of parasite antigens in the blood are useful. The treatment of choice is triclabendazole. However, parasite resistance in animals, as well as in man, has been reported to this drug. We report four patients in whom the parasitic infection persisted despite a course of treatment with triclabendazole.

Comparison between albendazole and triclabendazole against Fasciola gigan-tica in human / 中国血吸虫病防治杂志

Objective To compare the anthelmintic effect of albendazole with that of triclabendazole against Fasciola giganti-ca. Methods Two patients infected with Fasciola gigantica were investigated,and one was administered with albendazole orally (200 mg,twice per day for 5 days)and another was administered with triclabendazole[10 mg/(kg?d)for 2 days]. Their total fe-ces were collected daily during the period of whole therapy,and the eggs of the parasite were collected by using the nylon bag method,and incubated at 28℃. Results The parasite eggs were detected from the first patient’s dejecta on the 1st,2nd and 5th day after the end of the treatment,and no miracidiums hatched out as well as no eggs developed during the period of 25 days of the incubation. Meanwhile,her body temperature fluctuated between 37.4℃and 38.3℃,and she still complained bellyache. For the other invalid,the eggs were not detected on the 2nd and 5th day after the end of the treatment. However,the eggs before and dur-ing the treatment developed the miracidiums of Fasciola gigantica on the 13th day after the incubation,but the eggs collected from the 1st day after the termination of the therapy did not develop and no miracidiums hatched out. At the same time,the signs and symptoms of the patient vanished after the 4th day of the end of the therapy. Conclusions Albendazole has no obvious insecticid-al activity on adult Fasciola gigantica in the short term,but may affect the development of eggs. Triclabendazole has the anthelmin-tic effect on the adults as well as eggs of Fasciola gigantica. In addition,triclabendazole has the characteristics of well curative ef-fect,short course of treatment,and no obvious side effects.

Spectrophotometric determination of triclabendazole by acid-dye complexation method in bulk and pharmaceutical formulation.

Two simple, accurate and sensitive spectrophotometric methods were developed for the determination of ticlabendazole in bulk and pharmaceutical formulation. These methods were based on the formation of ion-pair association complex (1:1) with bromocresol purple (BCP) and bromophenol blue (BPB). The coloured products were extracted into chloroform and measured spectrophotometrically at 420 nm. Linearity ranges were 20 – 100 μg/ml for BCP and 10 – 100 μg/ml for BPB, the mean percentage recoveries were 99.61±1.152% and 99.60±0.986% for BCP and BPB respectively. Statistical comparison between the results obtained by these methods and the manufacturer’s method was done, and no significance difference was obtained.

Twenty six cases of human Fasciola gigantica infection in Dali, Yunnan province / 中国地方病学杂志

Objective The aim of the study was to investigate the epidemic situation,clinical symptom,diagnosis and epidemiological characteristics of human Fasciola gigantica infection in Dali,Yunnan province.It will also provide a scientific basis for fasciolosis control and prevention.Methods Epidemic data were collected and patient's clinical signs and symptoms were studied.Serum soluble antigen of Fasciola gigantica of patients and part of family members and health people in the same village was detected using enzyme-linked immunosorbent assay (ELISA) and the eggs of Fasciola gigantica in stool were observed under microscope.Sequencing and PCR amplification of Fasciola gigantica eggs had been done.Sequencing results were analyzed using basic local alignment search tool (BLAST) program of the U.S.National Center for Biotechnology Information (NCBI) and the similarity of the two in the sequence of nucleic acid was compared.Furthermore,patients were experimentally given orally therapeutic doses of Triclabendazole 10 mg·kg-1·d-1 daily for 2 days,and kept in the hospital for observation for one week.Moreover,host and vector were investigated in the surrounding ditches of Dali prefecture and Limnaea peregra snail samples were collected.All the snails were squashed by glass sheet in order to detect the cercarie.Cow dung and sheep manure was collected in the Limnaea peregra distribution environment,and the eggs in the feces were checked by microscope after washing and precipitation.Results All the 26 patients had a continued hyperpyrexia with distinct alimentary system symptoms of nausea,vomiting,stomachache,abdominal distension as well as hepatomegaly,sensitive to percussion,different levels of liver damage detected by CT.All the patients had an eaten history of raw Herba Houttuyniae and other aquatic plants,and the course of the disease was similar,with the same epidemiological characteristics.ELISA detection was used in the 26 patients,family members and other healthy population,the results of all the 26 patients were positive(100.0％,26/26) ; the positive rates of the 57 family members and other health people of the same village were 31.6％ (18/57) and 17.1％ (6/35),respectively.The results of sequencing and BLAST program showed that the pathogen was Fasciola gigantica with the similarity between 99％-100％.PCR amplification also confirmed that the eggs were Fasciola gigantica eggs with an approximately 1000 bp band on agarose gel.After treatment with Triclabendazole,body temperature of the patients dropped to normal and symptoms improved markedly.Moreover,329 Limnaea peregra snails were collected including 5 ones with redia and one-tailed cercariae which were preliminary identified as the larva of Fasciola gigantica.There were also eggs of Fasciola gigantica detected in one stool of cattle and one of goat.Conclusions Eating raw food is the leading cause of the onset of the disease.Triclabendazole is the drug of choice to treat Fasciolasis.Health education should be strengthened by government and disease prevention and control departments in order to make the local residents to understand the potential hazard of eating raw aquatic vegetable and drinking unboiled water,which is the key to prevent the occurrence of the disease.

Comportamiento clínico-terapéutico de Fasciola hepatica en una serie de 87 pacientes / Clinical and therapeutic behaviour of Fasciola hepatica in a series of 87 patients

Introducción: la fasciolosis, por Fasciola hepatica, muestra a escala mundial un incremento en la incidencia de enfermos en los últimos años. Cuba se encuentra entre aquellos países donde se reportan casos esporádicos y algunos brotes epidémicos. Objetivo: describir el comportamiento clínico-terapéutico de esta trematodiosis de trasmisión digestiva en una serie de 87 pacientes ingresados en el Instituto de Medicina Tropical "Pedro Kourí" desde enero de 1996 a diciembre de 2005. Método: los pacientes se dividieron en 2 grupos atendiendo al fármaco prescrito, dihidroemetina o triclabendazol. Se recogieron las variables clínicas al inicio del diagnóstico y 90 d después del tratamiento; se hallaron las medias y la desviación estándar. Resultados: el sexo masculino predominó discretamente con 54 por ciento en nuestra serie de pacientes ingresados en el servicio de medicina tropical del instituto. La ingestión de berro (Nasturtium officinale) estuvo presente en casi la mitad de los pacientes. El dolor abdominal, fiebre y astenia resultaron los síntomas de mayor frecuencia. El triclabendazol y la dihidroemetina fueron útiles en el tratamiento. Conclusiones: se comprobó la utilidad de los exámenes de laboratorio en el diagnóstico y seguimiento de los enfermos. Los antiparasitarios dihidroemetina y triclabendazol resultaron efectivos a las dosis utilizadas con efectos adversos menores.

Introduction: in the last few years, the Incidence rate of fascioliosis caused by Fasciola hepatica has increased worldwide. Cuba is one of the countries that have reported sporadic cases and also some outbreaks of fasciolosis. Objective: to describe clinical and therapeutic features of this trematodiasis of digestive transmission found in 87 patients, who had been admitted to "Pedro Kourí" Institute of Tropical Medicine from January 1996 to December 2005. Methods: patients were divided into 2 groups according to the prescribed drug, that is, triclabendazole and dihydroemetine. The clinical variables were collected at the time of diagnosis and 90 days after treatment; the means and the standard deviation were estimated. Results: males was slightly predominant (54) in our series of patients admitted to the institute service. Consumption of watercress (Nasturtium officinale) was found in almost half of the patients. Abdominal pain, fever and malaise were the most frequent symptoms. Both drugs were useful to treat F. hepatica. Conclusions: this study showed the usefulness of lab tests for diagnosis and follow-up of patients after treatment. The anti-parasitic drugs dihydroemetine and triclabendazole proved to be effective at the prescribed doses in this research with minor adverse effects.

A Paragonimiasis Patient with Allergic Reaction to Praziquantel and Resistance to Triclabendazole: Successful Treatment after Desensitization to Praziquantel

Paragonimiasis is an infectious disease caused by trematodes of the genus Paragonimus. This trematode can be treated successfully with praziquantel in more than 90% of the cases. Although praziquantel is generally well tolerated, anaphylactic reactions to this drug have been reported in a few cases. We report here a 46-year-old Korean female with paragonimiasis, presumed to be due to Paragonimus westermani, who displayed an allergic reaction to praziquantel and resistance to triclabendazole treatment. The patient was successfully treated with praziquantel following a rapid desensitization procedure. Desensitization to praziquantel could be considered when no alternative drugs are available.

Therapeutic efficacy of triclabendazole in treatment of human fascioliasis

Human fascioliasis has recently been widely found in many regions of Vietnam confirmed by clinical and laboratory examinations. Therapeutic efficacy of the specific treatment drug for this disease - triclabendazole (provided by WHO) - was investigated in a study conducted in the hospital for tropical diseases, Ho Chi Minh city from November 2004 to August 2005. A total number of 53 patients treated with single dose of triclabendazole 10 mg/kg of body weight were found to have good compliance. All clinical symptoms disappeared within 24 hours of drug administration and three days later the patients were allowed to discharge with the good health status: pinky face, no abdominal pain and fever, normal vital signs, and good general status. All the patients were requested to return to hospital for re-checking after three months. However, only 18 of them had followed the request due to the objective reasons. The returned ones were found to have good health state with no resurgent clinical features and normal laboratory findings except for a slow decrease of antibody titer. The remaining patients were followed up via telephone and mails showed good health status. Triclabendazole was found to be a good anti-fascioliasis drug with high safety and efficacy and low side effects, and is recommended to widely use in treatment for fascioliasis.

Therapeutic efficacy of triclabendazole in threatment of fasciolopsis

Triclabendazole was used in treatment of 249 fascioliasis patients selected from 25 provinces including 19 Northern and 6 Southern ones. Two different doses were used for two groups: 10mg/kg/body for 226 patients, and 20mg/kg/body for 43 others, twice per day with the interval 6-8 hours from meals. Symptoms on these fascioliasis patients were found as positive ELISA test with Fasciola gigantica antigen (100%), prejudice in liver by ultrasound (87.9%), pain of liver (87.1 %), eosinophilia (63.5%), plodding (26.1 %), fever (39.8%), digestive disorder (20.1%) and positive stool examination with Fasciola egg (16.9%). Most of symptoms were decreased and disappeared within 1 month after treatment except for pain of liver in some patients that lasted longer and disappeared within 6 to 12 months after treatment. The cure rate was 92.9% for 1 month after treatment, 95.2% for 3 months after treatment and 100% for 6 months after treatment. Ultrasound prejudice in liver decreased and disappeared 80.9% for 1 month, 92.6% for 3 months, 96.3% for 6 months and 100% for 12 months after treatment. Eosinophilia rate returned to normal of 90.7% for 6 months and 100% for 12 months after treatment. ELISA test with F. gigantica antigen become negative of 89.4% for 6 months and 100% for 12 months. GOT, GPT, urea and creatinin tests had not pathological change by 1 month using triclabendazole. Side effect of triclabendazole was inconsiderable and disappeared without medical treatment. Triclabendazole may be recommended in treatment for fascioliasis in Vietnam with doses of 10 or 20 mg/kg of body weight.

A Case of Fasciolia Liver Abscess with Severe Eosinophilia in a Child / 소아알레르기및호흡기학회지

A case of child fasciola liver abscess was reported. This case was a. A 5-years-old boy who had a history of fever and abdominal pain for 2 days. There was eosinophilia (15%) and an abdominal ultrasound demonstrated heterogenous hypoechoic mass in the liver. He was diagnosed with bacterial liver abscess and was treated with Unasyn, Amikin, Cefotaxime, and metronidazole. But, the fever did not subside completely and blood eosinophil count was increased to 50%. New hypoechoic lesion in the liver was revealed on the follow-up abdominal ultrasound. Liver biopsy was done and it revealed eosinophil infiltration. Also, there was eosinophil infiltration (20%) in his bone marrow. The serologic test for parasite-specific IgG antibody by micro-ELISA confirmed the diagnosis of Fasciola hepatica infection. He was successfully treated for two days with oral Triclabendazole, 15 mg/kg, daily. Blood eosinophil count was down to 10% and there was no abnormal lesion in the liver on abdominal ultrasound finding.

A Clinical Trial of Triclabendazole in the Treatment of Human Paragonimiasis skrjabini / 中国寄生虫学与寄生虫病杂志

Objective To observe the therapeutic effect of triclabendazole in patients with paragonimiasis skrjabini. Methods Four patients were treated with triclabendazole at dosage of 10 mg/kg bid for 3 days and were followed up for 6～10 months. The clinical symptoms, chest X ray, hemogram and liver function tests were observed before and after treatment. Results Migratory subcutaneous nodules in three patients all disappeared. Small amount of pleural effusion were absorbed in two patients. Severe headache subsided in a patient with cerebral lesion. MRI showed a bean sized calcified spot in the right frontal region. Chest X ray in 2 patients showed that pulmonary lesions were markedly absorbed and disappeared. There was no adverse effect of the drug.Conclusion Triclabendazole has marked therapeutic effect on paragonimiasis skrjabini. It is safe in administration and well tolerated.