Asociación de fascioliasis con el estado nutricional y coinfección enteroparasitaria en niños / Association of fascioliasis to nutritional status and enteroparasite coinfection in children

Introducción: La fascioliasis es causada por el trematodo Fasciola hepatica que afecta a animales herbívoros, omnívoros y al humano. Los niños de edad escolar son los más afectados y el órgano más dañado es el hígado. Este parásito requiere de reservorio y huésped intermediario para completar su ciclo biológico. Objetivo: Determinar la asociación de la fascioliasis con el estado nutricional y coinfección enteroparasitaria en niños. Métodos: La investigación se realizó entre septiembre de 2016 y abril de 2017 en el distrito de Santa María de Chicmo, región Apurímac. El estudio fue analítico de corte transversal. La población de niños de 6 a 16 años estuvo constituida por 2 172 individuos. El tamaño de muestra fue de 435 niños y se determinó mediante un muestreo simple al azar. Además, para que el muestreo fuera más eficiente se distribuyó el tamaño total de la muestra entre los estratos I.E. Primaria e I.E. Secundaria, para un resultado de 209 y 226 muestras, respectivamente. Sin embargo, se logró tomar 493 muestras coprológicas y serológicas repartidas proporcionalmente entre la totalidad de 23 instituciones educativas. Resultados: La prevalencia de fascioliasis fue de 5,3 por ciento (26/493; IC95 por ciento =3,2-7,4). Las instituciones educativas con mayor prevalencia fueron: Taramba con 17,2 por ciento (5/29; IC95 por ciento = 5,9-35,8), Libertadores de América con 16,1 por ciento (5/31; IC95 por ciento = 5,5-33,7), Mariano Melgar con 15 por ciento (3/20; IC95 por ciento = 3,2-37,9) y Nuestra Señora de Guadalupe con 10,8 por ciento (4/37; IC95 por ciento = 3-25,4). No se encontró asociación de fascioliasis con la valoración nutricional antropométrica ni con la coinfección enteroparasitaria en niños (p˃ 0,05). Conclusiones: La fascioliasis no estaría afectando el estado nutricional de los niños; asimismo, los signos clínicos, atribuidos a fascioliasis, corresponderían también a la alta presentación de parásitos entéricos(AU)

Introduction: Fascioliasis is caused by the trematode Fasciola hepatica and affects herbivorous and omnivorous animals as well as humans. Schoolchildren are the most affected group, and the organ most commonly targeted is the liver. This parasite requires an intermediate reservoir and host to complete its biological cycle. Objective: Determine the association of fascioliasis to nutritional status and enteroparasite coinfection in children. Methods: An analytical cross-sectional study was conducted from September 2016 to April 2017 in the district of Santa María de Chicmo, Apurímac Region. The child population aged 6-16 years was composed of 2 172 individuals. The sample size was 435 children, and it was determined by simple random sampling. Additionally, in order for the sampling to be more efficient, the total sample size was distributed between the strata Primary E.I. and Secondary E.I., for 209 and 226 samples, respectively. However, 493 coprological and serological samples were proportionally taken from the total 23 educational institutions. Results: Prevalence of fascioliasis was 5.3 percent (26/493; CI95 percent=3.2-7.4). The educational institutions with the highest prevalence were Taramba with 17.2 percent (5/29; CI95 percent= 5.9-35.8), Libertadores de América with 16.1 percent (5/31; CI95 percent= 5.5-33.7), Mariano Melgar with 15 percent (3/20; CI95 percent= 3.2-37.9) and Nuestra Señora de Guadalupe with 10.8 percent (4/37; CI95 percent= 3-25.4). No association was found between fascioliasis and nutritional anthropometric assessment or enteroparasite coinfection in children (p˃ 0.05). Conclusions: Fascioliasis was not found to affect the nutritional status of children. On the other hand, the clinical signs attributed to fascioliasis also correspond to the high presentation of enteric parasites(AU)

Fasciolasis Hepática, serie de casos reportados en Matanzas. Cuba / Hepatic fasciolosis, a series of cases reported in Matanzas, Cuba

RESUMEN Introducción: la fasciolasis hepática es una enfermedad parasitaria de difícil diagnóstico. La variada y múltiple sintomatología que caracteriza la enfermedad, la expulsión intermitente y tardía de los huevos del parasito, así como el difícil acceso a los estudios inmunológicos en las zonas rurales atenta contra la confirmación de parasitosis en casos esporádicos. En la provincia de Matanzas en los últimos años se constataron enfermos sospechosos de fasciolosis procedentes de Pedro Betancourt con diversos síntomas digestivos, fiebre y eosinofilia. Objetivo: caracterizar los aspectos clínicos y epidemiológicos de los pacientes diagnosticados de fasciolosis hepática. Materiales y Método: se realizó un estudio observacional, descriptivo a pacientes hospitalizados con el diagnóstico presuntivo de fasciolosis hepática en el Servicio de Medicina Interna del Hospital Faustino Pérez en el período enero del año 2011 a diciembre del 2013. La recolección de datos se realizó a través del interrogatorio, examen físico, Historia clínica y encuestas epidemiológicas. Resultados: se muestra la presencia de consumo de plantas acuáticas y consumo de agua sin hervir en los afectados. La fase aguda de la enfermedad en estos pacientes se caracterizó por fiebre, dolor abdominal, hepatomegalia y gran eosinofilia. Conclusiones: el diagnóstico de certeza se realizó a través de pruebas inmunológicas. Esto se debe a que a pesar de los múltiples exámenes parasitológicos de las heces fecales no se identificó huevos. Los pacientes del estudio fueron tratados con el triclabendazol y se logró mejoría clínica de los pacientes y pocas reacciones adversas (AU).

SUMMARY Introduction: the hepatic fasciolosis is a parasitic disease of difficult prognosis. The varied and multiple symptoms characterizing the disease, the intermittent and late ejection of the parasite eggs, and also the difficult access to immunological studies in the country areas sometimes attempts against the confirmation of parasitism. During the last years, in the province of Matanzas, several sick persons from Pedro Betancourt were suspicious of fasciolosis with different digestive symptoms, fever and eosinophilia. Objective: to characterize the clinical and epidemiological aspects of the patients diagnosed of hepatic fasciolosis. Materials and method: an observational, descriptive study was performed in in-patients of the Service of Internal Medicine of the Hospital Faustino Perez with the presumptive diagnosis of hepatic fascilosis in the period January 2011-December 2013. Data collection was made through questioning, physical examination, clinical record and epidemiological inquiries. Results: risk behaviors are evidenced given the water plants and un-boiled water consumption in affected persons. The acute `hase in these individuals is characterized by fever, abdominal pain, hepatomegaly and big eosinophilia. The diagnosis of certainty was made by immunologic tests. The patients were treated with triclabendazol with clinical improvement and little adverse reactions. Conclusions: health professionals when assisting a patient from a country area with eating habits of fresh vegetable consumption and suggestive clinical characteristics should carry out studies to confirm Fasciola hepatica infection (AU).

Negative serology of Fasciola hepatica infection in patients with liver cancer in Peru: a preliminary report

Abstract INTRODUCTION: The etiology of several hepatocellular carcinoma (HCC) cases remains largely unknown. Although Fasciola hepatica has been associated with liver fibrosis in Latin America, it has not yet been associated with HCC. This study aimed to determine the existence of specific IgG antibodies against F. hepatica in the serum samples of HCC patients. METHODS In total, 13 serum samples from 13 HCC patients were screened using Fas2-ELISA. RESULTS Fas2-ELISA demonstrated negative results in all HCC patients included in this study. CONCLUSIONS The pre-existence of F. hepatica infection in HCC patients needs to be further investigated in epidemiological and experimental studies.

A Case of Fascioliasis in the Intrahepatic Duct with Concurrent Clonochiasis / 대한소화기학회지

The main causes of biliary obstruction are stones and cancers. Fascioliasis is a very rare case which causes biliary obstruction. Fascioliasis is a zoonosis caused by Fasciola hepatica which infects herbivores like sheep and cattle. F. hepatica lives in the biliary system or the liver parenchyma of a host. In Korea, the occurrence of this infection in human is very rare and only few cases have been reported. A 32-year-old male presented with upper abdominal pain and jaundice. His laboratory finding revealed elevated liver transaminases. Abdomen CT scan showed mild left intrahepatic bile duct dilatation. On ERCP, adult F. hepatica worms were found and were thus removed. Concurrently, clonorchiasis was diagnosed by stool exam and serologic enzyme-linked immunosorbent assay test. Clonorchiasis was treated with praziquantel. Herein, we report a case of intrahepatic bile duct dilatation due to F. hepatica infection with concurrent Clonorchis sinensis infestation.

Zoonotic ectopic fascioliasis: review and discussion

Ectopic fascioliasis [EF] has direct and indirect effects on both humans and animals. The phenomenon of EF was individual cases in the period from 1950 up to the end of last century. From the period of 2000 up .to 2006, plenty of researches were on EF in the developed and undeveloped countries. Nineteen EF cases infected with the immature and few with the mature worms were 13 females and 6 males. Three cases of lymphatic, pleural and breast fascioliasis reached the adults and laid their eggs in a lymph node in the cervical region pleural cavity and breast tissues. Until recent, knowledge about the ectopic fascioliasis pathway is little. Fasciola hepatica was the commonest species in most cases. The effect of fascioliasis might be direct to liver as ectopic foci or indirect on other organs due to the metabolites and secretory excretory products. All ages and both sexes were EF infected. Watercress topped the list of water plants born encysted metacercariae followed by lettuce, mint, and alfalfa. Nearly 24 million Egyptians at risk and about 800.000 were infected. On the global scale, about 180 million are at risk of infection

Hematoma subcapsular por Fasciolasis / Liver subcapsular hematoma caused by Fasciola hepatica: report of one case

We report a 60 years old female admitted for pain in the right upper quadrant of the abdomen, vomiting and fever. Initial laboratory showed leukocytosis with 56 percent of eosinophils. An abdominal CAT scan showed a subcapsular fluid collection in the liver. The patient was operated and the presence of a subcapsular hematoma was confirmed. Blood serological tests were positive for Fasciola hepatica. The patient was treated with tricabendazole and after one year of follow up, is in good conditions.

Presentamos el caso de una paciente de sexo femenino de 60 años de edad, ingresada en nuestro centro hospitalario por cuadro agudo de dolor abdominal en hipocondrio derecho asociado a vómitos y fiebre. Destaca la presencia de leucocitosis con eosinofilia de 56 por ciento. La tomografía computarizada abdominal muestra una colección subcapsular hepática. Durante su evolución presenta abdomen agudo, realizándose una laparoscopía exploratoria que confirma un hematoma subcapsular con presencia de hemopentoneo de escasa cuantía. La serología confirma infección por fasciola hepática. Se realizó su tratamiento con triclabendazol en monodosis. Además, realizamos una revisión de la literatura nacional e internacional sobre el tema, sus manifestaciones clínicas, métodos diagnósticos y tratamiento.

Early development of osteoporosis in male smokers with hypoandrogenism due to fascioliasis with or without schistosomiasis added by life style

The rnultifactor outcome of hypoandrogenemia with the impact of oxidative stress induced by glucose intolerance, fascioliasis with or without schistosomiasis and cumulative smoking influence on bone remodeling and the early development of osteo-porotic manifestations were studied. The effect on vascular endothelium immune mediated mechanisms and antioxidant capacity were monitored in cases of youth aged selected male smokers involving 20 with hypoandrogenemia who were either subjected to sedentary life style, glucose intolerance fascioliasis hepatic fibrosis [FHF] [G1] or without [G2] and GI after following 6 months therapy [G3]. Monitoring of clinical picture and biochemical assessments of osteoporotic indices [osteocolcin, bone alkaline phosphatase, parathyroid hormone, urinary cyclic AMP], hypoandrogenism [dehydroepiandrosterane sulphate or DHEAS and testosterone] glycemic determinant [insulin] immuno-inflammatory response [inter-leukein-6, tumor necrosis factor a, E-selectin, ceruloplasmin] smoking index [serum cotinine], total antioxidant capacity [AOC] and lipid peroxidation [malonedialdehyde] was done before and after 6 months therapeutic program involving supplement of DHEAS, mirazid, chromium picolinate, and megavit zinc alongside smoking cessation and physical exercise daily for at least 30 minutes. Treatment with Mirazid supplied as 10 mg/kg for 6 successive days resulted in 100% cure of fascioliasis whether single or combined with schistosomiasis

Fascioliasis

Fascioliasis is a parasitic Hepatobilliary disease caused by most prevalent Fasciola Hepatica Trematoda. This illness occurs worldwide in all age group and race. Incidence of infection has increased over the past 20 years. An estimated 180 million cases have been at risk of infection and 2.4 million cases have infected, worldwide. Northern of Guilan has been in the high prevalent region of this infection. In Guilan province, 10000-15000 cases in 1368 and, 30000 cases in 1387; the second peak of infection prevalence, affected. In chronic Fascioliasis infection that doesn't treat in human, complication of disease manifests with iron deficiency anemia, billiary obstruction and collangitis or portal fibrosis. Extra Hepatic manifestation among them, pleura Pericarditis, meningitis, Lymphadenopathy

Parásitos de fasciola hepática intracoledociano / Common bile duct fasciolasis: report of one case

La fasciolasis es una enfermedad parasitaria producida por el tremátodo digeneo Fasciola hepática. Durante la fase crónica de la enfermedad los parásitos pueden entran en los conductos biliares, y ser causa de ictericia obstructiva, colangitis, pancreatitis y otras complicaciones. Se presenta el caso clínico de una paciente intervenida por sospecha de colelitiasis y colédocolitiasis, a la cual durante la exploración coledociana intraoperatoria le fueron extraídos múltiples parásitos adultos de Fasciola hepática. Este hallazgo sólo fue aclarado posteriormente en la biopsia diferida. Se realiza una revisión breve del tema, métodos de diagnóstico, tratamiento médico y alternativas quirúrgicas de tratamiento.

Fasciolasis is a zoonotic disease caused by the digenean trematode Fasciola hepatica. During the chronic phase of the disease the parasites invade the main biliary ducts, causing obstructive jaundice, cholangitis, pancreatitis and other complications. We report a 75 years old female, operated due to the suspicion of a choledocholithiasis. During the exploration of the choledochus, adult F. hepatica parasites were extracted. The pathology report of the parasites confirmed the diagnosis.

Hematoma subcapsular hepático por fasciolasis / Hepatic subcapsular hematoma caused by fascioliasis

Hepatic fasciolasis is a worldwide spread zoonoses mainly affecting cattle-raising countries. It is caused by the trematode Fasciola hepßtica and it is characterized by abdominal pain, fever, nausea and vomitus, weight loss, diahrrea, paleness, general malaise, and hypereosinophilia. Immunological diagnosis as well as stool eggs count may be performed. Hepatic subcapsular and intraparenchymatous hematoma is an infrequent complication of human fascioliasis. Nevertheless, for establishing a proper diagnosis and treatment, any suspicion of its presence must be carefully discarded through, clinical epidemiology, laboratory and imaging exams and procedures. The aim of this study is to expand knowledge on this unfrequently dealt pathology in medical literature by presenting four case reports related to patients undergoing a two-year treatment. All of them had been referred from Departamento de Cajamarca, Peru.

La fasciolasis hepática es una zoonosis mundialmente difundida, sobre todo en los países productores de ganado; causada por la fasciola hepática. Se manifiesta por dolor abdominal, fiebre, nauseas y vómitos, baja de peso, diarrea, palidez, malestar general e hipereosinofilia. El diagnóstico es inmunológico y también puede hacerse por recuento de huevos en heces. El hematoma subcapsular e intraparenquimatoso hepático es una complicación rara de la fasciolasis humana pero se debe tener un alto índice de sospecha uniendo epidemiología, clínica, laboratorio e imaginologia para un adecuado diagnóstico y tratamiento. El propósito de reportar estos casos es dar a conocer una patología poco frecuente en la literatura, con una casuística de cuatro pacientes tratados en el lapso de dos años, todos referidos del Departamento de Cajamarca.

Diagnostic importance of serological methods and eosinophilia in tissue parasites.

This case-control study was carried out to investigate whether eosinophilia is a common finding in parasitic diseases and to determine the prevalence of the parasitic diseases in definitive groups. Toxocariasis and fasciolosis were investigated in patients with eosinophilia, patients with non-eosinophilia, and healthy controls. All cases were analyzed for antibodies against Toxocara canis and Fasciola hepatica by modified enzyme-linked immunosorbent assay (ELISA) employing, as antigen, excretory/secretory products of Toxocara and Fasciola (ES-ELISA). Seropositivity was determined in 39 (29.1%) and 12 (8.9%) toxocariasis and fasciolosis patients with eosinophilia respectively. The seropositivity was found in 26 (19.4%) and 5 (3.7%) toxocariasis and fasciolosis patients without eosinophilia respectively. The seropositivity was found in 13 (15.5%) and 1 (1.2%) toxocariasis and fasciolosis patients in the control group. The total seropositivity in both toxocariasis and fasciolosis in the eosinophilic group (8.5%) increased significantly compared to patients without eosinophilia (23.1%) and healthy controls (6.6%) (chi2:6.343, p < 0.05 and chi2:10.293, p < 0.01). Eosinophilia correlated with antibodies against Toxocara and E. hepatica. The results suggest that serological methods can be used for diagnosis of parasitic infections in tissue. Thus, the actual prevalence of tissue parasites can be revealed particularly in developing and emerging countries.

Hematoma hepático por fascioliasis / Hepatic hematoma caused by fascioliasis

The clinical presentation of two patients was carried out, with the history of having consumed in their diet watercress, and presented digestive and general symptoms. One of the patients presented hepatomegalia; but both presented jaundice and eosinophilia; CAT scan was suggestive in both cases of the presence of hepatic hematomas, confirmed by laparoscopic study and surgical intervention. The definitive diagnosis of hepatic hematoma by fasciolasis was obtained during the operation and the postoperative study, added to the other important complementary exams in this entity.

Current status of infection-related gastrointestinal and hepatobiliary diseases in Thailand.

The objective of this overview is to assess the present situation with regards to gastrointestinal and hepatobiliary diseases prevailing in Thailand. In that context, special emphasis has been put on those forms of viral hepatitis prevalent in the region, namely, hepatitis A the frequency of which has undergone a change from hyper- to hypoendemic with a resulting decline in naturally acquired immunity; hepatitis B with its tendency to cause chronic liver disease mainly due to asymptomatic infections during early childhood and the impact of mass vaccination programs on its endemicity; hepatitis C which can also lead to chronicity; hepatitis D solely found as a coinfection with hepatitis B; hepatitis E acute cases of which can sporadically be found; hepatitis G encountered in healthy subjects at a prevalence similar to that seen in patients with chronic liver disease and rather more prevalent among people at risk for contracting blood borne agents; finally the novel hepatitis TT virus with a distribution comparable to that of hepatitis G virus and a similarly unclear role as to the etiology of serious liver disease. Particularly in connection with hepatitis B we have examined the situation regarding hepatocellular carcinoma which represents one of the most common malignancies among the Thai population. Cholangiocarcinoma caused by the liver fluke Opisthorchis viverrini is the most common form of liver cancer in the northeastern part of Thailand where an estimated 70% of the population are infested with the parasite. Peptic ulcer caused by Helicobacter pylori constitutes another common gastrointestinal affliction with the overall prevalence of antibodies to the agent amounting to 63 to 74% in patients exhibiting gastroduodenal symptoms. The final part of the paper deals with HIV-related gastrointestinal and liver disease and with amebic and pyogenic liver abscesses.

Human chronic fascioliasis: Hepatitis B and C among infected cases

Sera from one hundred and fifty three chronic Fasciola cases were screened for the presence of HB markers [HBsAg, anti HBc and anti HBs] and anti HCV using ELISA technique. Quantitative stool examination and estimation of liver enzymes [AST-ALT-bilirubin] levels of the study population were performed. HBsAg was present in 5 [3.3%], anti HBs in 13 [8.5%], HBexposed [HBex] in 44 [28.8%] and anti HCV in 13 [8.5%] of examined sera. HBV and HCV markers were significantly higher among older age groups. Concerning familial aggregation of hepatitis markers, 7 [15.9%] of the 44 HBex cases had two individuals per family who had evidence of exposure to HBV. No significant change in Fasciola GMEC and liver function tests have been noticed

Fascioliasis as an aetiologie case of fever of unknown origin [FUO] among children [4-12 years] old

Idiopathic fever represents a diagnostic dilemma in small age group. Little attention was given as regard parasitic infections and fever of unknown origin [FUO]. The objective of this study was to throw some light upon the role of fascioliasis as a cause of fever of unknown origin. The study revealed fascioliasis by stool analysis in 14 cases out of children [4.3%] presenting by undiagnosed and prolonged fever and their ages [4-12 years]. Dot- ELISA enabled us to discover 20 cases out of those 320 patients [6.25%], the difference between the results obtained by stool analysis and dot-ELlSA is not significant. Fever [38 drgree] was prolonged and was complained by all the Fasciola seropositive cases by dot-ELISA i.e. 20 cases [100%], eosinophilia in high counts was reported in most of the cases, it is a characteristic of fascioliasis. Hepatobiliary disorders and weight loss were recorded in 60% of the seropositive cases. The scleral tinge of jaundice was noticed in 40% of cases, while diarrhoea, liver enlargement and abdominal pains were reported in 20% of feverish children. Vomiting was complained only by 10% of cases. So Fasciola infection should be considered as one of the aetiological causes of fever of unknown origin [FUO] [6.25%] in children [4-12 years]. Fascioliasis in children usually presented by fever and eosinophilia. Dot- ELISA is an important tool for Fasciola diagnosis, besides the stool examination techniques. Young- aged male children suffered from fascioliasis as a cause of fever of unknown origin more than female children

Obstructive jaundice due to Fasciola hepatica.

A middle aged woman presented with obstructive jaundice of 6 months duration. Radiological investigations revealed multiple pyogenic liver abscesses with the possibility of choledocholithiasis. Exploration of common bile duct revealed that Fasciola hepatica was responsible for the illness. The case is reported because of its rarity.

Fasciolasis hepática : causa infrecuente de síndrome febril prolongado con hipereosinofilia e imágenes hipodensas en la tomografía computada de hígado / Hepatic fascioliasis: unfrequent cause of prolonged febrile syndrome with hypereosinophilia and hypodense images in the computed tomography of the liver

Se presenta el caso de un varón de 40 años portador de un síndrome febril prolongado con hipereosinofilia, elevación de las enzimas de coletasis e imágenes hipodensas en la tomografía computada (TC) de hígado. Se excluyó la etiología neoplásica, piógenica y amebiana del proceso, a través del examen histológico, bacteriológico, y parasitológico del material obtenido por punción biopsia hepática guiada por TC. La búsqueda de parásitos en material fecal fue reiteradamente negativa. El hallazgo de huevos operculados en el líquido obtenido por sondeo duodenal confirmó el daignóstico de faciolasis hepática. La coexistencia de síndrome febril prolongado con hipereosinofilia y alteraciones focales en la tomografía computada de hígado debe ser motivo de búsqueda de fasciola hepática en el líquido obtenido por sondeo duodenal, y en materia fecal. El triclabendazol, compuesto benzimidazólico, constituye una nueva posibilidad terapéutica que actúa sobre los distintos estadios evolutivos (inmaduros y adultos) del parásito en el hígado

Acute cholecystitis and Fasciola sp. infection in Thailand: report of two cases.

Two cases of fascioliasis gigantica from Northeast Thailand presenting with cholecystitis and gall stones were reported. Both cases complained of abdominal pain. On laparotomy the worms were found. In one case five worms were recovered during bile duct exploration and bile drainage; eggs were also revealed in the bile. In the other case of ectopic fascioliasis one young adult worm was found in a nodule which adhered to liver and diaphragm. The parasites were identified as Fasciola gigantica.

Urticaria y fasciola hepática / Urticaria and fasciola hepatica

Se estudiaron 34 historias clínicas de pacientes ingresados en el Instituto de Medicina Tropical "Pedro Kourí", entre 1981 y 1984, con el diagnóstico de fascioliasis hepática, insistiendo en las manifestaciones cutáneas de los enfermos. Se encontró urticaria en el 20,6 de los pacientes, sin que haya diferencia entre las formas aguda y crónica de la misma. La mayor incidencia se presentó en los grupos comprendidos entre 41 y 60 años; no hubo diferencias significativas en cuanto al sexo y todos los pacientes eran de raza blanca. Se observó curación de las lesiones cutáneas después del tratamiento antiparasitario en todos los casos