Gastos hospitalarios en pacientes con fascioliasis en fase aguda, hidatidosis de tratamiento quirúrgico y neurocisticercosis en un hospital general en Chile / Hospital care expenses caused by acute fascioliasis, cystic echinococcosis, and neurocysticercosis in Santiago, Chile

Background: Acute fascioliasis (FA), cystic echinococcosis (CE) and neurocysticercosis (NCC) are three endemic parasitic diseases in Chile for whom there is scarce information about the economic impact they represent during management at the hospital. Aims: To quantify and compare hospital care expenses caused by these three endemic helminth infections in a Chilean hospital. Methods: Retrospective analysis of hospital costs at a referral hospital in Santiago between 2006 and 2010. Hospital databases were used to identify patients with the corresponding infections, and those with sufficient data on hospital costs were included. Results: A total of 16 patients representing 21 cases were identified and analyzed: four with AF, eleven with CE, and six with NCC. Median hospital expenses for cases with AF were US$ 1799 and mainly caused by bed-day costs. Median hospital costs for cases of CE were US$ 4707 and the most important costs components were medications, bed-day costs and consumables. NCC patients had median costs of US$ 1293, which were mainly due to bed-day costs. Non-parenchymatous or mixed forms of NCC showed a trend toward higher hospital costs compared with parenchymatous forms. Conclusions: Although helminth infections in Chile, an upper middle income country, are declining and considered rare in routine clinical practice, hospital care expenses caused by patients with AF, CE, and NCC are high and might still present an important economic burden to the Chilean healthcare system.

Antecedentes: La fascioliasis aguda (FA), la equinococosis o hidatidosis (H) y la neurocisticercosis (NCC) son tres enfermedades parasitarias endémicas en Chile de las cuales hay escasa información sobre el impacto económico que ellas generan por atención hospitalaria. Objetivos: Cuantificar y comparar los gastos hospitalarios causados por estas tres infecciones por helmintos en un hospital en Chile. Materiales y Métodos: Análisis retrospectivo de gastos hospitalarios en un hospital de referencia en Santiago entre los años 2006 y 2010. Se incluyeron aquellos casos identificados en las bases de datos de hospital y que contaran con datos económicos suficientes. Resultados: Un total de 16 pacientes con 21 ingresos fue identificado y analizado: 4 con FA, 11 con H y 6 con NCC. La mediana de gastos hospitalarios para los ingresos por FA fue de US$ 1.799, originados fundamentalmente por el costo del día cama. La mediana de los gastos en ingresos por H fue de US$ 4.707 y los componentes más importantes en el gasto fueron los medicamentos, estadía hospitalaria e insumos. Los pacientes con NCC tuvieron una mediana de gastos de US$ 1.293 explicado principalmente por la estadía hospitalaria. Los pacientes con formas no parenquimatosas o mixtas tuvieron una tendencia a presentar gastos más altos que aquellos con formas parenquimatosas de NCC. Conclusiones: Aunque las infecciones por helmintos están en declinación en Chile, un país de ingresos medios, y son consideradas raras en la práctica clínica, los gastos hospitalarios generados por la atención de pacientes con FA, H y NCC, son elevados y aún representan una importante carga económica para el sistema de salud chileno.

Prevalence of liver condemnation due to bovine fasciolosis in Southern Espírito Santo: temporal distribution and economic losses / Prevalência de condenação de fígados bovinos por fasciolose no Sul do Espírito Santo: distribuição temporal e perdas econômicas

The present study was conducted to evaluate the economic losses and temporal distribution of the prevalence of liver condemnation due to bovine fasciolosis. The abattoir in Atílio Vivácqua, in the South of the State of Espírito Santo, which is under state inspection by the veterinary service of the Livestock and Forest Protection Institute of Espírito Santo, was used as the data source. The prevalence of liver condemnation due to fasciolosis over the period 2006-2009 was calculated. The χ2 test, simple linear regression analysis and χ2 for trend were used, with a significance level of p < 0.05. Over the period analyzed, 110,956 cattle were slaughtered and the prevalence of liver condemnation due to Fasciola hepatica was 15.24 percent in 2006, 23.93 percent in 2007, 28.57 percent in 2008 and 28.24 percent in 2009. The historical trend of liver condemnation is an increasing trend, thus indicating that this parasitism has become established in the herd as a problem in this region, with prevalence similar to that of traditionally endemic regions. Condemnations occurred throughout the year, with the highest prevalence in April and May and with significant differences between the dry and wet seasons. The economic losses from liver condemnation can be considered high.

O presente trabalho foi realizado com o objetivo de avaliar as perdas econômicas e a distribuição temporal da prevalência de condenação de fígados bovinos devido a fasciolose. O matadouro frigorífico de Atílio Vivácqua, no sul do Estado do Espírito Santo, com inspeção estadual, realizada por médico veterinário vinculado ao Instituto de Defesa Agropecuária e Florestal do Espírito Santo, foi utilizado como fonte de dados. A prevalência de condenação de fígados por fasciolose no período de 2006-2009 foi calculada. O teste do χ2, a análise de regressão linear simples e o χ2 para tendência foram utilizados, considerando-se o nível de significância p < 0,05. No período analisado foram abatidos 110.956 bovinos, observando-se prevalências de condenação de fígados por Fasciola hepatica, de 15,24 por cento em 2006, 23,93 por cento em 2007, 28,57 por cento em 2008 e de 28,24 por cento em 2009. A tendência histórica da condenação de fígados é crescente, indicando que este parasitismo estabeleceu-se no rebanho como um problema na região com prevalência similar a de regiões tradicionalmente endêmicas. As condenações ocorreram o ano todo com maior prevalência nos meses de abril e maio e com diferenças significativas entre os períodos seco e chuvoso. As perdas econômicas devido a condenação de fígados podem ser consideradas altas.

Fasciolosis humana y animal en el Perú: impacto en la economía de las zonas endémicas / Human and animal fascioliasis in Peru: impact in the economy of endemic zones

Fasciola hepatica es el agente etiológico de la fasciolosis en el Perú. La fasciolosis es un problema de salud pública por la alta prevalencia de la infección humana, especialmente niños y un problema veterinario de importancia por las altas tasas de infección del ganado en la mayoría de regiones del País. La fasciolosis es endémica en la sierra y la costa, y esporádica en la región amazónica. La infección humana se reporta en 18 regiones y la animal en 21 de las 24 regiones del Perú. La transmisión humana ocurre en poblaciones andinas rurales dedicadas a la agricultura, pero hay un creciente número de casos en ciudades. Diferentes situaciones epidemiológicas de la infección humana se presentan: i) Regiones con casos no autóctonos, donde la infección es por consumo de vegetales contaminados traídos de zonas endémicas; ii) Regiones con poblados hipo- y mesoendémicos, transmisión local y prevalencia < 10 por ciento; y iii) Regiones con poblados hiperendémicos, transmisión local y prevalencia ≥ 10 por ciento. El parásito infecta a vacunos, ovinos, equinos, caprinos, porcinos, camélidos, cobayos y conejos. La pérdida ganadera anual por la fasciolosis es no menor de US$ 50 millones, estimada por la prevalencia de la infección y los decomisos de hígados de vacunos en mataderos. Es difícil estimar el impacto económico de la fasciolosis humana por su estatus de enfermedad desatendida, lo cierto es que la fasciolosis es endémica, y en algunos casos hiperendémica, en las regiones más pobres de nuestro país, donde la situación debe ser reconocida como una emergencia de salud pública.

Fasciola hepatica is the causative agent of fasciolosis in Peru; the disease is an important public health problem by the high prevalence of the human infection affecting mainly children and a major veterinary problem by the high rates of infected livestock. The human disease is endemic in the Sierra and the Coast but sporadic in the Amazonia, and reported in 18 Departments, while the animal infection in 21 of 24 Departments of Peru. Transmission occurs in Andean rural populations engaged in agriculture, but recently an increasing number of people became infected in the cities. The epidemiological situation in Peru includes i) Departments with non-autochtonous cases, where infection occurs by consumption of contaminated vegetables brought from endemic areas or infection is acquired by visit to endemic areas; ii) Departments with hypoendemic and mesoendemic villages, where transmission occurs by ingest of contaminated vegetables and prevalence ≤10 percent; and iii) Departments with hyper-endemic villages with human prevalence >10 percent, with an intense transmission by consumption of contaminated vegetables. The disease affects bovine, sheep, goat, swine, equine, South American camelids, rabbits and guinea pigs. The negative impact of fasciolosis in the livestock economy is not lesser than US$ 50 million per year, estimation based on the prevalence and the number of condemned livers in the abattoirs. It is difficult to estimate the economic impact of this infection in the human health due to its status of neglected disease, but fasciolosis is hyper-endemic in the poorest Andean areas of Peru where the situation has to be recognized as a public health emergency.

Liver fluke disease (fascioliasis): epidemiology, economic impact and public health significance.

Liver fluke disease (fascioliasis) is an important parasitic disease found worldwide affecting sheep, goats, cattle and buffalo, as well as other domestic ruminants. The common causative agents are Fasciola hepatica and F. gigantica which require various species of Lymnaea, fresh water snails, as their intermediate hosts. The epidemiology of the disease and its prevalence in Malaysia is mentioned briefly. The disease causes considerable impact on the economy of the livestock industry. The economic losses consist of costs of anthelmintics, drenches, labor, liver condemnation at meat inspection; and losses in production due to mortality, reduction in meat, milk and wool production; and reduction in growth rate, fertility and draught power. The disease also has public health significance, causing human fascioliasis and "halzoun".