Fascíola hepática: relato de caso / Fasciola hepatica: case study

As síndromes consumptivas possuem ampla variedade de diagnósticos diferenciais, sendo um desafio na prática médica. Neste relato, a paciente apresentou astenia, diarreia e tosse, evoluindo com dor em hipocôndrio direito. A elucidação adveio da análise histopatológica após a primeira suspeição ser de lesão hepática maligna. Como desfecho, a infecção pelo trematódeo Fasciola hepatica, endêmico de clima temperado, foi a causa etiopatogênica. Nesse sentido, a intenção deste relato é trazer para discussão diagnósticos diferenciais de síndrome consumptiva tendo em vista etiologias endêmicas.

Consumptive syndromes have an ample variety of differential diagnoses and are a challenge in the medical practice. In this report, the patient presented asthenia, diarrhea, and cough, evolving to pain in the right hypochondrium. The elucidation came from the histopathological analysis after the first suspicion of it being a malignant hepatic lesion. The outcome, infection by the trematode Fasciola hepatica, endemic of temperate climate, was the etiopathogenic cause. In this sense, this report aims to discuss differential diagnostics of consumptive syndrome considering endemic etiologies.

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)

One Health initiative in the Bolivian Altiplano human fascioliasis hyperendemic area: Lymnaeid biology, population dynamics, microecology and climatic factor influences / Aplicação do conceito One Health na área hiperendêmica de fasciolíase humana do Altiplano Boliviano: biologia dos limneídeos, dinâmica populacional, microecologia e influência de fatores climáticos

Abstract Fascioliasis is a freshwater snail-borne zoonotic disease. The Northern Bolivian Altiplano is a very high altitude endemic area where the highest human prevalences and intensities have been reported. Preventive chemotherapy by treatment campaigns is yearly applied. However, liver fluke infection of cattle, sheep, pigs and donkeys assures endemicity and consequent human infection and re-infection risks. A One Health action has therefore been implemented. Activity concerns lymnaeid vectors and environment diversity. Studies included growth, egg-laying and life span in laboratory-reared lymnaeids. Different habitat types and influencing factors were assessed. All populations proved to belong to Galba truncatula by rDNA sequencing. Analyses comprised physico-chemical characteristics and monthly follow-up of water temperature, pH and quantity, and lymnaeid abundance and density. Population dynamics in the transmission foci differed. Mean environmental temperature was lower than fluke development minimum temperature threshold, but water temperature was higher, except during winter. A two generations/year pattern appeared in permanent water habitats, and one generation/year pattern in habitats drying out for months. The multidisciplinary control measures can be extended from one part of the endemic area to another. These studies, made for the first time at very high altitude, constitute a baseline useful for fascioliasis control in other countries.

Resumo A fasciolíase é uma doença zoonótica transmitida para os humanos por formas evolucionárias de Fasciola hepatica oriundas de limneídeos infectados. O Altiplano Boliviano Norte é uma área endêmica de altitude muito alta, onde foram relatadas as maiores prevalências e intensidades em infecções humanas. A quimioterapia preventiva por campanhas de tratamento é aplicada anualmente. No entanto, infecção por Fasciola hepatica em bovinos, ovelhas, suínos e asininos garante endemicidade e consequentes riscos de infecção e reinfecção humana. Portanto, ações norteadas no conceito "One Health" foram implementadas. As atividades envolveram os limneídeos e a avaliação da diversidade de ambientes. Os estudos incluíram o crescimento, postura de ovos e expectativa de vida de limneídeos criados em laboratório, bem como a avaliação da influência dos diferentes hábitats. Todas as populações foram identificadas como Galba truncatula por meio do sequenciamento de rDNA. As análises incluíram características físico-químicas e acompanhamento mensal da temperatura, pH, quantidade da água, abundância e densidade de limneídeos. A dinâmica populacional nos focos de transmissão diferiu. A temperatura ambiente média foi mais baixa do que o limite mínimo de temperatura do desenvolvimento do helminto, mas a temperatura da água foi mais alta, exceto durante o inverno. Um padrão de duas gerações/ano apareceu em hábitats com água permanente, enquanto um padrão de uma geração/ano foi observado em habitats que ficam secos durante meses. Os resultados permitem concluir que as medidas multidisciplinares de controle podem ser estendidas de uma parte da área endêmica para outra. Esses estudos, realizados pela primeira vez em altitudes muito elevadas, constituem uma base útil e extrapolável para o controle da fasciolíase.

Molecular confirmation of Fasciola hepatica infection in capybaras (Hydrochoerus hydrochaeris) from the state of Espírito Santo, Brazil / Confirmação molecular de infecção por Fasciola hepatica em capivaras (Hydrochoerus hydrochaeris) do Estado do Espírito Santo, Brasil

Abstract Sixty-two fecal samples of capybara (Hydrochoerus hydrochaeris) living in eight conservation units (CUs) across the state of Espírito Santo, southeastern Brazil, were assessed for the presence of eggs of liver flukes via sedimentation. Fasciola hepatica eggs were found in 37.1% (23/62) of the samples. Positive samples were found in six CUs (75%), three CUs located in the southern region of the state and three others in the metropolitan region of the capital city of Vitória. Identification of Fasciola hepatica eggs collected from capybara fecal samples were based on morphology, and confirmed using molecular methods. Our results suggest that capybaras may serve as a wild reservoir host for F. hepatica, possibly contributing to the epidemiology and geographic range expansion of this zoonotic parasite across its vast range of distribution in South America.

Resumo Sessenta e duas amostras fecais de capivaras (Hydrochoerus hydrochaeris), coletadas em oito unidades de conservação (UCs) no estado do Espírito Santo, Brasil, foram avaliadas quanto à presença de ovos de Fasciola hepatica por método de sedimentação. Ovos foram encontrados em 37,1% (23/62) das amostras, abrangendo seis UCs (75%), três UCs, localizadas na região sul do Estado, e outras três na região metropolitana da capital Vitória. A identificação dos ovos de F. hepatica coletados nas amostras fecais foi baseada na morfologia e confirmada por métodos moleculares. Os resultados sugerem que as capivaras podem servir como hospedeiros reservatórios selvagens para F. hepatica, possivelmente contribuindo para a epidemiologia e a expansão geográfica deste parasito zoonótico em sua vasta distribuição na América do Sul.

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).

Diagnóstico serológico de la infección por Fasciola hepática: una revisión sistemática / Serological diagnosis of Fasciola hepatica infection: a systematic review

RESUMEN Introducción: La fascioliasis es una enfermedad causada por el parásito Fasciola hepática, según su cuadro clínico puede clasificarse en dos fases: aguda y crónica, actualmente el diagnóstico se realiza durante la fase crónica, sin embargo, la detección temprana permitiría brindar un tratamiento eficaz y oportuno. Objetivo: Este estudio se realiza con el objetivo de evaluar la validez diagnóstica de las pruebas serológicas para el diagnóstico oportuno de fascioliasis hepática. Materiales y métodos: se realizó una búsqueda sistemática de la literatura en Embase, MedLine, Cochrane Library y LILACS. La selección de estudios se realizó mediante pares de revisores, se seleccionaron estudios de pruebas diagnósticas utilizando: ELISA, ELISA indirecto, ELISA rápido, Fas2 ELISA, Arco2 comparada con técnicas de sedimentación para el diagnóstico de fascioliasis hepática en adultos. Los estudios fueron evaluados mediante la herramienta QUADAS-2. Resultados: Se identificaron siete estudios que responden a la pregunta PICO, con un total de 1317 muestras de suero humano, las pruebas reportaron alta sensibilidad y especificidad, FhTA, ELISA, número de estudios y participantes identificados, estimadores resumen con los correspondientes intervalos de confianza/credibilidad, también se puede discutir el ranking de tratamientos. Discusión: en general la especificidad de las pruebas serológicas fue ligeramente superior que la sensibilidad, existe evidencia de moderada a baja calidad que reporta su rendimiento, sin embargo, la calidad de la evidencia y la heterogeneidad entre los estudios no permite determinar su utilidad durante la fase aguda de la enfermedad. Se necesitan más estudios al respecto. Los estudios fueron clínicamente heterogéneos entre ellos.

ABSTRACT Introduction: Fascioliasis is a disease caused by the parasite Fasciola hepatica, according to its clinical picture, it can be classified into two phases: acute and chronic, currently the diagnosis is made during the chronic phase, however, early detection would allow to provide an effective treatment and timely. Objetive: This study is carried out with the objective of evaluating the diagnostic validity of serological tests for the timely diagnosis of hepatic fascioliasis. Materials and methods: a systematic search of the literature was carried out in Embase, MedLine, Cochrane Library and LILACS. Study selection was performed by pairs of reviewers, diagnostic test studies were selected using: ELISA, indirect ELISA, rapid ELISA, Fas2 ELISA, Arco2 compared to sedimentation techniques for the diagnosis of hepatic fascioliasis in adults. The studies were evaluated using the QUADAS-2 tool. Results: Seven studies were identified that answer the PICO question, with a total of 1,317 human serum samples, the tests reported high sensitivity and specificity, FhTA, ELISA, number of studies and participants identified, summary estimators with the corresponding confidence intervals / credibility, and the ranking of treatments. Discussion: In general, the specificity of the serological tests was slightly higher than the sensitivity, there is evidence of moderate to low quality that reports their performance, however, the quality of the evidence and the heterogeneity between the studies do not allow determining its usefulness during the acute phase of the disease. More studies are needed in this regard. The studies were clinically heterogeneous between them.

Copro-prevalence of Fasciola hepatica in Chilean breed horses in the province of Concepción, Chile / Copro-prevalência de Fasciola hepatica em equinos de raça chilena na província de Concepción, Chile

Abstract The aim of this research was to assess the copro-prevalence of Fasciola hepatica in owned Chilean breed horses (Equus caballus) residing in the province of Concepción, Chile. The study was carried out throughout October 2017. Samples were taken from all (100%) Chilean breed horse (124 specimens; 45 females and 79 males, aged between 7 months and 24 years old) from the Concepción province. A rectal stool sample was obtained from each animal. This was analyzed using the Army Medical School method (AMS III) technique to detect F. hepatica eggs. Information about the horse's age, sex, previous fasciolicide application, and an assessment of body condition was also obtained. Fisher tests were carried out to analyze the results. Ten horses (8.06%) were positive for the presence of F. hepatica eggs. No significant difference of copro-prevalence was found between age (young 8.47%, old 7.69%), sex (female 11.1%, male 6.33%), the previous application of fasciolicide (dewormed 10%, not dewormed 7.89%), or body condition (low condition 11.1%, high condition 0.7%) categories (Fisher tests: P>0.05 in all cases). The results of this study suggest that Chilean breed horses constitute part of the reservoir of F. hepatica for both ruminant populations and humans in the Concepción province.

Resumo O objetivo desta pesquisa foi avaliar a coproprevalência de Fasciola hepatica em equinos chilenos (Equus caballus), residentes na província de Concepción, região de Bío-Bío, Chile. O estudo foi realizado durante o mês de outubro de 2017. Foram coletadas amostras de todos os equinos estabulados (124 espécimes; 45 fêmeas e 79 machos, com idades entre 7 meses e 24 anos) da província de Concepción. Uma amostra de fezes transretal foi obtida de cada animal, analisada no Laboratório "Dr. Luis Rubilar", da Universidad de Concepción, usando-se a técnica AMS III, para detectar a presença de ovos de F. hepatica. O diagnóstico fecal foi complementado com informações sobre a idade do animal, sexo, aplicação prévia de fasciolicida e uma avaliação da condição corporal. Testes de Fisher foram realizados para analisar os resultados. Dos 124 equinos, 10 (8,06%) foram positivos para ovos de F. hepatica. Não foi encontrada associação significativa entre idade, sexo, aplicação prévia de fasciolicida ou condição corporal com a presença de ovos. Um cavalo tratado com triclabendazol foi positivo para ovos de F. hepatica.

Correlation between climate data and land altitude for Fasciola hepatica infection in cattle in Santa Catarina, Brazil / Correlação entre clima e altitude para determinar a infecção de Fasciola hepatica em bovinos em Santa Catarina, Brasil

Abstract Fascioliasis is a food-borne parasitic disease that affects a range of animals, including humans caused by Fasciola hepatica. The present study aimed to determine the spatial distribution of bovine fasciolosis and to assess the correlation between the high Positivity Index (PI) and climate data and land altitude, from 2004 to 2008 and 2010 in Santa Catarina (SC), Brazil. Condemned livers of slaughtered animals were obtained from 198 out of 293 municipalities and from 518.635 animals, exclusively from SC. There was a statistically significant difference (P < 0.001) between the prevalence of F. hepatica and land altitude ( ρ ^ s = -0.43). The highest PI (above 10.1%) was observed in cities at 500 to 600 m (P < 0.01; ρ ^ s = -0.47) of altitude. There was no correlation between fascioliasis and rainfall in SC. It was determined that weather conditions in the past decade did not impose any limitation to the occurrence of the parasite, making it a disease of permanent clinical importance. These findings are essential to regions with similar geographical and climate conditions (i.e. altitude), when considering long-term control measurements, where animals and humans can be infected.

Resumo A fasciolose é uma doença parasitária que afeta uma gama de animais, incluindo humanos, causada por Fasciola hepatica no Brasil. Este estudo teve o objetivo de determinar a distribuição espacial da fasciolose e conferir a correlação do alto índice de positividade (PI), com os dados de clima e altitude, entre 2004 a 2008 e 2010 em Santa Catarina (SC), Brasil. Foram obtidos fígados em frigoríficos de SC, de 518.635 animais de 198 municípios, de um total de 293. Houve diferença estatística significativa (P < 0,001) entre a prevalência de F. hepatica e a altitude ( ρ ^ s = -0,43). O maior PI (acima de 10,1%) foi observado em municípios de 500 a 600 m (P < 0,01; ρ ^ s = -0,47) de altitude. Não foi observada correlação entre fígados parasitados e pluviosidade em SC. Foi observado que os dados climáticos na ultima década não apresentaram limitação para a ocorrência do parasito, fazendo com que o desafio clinico da infecção tenha sido permanente. Os dados são importantes para locais com condições geográficas e climáticas semelhantes (ex. altitude), para considerar medidas de controle a longo prazo, nas quais animais e humanos poderão ser infectados.

Potencialidad de Pseudosuccinea columella (Say, 1817) (Molusca: Gastropoda: lymnaeidae) en la transmisión de la fascioliasis humana en República Dominicana / Potentiality of Pseudosuccinea columella (Say, 1817) (Molusca: Gastropoda: lymnaeidae) in the transmission of human fascioliasis in the Dominican Republic

Introducción: en el paisaje epidemiológico de la fascioliasis humana, dos aspectos son de fundamental importancia: a) presencia de hospederos definitivos (especialmente ganado bovino y humanos) parasitados con adultos del tremátodo y; b) presencia de hospederos intermediarios invertebrados, moluscos de la familia Lymnaeidae, en los que se desarrollan los estadios larvarios, además de plantas acuáticas de consumo humano. Material y métodos: con el objetivo de prevenir brotes de fascioliasis humana mediante la correcta identificación de aspectos de interés epidemiológico, un humedal fue seleccionado en el sector de Palo Blanco, municipio de Jarabacoa, provincia de La Vega, en el cual se realizó un estudio malacológico en octubre de 2016, en busca de especies de moluscos limneidos e hidrófitos asociados. En el laboratorio se obtuvieron los índices de infección natural y experimental a Fasciola hepatica. Resultados: se identificó el limneido Pseudosuccinea columella, en proporciones de 250 especímenes por persona/hora. El vegetal predominante fue el berro (Nasturtiun officinale), cultivado comercialmente en tres cuadrantes del humedal y en el otro cuadrante se observaron bovinos pastando. El índice de infección experimental de los moluscos fue de 94 % a la cepa simpátrica de F. hepatica de Dajabón; no se encontraron moluscos parasitados naturalmente. Conclusiones: Pseudosuccinea columella debe considerarse como un molusco de relevancia epidemiológica en la transmisión de la fascioliasis en República Dominicana, a tenor de su dispersión y elevado índice de infección experimental obtenido en el presente estudio

Introduction: in the epidemiological landscape of human fascioliasis, two aspects are of fundamental importance: a) presence of definite hosts (especially cattle and humans) parasitized with trematode adults and b) presence of invertebrate intermediate hosts, mollusks of the family Lymnaeidae, in which larval stages develop, in addition to aquatic plants for human consumption. Material and methods: in order to prevent outbreaks of human fascioliasis by correctly identifying aspects of epidemiological interest, a wetland was selected in the sector of Palo Blanco, municipality of Jarabacoa, province of La Vega, in which a malacological study was carried out in October 2016, in search of limneid mollusk species and associated hydrophytes. Natural and experimental infection rates to Fasciola hepaticawere obtained in the laboratory. Results: the lymnaeid Pseudosuccinea columella was identified, in proportions of 250 specimens collected per person/hour. The predominant vegetable was the watercress (Nasturtiun officinale), commercially cultivated in three quadrants of the wetland and in the other quadrant were observed cattle grazing. The rate of experimental infection of mollusks was 94 % to the sympatric strain of F. hepatica of Dajabón; no naturally parasitized mollusks were found. Conclusions: Pseudosuccinea columella should be considered as a mollusk of epidemiological relevance in the transmission of fascioliasis in the Dominican Republic, due to its dispersion and high rate of experimental infection obtained in the present study

Fascioliasis in buffaloes: A 5-year forecast analysis of the disease based on a 15-year survey in Brazil / Fasciolose em búfalos: uma análise de previsão de 5 anos da doença com base em uma pesquisa de 15 anos no Brasil

Abstract In South America, fascioliasis caused by the trematode Fasciola hepatica is an anthropozoonosis disease associated with significant economic losses and poor animal welfare. The objective of this study was to determine the prevalence of F. hepatica in the liver of buffaloes slaughtered from 2003 to 2017 in Brazil, and to perform a forecast analysis of the disease for the next five years using the Autoregressive Integrated Moving Average (ARIMA) model. Data analysis revealed an incidence of 7,187 cases out of 226,561 individuals. The disease presented a considerable interannual variation (p<0.005). Fasciola hepatica was more prevalent in the southern states of Brazil; Paraná, Rio Grande do Sul, and Santa Catarina, presenting 11.9, 7.7, and 3.2% of infected livers, respectively. The high frequency of liver condemnation in Paraná was influenced by weather conditions. The ARIMA models calculated a constant trend of the disease, depicting an average of its future prevalence. The models also described a worse-case and a positive-case scenario, calculating the effects of intervention measurements. In reality, there is an urgent need for regular diagnostic in the animals (fecal and immune diagnose) and in the environment (intermediate host), in order to avoid the high rates of infection.

Resumo Na América do Sul, a fasciolose causada pelo Trematoda Fasciola hepatica é uma antropozoonose associada a perdas econômicas significativas e baixo grau de bem-estar animal. O objetivo deste estudo foi determinar a prevalência de F. hepatica no fígado de búfalos abatidos entre 2003 a 2017 e realizar uma análise de previsão da doença para os próximos cinco anos, utilizando o modelo Auto-Regressivo Integrado de Médias Móveis (ARIMA). A análise dos dados revelou uma incidência total de 7.187 casos em 226.561 indivíduos. Houve um acentuado grau de variação interanual nas taxas de prevalência (p<0,005). Fasciola hepatica foi mais prevalente nos estados do sul do Brasil; Paraná, Rio Grande do Sul e Santa Catarina, com 11,9; 7,7; e 3,2% de fígados condenados, respectivamente. A alta incidência de condenação de fígado no Paraná foi influenciada pelo fator climático. Os modelos ARIMA indicaram uma tendência constante na ocorrência da doença, destacando um padrão futuro da doença. Os modelos também descreveram cenários de piora e de possível melhoria, calculando os efeitos de medidas de intervenção. Assim, existe a urgência de realizar diagnóstico constante nos animais (coprológico e diagnóstico imunológico) e no ambiente, para que se evite os altos índices de infecção.

Fasciolosis intrahepática que simulaba un colangiocarcinoma: Reporte de un caso infrecuente / Intrahepatic fasciolosis that simulated a cholangiocarcinoma: Report an infrequent case

La fasciolosis es una infección parasitaria causada por 2 tipos de fasciola, siendo la más común de tipo hepática, la forma infectante son las metacercarias. Su prevalencia radica en zonas de nivel socioeconómicas bajo y zonas ganaderas. El objetivo es presentar un caso de presentación atípica en el que se evitó someter al paciente a un tratamiento quirúrgico innecesario. Presentamos un caso de un paciente masculino de 69 años que presentó Colangitis, su ecografía y tomografía evidenció dilatación de la vía biliar, por lo que se le realizó una con la colangiopancreatografía retrograda endoscópica (CPRE) evidenciándose una estenosis de colédoco cerca de la bifurcación biliar y una larva de fasciola hepática, la endomicroscopía confocal (EM) no era concluyente, se tomó biopsia de la estenosis que reportó colangiocarcinoma, pero como el paciente no tenía pérdida patológica de peso y marcadores tumorales negativos, se le indicó tratamiento antiparasitario y se realizó una nueva CPRE que evidenció en la EM mucosa inflamatoria de aspecto crónico no tumoral que se confirmó con la nueva biopsia, el paciente tuvo una evolución favorable, de esta forma evitamos un tratamiento no requerido.

Fasciolosis is a parasitic infection caused by 2 types of fasciola, being the most common of hepatic type, the infective form is the metacercariae. Its prevalence lies in low socio-economic zones and livestock areas. The objective is to present a case of atypical presentation in which the patient was avoided to undergo an unnecessary surgical treatment. We present a case of a 69-year-old male patient who presented Cholangitis, his sonography and tomography evidenced dilatation of the bile duct, and one was performed with endoscopic retrograde cholangiopancreatography (ERCP), showing a choledochal stenosis near the bile bifurcation And a liver fasciola larva, confocal endomicroscopy (MS) was inconclusive, biopsy of the stenosis that reported cholangiocarcinoma was reported, but since the patient had no pathological weight loss and negative tumor markers, he was given antiparasitic treatment and was performed A new ERCP that showed in the inflammatory mucosa of chronic non-tumor aspect that was confirmed with the new biopsy, the patient had a favorable evolution, thus avoiding an unnecessary treatment.

Flukicide efficacy against Fasciola hepatica of Triclabendazole and Nitroxynil in cattle of the central valley of Chile / Avaliação da eficácia de triclabendazol e nitroxinil para o tratamento da infeção por Fasciola hepatica em bovinos do Vale Central do Chile

Abstract On a farm with permanent history of fasciolasis a study was performed aimed to know the efficacy of triclabendazole (TCBZ) and then to contrast with that of nitroxynil. Thirty-nine cattle naturally infected with Fasciola hepatica were randomly allocated into 4 experimental groups: Group 1 (control) was left untreated. Group 2 was treated with of 12 mg/kg body weight (bw) of TCBZ by oral route. Group 3 treated with 24 mg/kg bw TCBZ orally. Group 4 was treated with 10 mg/kg bw of nitroxynil subcutaneously. The anthelmintic efficacy was calculated as the percentage of reduction in faecal egg count (FEC) at 14 and 28 d post-treatment. Results indicated that there were no significant differences in the percentage of FEC reduction between control group and the groups treated with 12 or 24 mg/kg of TCBZ. On the contrary, the treatment with nitroxinyl significantly reduced the FEC and decreased the percentage of positive animals. In conclusion, Fasciola hepatica is reported for first time as resistant to TCBZ in Chile, which highlights the need of rotating drugs and assessing the efficacy of the administered drug in order to avoid the selection of resistant worms.

Resumo Em uma fazenda com histórico de fasciolose permanente, foi realizado um estudo com o objetivo de conhecer a eficácia do triclabendazol (TCBZ) e depois contrastar com o do nitroxinil. Trinta e nove bovinos naturalmente infectados com Fasciola hepatica foram distribuídos aleatoriamente em 4 grupos experimentais: Grupo 1 (controle), sem tratamento. O grupo 2 foi tratado com 12 mg/kg de peso vivo (PV) do TCBZ por via oral (VO). Grupo 3 tratado com 24 mg/kg de PV TCBZ por VO. O grupo 4 foi tratado com 10 mg /kg de PV Nitroxinil via subcutânea. A eficácia anti-helmíntica foi calculada comparando a percentagem de redução na contagem de ovos fecais (FEC) 14 e 28 dias pós tratamento. Não houve diferença significativa na porcentagem de redução FEC entre o grupo controle e os grupos tratados com 12 ou 24 mg/kg de TCBZ. Entretanto, o tratamento com nitroxinil reduziu significativamente o FEC e diminuiu a porcentagem de animais positivos. Em conclusão, a Fasciola hepatica é relatada pela primeira vez como resistente ao TCBZ no Chile, o que destaca a necessidade de realizar uma rotação em relação aos medicamentos anti-helmínticos e avaliar a eficácia do mesmo, a fim de evitar a seleção de vermes resistentes.

Histopathological findings of Fasciola hepatica infection in non-native European hare (Lepus europaeus) in Southern Chile / Achados histopatológicos da infecção por Fasciola hepatica em lebre europeia não-nativa (Lepus europaeus) no Sul do Chile

Abstract Fasciola hepatica is a parasite introduced in America from Europe, being considered of concern for public health and animal production, especially in countries with endemic areas as occur in Chile. In this country, the research has been focused mainly in domestic ruminants, with native and introduced wildlife being largely ignored. Thus, the aim of this study was to report the infection by Fasciola hepatica in an introduced mammal, the European hare, which is distributed along a vast area of the country. One in 42 hares hunted showed histological lesions compatible with F. hepatica, and harbored a parasitic load of 6 liver flukes. This is the first report of this lagomorph acting as host of this helminth in the country and the third in South America. Yet, we found no previous reports regard the pathology of this fluke in the species. Thus, we emphasize the importance of more studies regarding introduced mammals which could be acting as reservoirs for this important fluke.

Resumo Fasciola hepatica é um parasita de origem europeia introduzido na América, de importância em saúde pública e animais de produção, especialmente em países com áreas endêmicas, como ocorre no Chile. Neste país, a pesquisa foi focada principalmente em ruminantes domésticos, com a fauna nativa e introduzida sendo amplamente ignorada. O objetivo desse trabalho é relatar a infecção por Fasciola hepatica em lebre europeia, espécie distribuída em vasta extensão do país. Uma em 42 lebres caçadas, mostrou lesões histológicas compatíveis com infestação por F. hepatica, alojando 6 vermes hepáticos. Este é o primeiro relato deste lagomorfo apresentando este tipo de parasitismo no Chile, o terceiro na América do Sul. No entanto, não encontramos relatos anteriores sobre a patologia deste acaso na espécie. Este relato salienta a importância de mais estudos considerando espécies introduzidas, as quais podem ser reservatórios desse importante parasita.

Microscopic alterations in Fasciola hepatica from sheep treated with albendazole / Alterações microscópicas em Fasciola hepatica de ovelhas tratadas com albendazol

Abstract Currently, albendazole is one of the most commonly used drugs because of its affordability. The objective was to evaluate the histopathology of Fasciola hepatica specimens. For this, the efficacy test was performed on sheep treated with albendazole at the dose recommended for F. hepatica, in which the helminths recovered at necropsy were counted and separated for histology. Spermatogenic cells from parasites recovered from treated and control sheep were examined by microscopy. The fecal egg-count reduction test revealed 97.06% efficacy of albendazole in the treatment of F. hepatica. Changes in testicular tubule cells started 48 hours after treatment and became evident within 72 hours, at which point it became difficult to identify cell types. Primary and secondary spermatogonia became increasingly rare and intercellular vacuolization was more evident. Signs of apoptosis, with pycnotic nuclei and evidence of keriorrexia were observed at all times. Cell debris was identified 96 hours after treatment. The results indicated that parasitic spermatogenesis was severely affected by albendazole and demonstrated the importance of the use of histopathology for the diagnosis of therapeutic efficacy in field strains.

Resumo Na atualidade, o albendazol é uma das drogas mais usadas devido à sua acessibilidade econômica. O objetivo foi avaliar a histopatologia dos espécimes de Fasciola hepatica. Para isso, foi realizado o teste de eficácia em ovinos tratados com albendazol na dose recomendada para Fasciola hepatica, no qual os helmintos recuperados em necropsia foram contabilizados e separados para histologia. As células espermatogênicas de parasitas recuperados de ovinos tratados e controle foram examinadas por microscopia. O teste de redução de ovos por grama de fezes revelou 97,06% de eficácia do albendazol no tratamento de F. hepatica. As alterações nas células dos túbulos testiculares iniciaram-se 48 horas após o tratamento e tornaram-se evidentes em 72 horas, altura em que tornou-se difícil identificar os tipos de células. As espermatogônias primárias e secundárias tornaram-se cada vez mais raras e a vacuolização intercelular foi mais evidente. Sinais de apoptose, com núcleos picnóticos e evidência de cariorrexia foram observados em todos os momentos. Os detritos celulares foram identificados 96 horas após o tratamento. Os resultados indicaram que a espermatogênese parasitária foi severamente afetada pelo albendazol e demonstrou a importância do uso da histopatologia para o diagnóstico de eficácia terapêutica em cepas de campo.

First reported case of clinical fascioliasis in Santa Catarina, Brazil

Abstract Fascioliasis is a food-borne anthropozoonotic disease caused by Fasciola hepatica that affects multiple hosts, including humans. We herein report the first case of human fascioliasis in the state of Santa Catarina, Brazil. A 57-year-old female patient complaining of abdominal pain was admitted to the hospital for a clinical investigation. The diagnosis of F. hepatica was confirmed by ultrasound and indirect enzyme-linked immunosorbent assay. Authorities of the Northern coast of Santa Catarina were notified to investigate other cases and risk factors for contamination. The disease is also prevalent in cattle, which could pose as a potential route for infection.

Freshwater snails as the intermediate host of trematodes in Iran: a systematic review / 한국역학회지

Freshwater snails, as the first intermediate hosts of trematodes, can cause health hazards in animals and humans. Recently, the World Health Organization has included Iran in a list of 6 countries known to have serious problems with fascioliasis. In addition, cercarial dermatitis is a job-related disease that is seen often in paddy workers, agricultural labourers, and fishermen in Iran, particularly in Mazandaran Province. Many studies have been conducted in Iran to survey larval trematodes in freshwater snails. However, to the best of our knowledge, no comprehensive data exist regarding infections in gastropods. Therefore, the aim of the present study was to estimate the types and prevalence of cercarial infections in snails in Iran. Electronic English-language and Persian-language databases were searched to identify 24 published articles reporting the prevalence of trematode infections in snails (9 species from 6 families) in various provinces of Iran. In total, 4.4% of gastropods were infected with the larval stages of trematodes. According to the studies reviewed in this meta-analysis‚ the highest infection prevalence was found in Radix auricularia (9.9%). Twelve larval species of trematodes were identified, and the highest prevalence of cercariae was found for Echinostomatidae cercariae (4.3%). Among the provinces explored, West Azerbaijan had the highest prevalence of infected snails (16.9%). The presence of trematodes in snails could pose a serious health problem in Iran. Thus, further studies are necessary to characterize these infections in other provinces.

Freshwater snails as the intermediate host of trematodes in Iran: a systematic review / 한국역학회지

Freshwater snails, as the first intermediate hosts of trematodes, can cause health hazards in animals and humans. Recently, the World Health Organization has included Iran in a list of 6 countries known to have serious problems with fascioliasis. In addition, cercarial dermatitis is a job-related disease that is seen often in paddy workers, agricultural labourers, and fishermen in Iran, particularly in Mazandaran Province. Many studies have been conducted in Iran to survey larval trematodes in freshwater snails. However, to the best of our knowledge, no comprehensive data exist regarding infections in gastropods. Therefore, the aim of the present study was to estimate the types and prevalence of cercarial infections in snails in Iran. Electronic English-language and Persian-language databases were searched to identify 24 published articles reporting the prevalence of trematode infections in snails (9 species from 6 families) in various provinces of Iran. In total, 4.4% of gastropods were infected with the larval stages of trematodes. According to the studies reviewed in this meta-analysis‚ the highest infection prevalence was found in Radix auricularia (9.9%). Twelve larval species of trematodes were identified, and the highest prevalence of cercariae was found for Echinostomatidae cercariae (4.3%). Among the provinces explored, West Azerbaijan had the highest prevalence of infected snails (16.9%). The presence of trematodes in snails could pose a serious health problem in Iran. Thus, further studies are necessary to characterize these infections in other provinces.

Anticuerpos de cadena única de alpaca para la detección de antígenos de Fasciola hepática / Single-chain antibodies from alpaca for the detection of Fasciola hepatica antigens

RESUMEN Objetivo. Producir anticuerpos recombinantes de cadena única de alpaca que se unan con alta afinidad y especificidad al antígeno excretado-secretado (ES) de Fasciola hepatica para el desarrollo de tecnologías nuevas de diagnóstico de fascioliasis humana y animal. Materiales y métodos. Se ha construido una genoteca de cADNde los dominios variables de anticuerpos de cadena única pesada, conocidos como VHH, a partir de células mononucleares de sangre periférica de una alpaca inmunizada con el antígeno ES de F. hepatica. La genoteca fue tamizada con el antígeno ES por despliegue diferencial de fagos (phage display), seleccionando diez VHH que se unen específicamente a ES. El VHH anti ES fue clonado en un vector de expresión, la proteína recombinante (VHH-ES1) de 15,3 kDa fue producida por fermentación en E. coli y purificada a homogeneidad por cromatografía de afinidad. La unión del VHH-ES1 al antígeno ES fue evaluada por ELISA usando VHH-ES1 como anticuerpo de captura, antisuero policlonal anti-ES de conejo y conjugado anti IgG de conejo con peróxidasa de rábano. Resultados. Se ha identificado y producido un VHH-ES1 recombinante que se une al antígeno ES (VHH-ES1) que correspondía a un anticuerpo de la subclase IgG2 de bisagra larga. La unión del anticuerpo VHH-ES1 al antígeno muestra linealidad respecto a la concentración de ES en el rango de 50-5000 ng/mL y el valor límite de detección del antígeno está en el rango de 30-170 ng/mL de ES (R2=0,99). Conclusión . El VHH-ES1 se une con afinidad y especificidad al antígeno ES de F. hepatica y es un anticuerpo promisorio a evaluar para el desarrollo de nuevas tecnologías de diagnóstico de fascioliasis.

ABSTRACT Objectives. To produce recombinant single-chain antibodies from alpaca that will bind to the excreted-secreted (ES) Fasciola hepatica antigen with high affinity and specificity, so as to develop new diagnostic technologies of human and animal fascioliasis. Materials and Methods. A gene bank of DNA of the variable dominions of heavy single-chain antibodies (VHH) has been created, based on mononuclear cells of peripheral blood of an alpaca immunized with the ES antigen of F. hepatica. The gene bank was screened with the ES antigen by differential phage display, selecting ten VHH that bind specifically to ES. The anti-ES VHH was cloned in an expression vector, the recombinant protein (VHH-ES1) of 15.3 kDa was produced by fermentation in E. coli and purified to homogeneity by affinity chromatography. The binding of VHH-ES1 to the ES antigen was evaluated by ELISA using VHH-ES1 as capture antibody, policlonal anti-ES serum of rabbit and conjugated rabbit anti IgG with radish peroxidase. Results. A VHH that binds to the ES antigen (VHH-ES1) has been identified through differential phage display and produced by fermentation in E. coli; this corresponds to an antibody of the long-hinge IgG2 subclass. The binding of the VHH-ES1 antibody to the antigen shows linearity with respect to the concentration of ES in the 50-5,000 ng/mL range and the limit of detection value of the antigen is in the 30-170 ng/mL range of ES (R2=0.99). Conclusions. The VHH-ES1 binds with affinity and specificity to the ES antigen of F. hepatica and is a promissory antibody to be assessed for the development of new fascioliasis diagnostic technologies.

Epidemiological and clinical-pathological aspects of fasciolosis in livers of cattle slaughtered in southern Brazil / Aspectos epidemiológicos e clínico-patológicos de fasciolose em fígados de bovinos abatidos no sul do Brasil

Infection by Fasciola hepatica is an important cause of economic loss in cattle raised in Brazil and others countries. In slaughterhouses, the losses are mainly associated with condemnation of livers; however, it is believed that these losses can extend to diminished carcass yield and productivity throughout the life of the animals. Three slaughterhouses with a daily routine of approximately 15-20 cattle slaughters were monitored from July 2016 to November 2017. After sample collection, weighing, and liver assessment, statistical studies were conducted to determine disease prevalence and measurement of economic losses caused by fasciolosis through condemnation of the organ of choice of the parasite. Of the 210 livers assessed, 79 (37.6%) were condemned because of presence of F. hepatica, 87 (41.4%) were considered appropriate for human consumption, and 44 (20.9%) were considered inappropriate because of some other macroscopic lesions. The aim of this study was to estimate the prevalence of fasciolosis, correlate epidemiological and clinical-pathological aspects, and estimate the economic losses caused by the disease. It is estimated that the losses in southwestern Rio Grande do Sul state could reach R$ 36,943,532.60 (37.6%; 95% CI = 30,753,525.80 - 43,526,55.65) or US$ 11,437,626.20 (37.6%; 95% CI = 9,521,215.40 - 13,475,713.80) only because of condemnation of livers.(AU)

A infecção por Fasciola hepatica é uma importante causa de prejuízos econômicos para o setor pecuário no Brasil e em outros países. Em frigoríficos, as perdas estão relacionadas principalmente a condenação dos fígados, porém acredita-se que esses prejuízos possam se estender a perdas no rendimento de carcaça e durante a vida produtiva do animal. Durante o período de julho de 2016 a novembro de 2017 foram realizados acompanhamentos periódicos mensais em três frigoríficos, os quais, possuem uma rotina diária de aproximadamente 15-20 abates. Após a coleta de dados, pesagem e avaliação dos fígados foram realizados estudos estatísticos para determinação da prevalência e mensuração dos prejuízos econômicos causados por fasciolose pela condenação do órgão de eleição do parasito. Dos 210 fígados avaliados, 79 (37,6%) foram condenados devido a presença de F. hepatica, 87 (41,4%) foram considerados próprios para consumo humano e 44 (20,9%) impróprios por alguma outra alteração macroscópica. O objetivo deste estudo foi estimar a prevalência da fasciolose, e associar os aspectos epidemiológicos e clinico patológicos, além de estimar os prejuízos econômicos causados pela doença. Estima-se que as perdas na mesorregião Sudeste Rio-grandense possam chegar à R$ 36.943.532,60 (37,6%; IC.95% = 30.753.525,80-43.526.55,65) ou US$ 11.437.626,20 (37,6%; IC.95% = 9.521.215,40-13.475.713,80) somente devido a condenação de fígados.(AU)

Recount of reported cases of human fascioliasis in Brazil over the last 60 years

Fascioliasis is an important anthropozoonotic disease caused by the ubiquitous trematode helminth, Fasciola spp. Here, as elsewhere, it is thought that the disease lacks proper reporting, and the available literature does not reflect unreported cases found in the Brazilian population, or new recently reported cases. The purpose of this work was to perform a recount of human fascioliasis (HF) cases in Brazil. For this, we considered all positive cases published in local and international official Journals, from 1950 to 2016. A theoretical-conceptual research method based on a systematic bibliographic review was applied to identify, select and index articles using the Endnote Basic Software. Here, only 48 cases of HF were found, of which 21 (43.7%) occurred in the South of the country. The small number of reported cases reflects the difficulty in diagnosing HF correctly (clinical and fecal tests). This work provides a real figure of HF reported cases in Brazil and has also corrected inaccurate information found in the literature by conducting a historical survey of the disease. Fasciola hepatica is highly endemic in ruminants and, hypothetically, the number of human cases should also be considerably higher than that reported in the literature. These findings call for more attention in regard to this neglected disease in Brazil.