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.

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.

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.

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.

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)

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.

"Liver fluke": conceptos actuales sobre fascioliasis / Liver fluke: update on fascioliasis

Fascioliasis is a parasitic disease produced mainly by the fluke Fasciola hepatica. The human infection is mainly due to the accidental intake of metacercariae present in watercress and/or contaminated water. The human disease is uncommon in Chile, despite the high prevalence of animal infection, which affects almost the entire national territory and determines high economic and productive impacts. Human fascioliasis can manifest like acute or chronic phase of the disease (in Chile, the majority in chronic phase) and its identification requires a high index of suspicion, in individuals with abdominal pain, hepatomegaly and eosinophilia, where the epidemiological background of watercress ingestion is usually present. Diagnosis usually requires the integration of egg visualization in stools, serology and imaging studies. The treatment of choice with triclabendazole is usually highly effective and safe.

La fascioliasis es una enfermedad parasitaria producida principalmente por el trematodo Fasciola hepática. La infección en el hombre, quien es un huésped accidental, se debe principalmente a la ingesta de metacercarias presentes en berros y/o aguas contaminadas. La enfermedad en humanos es infrecuente en Chile, a pesar de la alta prevalencia de infección animal, que afecta a casi todo el territorio nacional y determina un alto impacto económico y productivo. La fascioliasis humana puede manifestarse en fase aguda o crónica (en Chile, la mayoría en fase crónica) y su identificación requiere un alto índice de sospecha, en individuos con dolor abdominal, hepatomegalia y eosinofilia, donde el antecedente epidemiológico de ingesta de berros suele estar presente. El diagnóstico, habitualmente requiere la integración de la visualización directa de huevos en las deposiciones, estudios de serología e imágenes. El tratamiento de elección con triclabendazol, habitualmente es altamente efectivo y seguro.

Validity of a commercial kit for detection of antibodies in bovine serum in an endemic area for fasciolosis / Validade de um kit comercial para detecção de anticorpos no soro bovino em área endêmica de fasciolose

Abstract Fasciolosis is caused by Fasciola hepatica that affects the bile ducts and liver parenchyma of ruminants, which can result in economic loss. This study aimed to carry out the validity of the commercial kit ELISA® indirect front of the simple fecal sedimentation test used as the standard. 143 samples were collected blood and feces of cattle from Jerome, south of the Espírito Santo. Serum samples were left at -80 °C and used to perform the ELISA kit IDEXX®. All animals to stool examinations were also positive to the ELISA (22) and negative samples to test stool (121), 52 animals reacted positively against the antibody research. The frequency of fasciolosis was 15.4% in the stool examinations and 51.8% by ELISA. The validity was calculated by sensitivity (100%), specificity (57%), positive predictive value (29%) and negative predictive value (100%), and the correlation between the tests calculated using the kappa index of 0.35. The better sensitivity of the ELISA commercial kit should not be a separately evaluated, since the cost benefit and the technical facility must be considered.

Resumo Fasciolose é causada pela Fasciola hepatica, parasito que acomete os ductos biliares e o parênquima hepático dos ruminantes e pode resultar em perdas econômicas. Objetivou-se realizar a validade do kit comercial ELISA® indireto frente ao teste de sedimentação fecal simples utilizado como padrão. Foram coletadas 143 amostras de sangue e fezes de vacas provenientes do Sul do Espírito Santo. As amostras de sangue foram centrifugadas para separação do soro. As amostras de soro foram congeladas a -80ºC e utilizadas para análise com o kit de ELISA IDEXX®. Todos os 22 animais positivos ao exame coproparasitológico também foram positivos ao ELISA e, das 121 amostras negativas ao exame de fezes, 52 reagiram positivamente frente à pesquisa de anticorpos. A frequência de fasciolose foi de 15,4% no exame coproparasitológico e 51,8% pelo ELISA. A validade foi calculada pela sensibilidade (100%), especificidade (57%), valor preditivo positivo (29%) e valor preditivo negativo (100%), sendo considerada medíocre a concordância entre os testes, calculada pelo índice kappa (0,35). A maior sensibilidade obtida para o kit comercial ELISA não deve ser avaliada isoladamente, uma vez que o custo benefício e a facilidade da técnica devem ser considerados.

Hepatic fascioliasis in Mashhad, Northeast Iran: first report

Abstract Fascioliasis is a zoonotic disease caused by a leaf-like worm (fluke) called Fasciola. Herein, we present a case of human hepatic fascioliasis. A 57-year-old man was referred to the hospital for ambiguous gastrointestinal symptoms with suspected hemangioma. Hepatic fascioliasis was diagnosed using abdominal computed tomography and serology. He tested positive for the IgG antibody against Fasciola hepatica. The patient was treated successfully with triclabendazole. This is the first published report on the occurrence of fascioliasis in Northeast Iran, a non-endemic area for fascioliasis. Our results suggest the emergence of a new focus in the region.

Caracterização do imunofenótipo das células envolvidas no processo fibrótico de fígados bovinos cronicamente infectados por Fasciola hepatica / Immunophenotype characterization of the cells involved in the fibrotic process of bovine livers chronically infected by Fasciola hepatica

A fasciolose é uma doença parasitária causada por trematódeo do gênero Fasciola sp., que pode ocasionar fibrose hepática. Objetivou-se caracterizar o imunofenótipo das células que participam da fibrogênese de fígados bovinos frente à infecção por F. hepatica. Foram utilizados fragmentos dos lobos direito e esquerdo de 74 fígados bovinos com fasciolose. Os fragmentos foram submetidos a processamento histológico, coloração com tricrômico de Masson e imuno-histoquímica. Utilizaram-se análise estatística descritiva e teste de correlação de Spearmann com 5% de probabilidade. Na classificação do grau de fibrose, observou-se prevalência do grau 1, com associação positiva e significativa entre o grau de fibrose e o lobo hepático esquerdo (ρ=0,41; P<0,0001). Os imunofenótipos observados foram células estreladas hepáticas (CEHs) no parênquima e miofibroblastos (MFs) no espaço porta (EP). Não foram encontrados fibroblastos. Não houve correlação significativa entre o grau de fibrose e a quantidade de CEH nos lobos hepáticos, direito e esquerdo. Verificou-se aumento do número de estruturas portais, bem como do número de camadas circundando cada estrutura no EP, contudo não houve influência de qualquer estrutura sobre o grau de fibrose hepática (P>0,05). Concluiu-se que as células CEH e os MFs participam da fibrogênese de fígados bovinos com fasciolose crônica.(AU)

Fascioliasis is a parasitic disease caused by a fluke of the genus Fasciola sp., which can lead to end liver fibrosis. This study aimed to characterize the immunophenotype of cells that participate in the fibrogenesis of livers of cattle that face infection by F. hepatica. Fragments of the right and left lobes of 74 cattle livers with fascioliasis were used. The fragments were subjected to histological analysis, Masson's trichrome special stain, and immunohistochemistry. A descriptive statistical analysis was used, with a 5% probability in Spearman correlation test. The classification of degree of fibrosis revealed prevalence of grade 1, with a positive and significant association between the degree of fibrosis and the left hepatic lobe (ρ = 0.41; p <0.0001). The observed immunophenotypes corresponded to hepatic stellate cells (HSCs) in the parenchyma and myofibroblasts (MFs) in the portal tract (PT). Fibroblasts were not found. There was no significant correlation between the degree of fibrosis and the amount of HSC in right and left hepatic lobes. There was an increase in the number of portal structures, as well as in the number of layers surrounding each structure of the PT, but there was no influence of any structure of the PT on the degree of liver fibrosis (P>0.05). HSCs and MFs were concluded to play a role in the fibrogenesis of cattle livers with chronic fascioliasis.(AU)

Rendimiento diagnóstico del Western Blot para detectar simultaneamente anticuerpos en pacientes con cisticercosis, hidatidosis y fascioliasis humana / Western Blot diagnostic yield for simultaneous antibody-detection in patients with human cysticercosis, hydatidosis, and human fascioliasis

RESUMEN Objetivo. Determinar el rendimiento diagnóstico de la técnica de Western Blot para detectar simultáneamente anticuerpos en pacientes con cisticercosis, hidatidosis y fascioliasis humana. Materiales y métodos. Estudio transversal de evaluación de prueba diagnóstica. Se obtuvieron los antígenos de excreción-secreción de las larvas de Taenia solium, quistes de Echinococcus granulosus; y la forma adulta de Fasciola hepática; que luego fueron separados electroforéticamente en geles de poliacrilamida individuales, transferidos y fijados a una membrana de nitrocelulosa para ser enfrentados con sueros de pacientes con las tres parasitosis. La sensibilidad de la técnica se evaluó empleando 300 sueros individuales, 60 pools de dos parasitosis y 20 pools de tres parasitosis y la especificidad con 75 sueros de pacientes con otras parasitosis, 10 de pacientes con otras enfermedades y 15 sueros de personas no parasitadas. Resultados . La técnica reconoció trece glicoproteínas (GP): GP 35, 31, 24, 23, 18, 17, 14 y 13 kDa para cisticercosis, GP 8,16 y 21 kDa para hidatidosis y GP: 17 y 23 kDa para fascioliasis. La prueba detectó la presencia de anticuerpos alcanzando una sensibilidad de 96% (IC95%: 94,62-98,54%) en la detección de una o las trece bandas, una especificidad de 100% (IC95%: 99,50 - 100,00%); individualmente, se tuvo una sensibilidad para cisticercosis de 97% (IC95%: 93,16-100%), para hidatidosis de 94% (IC95%: 88,85-99,15%) y para fascioliasis de 96% (IC95%: 91,66-100%). Conclusiones. La prueba de Western blot es eficaz en la detección, simultanea de anticuerpos en pacientes con cisticercosis, hidatidosis y fascioliasis humana, y puede ser utilizada como prueba de descarte o confirmatoria en zonas endémicas.

ABSTRACT Objectives . To determine the diagnostic yield using western blotting to simultaneously detect antibodies in patients with human cysticercosis, hydatidosis, and human fascioliasis. Materials and methods . Cross-sectional study of diagnostic yield assessment. Excretory/secretory antigens were obtained from Taenia solium larvae, Echinococcus granulosus cysts, and the adult flukes of Fasciola hepática, which were then separated using the polyacrylamide gel electrophoresis technique, transferred, and attached to a nitrocellulose membrane to be probed with sera from the patient infected with the three parasites. The sensitivity of the technique was assessed using 300 individual serum samples, 60 pools of two parasites, and 20 pools of three parasites with 75 sera from patients with other parasites, 10 from patients with other diseases, and 15 from patients without parasites. Results . The technique revealed 13 glycoproteins (GP): GP 35, 31, 24, 23, 18, 17, 14, and 13 kDa for cysticercosis; GP 8, 16, and 21 kDa for hydatidosis; and GP 17 and 23 kDa for fascioliasis. The test detected the presence of antibodies with a sensitivity of 96% (95% confidence interval [CI] = 94.62-98.54%) in the detection of one or the thirteen bands, a specificity of 100% (95% CI = 99.50-100.00%); individually, there was a sensitivity for cysticercosis of 97% (95% CI = 93.16-100.00%), for hydatidosis of 94% (95% CI = 88.85-99.15%) and for fascioliasis of 96% (95% CI = 91.66-100.00%). Conclusions . Western blotting is effective in the simultaneous detection of antibodies in patients with human cysticercosis, hydatidosis, and fascioliasis, and it can be used as a diagnostic test to either rule out or confirm the presence of antibodies in endemic areas.

Evaluación de la técnica modificada de Dennis para el diagnóstico de fasciolosis bovina / Evaluation of modified Dennis parasitological technique for diagnosis of bovine fascioliasis

Introducción. La fasciolosis bovina genera cuantiosas pérdidas económicas, que en Colombia se estiman en COP$12.483 millones anuales, y tiene una prevalencia de 25 % en vacunos lecheros. La enfermedad se diagnostica mediante pruebas parasitológicas. En el país se utiliza la técnica de Dennis modificada en el 2002, pero su sensibilidad, especificidad y validez se desconocen. Objetivo. Evaluar la validez y el desempeño de la técnica modificada de Dennis para el diagnóstico de fasciolosis bovina, usando como prueba de referencia la observación de parásitos en el hígado. Materiales y métodos. Se hizo un estudio de evaluación diagnóstica. Se seleccionaron por conveniencia bóvidos de descarte sacrificados entre marzo y junio de 2013 en Frigocolanta; de cada ejemplar se recolectaron 25 g de heces y se examinaron los conductos biliares y el hígado en busca de Fasciola hepatica . Se estimaron los valores de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo e índice de validez, con intervalos de confianza de 95 %. Como prueba de referencia se usó la evaluación post mortem. Resultados. Se analizaron 180 bóvidos. La sensibilidad y la especificidad de la técnica modificada de Dennis fueron de 73,2 % (IC 95% 58,4-87,9) y 84,2 % (IC 95% 77,7-90,6), respectivamente. El valor predictivo positivo fue de 57,7 % (IC 95% 43,3-72,1) y el negativo fue de 91,4 % (IC 95% 86,2-96,6). La prevalencia de fasciolosis bovina fue de 22,8 % (IC 95% 16,4-29,2). Conclusión. La validez y el desempeño de la técnica modificada de Dennis fueron superiores a los de la técnica tradicional, por lo que constituye una buena heramienta de tamización para el diagnóstico de la fasciolosis en estudios poblacionales y de prevalencia, así como en jornadas de salud animal.

Introduction: Bovine fascioliasis causes important economic losses, estimated at COP$ 12,483 billion per year; its prevalence is 25% in dairy cattle. Parasitological techniques are required for it diagnosis. The Dennis technique, modified in 2002, is the one used in Colombia, but its sensitivity, specificity and validity are not known. Objective: To evaluate the validity and performance of the modified Dennis technique for diagnosis of bovine fascioliasis using as reference test the observation of parasites in the liver. Materials and methods: We conducted a diagnostic evaluation study. We selected a convenience sample of discarded bovines sacrificed between March and June, 2013, in Frigocolanta for the study. We collected 25 g of feces from each animal and their liver and bile ducts were examined for Fasciola hepatica . The sensitivity, specificity, predictive positive value, predictive negative value, and validity index were calculated with 95% confidence intervals. The post-mortem evaluation was used as the gold standard. Results: We analyzed 180 bovines. The sensitivity and specificity of the modified Dennis technique were 73.2% (95% CI=58.4% - 87.9%) and 84.2% (95% CI= 77.7% - 90.6%), respectively. The positive predictive value was 57.7% (95% CI= 43.3% - 72.1%) and the negative one 91.4% (95% CI= 86.2% - 96.6%). The prevalence of bovine fascioliasis was 22.8% (95% CI= 16.4% - 29.2%). Conclusion: The validity and the performance of the modified Dennis technique were higher than those of the traditional one, which makes it a good screening test for diagnosing fascioliasis for population and prevalence studies and during animal health campaigns.

Caracterización clínica y epidemiológica de la infección por fasciola hepática entre los años 2003-2010 en el Hospital Nacional Cayetano Heredia, Lima, Perú / Demographic and clinical aspects of hepatic fascioliasis between 2013-2010 in National Hospital Cayetano Heredia, Lima, Peru

Describir la distribución demográfica y clínica de la fasciolosis hepática, así como las complicaciones y asociaciones entre diversos factores y la enfermedad en un hospital de referencia. Material y métodos: Estudio descriptivo y retrospectivo de tipo serie de casos, se incluyeron todos los pacientes con diagnóstico de fasciolosis hepática por primera vez entre 2003 a 2010 en el Hospital Nacional Cayetano Heredia, se analizaron variables demográficas y clínicas incluyendo las complicaciones y el tratamiento. Resultado: Se encontraron 68 historias clínicas aptas para el estudio, el promedio de edad fue 36 años, Ancash fue el departamento de nacimiento y procedencia más frecuente. La mayoría se diagnosticó en fase crónica, el síntoma más frecuente fue dolor abdominal y se presentó complicaciones en 6 pacientes: 3 abscesos hepáticos, 1 hematoma subcapsular, 1 colangitis y 1 colangitis más colecistitis. Se encontraron las siguientes asociaciones: edad menor de 15 años con la fase crónica e hiporexia, ser estudiante con un coprológico positivo; y entre el nacimiento de una zona endémica con la ausencia de desarrollar complicaciones. Conclusiones: La fasciolosis hepática tiene una presentación clínica poco específica, por lo que los antecedentes epidemiológicos o alimentarios, y especialmente la eosinofilia deben orientar el diagnóstico...

To describe the demographic and clinical aspects of hepatic fascioliasis as well as the complications and associations between various factors and the disease in a reference hospital. Methods: This is a descriptive and retrospective case series study; we included all patients who had a recent diagnosis of hepatic fascioliasis from 2003 to 2010 in the Hospital Nacional Cayetano Heredia. Demographic and clinical variables were analyzed including complications and treatment received. Results: 68 medical records were found eligible for the study. The mean age was 36 years. Ancash department was the most frequent place of origin and residence. Most of them were diagnosed in the chronic phase, the most common symptom was abdominal pain and eight patients had complications: 3 hepatic abscess, 1 subcapsular hematoma, 1 cholangitis and 1 cholangitis plus cholecystitis. There were the following associations: Age under 15 years with chronic phase and hyporexia, being a student with a positive stool analysis; and between being born in an endemic area with the absence of complications. Conclusions: Hepatic fascioliasis has unspecific clinical presentation so the epidemiological or dietary history and specially eosinophilia should guide the diagnosis...

Pseudotumor inflamatorio por Fasciola hepática: a propósito de un caso / Inflammatory pseudotumor by Fasciola hepática: a case report

Introduction: Fasciola hepatica is a parasite of the class Trematoda. It commonly has been found in developing countries. When it infects humans is characterized by a triad of fever, pain in right upper quadrant and peripheral eosinophilia. We present a 67-year-old female from a rural town of the north of Lima, Peru, it was found abdominal pain, eosinophilia and focal hepatic lesions. For this reason, a hepatic mass was the initial suspicion. The hepatic biopsy was performed and one of the findings was eosinophilia. Fasciola hepatica infection should be considered as part of differential diagnosis in hepatic tumors with eosinophilia when the origin of the patient is from endemic areas of F. hepatica.

Fasciola hepática es un parásito de la clase Trematoda común en países en desarrollo. La infección en el ser humano se caracteriza por la triada de fiebre, dolor abdominal en el cuadrante superior derecho y eosinofilia. Se presenta el caso de una mujer de 67 años procedente de una zona rural al norte de Lima, con historia de dolor abdominal de seis meses de evolución, con una imagen hipodensa hepática en el TAC abdominal y eosinofilia. La biopsia hepática mostró un infiltrado inflamatorio con eosinofilia. En el diagnóstico diferencial en pacientes con un tumor hepático y eosinofilia, se deben incluir infecciones parasitarias como F. hepatica; sobre todo en pacientes que proceden de áreas endémicas.

Ectopic Human Fasciola hepatica Infection by an Adult Worm in the Mesocolon

We report here an ectopic case of Fasciola hepatica infection confirmed by recovery of an adult worm in the mesocolon. A 56-year-old female was admitted to our hospital with discomfort and pain in the left lower quadrant of the abdomen. Abdominal CT showed 3 abscesses in the left upper quadrant, mesentery, and pelvic cavity. On surgical exploration, abscess pockets were found in the mesocolon of the sigmoid colon and transverse colon. A leaf-like worm found in the abscess pocket of the mesocolon of the left colon was diagnosed as an adult fluke of F. hepatica. Histologically, numerous eggs of F. hepatica were noted with acute and chronic granulomatous inflammations in the subserosa and pericolic adipose tissues. Conclusively, a rare case of ectopic fascioliasis has been confirmed in this study by the adult worm recovery of F. hepatica in the mesocolon.

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.