Norma técnica de salud para la vigilancia, prevención y control de la fasciolosis humana en el Perú / Technical health standard for the surveillance, prevention and control of human fasciolosis in Peru

La norma técnica contiene: finalidad y justificación técnica, ámbito de aplicación, base legal, disposiciones generales y específicas para la vigilancia, prevención y control de la fasciolosis humana en el Perú.

An Autochthonous Human Case of Fasciolopsiasis in Nepal

Fasciolopsiasis is rarely known as the parasitic disease in Nepal. Herein, we report a case of fasciolopsiasis in a 22-year-old man who was admitted in the hospital with abdominal pain, distension and loss of appetite for a month. He had previously diagnosed with acute viral hepatitis but, his abdominal pain was not resolving despite improvement in his liver function and general condition. During endoscopy an adult digenean worm was seen in the first part of the duodenum. After isolation, the worm was identified morphologically as Fasciolopsis buski. Microscogic examination of the patient’s stool revealed eggs with a morphology consistent with F. buski. Eggs were yellow-brown, ellipsoidal, unembmbryonated, operculated, filled with yolk cells, with thin shell and ranging 118–130 μm in length and 60–69 μm in width. The abdominal pain of the patient was resolved after treatment with praziquantel. By the present study, it was confirmed for the first time that fasciolopsiasis is indigenously transmitted in Nepal. Accordingly, the epidemiological studies in humans and reservoir host animals should be performed intensively in near future.

Ancient Human Parasites in Ethnic Chinese Populations

Whilst archaeological evidence for many aspects of life in ancient China is well studied, there has been much less interest in ancient infectious diseases, such as intestinal parasites in past Chinese populations. Here, we bring together evidence from mummies, ancient latrines, and pelvic soil from burials, dating from the Neolithic Period to the Qing Dynasty, in order to better understand the health of the past inhabitants of China and the diseases endemic in the region. Seven species of intestinal parasite have been identified, namely roundworm, whipworm, Chinese liver fluke, oriental schistosome, pinworm, Taenia sp. tapeworm, and the intestinal fluke Fasciolopsis buski. It was found that in the past, roundworm, whipworm, and Chinese liver fluke appear to have been much more common than the other species. While roundworm and whipworm remained common into the late 20th century, Chinese liver fluke seems to have undergone a marked decline in its prevalence over time. The iconic transport route known as the Silk Road has been shown to have acted as a vector for the transmission of ancient diseases, highlighted by the discovery of Chinese liver fluke in a 2,000 year-old relay station in northwest China, 1,500 km outside its endemic range.

Complete Mitochondrial Genome of Echinostoma hortense (Digenea: Echinostomatidae)

Echinostoma hortense (Digenea: Echinostomatidae) is one of the intestinal flukes with medical importance in humans. However, the mitochondrial (mt) genome of this fluke has not been known yet. The present study has determined the complete mt genome sequences of E. hortense and assessed the phylogenetic relationships with other digenean species for which the complete mt genome sequences are available in GenBank using concatenated amino acid sequences inferred from 12 protein-coding genes. The mt genome of E. hortense contained 12 protein-coding genes, 22 transfer RNA genes, 2 ribosomal RNA genes, and 1 non-coding region. The length of the mt genome of E. hortense was 14,994 bp, which was somewhat smaller than those of other trematode species. Phylogenetic analyses based on concatenated nucleotide sequence datasets for all 12 protein-coding genes using maximum parsimony (MP) method showed that E. hortense and Hypoderaeum conoideum gathered together, and they were closer to each other than to Fasciolidae and other echinostomatid trematodes. The availability of the complete mt genome sequences of E. hortense provides important genetic markers for diagnostics, population genetics, and evolutionary studies of digeneans.

Intestinal trematode infection in North Bihar.

Reports of intestinal trematode infections are not common from Bihar, India. However, we herewith report one case of fasciolopsiasis from North Bihar, India. A 14 years old girl presented with diarrhea, vomiting, generalized pain abdomen and loss of weight. Routine stool examination and upper gastrointestinal endoscopy revealed fasciolopsis buski in large numbers. Her rural life style and food habit (ingestion of raw vegetables- caltrops and water chest nuts) supported the cause of infestation. Despite treatment with praziquantel, the patient died after two days. Mild infestations of Fasciolopsis buski may pass on unnoticed. However, heavy infestations may cause considerable prostration, illness and even death in younger age groups. Awareness regarding this parasitic infestation (endemic in some regions), especially in the rural set up is still a much needed entity.

Fasciolopsiasis: a first case report from Malaysia.

Fasciolopsiasis is a disease caused by the largest intestinal fluke, Fasciolopsis buski. The disease is endemic in the Far East and Southeast Asia. Human acquires the infection after eating raw freshwater plants contaminated with the infective metacercariae. There has been no report of fasciolopsiasis either in man or in animal in Malaysia. We are reporting the first case of fasciolopsiasis in Malaysia in a 39-year-old female farmer, a native of Sabah (East Malaysia). This patient complained of cough and fever for a duration of two weeks, associated with loss of appetite and loss of weight. She had no history of traveling overseas. Physical examination showed pallor, multiple cervical and inguinal lymph nodes and hepatosplenomegaly. Laboratory investigations showed that she had iron deficiency anemia. There was leukocytosis and a raised ESR. Lymph node biopsy revealed a caseating granuloma. Stool examination was positive for the eggs of Fasciolopsis buski. The eggs measure 140 x 72.5 microm and are operculated. In this case, the patient did not present with symptoms suggestive of any intestinal parasitic infections. Detection of Fasciolopsis buski eggs in the stool was an incidental finding. She was diagnosed as a case of disseminated tuberculosis with fasciolopsiasis and was treated with antituberculosis drugs and praziquantel, respectively.

Therapeutic efficacy of triclabendazole in threatment of fasciolopsis

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

Sequencing analysis of 18S ribosomal RNA of human giant intestinal fluke (Fasciolopsis rusk/) collected in Ninh Binh and Nghe An provinces

Fasciolopsis buski is common parasite in pigs. Some patients who infected by adult worms of Fasciolopsis buski in several areas, including the provinces of Ninh Binh and Nghe An were sampled. Genome of 18S ribosomal RNA with 1950 nucleotides from giant intestinal fluke (Fasciolopsis buski) was obtained using polymerase chain reaction (PCR) and sequencing approach for comparative analysis each others and with the data deposited in GenBank (L06668). The adult worms from Ninh Binh and Nghe An were morphologically identified as Fasciolopsis buski. The genetic analysis revealed that the 18S rRNA gene of the giant intestinal flukes isolated in Ninh Binh and Nghe An were similar (homogenous 100% of nucleotides) and showed nearly absolute identity with only 2 divergent nucleotides of 0.01% (2/1950 nucleotides) to the 18S rRNA of the pig Fasciolopsis buski as the data deposited in GenBank (L066608). However, 18S ribosomal RNA of the adult worms of human Fasciolopsis buski collected from the provinces of Ninh Binh and Nghe An were similar to one another

18S ribosomal RAN besed molecular identification of giant intestinal fluke (fasciolopsis buski) isolated in human in Vietnam

The total sequence of 18S rRNA and the neighbours including 1950 pairs of nucleotide (N) was received by PCR and expressed orderly. The examinated sample was 1 of 8 adult worms collected from 12.5 years old male patient. The worm was determined morphologically as Fasciolopsis buski. The comparison showed that in this intestinal fluke worm there is an almost absolutely analogous coefficient concerning nitrogen components of 18S rRNA in only 2 differences on 1950 N (0.01%) with the gene sequence of 18S rRNA kept in the bank of genes. In Viet Nam, this is the first molecular determination realized on human

Report on a fasciolopsis buski case detected in human in Nghe An province

A male patient of 2,5 year old living in Vinh city, Nghe An province, who often had abdominal paine. On October 3rd, 2001, he has vomitted with 8 flukes, which were identified by morphology and lately confirmed by molecular approach in Institute of Biological Technology as Fasciolopsis buski

Fasciolopslasis--a re-emerging infection in Azamgarh (Uttar Pradesh).

Fasciolopsiasis is endemic in the far east. In India, there have been a few reports of the infection, prior to the 1990's. We report two cases from Azamgarh district of Uttar Pradesh. Both the cases were from nearby villages where water chestnuts are cultivated. These may be a source of infection. Pigs are commonly observed in these areas and and may be the source of ova. The only missing link is the finding of infected snails. Presence of at least three cases (one reported earlier) in the area indicates the potential for the infection to re-emerge. Further epidemiological studies are needed to analyse the various ecological factors of transmission. Fasciolopsiasis is endemic in China, Taiwan, Vietnam and Thailand. In India, (Fascilopsis buski) infections in man have been reported earlier from Assam, Maharashtra, Tamil Nadu and parts of Uttar Pradesh. However, to the best of our knowledge, no such reports have been made since 1990's. We herewith report two recent cases from district Azamgarh, Uttar Pradesh (U.P.), India. Factors, such as cultivation of water chestnuts, presence of snails as intermediate hosts and pigs as definitive host in this geographical area seem to be suggestive of an endemic focus and thus needs further epidemiological survey for preventive and control measures, at the earliest.

Fasciolopsiasis--a persisting problem in eastern U.P.--a case report.

Fasciolopsiasis, or infection by the intestinal fluke, Fascilopsis buski, is endemic in the eastern states of our country. While it is by no means a rarity, especially in the rural set up, awareness regarding this common parasitic infestation is still a much-needed entity. The importance of a strong degree of suspicion and early diagnosis cannot be over emphasised, if a successful campaign is to be launched in its control. With this as our central theme, we proceed to report a case of and unsually heavy Fasciolopsis buski infection in our hospital, which had failed to be diagnosed in a semi urban setup in UP.

Fasciolopsis buski (giant intestinal fluke)--a case report.

A girl, aged 20 years presented with diarrhoea, vomiting, pain abdomen and loss of weight, the routine Stool examination revealed Fasciolopsis buski (giant intestinal fluke) in large numbers. Despite treatment with Praziquantel, she died after three days.

Intestinal absorption studies in Fasciolopsis buski infection.

The intestinal absorption of carbohydrate, fat, protein and vitamin B12, serum vitamin B12, serum and red cell folate levels were performed in 10 patients harbouring F. buski. No disturbance of carbohydrate, fat and protein absorption was observed but vitamin B12 absorption was found to be slightly lower than normal in 8 out of 10 patients, and serum vitamin B12 was also lower than normal in 4 out of 9 patients. Red cell and serum flolate levels were within the normal limits. Histological study of jejunal biopsy was normal in 7 out of 8 patients.

Field trial on the treatment of fasciolopsiasis with praziquantel.

Eight-five of 816 (10.7%) students attending a primary school in Central Thailand were examined and found infected with Fasciolopsis buski. All of students ate fresh water lily stems and most ate other fresh water plants including caltrop, water cress and morning glory. The 85 students were given praziquantel in randomized single doses of 15, 25 or 40 mg/kg body weight. Side effects were mild and transient and consisted of headache, dizziness, nausea, sleepiness, abdominal discomfort, anorexia, diarrhea, epigastric pain, vomiting and lassitude. Those receiving the highest dosages had more side effects than students in the other 2 groups. Large blisters were observed on the tegument of F. buski passed in feces and this was believed to be caused by the drug. The authors recommend a single dose of praziquantel in a dosage of 15 mg/kg of body weight for the treatment of parasitosis.