Triclabendazole in treatment of human fascioliasis

Recent outbreaks of human fascioliasis had been reported in Alexandria and Behira provinces. The presentation of Fasciola species infection in man varies with the age of the patient and with the stage of the disease. Many drugs have been tried in human fascioliasis but still the drug of choice remains to be determined. Triclabendazole is a novel antihelminth that affects both immature and mature stages of Fasciola infection. Previous preliminary studies showed that the drug has a promising value in treatment of human fascioliasis. The present study was carried out on 54 patients with fascioliasis, 26 of them were incubating patients and 28 with established fascioliasis. Regarding the age, 37 were children and 17 were adult patients. Patients were assessed clinically and by laboratory investigations. They were treated with triclabendazole suspension 10% solution in a dose of 20 mg/kg body weight on fasting stomach. The study revealed that the drug is finely tolerated safe and effective. Acute or incubating fascioliasis in children is more preferably treated by two doses [second dose raised cure rate from 37 to 83%]. Adults require a single dose whatever the stage of the disease [cure rate of the single dose was 78-90%]

ERCP findings in clonorchiasis of the liver

ERCP was performed in 38 cases of clonorchiasis of the liver, which was confirmed by stool egg test withStoll's dilution method from Apr. 1979 to Oct. 1982. The resuls were as follows 1. The sex distribution ofclonorchiasis showed marked male predominance by 97.4% and age distrigution were higher in 5th and 6th decades. 2.Multiple small filling defects in the intrahepatic bile duct was the most characteristic finding in ERCP and widespread irregular stenosis, dilatation of terminal portion, disturbance of peripheral filling, fuziness andraggedness of intrahepatic duct were also noted. 3. The severity of clonorchiasis by ERCP were classifed asfollows; Grade I-7 cases (18.4%), GradeII-9 cases(23.7%) Grade III-12 cases (31.6%) and Grade IV-10 cases(26.3%)4. Chronic cholecystitis 10 cases(26.3%), Billary tree stone 7 cases (18.4%), malignancy of distal CBD 1 case(2.6%) were found with clonorchiasis by ERCP. 5. Three cases, treated with Niclofolan, showed marked improvementof pathology on follow-up ERCP.

A case of niclofolan (Bilevon) intoxication

The authors reported a case of niclofolan intoxication occurred during the trial of clonorchiasis treatment. The case, a 15 years old Korean schoolboy, took niclofolan(Bilevon) of total 473 mg(11 mg/kg) in 11 divided doses during 20 days. And the case suffered from neurologic symptoms such as severe headache, dizziness, nausea, vomiting, blurred vision, papilledema, retinal hemorrhage, an epsiode of seizure attack and elevated intracranial pressure, and hepatotoxic symptoms such as hepatomegaly, increased serum transaminases, and shoulder pain, excessive sweating and weight loss. Therapy was concentrated to the management of the elevated intracranial pressure. Hepatotoxic manifestations subsided within one month. The clinical signs related to elevated intracranial pressure persisted two months. Body weight regained after 2 months. And the symptoms of headache, dizziness and vomiting were complained intermittently until 4 months after onset. However, no subsequent clinical problems related with this episode has been noted until this record.

Studies on the chemotherapy of human opisthorchiasis: II. Clinical trial of niclofolan.

A clinical trial of Niclofolan on human opisthorchiasis was carried out in 60 patients admitted to the Hospital for Tropical Diseases. Two dosage regimen, 2 mg and 3 mg per kg body weight repeated after a 72 hour interval was administered to 31 and 4 patients respectively. Comparative evaluation with the placebo group of 25 patients was made by the Stoll count on day 20, 40 and 60 after treatment. On day 60 percentage egg reduction of the treated and the placebo groups were similar. Mild and transient side effects such as nausea, anorexia, myalgia and arthralgia were recorded in all 3 groups but more severe in the higher dosage group. In this study, Niclofolan failed in reducing the egg production of Opisthorchis viverrini.

In vitro activities of various drugs against adult worms of Clonorchis sinensis

The present study was undertaken to evaluate in vitro activities of following drugs against adult worms of Clororchis sinensis: i.e., stibnal, chloroquine diphosphate, Hetol (1,4-bis-trichloromethylbenzol), dehydroemetine 'Roche' (Ro 1-9334), niridazole (Ambilhar), bisbendazole, gentian violet, dithiazanine iodide, hexachlorophene, bithionol, niclofolan (Bilevon, Bayer 9015) and praziquantel (Embay 8440, Biltricide). After isolation from bile ducts of experimentally infected rabbits (3 months infection), the parasites were rinsed in sterilized Tyrode's solution and incubated for 24 hours at 37 C in TC 199 medium with Earle's balanced salt solution containing 0, 0.01, 0.1, 1.0, 10 and 100 microgram/ml concentrations of each above drugs. The activities of each concentrations with each drugs were evaluated by the motility of the worms in culture tubes observing at 15, 30, 60 minutes and 2, 4, 6, 12, 18 and 24 hours by stereomicroscope. In the results, no effect was found at the adult worms of C. sinensis in all concentrations with stibnal, chloroquine diphosphate, Hetol, dehydroemetine, niridazole and bisbendazole. However, moderate activities were observed in the concentrations of 1.0 and 0.1 microgram/ml of gentian violet, dithiazanine iodide, hexachlorophene and bithionol. The highest activities were observed in all concentrations of niclofolan and praziquantel.

Anthelmintic effects of various drugs against metagonimiasis

The infection of Metagonimus yokogawai has been known to be present nationwidely and endemic in some parts in Korea. In order to select a highly effective compound against Metagonimus infections, the therapeutic effects were observed in 156 cases who were treated with several anthelmintic i.e. bithionol, niclosamide, niclofolan and praziquantel. All of the above drugs showed highly effective to the treatment of metagonimiasis by a single or two medication days. The egg reduction rates were in the range of 80.2 to 100 per cent. However, relatively low cure rates(8.3 to 37.5 percent) were observed in the groups treated by two doses of 30 mg/kg of bithionol, a single day treatment with 100 mg/kg of niclosamide and two doses of 1.0 mg/kg of niclofolan. On the other hand, the high cure rates were observed at the following dose rates of each drugs, i.e. the cure rate of 66.7 percent was obtained at two doses of 100 mg/kg of niclosamide, 88.9 percent of cure rate was observed at two doses of 2.0 mg/kg of niclofolan and a single dose of 10 and 20 mg/kg of praziquantel were shown as 85.0 percent and 88.0 percent of cure rates respectively. But the complete radical cure was obtained in the group treated by two doses of 20 mg/kg of praziquantel in 10 metagonimiasis cases. From the above results praziquantel was shown as the most highly effective against metagonimiasis and it was well tolerated without any side effect. Therefore, praziquantel is a very promising drug for mass treatment against metagonimiasis.

Expermental chemotherapeutic effects of niclofolan (Bayer 9015, Bilevon) on the animals infected with Paragonimus westermani or P. iloktsuenensis

The new drug niclofolan (bayer 9015, Bilevon), 5,5'-dichloro-2,2'-dihydroxy-3, 3'-dinitrobiphenyl, has been used in the treatment of Paragonimus westermani in dogs and cats and P. iloktsuenensis in rats. It was proved that administration of daily dose of 1.0 mg/kg body weight for 3 days or in 2 doses of 2.0 mg/kg body weight by alternate days were evidently effective for the infected dogs, cats and rats with the lung flukes, and toxic manifestations were not found.