Observational study on the effectiveness and safety of multiple regimens of triclabendazole in human fascioliasis after failure to standard-of-care regimens.

OBJECTIVES: Triclabendazole (TCBZ) is the recommended anthelmintic against Fasciola hepatica at a dose of 10 mg/kg body weight administered as a single or double dose. However, treatment failures to TCBZ standard-of-care (SOC) doses have been reported in humans. The aim of this study was to describe the effectiveness and tolerability of alternative TCBZ regimens in those patients who failed the SOC regimen for fascioliasis in Peru. METHODS: A retrospective study was conducted at a major referral centre for fascioliasis in Peru between 2002 and 2018. Inclusion criteria were cases with chronic F. hepatica infection who failed the SOC regimen for human fascioliasis with TCBZ at 10 mg/kg orally as single dose with food. RESULTS: A total of 27 cases (59% female; mean age 39.4 years, range 6-71 years) with chronic fascioliasis failed at least once the current SOC regimen of TCBZ. Of 27 cases, 21 failed a second treatment regimen. Multiple regimens of TCBZ were given to these patients until three consecutive stool examinations were negative for Fasciola eggs. The overall cure rate was 74%. TCBZ was well tolerated with minimal side effects. CONCLUSION: According to the results of this study, patients labelled as having 'TCBZ resistance' may respond to multiple regimens of TCBZ with a cure rate of 74%. Thus, the term 'TCBZ resistance' should be re-evaluated using biomarkers.

Triclabendazole for the treatment of human fascioliasis and the threat of treatment failures.

INTRODUCTION: The only drug effective against the infection caused by Fasciola hepatica or F. gigantica is triclabendazole (TCBZ), recommended by the WHO and recently approved by the FDA. Here, we describe the evolution of TCBZ regimens and the emergence of TCBZ failure to Fasciola infection. AREAS COVERED: The present review focuses on the evidence of TCBZ for the treatment of fascioliasis. For acute fascioliasis, there is a lack of studies to measure the presence of eggs of Fasciola in stool samples on the follow-up after initial TCBZ treatment. For chronic fascioliasis, WHO recommends a single oral dose of TCBZ 10 mg/kg whereas CDC recommends two doses of TCBZ 10 mg/kg 12 h apart. Incremental number of treatment failures have been documented worldwide. There are currently no therapeutic alternatives for the treatment of fascioliasis in humans. EXPERT OPINION: Most cases of human fascioliasis are successfully treated with TCBZ, but some continue excreting eggs in the stools despite 1-2 standard of care regimens of TCBZ. A precise regimen is unclear for those patients who fail the initial treatment with TCBZ. Further clinical trials are needed to address the possible TCBZ emerging resistance.

Association of Fasciola hepatica Infection with Liver Fibrosis, Cirrhosis, and Cancer: A Systematic Review.

BACKGROUND: Fascioliasis has been sporadically associated with chronic liver disease on previous studies. In order to describe the current evidence, we carried out a systematic review to assess the association between fascioliasis with liver fibrosis, cirrhosis and cancer. METHODOLOGY AND PRINCIPAL FINDINGS: A systematic search of electronic databases (PubMed, LILACS, Scopus, Embase, Cochrane, and Scielo) was conducted from June to July 2015 and yielded 1,557 published studies. Among 21 studies that met inclusion and exclusion criteria, 12 studies explored the association of F. hepatica with liver fibrosis, 4 with liver cirrhosis, and 5 with cancer. Globally these studies suggested the ability of F. hepatica to promote liver fibrosis and cirrhosis. The role of F. hepatica in cancer is unknown. Given the heterogeneity of the studies, a meta-analysis could not be performed. CONCLUSIONS: Future high-quality studies are needed to determine the role of F. hepatica on the development of liver fibrosis, liver cirrhosis, and cancer in humans.

Efficacy and tolerability of two single-day regimens of triclabendazole for fascioliasis in Peruvian children.

INTRODUCTION: The therapeutic scheme of triclabendazole (TCBZ), the recommended anthelmintic against Fasciola hepatica , involves 10mg/kg of body weight administered in a single dose; however, clinical trials in children are scarce. We evaluated the efficacy and tolerability of 2 schemes of TCBZ. METHODS: Eighty-four Peruvian children with F. hepatica eggs in their stools were allocated into 2 groups: 44 received 2 dosages of 7.5mg/kg each with a 12-h interval (Group I), and 40 received a single 10-mg/kg dose (Group II). Evaluation of efficacy was based on the presence of eggs in stools, and tolerability was based on the presence of symptoms and signs post-treatment. RESULTS: A parasitological cure was obtained in 100% of individuals from Group I and 95% of individuals from Group II. The most common adverse event was biliary colic. CONCLUSIONS: The tested scheme was efficacious and tolerable, and it might be an optimal scheme in the region. To the best of our knowledge, this represents the largest series of children treated with TCBZ in a non-hospital setting.

Efficacy and tolerability of two single-day regimens of triclabendazole for fascioliasis in Peruvian children

The therapeutic scheme of triclabendazole (TCBZ), the recommended anthelmintic against Fasciola hepatica , involves 10mg/kg of body weight administered in a single dose; however, clinical trials in children are scarce. We evaluated the efficacy and tolerability of 2 schemes of TCBZ.

Histopathological features of tungiasis in Peru.

Tungiasis is an ectoparasitic skin disease caused by Tunga penetrans and Tunga trimamillata. There is a lack of histopathological studies that evaluate the recognition of this flea in tissues. We describe the ex vivo dermoscopic and the histopathological patterns of six cases and relate the findings to the developmental stage of the parasite as defined by the Fortaleza classification: two were classified as Fortaleza 3b, 3 as 4a, and 1 as 4b. Two dermoscopic patterns were observed: a brown pigmented ring and a radial crown with a central pore. The most common histopathological findings were an eosinophilic cuticle, eggs in different stages of development, tracheal rings (parasite), and basal hyperplasia (host). The eosinophilic cuticle, eggs in different stages of evolution, and tracheal rings can help to establish the diagnosis when other parts of the parasite are lacking. The Fortaleza staging may represent a tool for pathology reporting purposes.

Fasciola hepatica phenotypic characterization in Andean human endemic areas: valley versus altiplanic patterns analysed in liver flukes from sheep from Cajamarca and Mantaro, Peru.

Fascioliasis is a zoonotic parasitic disease caused by Fasciola hepatica and Fasciola gigantica. Of both species, F. hepatica is the only one described in the Americas, mainly transmitted by lymnaeid snail vectors of the Galba/Fossaria group. Human fascioliasis endemic areas are mainly located in high altitude areas of Andean countries. Given the necessity to characterize F. hepatica populations involved, the phenotypic features of fasciolid adults infecting sheep present in human fascioliasis endemic areas were analysed in the Cajamarca Valley and Mantaro Valley (valley transmission patterns) and the northern Bolivian Altiplano (altiplanic transmission pattern). A computer image analysis system (CIAS) was applied on the basis of standardized measurements. The aforementioned highland populations were compared to standard lowland natural and experimental populations of European origin. Liver fluke size was studied by multivariate analyses. Two phenotypic patterns could be distinguished in F. hepatica adult size: the valley pattern (Cajamarca and Mantaro, Peru) and the altiplanic pattern (northern Altiplano, Bolivia). Results showed that the Andean valley population and European standard populations presented a phenotypic homogeneity. The Altiplano population showed a large size range with a pronouncedly lower minimum size indicating that uterus gravidity is reached at a smaller size than in valley populations. The results of this study demonstrate that there is no apparent relationship between the shape of fasciolid adults with regard to altitudinal difference or geographical origin and that allometry-free shape appears as a more stable trait than size in fasciolid species. Results are analysed in terms of intensity/crowding effect aspects and permanent/seasonal transmission characteristics.

Evidence of tungiasis in pre-Hispanic America.

Ancient parasites of the genus Tunga originated in America and, during the first half of the 19th century, were transported to the Eastern Hemisphere on transatlantic voyages. Although they were first documented by Spanish chroniclers after the arrival of Columbus, little is known about their presence in pre-Hispanic America. To evaluate the antiquity of tungiasis in America, we assessed several kinds of early documentation, including written evidence and pre-Incan earthenware reproductions. We identified 17 written documents and 4 anthropomorphic figures, of which 3 originated from the Chimu culture and 1 from the Maranga culture. Tungiasis has been endemic to Peru for at least 14 centuries. We also identified a pottery fragment during this study. This fragment is the fourth representation of tungiasis in pre-Hispanic America identified and provides explicit evidence of disease endemicity in ancient Peru.

Human herpesvirus 8 genotype E in patients with Kaposi sarcoma, Peru.

To determine human herpesvirus 8 (HHV-8) K1 genotypes in patients with Kaposi sarcoma (KS) from Peru, we characterized HHV-8 in 25 KS biopsy samples. Our findings of 8 A, 1 B, 14 C, and 2 E subtypes showed high HHV-8 diversity in these patients and association between E genotype and KS development.

An ectopic case of Tunga spp. infection in Peru.

Tungiasis is a neglected ectoparasitism of impoverished areas in South America and sub-Saharan Africa. The sand flea Tunga spp. preferably infests the soles and the periungueal and interdigital regions of the feet. Ectopic tungiasis is rare, even in highly endemic areas. We describe a case of an indigenous patient in Peru who presented with a nodular lesion in the extensor aspect of the knee and whose biopsy was compatible with Tunga spp. This is the first documented case of knee tungiasis in an endemic country. The historical, clinical, histological, and current epidemiological aspects of tungiasis in Peru are discussed here.

Un caso de infección ectópica provocado por la pulga spp. en Perú / A case of ectopic infection caused by the tunga spp. in Perú

Información sobre la infeccion tungiasis, que por lo general ataca la parte distal de las extremidades inferiores, y sobre un caso diagnosticado por biopsia en un niña de 9 años, en la ciudad de Lima, Perú.(AU)

Un caso de infección ectópica provocado por la pulga spp. en Perú / A case of ectopic infection caused by the tunga spp. in Perú

Información sobre la infeccion tungiasis, que por lo general ataca la parte distal de las extremidades inferiores, y sobre un caso diagnosticado por biopsia en un niña de 9 años, en la ciudad de Lima, Perú.

Técnica de sedimentación en tubo de alta sensibilidad para el diagnóstico de 305 parásitos intestinales / Spontaneous sedimentation in tube technique (SSTT) for diagnosis of intestinal parasites

OBJETIVO. El objetivo de este estudio fue medir la eficacia diagnóstica de la técnica de sedimentación espontánea en tubo descrita por Tello (TSET), en comparación con el examen directo y otras técnicas de concentración, cuando se usa para determinar la prevalenciade enteroparasitosis en trabajos de campo y laboratorio en zonas rurales de la sierra y selvas peruanas.METODOS. Se realizó un estudio prospectivo (2000 û 2004) donde se incluyeron 1 802 muestrasde heces de diversas zonas del Perú: Iquitos (N=74), Puno (N=399), Junín (N=1241), Lima (N=88). RESULTADOS. La TSET presentó mayor sensibilidad para la detección de helmintos y protozoarios en comparación con las otras técnicas convencionales empleadas simultáneamente (P<0.000). Aunque no se debe prescindir de otras técnicas coprológicas, como Baermann para diagnóstico de Strongyloides stercoralis y la Técnica de Sedimentación Rápida de Lumbreras (TSR) para Fasciola hepatica, la TSET contribuye a un diagnóstico eficaz y oportuno de las enteroparasitosis. CONCLUSIONES. Debido a su bajo costo, fácil ejecución y adaptabilidad en la realización,tanto en el trabajo dentro de laboratorios como en los trabajos de campo, se constituye en un hecho de necesidad urgente su implementación en los laboratorios de áreas rurales, asícomo la capacitación del personal de salud encargado del diagnóstico, como un primer paso en la lucha contra la parasitosis intestinal en el Perú.

OBJECTIVE. The objective of this study was to evaluate the diagnostic efficacy of the Spontaneous Sedimentation in Tube Technique (SSTT) described by Tello, in comparison with thedirect smear and other concentration techniques, when it is used to determine the prevalence of intestinal parasites in field and laboratory studies in rural areas of the Andean Region. METHODS. A prospective study (2000 û 2004) was carried out including 1 802 fecal samplesfrom several areas around Peru: Iquitos (N=74), Puno (N=399), Junín (N=1241), Lima (N=88). RESULTS. SSTT showed more sensitivity to detect helminthes and protozoa in comparisonto other conventional techniques carried out simultaneously (P;0.000). Although Baermann Technique and LumbreraÆs Rapid Sedimentation Technique are crucial for Strongyloides larvae and Fasciola eggs detection, respectively; SSTT contributes to an effective andtimely diagnosis of the intestinal parasites. CONCLUSIONS. Due to its low cost, easy reproducibility and adaptability both in the laboratoryand field work, it should be mandatory and urgent its implementation in laboratories from rural areas, as well as training of the staff involved in the diagnosis, as first step in the fightagainst intestinal parasites in Peru.

[Spontaneous sedimentation in tube technique (SSTT) for diagnosis of intestinal parasites]. / Técnica de sedimentación en tubo de alta sensibilidad para el diagnóstico de Parásitos intestinales.

OBJECTIVE: The objective of this study was to evaluate the diagnostic efficacy of the Spontaneous Sedimentation in Tube Technique (SSTT) described by Tello, in comparison with the direct smear and other concentration techniques, when it is used to determine the prevalence of intestinal parasites in field and laboratory studies in rural areas of the Andean Region. METHODS: A prospective study (2000-2004) was carried out including 1 802 fecal samples from several areas around Peru: Iquitos (N = 74), Puno (N = 399), Junín (N = 1241), Lima (N = 88). RESULTS: SSTT showed more sensitivity to detect helminthes and protozoa in comparison to other conventional techniques carried out simultaneously (P;0.000). Although Baermann Technique and Lumbrera's Rapid Sedimentation Technique are crucial for Strongyloides larvae and Fasciola eggs detection, respectively; SSTT contributes to an effective and timely diagnosis of the intestinal parasites. CONCLUSIONS: Due to its low cost, easy reproducibility and adaptability both in the laboratory and field work, it should be mandatory and urgent its implementation in laboratories from rural areas, as well as training of the staff involved in the diagnosis, as first step in the fight against intestinal parasites in Peru.

Evaluation of Fas2-ELISA for the serological detection of Fasciola hepatica infection in humans.

The performance of Fas2-ELISA for the diagnosis of Fasciola hepatica infection in children living in areas of high endemicity for fascioliasis in the Peruvian Andes is analyzed. Fas2-ELISA is based on the detection of circulating IgG antibodies elicited in infected individuals against a F. hepatica antigen termed Fas2. The study was conducted in three Andean localities, Huertas-Julcan in Junin, Asillo in Puno, and Cajamarca, with a total population of 634 children in an age range 1 to 16 years old. Child fascioliasis prevalence was 21.1% in Huertas-Julcan, 25.4% in Asillo, and 24% in Cajamarca, estimated by coprological inspection. The seroprevalence of F. hepatica infection, determined by Fas2-ELISA, was 27.8% in Huertas-Julcan, 44.6% in Asillo, and 29.1% in Cajamarca. The overall sensitivity of Fas2-ELISA was 92.4%, the specificity 83.6%, and the negative predictive value 97.2%. No association between OD(450) Fas2-ELISA and infection intensity measured by egg counting was observed. Results show that Fas2-ELISA is a highly sensitive immunodiagnostic test for the detection of F. hepatica infection in children living in human fascioliasis endemic areas.