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Zárate-Rendón DA, Briones-Montero A, Huaraca-Oré NA, Veirano GS, Levecke B, Geldhof P. Comparison of the therapeutic efficacy of five anthelmintics against natural Fasciola hepatica infections in dairy cattle from the Mantaro Valley, Peru. Vet Parasitol Reg Stud Reports 2023; 38:100827. [PMID: 36725157 DOI: 10.1016/j.vprsr.2022.100827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/14/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
The intensive use of anthelmintic drugs to control Fasciola hepatica infections in dairy cattle has resulted in the emergence of anthelmintic resistance. Cases of resistance to triclabendazole (TCBZ) have been reported worldwide. The main goal of this research was to evaluate the main five fasciolicides to control fasciolosis in dairy cattle in the Mantaro Valley, Peru. Two fecal egg count reduction tests were performed. In a first study, 24 naturally F. hepatica infected cattle were randomly grouped into three experimental groups (n = 8). Groups were treated with either TCBZ, nitroxynil (NTX) or closantel (CLOS). In a second experiment, 55 naturally infected cows were grouped into three experimental groups and treated with either TCBZ (n = 18), rafoxanide (RFX) + albendazole (ABZ) (n = 19) or clorsulon (CLN) + ivermectin (IVM) (n = 18). Therapeutic efficacy was determined following the WAAVP guidelines by measuring reduction in fluke egg output at days 15 and 30 post-treatment. Bootstrapping method was used to obtain the 95% confidence intervals. The efficacy of TCBZ was inadequate in both studies (≤80.8%). Closantel showed high efficacy (≥ 90%) at both days, while NTX showed 92.9% (83-100) and 82.1% (53.6-100), efficacy, at days 15 and 30, respectively. Efficacy for RFX were 92.1% (79.6-98.9) and 97.4% (94.1-99.4); and for CLN, 98.8% (97.6-100) and 80.1% (44.7-99.4), at days 15 and 30, respectively. The outcome of this study indicates reduced therapeutic efficacy of TCBZ against F. hepatica in an important dairy area of the Peruvian central highlands but also demonstrates the validity of four alternatives.
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Affiliation(s)
- Daniel A Zárate-Rendón
- Laboratorio de Parasitología, Departamento Académico de Nutrición, Facultad de Zootecnia, Universidad Nacional Agraria La Molina, Lima, Peru.
| | - Andrea Briones-Montero
- Laboratorio de Parasitología, Departamento Académico de Nutrición, Facultad de Zootecnia, Universidad Nacional Agraria La Molina, Lima, Peru
| | - Natividad A Huaraca-Oré
- Laboratorio de Parasitología, Departamento Académico de Nutrición, Facultad de Zootecnia, Universidad Nacional Agraria La Molina, Lima, Peru
| | - Gonzalo Suárez Veirano
- Unidad Farmacología y Terapéutica, Facultad de Veterinaria, Universidad de la Republica, Uruguay
| | - Bruno Levecke
- Laboratory of Parasitology, Faculty of Veterinary Medicine, University of Ghent, Merelbeke, Belgium
| | - Peter Geldhof
- Laboratory of Parasitology, Faculty of Veterinary Medicine, University of Ghent, Merelbeke, Belgium
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Morales ML, Tanabe MB, White AC, Lopez M, Bascope R, Cabada MM. Triclabendazole Treatment Failure for Fasciola hepatica Infection among Preschool and School-Age Children, Cusco, Peru 1. Emerg Infect Dis 2021; 27:1850-1857. [PMID: 34152949 PMCID: PMC8237897 DOI: 10.3201/eid2707.203900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted a retrospective cohort study of children who had chronic fascioliasis in the highlands of Peru to determine triclabendazole treatment efficacy. Children passing Fasciola eggs in stool were offered directly observed triclabendazole treatment (>1 doses of 10 mg/kg). Parasitologic cure was evaluated by using microscopy of stool 1–4 months after each treatment. A total of 146 children who had chronic fascioliasis participated in the study; 53% were female, and the mean ± SD age was 10.4 ± 3.1 years. After the first treatment, 55% of the children achieved parasitologic cure. Cure rates decreased after the second (38%), third (30%), and fourth (23%) treatments; 17 children (11.6%) did not achieve cure after 4 treatments. Higher baseline egg counts and lower socioeconomic status were associated with triclabendazole treatment failure. Decreased triclabendazole efficacy in disease-endemic communities threatens control efforts. Further research on triclabendazole resistance and new drugs to overcome it are urgently needed.
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Observational study on the effectiveness and safety of multiple regimens of triclabendazole in human fascioliasis after failure to standard-of-care regimens. J Glob Antimicrob Resist 2021; 25:264-267. [PMID: 33862276 DOI: 10.1016/j.jgar.2021.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
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.
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Marcos L, Maco V, Terashima A. Triclabendazole for the treatment of human fascioliasis and the threat of treatment failures. Expert Rev Anti Infect Ther 2020; 19:817-823. [PMID: 33267701 DOI: 10.1080/14787210.2021.1858798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Luis Marcos
- Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.,Department of Microbiology and Immunology, Stony Brook University, Stony Brook, NY, USA
| | - Vicente Maco
- Laboratorio De Parasitologia, Instituto De Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angelica Terashima
- Laboratorio De Parasitologia, Instituto De Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,Departamento De Enfermedades Infecciosas, Tropicales Y Dermatologicas, Hospital Cayetano Heredia, Lima, Peru
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Gandhi P, Schmitt EK, Chen CW, Samantray S, Venishetty VK, Hughes D. Triclabendazole in the treatment of human fascioliasis: a review. Trans R Soc Trop Med Hyg 2020; 113:797-804. [PMID: 31638149 PMCID: PMC6906998 DOI: 10.1093/trstmh/trz093] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/26/2019] [Accepted: 08/06/2019] [Indexed: 01/09/2023] Open
Abstract
Fascioliasis occurs on all inhabited continents. It is caused by Fasciola hepatica and Fasciola gigantica, trematode parasites with complex life cycles, and primarily affects domestic livestock. Humans become infected after ingestion of contaminated food (typically wild aquatic vegetables) or water. Fascioliasis may be difficult to diagnose as many symptoms are non-specific (e.g. fever, abdominal pain and anorexia). Treatment options are limited, with older effective therapies such as emetine and bithionol no longer used due to safety issues and unavailability, and most common anthelminthics having poor efficacy. Clinical trials conducted over a 25-year period, together with numerous case reports, demonstrated that triclabendazole has high efficacy in the treatment of human fascioliasis in adults and children and in all stages and forms of infection. Triclabendazole was approved for human use in Egypt in 1997 and in France in 2002 and a donation program for the treatment of fascioliasis in endemic countries was subsequently established by the manufacturer and administered by the World Health Organization. Here the published data on triclabendazole in the treatment of human fascioliasis are reviewed, with a focus on more recent data, in light of the 2019 US Food and Drug Administration approval of the drug for use in human infections.
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Affiliation(s)
- Preetam Gandhi
- Global Health Development Unit, Forum 3, Novartis Pharma AG, Novartis Campus, Lichtstrasse, 4002 Basel, Switzerland
| | - Esther K Schmitt
- Global Health Development Unit, Forum 3, Novartis Pharma AG, Novartis Campus, Lichtstrasse, 4002 Basel, Switzerland
| | - Chien-Wei Chen
- Novartis Pharmaceuticals Corporation, One Health Plaza-315/5320 B, East Hanover NJ, 07936 USA
| | - Sanjay Samantray
- Novartis Healthcare Pvt. Ltd, Salarpuria-Sattva Knowledge City, Inorbit Mall Rd, Silpa Gram Craft Village, HITEC City, Hyderabad, Telangana 500081, India
| | - Vinay Kumar Venishetty
- Novartis Healthcare Pvt. Ltd, Salarpuria-Sattva Knowledge City, Inorbit Mall Rd, Silpa Gram Craft Village, HITEC City, Hyderabad, Telangana 500081, India
| | - David Hughes
- Global Health Development Unit, Forum 3, Novartis Pharma AG, Novartis Campus, Lichtstrasse, 4002 Basel, Switzerland
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Mollinedo S, Gutierrez P, Azurduy R, Valle F, Salas A, Mollinedo Z, Soto P, Villarroel CF, Ransom J, Lawrence R, Berman J, Soto J. Mass Drug Administration of Triclabendazole for Fasciola Hepatica in Bolivia. Am J Trop Med Hyg 2020; 100:1494-1497. [PMID: 31115295 DOI: 10.4269/ajtmh.19-0060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Human infection with Fasciola hepatica leads to obstruction of the common bile duct by adult worms and disease characterized by biliary colic, epigastric pain, and nausea. Recommended treatment is a single dose of triclabendazole (TCBZ) (10 mg/kg). Because in the 1990s the Bolivian Altiplano bordering Lake Titicaca was thought to have the highest prevalence of human fascioliasis worldwide, the Bolivian Ministry of Health instituted TCBZ mass drug administration (MDA). From 2008 to 2016 (excepting 2015), one dose of 250 mg was administered, usually in September/October, to each resident of highly endemic regions willing to participate. This is apparently the first reported use of MDA for Fasciola. The proportion of persons in key regions receiving TCBZ MDA was 87% in 2016. In 2017, we resurveyed key regions, and found that the MDA program had been dramatically successful. Whereas Fasciola prevalence was reported as 26.9% in Huacullani/Tiahuanaco and 12.6% in Batallas in 1999, there was 0.7% prevalence in Huacullani/Tiahuanaco and 1% in Batallas in 2017. However, lessons from schistosomiasis control efforts suggest that for sustained control of Fasciola infection, Fasciola MDA needs to be maintained and coupled with measures to control infection in the intermediary snail and in the animal hosts of F. hepatica.
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Affiliation(s)
| | | | - Rosa Azurduy
- Servicio Departamental de Salud (SEDES), La Paz, Bolivia
| | - Freddy Valle
- Servicio Departamental de Salud (SEDES), La Paz, Bolivia
| | | | | | - Paula Soto
- FUNDERMA (Fundación Nacional de Dermatología), Santa Cruz, Bolivia
| | | | - Janet Ransom
- Fast-Track Drugs and Biologics, North Potomac, Maryland
| | | | | | - Jaime Soto
- FUNDERMA (Fundación Nacional de Dermatología), Santa Cruz, Bolivia
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Krsak M, Patel NU, Poeschla EM. Case Report: Hepatic Fascioliasis in a Young Afghani Woman with Severe Wheezing, High-Grade Peripheral Eosinophilia, and Liver Lesions: A Brief Literature Review. Am J Trop Med Hyg 2020; 100:588-590. [PMID: 30628571 DOI: 10.4269/ajtmh.18-0625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A 23-year-old recent emigrant from Afghanistan presented in August 2017 with severe wheezing and dyspnea that required hospital admission. Her illness was associated with marked peripheral blood eosinophilia (9,900-15,600/µL; 45.2-68%), as well as mild nausea, epigastric pain, and decreased appetite. She had lived until 3 months earlier in close proximity to cattle in her home in Kabul and did not recall eating watercress or other leafy plants associated with Fasciola hepatica transmission. Computerized tomography scanning showed bilateral ground-glass lung consolidations and multiple distinctive hypo-attenuating linear, tubuliform, and nodular liver lesions, including a large subcapsular hematoma. Numerous tests for rheumatological and malignant disorders were negative. Fasciola hepatica infestation was suspected on epidemiological, clinical, and radiographic grounds, and was confirmed by immunoblotting at the Centers for Disease Control (CDC). Multiple stool ova and parasite examinations were negative and endoscopic retrograde cholangiopancreatography did not identify trematodes. Her acute respiratory illness resolved with asthma-targeted therapies and her eosinophilia resolved with triclabendazole, which was obtained from CDC via an FDA Investigational New Drug application. Fascioliasis is uncommon in the United States, but the prolonged warfare and civil strife in Afghanistan and adjacent areas may lead to increased incidence outside the endemic region. Her case also demonstrates how hepatic imaging features of fascioliasis can be pathognomonic in clinical scenarios with eosinophilia and appropriate epidemiology and clinical features. We also highlight her relatively unusual presentation with symptoms of Loeffler-like syndrome alone.
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Affiliation(s)
- Martin Krsak
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
| | - Nayana U Patel
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Eric M Poeschla
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
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Recent developments in the epidemiology, diagnosis, and treatment of Fasciola infection. Curr Opin Infect Dis 2019; 31:409-414. [PMID: 30113327 DOI: 10.1097/qco.0000000000000482] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW This review aims at describing the latest research in Fasciola epidemiology, diagnosis, treatment, and control in endemic countries. RECENT FINDINGS The geographic distribution and range of reservoirs for Fasciola hepatica continues to expand. The impact of fascioliasis goes beyond human disease to affect food security and income in developed and developing countries. Promising serologic and molecular methods to diagnose fascioliasis have been described, but are not widely available. Triclabendazole remains the only highly active medication to treat human and livestock infected with juvenile and adult forms of Fasciola spp. Efforts to control fascioliasis may be hindered by the emergence of resistance to triclabendazole among livestock and subsequently in humans. SUMMARY Increased awareness and surveillance are likely to uncover the real distribution and burden of fascioliasis in human. Research into new drugs or adjuvants to tackle the emerging resistance to triclabendazole is imperative to treat and control Fasciola infection.
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Harrington D, Lamberton PHL, McGregor A. Human liver flukes. Lancet Gastroenterol Hepatol 2018; 2:680-689. [PMID: 28786389 DOI: 10.1016/s2468-1253(17)30111-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/26/2017] [Accepted: 04/03/2017] [Indexed: 12/12/2022]
Abstract
Liver fluke infections occur in people worldwide. In some low-income regions, a combination of ecological, agricultural, and culinary factors leads to a very high prevalence of infection but, in higher-income regions, infections are uncommon. Infection is associated with substantial morbidity and several liver fluke species are recognised as biological carcinogens. Here, we review the epidemiology, clinical significance, and diagnostic and treatment strategies of human infection with these pathogens.
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Affiliation(s)
- David Harrington
- Department of Infectious Diseases and Tropical Medicine, Northwick Park Hospital, London, UK.
| | - Poppy H L Lamberton
- Institute of Biodiversity, Animal Health, and Comparative Medicine, and Wellcome Centre for Molecular Parasitology, University of Glasgow, Glasgow, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Alastair McGregor
- Department of Infectious Diseases and Tropical Medicine, Northwick Park Hospital, London, UK; Faculty of Medicine, Imperial College London, London, UK
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Badirzadeh A, Sabzevari S. Hepatic fascioliasis in Mashhad, Northeast Iran: first report. Rev Soc Bras Med Trop 2017; 50:571-574. [DOI: 10.1590/0037-8682-0526-2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/28/2017] [Indexed: 11/22/2022] Open
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