Glutathione and related enzymes in fascioliasis before and after treatment with bithionol

The present work is an update evaluation of the glutathione status in patients with established fascioliasis before and after treatment with bithionol. Blood glutathione (GSH), erythrocyte glutathione S-transferase (GST) and serum gamma-glutamyl transferase (GGT) activities were studied. After treatment, the variations observed in these parameters were restored to the corresponding normal control values confirming the toxic features resulting from fascioliasis and suggesting no adverse effect of bithionol on the parameters studied. We recommend the use of serum GGT, blood GSH and erythrocyte GST for the early detection of therapeutic response in fascioliasis.     

Fascioliasis imported to Norway

We report 3 cases of fascioliasis imported to Norway: a 24-y-old male Vietnamese immigrant and a 51-y-old female Vietnamese immigrant with acute fascioliasis, and a 2-y-old male Ethiopian adoptee with chronic fascioliasis. Diagnosis was confirmed by detection of specific antibodies to Fasciola hepatica in the 2 first cases and by demonstration of Fasciola hepatica eggs in stool samples in the latter case. Treatment with oral triclabendazole led to prompt cure in all 3 patients. Imported fascioliasis is rarely reported but should be suspected in patients with a travel history to endemic areas, abdominal symptoms and hypereosinophilia of the blood.     

Praziquantel failure in the treatment of Fasciola hepatica

A case of human fascioliasis is presented in which the patient remained symptomatic after treatment with praziquantel and other agents but eventually responded to bithionol. The difficulties in finding an efficacious and tolerable drug therapy for this condition are reviewed with reference to the life cycle and pathogenesis of the parasite. It is concluded that while bithionol remains the current drug of choice, triclabendazole may play a dominant role in the near future.     

Fasciola hepatica infection: clinical and computerized tomographic findings of ten patients.

BACKGROUND/AIMS: Fasciola hepatica is the cause of liver infection, fascioliasis. Although rare, it is still a problem even in developed countries. In this study, the clinical and computerized tomographic findings of 10 patients diagnosed with fascioliasis are summarized. METHODS: The medical records of the patients with fascioliasis were retrospectively examined. Clinical, laboratory findings and computerized tomographic results were recorded. RESULTS: Abdominal pain, fever, eosinophilia and abnormal liver function tests were the most commonly encountered symptoms and signs. One patient was human immunodeficiency virus -positive with active tuberculosis. Serologic test for fasciola hepatica was positive in all patients. Nodular masses without prominent enhancement, and branching low-attenuated tubular lesions were the most commonly seen tomographic findings and were supportive for the diagnosis. All except the HIV-positive patient received bithionol therapy; six patients responded well, two lost contact with the clinic and one patient who was unresponsive to bithionol therapy received triclabendazole. During follow-up of the six patients who responded, all the clinical and radiological findings regressed. CONCLUSION: In any patient with peripheral eosinophilia, abdominal pain and elevated liver enzymes, especially when CT reveals tubular and nodular hypodense lesions particularly in subcapsular area, F. hepatica infection should be considered. Either triclabendazole or bithionol can be used effectively for the treatment.     

Computed Tomography Findings of Hepatic Lesions in Human Fascioliasis: Report of Two Cases

Two patients with hepatic fascioliasis are presented. Computed tomography demonstrated multiple low density areas located in the center and periphery of the liver. In one patient a spontaneous decrease in the size of the low-density areas occurred but the abdominal symptoms were persistent before bithionol treatment. After the treatment both patients became asymptomatic. The computed tomography scan can be a useful tool for the diagnosis and follow-up of the patients with hepatic fascioliasis.     

Hepatic fascioliasis. Resistance to praziquantel treatment and the radiological findings]

We report a case of hepatic fascioliasis. Fever and epigastric pain was the clinical presentation. We describe the features of the ultrasound and computed tomography examination. Symptoms were persistent after praziquantel treatment. Bithionol was effective and cured the patient.     

Human fascioliasis in Egypt: effect of infection and efficacy of bithionol treatment

The present study was conducted on 14 patients with established fascioliasis. The effect of infection on the haematological and biochemical parameters was determined and the liver and gall bladder were studied by ultrasonography. Bithionol was given in the dose of 30 mg kg-1 body weight every other day for 5 doses. The therapeutic efficacy was assessed by egg and eosinophilic counts and quantitative estimation of antibody titres by indirect haemagglutination test. Results revealed that fascioliasis caused normocytic hypochromic anaemia and eosinophilia. Serum bilirubin, ALT and AST were within normal range. Ultrasonography showed a normal echogenic pattern of the liver and gall bladder. One case showed thickness of the gall bladder wall which was tender under the transiducer. Fasciola eggs disappeared completely after the 5th dose giving a cure rate of 100%. Antibody titres reached a normal level at the end of the 3rd month post treatment. Bithionol proved to be a potent fasciolicidal drug with minimal side-effects.     

Lipid peroxidation level and antioxidant enzyme activities in the blood of patients with acute and chronic fascioliasis.

OBJECTIVE: In this study, we investigated the relationship between fascioliasis and serum malondialdehyde (MDA) levels, superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx) activities. We also investigated whether there are significant differences in MDA levels and antioxidant enzymatic activities between acute and chronic fascioliasis. METHODS: Forty fascioliasis patients who were diagnosed by ES-ELISA positivity were included in this study. The patients were classified as 18 with acute and 22 with chronic fascioliasis. RESULTS: In patients with fascioliasis, levels of MDA were statistically higher and erythrocyte SOD and GPx activities were statistically lower than in healthy controls. MDA levels were found to be higher in patients with acute fascioliasis than in patients with chronic fascioliasis although MDA levels were significantly higher in patients with chronic fascioliasis than in controls. There was no statistically significant difference between the two groups for the antioxidant enzyme activities. CONCLUSION: The results of this study may indicate that fascioliasis produces specific effects on the antioxidant defense mechanisms due to its inflammatory character. Our results also allow us to suggest that oxidative stress has an important role in the pathogenesis of fascioliasis and the persistence of this oxidative stress can be one of the underlying factors in the pathogenesis of the chronic disease.     

High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults

The current first-line choice of treatment of idiopathic thrombocytopenic purpura (ITP) in adults, prednisone, is effective but has many side effects. Furthermore, reduction of the dose leads to a relapse of ITP in a majority of cases. Courses of high-dose dexamethasone (HD) aim to avoid these problems. We treated 36 patients with newly diagnosed or recurrent ITP with an 8-day course of HD, with a peak dose of 40 mg/day. The courses were repeated up to a maximum of six courses, with a 28-day interval. Acute and chronic effects of HD on platelet counts were observed, as well as side effects. HD led to an acute response (rise of platelet count to a level above 50×10⁹/l) in 83%. When HD was given as a first-line treatment, 59% of patients were still in remission after 31 months. When HD was given as a second-line treatment, 50% of patients were in remission after 5 months, declining to 25% after 54 months. Side effects were frequent but rarely dangerous. In conclusion, acute effects of HD were excellent. Long-term effects of HD as a first-line therapy of ITP were good, but its long-term effects as a second-line therapy were much poorer.     

Chronic rejection after liver transplantation: a study of clinical, histopathological and immunological features

In an effort to better understand chronic liver transplant rejection, we studied 110 children and adults who survived for at least 2 mo after the transplant procedure. Chronic rejection was defined using a combination of clinical and histopathological criteria and was diagnosed in 10 of the 110 patients for an incidence of 9.1%. All 10 patients were children with the mean age 3.4 yr vs. 21.7 yr for patients without chronic rejection (p less than .001). Males and females were equally represented, and nine received a liver from a gender-matched donor. Four patients were non-Caucasian, resulting in an incidence of 21.7% in non-Caucasian recipients vs. 6.6% in Caucasian recipients (p less than .05). All chronic rejection patients received a liver from an ABO-compatible donor. T-cell crossmatch was negative in all patients in whom it was assessed, and no significant disparity in either the class I or class II human leukocyte antigen loci was noted. Patients who had chronic rejection experienced acute rejection earlier, 11 days vs. 16 days (p less than .05), than patients who did not. In 8 of 10 patients, chronic rejection appeared to evolve directly from early episodes of acute rejection that were unresponsive to immunosuppressive therapy. Two distinct histological presentations were noted. One was progressive loss of bile ducts without hepatocellular injury (four patients), and the other was characterized by worsening ischemic hepatocellular damage and fibrosis (six patients) in addition to severe ductular injury. The first was associated with a more benign clinical course, the second with rapidly deteriorating hepatic function. Three patients recovered spontaneously 9 to 14 mo after transplant, one died awaiting a donor for retransplant, and five had retransplants. We conclude that chronic rejection after the operation is a relatively uncommon complication of liver transplantation with a variable clinical course and unpredictable outcome.     

Human fascioliasis successfully treated with triclabendazole

Fascioliasis, caused by the common liver fluke Fusciolu hepatica , is an endemic infection in sheep and cattle in many parts of Australia. Infections in humans in Australia have been reported infrequently and the most appropriate therapy for human fascioliasis remains to be determined. This case report describes a patient with the infection unsuccessfully treated with multiple high doses of praziquantel, mebendazole or albendazole. The infection was successfully eliminated by the administration of triclabendazole in two single doses of 900 mg (12 mg/kg) two days apart. No side effects were observed after the treatment. Based on our experience and that recently reported in the literature, triclabendazole may be regarded as the drug of choice for the treatment of human fascioliasis. (Aust NZ J Med 1992; 22: 45–47.)     

Does hypereosinophilic syndrome precede common B acute lymphoblastic leukaemia in childhood? A case report

Hypereosinophilic syndrome (HES) and the association of hypereosinophilia with acute lymphoblastic leukaemia (ALL) are both rare in children. Some acute myelogenous leukaemias can present with eosinophilia, but the relationship between HES and ALL is not well known and is rarer than the relationship between HES and acute myelogenous leukaemia. Patients are diagnosed with HES when no cause is found to explain the eosinophilia leading to end organ damage. For this reason, it is recommended that patients presenting with hypereosinophilia be carefully assessed to exclude any malignant clonal proliferation. HES may present with severe clinical manifestations such as high leucocyte count, anaemia, thrombocytopaenia, hepatosplenomegaly or cardiac and neurological involvement, all of which are primarily features of myeloproliferative disorders. Some patients with HES can develop chronic eosinophilic leukaemia. Successful treatment of HES with agents used in chronic myeloid leukaemia supports the idea that HES can be a chronic myeloid disorder. There are few cases reporting an association between ALL and hypereosinophilia that precedes or is concomitant with ALL. Here we report the case of a 14-year-old girl who developed common B ALL 7 months after diagnosis and treatment of HES. Interestingly, eosinophilia was not concomitant with the diagnosis of ALL.     

Oral citrate in chronic pancreatitis A 36 months’ controlled trial

To assess the efficacy of oral citrate administration in dissolving intraductal stones in chronic pancreatitis, a controlled clinical trial vs placebo was carried out on a group of selected patients with advanced chronic calcified pancreatitis. Twenty-two cases were assigned to placebo for 18 mo, and then to citrate for a further 18 mo (20 g/d) (Schedule A); another 22 cases were randomly assigned to citrate (40 g/d) for 18 mo and then followed but not treated for a further 18 mo (Schedule B). Prior to entry and at the end of each 18 mo interval, clinical and lab data were collected and evaluated, and pancreatic calcifications were assessed. Whereas when the patients were on placebo a trend towards an increase in the number of calcifications was observed, at the end of the citrate treatments, one in four to one in five patients showed some reduction in radiologic calcification (p<0.05). Citrate was reasonably tolerated, and no relevant side effects were observed during and after its administration. Even if with the higher dose of citrate an increased number of patients underwent clinical remission, no clear relationship was found between the treatment being investigated and the clinical course of the disease. This investigation shows that oral citrate is capable of favoring some reduction of stones in patients with chronic calcified pancreatitis.     

Indirect evidence of ectopic pancreatic fascioliasis in a human

Fascioliasis is not common in humans and, furthermore, its ectopic migration into the pancreas is extremely rare. A definitive diagnosis of ectopic fascioliasis is based on the demonstration of flukes in the affected organ. If the flukes invade the parenchyma, however, imaging studies are limited in the detection of worms and surgical identification is required. We encountered a clinical case of probable ectopic pancreatic fascioliasis diagnosed through indirect evidence. A 46-year-old Korean woman was admitted with left upper quadrant pain. She had taken praziquantel for hepatic fascioliasis, which had been diagnosed at another hospital, and then developed abdominal pain. Peripheral eosinophilia, hyperamylasemia and hyperlipasemia were documented. Abdominal computed tomography (CT) revealed multiple, hypodense foci which had coalesced, forming irregular nodules in the medial and lateral segments of the left lobe of the liver, and similar 2- to 3-cm sized, hypodense lesions in the body and isthmus of the pancreas. IgG antibody against Fasciola hepatica was positive. Bithionol was given orally, and the patient's symptoms and biochemistry then improved, with reversal of eosinophilia. Radiological studies showed normalization of the liver and pancreas at the 10th week, and the serology for Fasciola hepatica was negative at the fifth month.     

The honeycomb gallbladder: a new category of acquired pseudo-multiseptate gallbladder

We report two cases of honeycomb gallbladder as a new category of acquired pseudo-multiseptate gallbladder associated with chronic cholecystitis with stones. The two patients were elderly women without any abdominal symptoms or abnormality of laboratory data. On the imaging examinations, a hyperechoic collection with acoustic shadowing on the inferior surface of the liver was typically observed on ultrasonography, with multiloculated gallbladder being observed on computed tomography. Macroscopic findings of the cut plane of the gallbladder showed a characteristic appearance, with thin pseudo-septations arising from the wall and bridging the lumen from side to side, with a honeycomb appearance, including small stones. Microscopic findings suggest that these septational structures could have developed over a chronic inflammatory course after acute obstruction of the cystic duct. Cholecystectomy should be the choice of treatment for honeycomb gallbladder from the viewpoint of clinical management.     

布地奈德混悬液吸人治疗慢性阻塞性肺疾病急性加重期的临床观察

目的 探讨雾化吸入布地奈德混悬液治疗慢性阻塞性肺疾病（COPD）急性加重期患者的疗效。方法 40例COPD急性加重期患者随机分成治疗组和对照组各20例，分别给予布地奈德混悬液及全身性应用糖皮质激素。观察2组治疗前后呼吸困难、肺功能、动脉血气变化及副作用的情况。结果 治疗组和对照组治疗前后的呼吸困难、肺功能、动脉血气变化均差异无显著性，雾化吸入布地奈德混悬液治疗组的副作用明显少于全身应用糖皮质激素的对照组。结论 雾化吸入布地奈德混悬液是治疗COPD急性加重期患者安全有效的方法，值得推广。     

The hypereosinophilic syndrome after residence in a tropical country: report of 4 cases

Severe eosinophilia may be complicated by acute or chronic visceral damage. The underlying origin of the hypereosinophilia may be infectious, allergic, toxic, malignant or systemic (the secondary or reactive hypereosinophilic syndrome), but in a number of cases no cause can be found (the idiopathic hypereosinophilic syndrome). We describe 4 cases with hypereosinophilia and secondary visceral damage after residence in a tropical region. In three cases a helminthic infection was the obvious cause, the brain and the heart were the target organs. After treatment of the infection both the hypereosinophilia and the neurological and cardiac lesions disappeared. The fourth patient died of multi-organ disease. No definite trigger of the hypereosinophilia could be found. We discuss clinical findings, necessary investigations and therapeutic strategies.     

The first trial of treating opisthorchiasis with the Soviet preparation azinoks]

7 patients in the acute and 51 patients in the chronic stages of opisthorchiasis were treated with azynoks in daily dose 60 mg per kilo. The radical cure was achieved in 95.8 +/- 0.4% of cases. The wild side effects (headache, vertigo, nausea, fatigue) were registered in 51.7 +/- 9.1% of the cases, predominantly during the first hours of the treatment. The biochemical and immunological changes during the first 2 weeks after azynoks administration were analogues to those seen after biltricide and chloxyl (hexaparaxylol) treatment.     

Clinical presentation and management of Fasciola hepatica infection: single-center experience

AIM:To identify the characteristic clinical,laboratory and radiological findings and response to treatment in patients with fascioliasis.METHODS:Patients who were diagnosed with Fasciola hepatica infection were included in this prospective study.Initial clinical,laboratory and radiological findings were recorded.All patients were followed until a complete response was achieved or for 6 mo after treatment discontinuation.RESULTS:Fasciola hepatica infection was diagnosed in 30 patients(24 females;mean age:42....     

Recent Advances in the Treatment of Common Intestinal Helminths

The major symptomatology produced by common intestinal helminths in the United States is reviewed. Worm eradication is required only for helminths of high pathogenic potential, i.e. worms which may produce disease when present singly or in small numbers or worms which can multiply in man. Other helminths are appropriately treated for relief of symptoms or reduction in parasite transmission; in these cases reduction in worm burden rather than eradication is an appropriate therapeutic goal. Current therapy and new drugs are compared. Major recent advances include mebendazole for trichuriasis, niclosamide for tapeworms and possibly bithionol for fascioliasis.