Flukes Of The Liver – Identification And Treatment

Large liver fluke disease (SLGL) is found mainly in the Central and Central Highlands. Only in the first 6 months of 2009, the number of people infected with 2500 cases, an increase of 45% over the same period in 2008 (according to Quy Nhon Institute for Malaria and Parasitology). Facing this reality, how is the supply and use of drugs now?
Identify the disease
The parasite SLGL Fasciola gigantica, Fasciola hepatica are found in brackish water fish, mainly in water-based vegetables (watercress, coriander, braised vegetables, celery, and lotus root).
Eating raw fish salad, raw vegetables makes the form of larvae (metacercaria) penetrate into the stomach and intestine, then peel off the shell, penetrate the intestinal membrane, follow the blood into the liver, develop in liver cells, and then shape in the bile duct.
After about 2 to 3 months of symptoms: fever, chills, abdominal pain, liver area (right hip)

. If not treated will turn to chronic.
At this time, the patient presents with fatigue, anorexia, nausea, gastrointestinal bleeding, anemia, joint pain, muscle aches, cough, possibly pleural effusion.
At the same time will create small abscesses, then large abscesses, destroying liver organization, leading to cirrhosis, causing biliary sclerosis, biliary obstruction, jaundice

Drug treatment
- Triclabendazol (TCB): it should be noted, with fasinex name used in veterinary medicine and with egaten name for human use.



TCB prevents mitochondrial oxidation of phosphorylation, makes the flukes unable to control respiration, and binds to tubulin molecules that prevent the formation of microtubules in the fluke. Since then, the parasite paralyzed and died.

TCB is effective against SLGL in the immature and adult stages, takes effect immediately after infection 24 hours and also in the acute, subacute, and chronic stages but is most effective in pre-pathological stages (weeks). 1- 4 postinfection).

TCB is taken orally, after eating it, swallowing whole tablets with a little water, not chewing. There are many ways to use such as single use only or used 2 times, 12 hours apart or used 3 times 12 hours apart. If after 60 days no symptoms disappear, use 1 more time

Three ways to get the same result.



TCB does not cause severe toxicity, only fatigue, weakness, chest pain, fever, nausea, vomiting, epigastric pain, right upper quadrant pain, hepatomegaly, mild hepatic dysfunction (emzym ASAT, ALAT, phosphattase increased alkalosis), biliary tract pain, jaundice (increased total bilirubin). These phenomena may be due to paralysis releasing parietal antigens rather than the drug itself. There are some other more rare manifestations: drowsiness, itching, back pain, cough, shortness of breath.
It is expected that strong biliary tract pain due to flukes will be thrown away when the drug is taken but only mild biliary tract pain is absent.
A few recent studies of the manufacturer show that the drug is teratogenic in animals (with a dose prescribed to be 10 times the human dose) but no teratogenicity has been recorded in humans.
There is no complete information on drug secretion in milk. No medicinal properties have been determined to be safe for children. Not recommended for pregnant, lactating, children under 6 years old.




Depending on the case, it is possible to coordinate with antispasmodics (to reduce pain, avoid jaundice), prednisolon (in case of acute or manifest toxic manifestations of Fasciola antigens), antibiotics (prophylaxis for biliary infections due to bile damage).
Not recommended for people with hypersensitivity to TCB or with bendazol derivatives (common: urticaria, uncommon: pruritus). TCB can cause hemolysis (be careful of people with glucose-6-phophashydrogenase deficiency).
This is a special remedy widely used in many countries. Our country has not imported, only WHO aid (through Quy Nhon Institute for Malaria and Parasitology).
- Artesunat (AT): The therapeutic effect of AT is not less than that of TCB but AT has the advantage: good tolerance (proven in the treatment of malaria) and no resistance, can be used in pregnancy, production. Being domestic, easy to buy and cheap while TCB is resistant (in animals), cannot be used by pregnant women and has not been imported into our country, the price is very expensive (about 3 million VND per dose).
-Albendazol & menbendazol: They are effective with SLGL in animals but have high failures in humans (almost ineffective in chronic form, with large lesions), must be used in very high doses, for a long time.




- Nitazoxanid: Clinically effective in the immature and mature stages of SLGL, very poor in other stages, the general effect is only about 36%.
- Emetin chlohydride: There are some effects, but have no adverse effects on the heart (myocarditis), only inpatient use so it is not convenient to use in the community (for injection, lasts up to 10 days).
- Chloroquin, dithiamin, metronidazole: Test on people with no results.
So: TCB is the only special medicine. In the experimental drugs, only AT is as effective as TCB can be used, but more research is needed. Other drugs are nowhere to be used. SLGL is a dangerous disease, requires good prevention (do not eat raw vegetables, raw fish), need to pay attention to the provision of specific drugs TCB and further AT research..

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