Marcos Raymundo Luis A, Maco Flores Vicente, Terashima Iwashita Angélica, Samalvides Cuba Frine, Gotuzzo Herencia Eduardo
Alumno de la Facultad de Medicina, Univrsidad Peruana Cayetano Heredia, Lima, Peru.
Rev Gastroenterol Peru. 2002 Jul-Sep;22(3):228-33.
Recent studies show that human fascioliasis is an infectious disease with significance in Peru and in other Latin American countries. The purpose of this study is to describe the clinical characteristics with a criteria towards the diagnosis of chronic infection by hepatic Fasciola in children. Sixty five individuals with ages ranging between 4 and 15 years were included, all from the District of Asillo (fascioliasis endemic area) in the Province of Azángaro, Department of Puno, Peru. A clinical exam was performed, as well as egg count per gram of feces (EPG count) and eosinophiles count. The group of children with ages between 8 and 11 years was the most affected, accounting for 47.5% of the total. The most frequent result in the exams was abdominal pain (82%) with epigastric location (37.7%), the Murphy symptom showed in 25 children (41% and there was a jaundice record in 17 children (27.9%). The rest of the symptoms and signs were non-specific. In the leukocyte count, 43.5% presented eosinophilia. The average count of eosinophiles and the severity of the infection (EPG count) decreased as the child became older. We concluded that chronic fascioliasis in endemic zones presents abdominal pain localized in the epigastrium and the Murphy symptom as the most frequent clinical biliary characteristics, while the rest of the symptoms are non-specific and this is probably due to the high endemic degree of other intestinal parasitosis which are present in this population. Finally the eosinophilia of chronic fascioliasis is in inverse relation with age in individuals of endemic zones and the number of parasites probably decreases as the person grows older, probably due to a modulation in the immune response of the individual or by the natural death of the parasite.
近期研究表明，人体肝片吸虫病在秘鲁和其他拉丁美洲国家是一种具有重要意义的传染病。本研究的目的是描述儿童慢性肝片吸虫感染诊断标准下的临床特征。纳入了65名年龄在4至15岁之间的个体，均来自秘鲁普诺省阿赞加罗省阿西洛区（肝片吸虫病流行区）。进行了临床检查、每克粪便虫卵计数（EPG计数）和嗜酸性粒细胞计数。年龄在8至11岁之间的儿童组受影响最大，占总数的47.5%。检查中最常见的结果是腹痛（82%），上腹部疼痛（37.7%），25名儿童出现墨菲氏征（41%），17名儿童有黄疸记录（27.9%）。其余症状和体征不具有特异性。在白细胞计数中，43.5%出现嗜酸性粒细胞增多。随着儿童年龄增长，嗜酸性粒细胞平均计数和感染严重程度（EPG计数）下降。我们得出结论，流行区的慢性肝片吸虫病以上腹部局限性腹痛和墨菲氏征为最常见的临床胆道特征，而其余症状不具有特异性，这可能是由于该人群中存在其他肠道寄生虫病的高流行程度所致。最后，慢性肝片吸虫病的嗜酸性粒细胞增多与流行区个体的年龄呈负相关，随着年龄增长寄生虫数量可能减少，这可能是由于个体免疫反应的调节或寄生虫的自然死亡。
