Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, 40002, Thailand.
Infect Dis Poverty. 2019 Mar 20;8(1):18. doi: 10.1186/s40249-019-0529-5.
Opisthorchis viverrini infection is highly prevalent in northeast Thailand. This liver fluke is classified as a carcinogen due to its causal links with cholangiocarcinoma (CCA) development. Although treatment with praziquantel (PZQ) effectively cures O. viverrini infection, the prevalence remains high due to the traditional consumption of raw fish. Therefore, re-infection is common in the endemic community, leading to severe hepato-biliary morbidities including the fatal CCA. In this study, we evaluate the association between the frequency of previous PZQ treatment and current O. viverrini infections among Thai adults living in the endemic area of northeast Thailand.
This study includes all participants who were screened for O. viverrini infection in the Cholangiocarcinoma Screening and Care Program (CASCAP), northeast Thailand. History of PZQ treatment was recorded using a health questionnaire. O. viverrini infections were diagnosed using urine antigen detection. Associations between PZQ and O. viverrini were determined by adjusted odds ratio (aOR) and 95% confidence interval (CI) using multiple logistic regression.
Among participants, 27.7% had previously been treated once with PZQ, 8.2% twice, 2.8% three times, and 3.5% more than three times. Current O. viverrini prevalence was 17% (n = 524). Compared with participants who never used PZQ, the aOR for infection among those who used the drug once was 1.09 (95% CI: 0.88-1.37), twice was 1.19 (95% CI: 0.85-1.68), three times was 1.28 (95% CI: 0.74-2.21), and more than three times was 1.86 (95% CI: 1.18-2.93; P = 0.007).
The population with a frequent history of PZQ use and still continued raw fish consumption showed high levels of repeated reinfection with O. viverrini. They were infected, treated and re-infected repeatedly. These findings suggest that certain participants continue raw fish consumption even after previous infection. This is a particular problem in highly endemic areas for O. viverrini and increases the risk of CCA.
华支睾吸虫感染在泰国东北部高度流行。由于与胆管癌（CCA）发展的因果关系，这种肝吸虫被归类为致癌物。虽然吡喹酮（PZQ）治疗有效治愈华支睾吸虫感染，但由于传统食用生鱼，感染率仍然很高。因此，在流行地区，再次感染很常见，导致严重的肝胆疾病，包括致命的 CCA。在这项研究中，我们评估了泰国东北部流行地区泰国成年人中既往 PZQ 治疗频率与当前华支睾吸虫感染之间的关系。
本研究包括所有在泰国东北部胆管癌筛查和护理计划（CASCAP）中筛查华支睾吸虫感染的参与者。使用健康问卷记录吡喹酮治疗史。使用尿抗原检测诊断华支睾吸虫感染。使用多因素逻辑回归确定 PZQ 与华支睾吸虫之间的关联，并使用调整后的优势比（aOR）和 95%置信区间（CI）进行分析。
参与者中，27.7%的人曾单次使用 PZQ 治疗，8.2%的人曾两次使用，2.8%的人曾三次使用，3.5%的人曾多次使用。当前华支睾吸虫感染率为 17%（n=524）。与从未使用过 PZQ 的参与者相比，使用过一次的参与者感染的 aOR 为 1.09（95%CI：0.88-1.37），使用过两次的为 1.19（95%CI：0.85-1.68），使用过三次的为 1.28（95%CI：0.74-2.21），使用过三次以上的为 1.86（95%CI：1.18-2.93；P=0.007）。
既往有频繁 PZQ 使用史且仍继续食用生鱼的人群对华支睾吸虫的再次感染率较高。他们反复感染、治疗和再感染。这些发现表明，某些参与者即使在先前感染后仍继续食用生鱼。这在华支睾吸虫高度流行地区是一个特殊问题，增加了患 CCA 的风险。
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