Branco Elsa Alves, Ruas Rogerio, Nuak João, Sarmento António
Infectious Diseases Department, Centro Hospitalar de São João EPE, Porto, Portugal.
Infectious Diseases Department, Centro Hospitalar de São João EPE, Porto, Portugal
BMJ Case Rep. 2020 Mar 18;13(3):e232299. doi: 10.1136/bcr-2019-232299.
Fascioliasis is a trematode flatworm infection caused by Humans are incidental hosts, and the infection is most often acquired by eating watercress grown in contaminated water in livestock-rearing areas. Triclabendazole is the only highly effective treatment, with a reported cure rate of >90%. Treatment failure may be due to several factors, though resistance is rare in humans and scarcely reported, most probably a reflection of the widespread use of anthelmintics in livestock. There are three papers describing cases of treatment failure, possibly due to resistance, in the Netherlands, Chile and Peru. We document for the first time one case of failure after multiple treatment courses with triclabendazole in Portugal, probably due to resistance to the anthelmintic. Our aim is to alert for the emergence of resistance across continents, with consequent predictable difficulties in the management of the disease and encourage more investigation in the field.
肝片吸虫病是由肝片吸虫引起的一种吸虫扁虫感染。人类是偶然宿主，感染通常是由于食用了在畜牧区受污染水中生长的水田芥所致。三氯苯达唑是唯一一种高效治疗药物，据报道治愈率>90%。治疗失败可能由多种因素导致，尽管人类耐药情况罕见且鲜有报道，这很可能反映了驱虫药在牲畜中的广泛使用。有三篇论文描述了在荷兰、智利和秘鲁出现的可能因耐药导致治疗失败的病例。我们首次记录了葡萄牙一例在多次使用三氯苯达唑治疗疗程后出现治疗失败的病例，可能是由于对该驱虫药产生了耐药性。我们的目的是警惕各大洲出现耐药情况，以及随之而来的可预见的疾病管理困难，并鼓励在该领域开展更多调查。
