Apt W, Aguilera X, Vega F, Miranda C, Zulantay I, Perez C, Gabor M, Apt P
Parasitology Unit, Faculty of Medicine, University of Chile, Santiago.
Am J Trop Med Hyg. 1995 Jun;52(6):532-5. doi: 10.4269/ajtmh.1995.52.532.
Between November 1990 and March 1992, 24 asymptomatic individuals in Chile with chronic hepatic fascioliasis confirmed by the presence of Fasciola hepatica eggs in feces were treated with a single oral dose of triclabendazole (10 mg/kg of body weight) after an overnight fast. Nineteen (79.2%) of 24 patients were egg-negative two months after treatment. Three of five cases with F. hepatica in feces after the first treatment were retreated and parasitologic cure was achieved. Tolerance to the drug was excellent; none of the patients had either secondary symptoms or important alterations in levels of aspartate and amino transferases, alkaline phosphatase, or bilirubin during or after treatment. Mild eosinophilia, present in 70% of the cases, persisted at least until 60 days after treatment. An enzyme-linked immunosorbent assay (ELISA) was highly effective in diagnosis and post-treatment monitoring. Before treatment, 20 (83.3%) of 24 confirmed cases had positive test results. The test results became negative by the second month of treatment in 40% of the cured cases. This percentage increased progressively, reaching 91.3% at 12 months after therapy. In the five cases in which treatment failed, the ELISA results remained positive until the end of the follow-up period (six months). In three of these cases who accepted a second round of therapy with triclabendazole six months after the first treatment, the ELISA results became negative in all three six months after parasitologic cure and remained negative until the end of the period. Due to its efficacy, excellent tolerance, and ease of administration (a single oral dose), triclabendazole appears to be the drug of choice for chronic human fascioliasis.
1990年11月至1992年3月期间，智利24名无症状个体经粪便中存在肝片形吸虫卵确诊为慢性肝片形吸虫病，禁食过夜后单次口服三氯苯达唑（10mg/kg体重）进行治疗。24例患者中有19例（79.2%）在治疗后两个月虫卵转阴。首次治疗后粪便中仍有肝片形吸虫的5例患者中有3例再次接受治疗并实现了寄生虫学治愈。药物耐受性良好；治疗期间及治疗后，所有患者均未出现继发症状，天冬氨酸氨基转移酶、碱性磷酸酶或胆红素水平也未出现显著变化。70%的病例出现轻度嗜酸性粒细胞增多，至少持续至治疗后60天。酶联免疫吸附测定（ELISA）在诊断和治疗后监测中非常有效。治疗前，24例确诊病例中有20例（83.3%）检测结果呈阳性。40%的治愈病例在治疗第二个月时检测结果转阴。这一比例逐渐上升，治疗后12个月时达到91.3%。在治疗失败的5例病例中，ELISA结果在随访期结束（6个月）时仍为阳性。其中3例患者在首次治疗6个月后接受了第二轮三氯苯达唑治疗，在寄生虫学治愈后的6个月内，所有3例患者的ELISA结果均转为阴性，并一直保持阴性直至随访期结束。由于其疗效、良好的耐受性和给药方便（单次口服剂量），三氯苯达唑似乎是慢性人类肝片形吸虫病的首选药物。
