Evaluation of nitazoxanide treatment following triclabendazole failure in an outbreak of human fascioliasis in Upper Egypt.
Background Fascioliasis is a neglected zoonosis with major public health implications in humans. Although triclabendazole (TCBZ) is the drug of choice, there are records of TCBZ failure worldwide. TCBZ-resistant fascioliasis is treated with alternative approved drugs including nitazoxanide (NTZ), wi...
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ftdoajarticles:oai:doaj.org/article:a7e88d165bb448c9aae49beee312756b 2023-05-15T15:14:08+02:00 Evaluation of nitazoxanide treatment following triclabendazole failure in an outbreak of human fascioliasis in Upper Egypt. Haidi Karam-Allah Ramadan Waleed Attia Hassan Nahed Ahmed Elossily Alzahraa Abdelraouf Ahmad Adnan Ahmed Mohamed Alaa Soliman Abd-Elkader Eman M Nagiub Abdelsalam Hani M J Khojah 2019-09-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0007779 https://doaj.org/article/a7e88d165bb448c9aae49beee312756b EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0007779 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007779 https://doaj.org/article/a7e88d165bb448c9aae49beee312756b PLoS Neglected Tropical Diseases, Vol 13, Iss 9, p e0007779 (2019) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2019 ftdoajarticles https://doi.org/10.1371/journal.pntd.0007779 2022-12-31T12:37:21Z Background Fascioliasis is a neglected zoonosis with major public health implications in humans. Although triclabendazole (TCBZ) is the drug of choice, there are records of TCBZ failure worldwide. TCBZ-resistant fascioliasis is treated with alternative approved drugs including nitazoxanide (NTZ), with varying levels of efficacy. Data on NTZ efficacy after TCBZ failure in Egypt is scarce. This study evaluated the efficacy of NTZ in cases of TCBZ failure during an outbreak of fascioliasis in Assiut governorate of Upper Egypt. Methodology/principal findings This prospective study included 67 patients from the outpatient clinic in Manfalout locality of Assiut governorate with clinical manifestations of acute fascioliasis. These included high eosinophilia (> 6% eosinophils in peripheral blood), positive anti-Fasciola antibodies, and hepatic focal lesions (HFL) or ascites on abdominal ultrasound or computed tomography. All patients initially received TCBZ at recommended doses. Patients were followed up after 1 month to assess response. According to the responses, patients were categorized as non-responders and responders. The non-responders received a trial of NTZ and were re-assessed for response based on clinical manifestations, eosinophil count, and abdominal ultrasound. Patients not responding to NTZ received additional doses of TCBZ. One month after initial TCBZ treatment, 37 patients responded well to TCBZ, while 30 patients failed to respond with persistence of fever, abdominal pain, high eosinophilia, and HFL. Most non-responders were male (56.7%); females predominated among TCBZ responders (62.2%). The mean age of the non-responders was relatively lower, at 20.57 ± 14.47 years (p = 0.004). Following NTZ therapy, HFL disappeared in 9/30 (30%) patients and eosinophil counts normalized in only 2 (6.7%) patients, indicating an overall efficacy of 36.6%. The remaining cases received additional doses of TCBZ with complete clinical, biochemical, and radiological resolution. Conclusions/significance Nitazoxanide ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 13 9 e0007779 |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Haidi Karam-Allah Ramadan Waleed Attia Hassan Nahed Ahmed Elossily Alzahraa Abdelraouf Ahmad Adnan Ahmed Mohamed Alaa Soliman Abd-Elkader Eman M Nagiub Abdelsalam Hani M J Khojah Evaluation of nitazoxanide treatment following triclabendazole failure in an outbreak of human fascioliasis in Upper Egypt. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Fascioliasis is a neglected zoonosis with major public health implications in humans. Although triclabendazole (TCBZ) is the drug of choice, there are records of TCBZ failure worldwide. TCBZ-resistant fascioliasis is treated with alternative approved drugs including nitazoxanide (NTZ), with varying levels of efficacy. Data on NTZ efficacy after TCBZ failure in Egypt is scarce. This study evaluated the efficacy of NTZ in cases of TCBZ failure during an outbreak of fascioliasis in Assiut governorate of Upper Egypt. Methodology/principal findings This prospective study included 67 patients from the outpatient clinic in Manfalout locality of Assiut governorate with clinical manifestations of acute fascioliasis. These included high eosinophilia (> 6% eosinophils in peripheral blood), positive anti-Fasciola antibodies, and hepatic focal lesions (HFL) or ascites on abdominal ultrasound or computed tomography. All patients initially received TCBZ at recommended doses. Patients were followed up after 1 month to assess response. According to the responses, patients were categorized as non-responders and responders. The non-responders received a trial of NTZ and were re-assessed for response based on clinical manifestations, eosinophil count, and abdominal ultrasound. Patients not responding to NTZ received additional doses of TCBZ. One month after initial TCBZ treatment, 37 patients responded well to TCBZ, while 30 patients failed to respond with persistence of fever, abdominal pain, high eosinophilia, and HFL. Most non-responders were male (56.7%); females predominated among TCBZ responders (62.2%). The mean age of the non-responders was relatively lower, at 20.57 ± 14.47 years (p = 0.004). Following NTZ therapy, HFL disappeared in 9/30 (30%) patients and eosinophil counts normalized in only 2 (6.7%) patients, indicating an overall efficacy of 36.6%. The remaining cases received additional doses of TCBZ with complete clinical, biochemical, and radiological resolution. Conclusions/significance Nitazoxanide ... |
format |
Article in Journal/Newspaper |
author |
Haidi Karam-Allah Ramadan Waleed Attia Hassan Nahed Ahmed Elossily Alzahraa Abdelraouf Ahmad Adnan Ahmed Mohamed Alaa Soliman Abd-Elkader Eman M Nagiub Abdelsalam Hani M J Khojah |
author_facet |
Haidi Karam-Allah Ramadan Waleed Attia Hassan Nahed Ahmed Elossily Alzahraa Abdelraouf Ahmad Adnan Ahmed Mohamed Alaa Soliman Abd-Elkader Eman M Nagiub Abdelsalam Hani M J Khojah |
author_sort |
Haidi Karam-Allah Ramadan |
title |
Evaluation of nitazoxanide treatment following triclabendazole failure in an outbreak of human fascioliasis in Upper Egypt. |
title_short |
Evaluation of nitazoxanide treatment following triclabendazole failure in an outbreak of human fascioliasis in Upper Egypt. |
title_full |
Evaluation of nitazoxanide treatment following triclabendazole failure in an outbreak of human fascioliasis in Upper Egypt. |
title_fullStr |
Evaluation of nitazoxanide treatment following triclabendazole failure in an outbreak of human fascioliasis in Upper Egypt. |
title_full_unstemmed |
Evaluation of nitazoxanide treatment following triclabendazole failure in an outbreak of human fascioliasis in Upper Egypt. |
title_sort |
evaluation of nitazoxanide treatment following triclabendazole failure in an outbreak of human fascioliasis in upper egypt. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2019 |
url |
https://doi.org/10.1371/journal.pntd.0007779 https://doaj.org/article/a7e88d165bb448c9aae49beee312756b |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 13, Iss 9, p e0007779 (2019) |
op_relation |
https://doi.org/10.1371/journal.pntd.0007779 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007779 https://doaj.org/article/a7e88d165bb448c9aae49beee312756b |
op_doi |
https://doi.org/10.1371/journal.pntd.0007779 |
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PLOS Neglected Tropical Diseases |
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13 |
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9 |
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e0007779 |
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