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Diagnosis and Treatment

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DIAGNOSIS

For a number of reasons, it is difficult to assess the morbidity and mortality of echinostomiasis. These reasons include a prolonged latent phase of the disease, a short acute phase, infections that are asymptomatic, and large similarities in symptoms between echinostomiasis and disease caused by other intestinal helminths (Fried, Graczyk, and Tamang).

While infections that are either asymptomatic or whose symptoms are nonspecific are very difficult to diagnose, laboratory diagnosis of the disease is most commonly done through demonstration of eggs in human feces. Finding the "characteristic operculate, unembryonated, illipsoidal, yellow to yellow-brown eggs in fecal specimens" is the most routine and the most surefire way to diagnose a patient with echinostomiasis (Fried and Graczyk). This task has still proved difficult, however. The eggs of echinostomes have thin shells and the operculum is normally difficult to see (Haseeb and Eveland). In addition, the species of infection cannot be determined upon demonstration of the eggs, because morphological differences between the eggs of different echinostome species are not known. Particular species can be identified based on morphology of the adults that are still present after anthelmintic treatment (Fried and Graczyk).

Serology studies have been done on infected animals (mice and hamsters) that detect immunoglobins (IgA, IgG, IgM), suggesting a possible way for further diagnosis (Haseeb and Eveland). But, the best methods remain demonstration of the eggs, and establishment of an exposure history.

TREATMENT

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The most effective and most-used drug for elimination of echinostomiasis (and other Trematodes) is Praziquantel. Other drugs that have effectively been used include mebendazole, albendazole, niclosamide, tetrachloroethylene (Fried and Graczyk; Fried, Graczyk, and Tamang; John and Petri).

Praziquantel should be administered at 25 mg/kg body weight three times in one day (John and Petri 171).

Tetrachloroethyylene should be given in a dose of 0.1 ml/kg body weight. It should be "taken on an empty stomach after a light meal the preceding night. The maximum adult dose is 5 ml. Alcohol and fats should be avoided for 24 hours before and after treatment, and nothing other than water should be taken for 3 hours after ingestion of the medication" (John and Petri 171-72).

According to a recent article by Jennifer Keiser, Reto Brun, Bernard Fried, and Jurg Utzinger, the only two very effective drugs for treatment and morbidity control of diseases like echinostomiasis are praziquantel and triclabendazole, demonstrating an urgent need for new drugs. The article summarized a recent study done that examined the in vitro and in vivo effectiveness of several artemisinins E. caproni infections in mice. Testing praziquantel for comparison, the study found that "both praziquantel and the artemisinins exhibited exposure-response relationships" when tested in vitro, and in vivo, "worm burden reductions of 100% were achieved with single oral doses of praziquantel, artesunate, and artemether" when administered with appropriate dosage (Keiser, Brun, Fried, Utzinger).

This study shows that there are other possible modes of chemotherapy out there that may prove to be effective against echinostomiasis and other helminthiases in the future. One thing that is already known, however, is that while difficult to diagnose, diagnosis and treatment programs for echinostomiasis should include animal reservoirs in addition to humans (Fried and Graczyk; Fried, Graczyk, and Tamang).