Case report: Infection with Dicrocoelium dendriticum in a Japanese Chin dog.

Dicrocoelium dendriticum is a trematode colonising the bile ducts of herbivores. Coproscopic findings in dogs are usually considered gastrointestinal passages of eggs after ingestion of unheated liver tissue or infected ruminant faeces. Here, a Japanese Chin presented with diarrhoea and weight loss. Eggs comparable to D. dendriticum were detected in faeces and infection was confirmed via PCR and by ruling out differential diagnoses. Egg excretion continued for a period of 10 months. Praziquantel (50 mg/kg body weight [BW]) was administered orally for four consecutive days. Egg excretion 10 days after treatment entailed further treatments with 100 mg/kg BW, again for four days. Faecal samples were negative ten days and four weeks afterwards, diarrhoea resolved, and the dog gained weight. In cases of repeated coproscopic positivity for D. dendriticum, an infection with dogs acting as definitive hosts should be considered. Treatment with praziquantel at a higher dosage may be required.

Treatment of sarcoptic and chorioptic mange in an alpaca (Vicugna pacos) herd with a combination of topical amitraz and subcutaneous ivermectin.

Clinical history: An outbreak of intense pruritus and weight loss in a herd of 40 alpacas (Vicugna pacos) in the south-west of France was investigated after the death of 14 adults. One alpaca was referred to a veterinary teaching hospital for diagnosis and treatment but died soon after and one of the dead alpacas was submitted for necropsy. Clinical findings: The remaining alpacas were intensely pruritic with variably severe and extensive alopecia, erythema, lichenification and crusting on the face, ventral abdomen and distal limbs. Superficial skin scrapes from five animals revealed large numbers of Sarcoptes scabiei mites, and less frequent and numerous Chorioptes bovis mites. Coproscopic examinations revealed a median of 1,350 (min 500, max 8800) strongyle epg. The alpaca admitted for treatment was anaemic and hypoalbuminaemic. Skin scrapes revealed copious S. scabiei and C. bovis mites. The two alpacas examined post-mortem had similar skin lesions to those examined on-farm and were cachexic. One had lung lesions attributed to protostrongylid infestation and its liver contained numerous Dicrocoelium spp. adults. Diagnosis: Sarcoptic and chorioptic mange with secondary superficial bacterial skin infection, associated with severe internal parasitism and underfeeding. Treatment and outcome: All 25 alpacas were treated topically with a 3% chlorhexidine shampoo followed by a 0.025% amitraz wash at the initial visit and then 1, 2, 3, 7 and 9 weeks later. A systemic treatment with S/C 500 µg/kg ivermectin was administered at the initial visit and then 2, 7 and 9 weeks later. The alpacas were treated orally with 50 mg/kg praziquantel to control dicrocoeliosis. Nutritional measures, including increased pasture area and supplemental feeding were simultaneously implemented. Pruritus was reduced 1 week after the start of treatment and had resolved after 2 weeks. After 9 weeks, skin lesions were markedly improved. Six months after the initial visit, skin lesions entirely resolved and superficial skin scrapes, taken from half of the animals, were negative for mites. Clinical relevance: This is the first report of the use of two acaricides combined with a chlorhexidine shampoo to successfully treat simultaneous sarcoptic and chorioptic mange in alpacas.

Dicrocoelium Dentriticum in Explanted Liver: Report of an Unusual Finding.

Dicrocoelium dentriticum, a member of trematode type helminths, is a liver parasite of ruminants. Humans are infected accidentally by ingestion of intermediate host, through infected ants via eating of raw vegetables or drinking of contaminated water. Infection is often asymptomatic or results in subtle symptoms; therefore, infections are usually unrecognized. However, it can produce chronic cholangitis and swelling or adenomatous proliferation in the bile ducts and lead to abdominal pain, diarrhea, fatigue, jaundice, and other symptoms. We report a 49-year-old female patient with end-stage hepatic cirrhosis from viral hepatitis B and D coinfection who underwent liver transplant. Shortly after transplant, she developed symptoms suggesting an obstructed biliary duct. Liver needle biopsy was done 24 hours after transplant to rule out rejection. Biopsy of her explanted liver was also examined pathologically. Microscopic examination of the liver needle biopsy ruled out rejection. Prepared sections of explanted liver revealed a helminth in the common bile duct. Morphologic reconstruction of helminth by microscopic findings and consultation with an expert parasitologist supported the diagnosis of Dicrocoelium dentriticum.

Efficacy and safety of oral praziquantel against Dicrocoelium dendriticum in llamas.

Dicrocoelium dendriticum can cause severe pathological changes of the liver and bile system in camelids, and therapeutic options for treatment are limited. To address this problem, the efficacy of two different dose rates of praziquantel was investigated in llamas suffering from natural D. dendriticum infections. 53 llamas were examined under field conditions on two occasions: before and two weeks after treatment. At the beginning of the study, the animals were weighed, randomly allocated to one of the treatment groups (n=21 each) or the control group (n=11) and dosed orally using a praziquantel-containing paste (250 mg/ml) at a dose of either 25 mg (group 1) or 50 mg (group 2) per kg of body weight. Criteria for efficacy were faecal egg count reduction (FECR) and extensity effect. Animals treated with 25 mg/kg of body weight showed a FECR of 85%. Therapy with 50 mg/kg led to a FECR of 91%. Almost twice the number of animals of group 1 (33%) still shed eggs two weeks after treatment compared with group 2. The results of this study indicate that 50 mg/kg oral praziquantel is required for efficacious dosing and that this dose rate is safe in llamas and thus is recommended for the treatment of camelids naturally infected with D. dendriticum.

The inability of tapeworm Hymenolepis diminuta and fluke Dicrocoelium dendriticum to metabolize praziquantel.

Biotransformation enzymes can, to a certain extent, protect parasitic worms against the toxic effects of anthelmintics and can contribute to drug-resistance development. The objective of our work was (1) to find and identify phase I and II metabolites of the anthelmintic praziquantel (PZQ) formed by the lancet fluke (Dicrocoelium dendriticum) and the rat tapeworm (Hymenolepis diminuta) and (2) to compare PZQ metabolites in helminths with PZQ biotransformation in rat as host species. Ultra high performance liquid chromatography/tandem mass spectrometry (UHPLC/MS/MS) was used for this purpose. During in vitro incubations, mitochondria-like and microsomes-like fractions (prepared from homogenates of adult worms or from rat liver homogenate) were incubated with 10 and 100 µM PZQ. Liquid/liquid extraction was used for samples during in vitro experiments. In the ex vivo study, living D. dendriticum and H. diminuta adults were incubated in RPMI-1640 medium in the presence of 50 nM or 100 nM PZQ for 24h. After incubation, the worms were removed from the medium and homogenized. Homogenates of worms, medium from the incubation of worms or rat hepatocytes and rat urine (collected during 24h after oral PZQ administration) were separately extracted using solid-phase extraction. The results showed that both D. dendriticum and H. diminuta enzymatic systems are not able to metabolize PZQ. On the other hand, thirty one different phase I and four phase II PZQ metabolites were detected in rat samples using UHPLC/MS/MS analyses. These results show that our experimental helminths, as the members of tapeworm and fluke groups of parasites, are not able to deactivate PZQ, and that the biotransformation enzymes of the studied helminths do not contribute to PZQ-resistance.

Human infection with Dicrocoelium dendriticum in Turkey.

Human dicrocoeliosis is reported sporadically in various parts of the world. We report a case in a 21-year-old male, who had right upper abdominal pain, weight loss, and chronic relapsing watery diarrhea three to four times daily for four weeks. The patient had abdominal tenderness to palpation in the right upper quadrant. Alkaline phosphatase, alanine aminotransferase, and serum immunoglobulin E levels were slightly elevated; all other biochemical and hematological findings were in their normal ranges. The duodenal biopsy samples were normal and an abdominal ultrasonography showed no biliary or hepatic abnormality. Stool microscopy revealed numerous eggs of Dicrocoelium dendriticum. As pseudoparasitosis can result from eating raw, infected animal liver, the patient was given a liver-free diet for three days, to rule out that possibility. Subsequent stool examinations showed eggs in each of the samples indicating that the infection was genuine. The patient was treated with triclabendazole 10 mg/kg in a single dose. Four weeks later, no parasite eggs were detected in the microscopic examination of the stool samples. The patient got better gradually and the symptoms disappeared. Physicians should keep in mind parasitic diseases such as the rarely encountered dicrocoeliosis.

Dicrocoelium dendriticum infection in a patient with Crohn's disease.

Infection with Dicrocoelium dendriticum in humans is rarely reported in the medical literature. This liver fluke, which commonly infects ruminants, has a complex life cycle with two intermediate hosts--the land snail and the ant. True human infection occurs by ingestion of the second intermediate host, but spurious infections have occurred after consumption of undercooked animal liver. The present report describes a patient with active Crohn's disease whose stool contained D dendriticum eggs. A brief discussion of the medical literature is presented.

[Human infection with Dicrocoelium dendriticum]. / Humane Infektion mit Dicrocoelium dendriticum.

UNLABELLED: MEDICAL HISTORY AND PHYSICAL EXAMINATION: A 36-year-old German reported having had chronic-relapsing diarrhea, right upper abdominal pain and weight-loss for about two years. His last journey had taken him to Morocco three and a half years ago. The physical examination was unremarkable except for an abdominal tenderness to palpation in the right upper quadrant. LABORATORY: The serum level of bilirubin was slightly raised to 1.13 mg/dl (<1.10 mg/dl) and the level of IgE was raised to 253 U/ml (<100 U/ml). All other laboratory findings were within normal limits. Stool examinations showed eggs of Dicrocoelium dendriticum. The abdominal ultrasound was unremarkable except for mild steatosis. TREATMENT AND COURSE: The patient denied consumption of liver or liver-products within the past weeks. Spurious infection due to eating infected liver could thus be excluded. The patient was treated for dicrocoeliasis with praziquantel (3 x 600 mg/day for three days). Further stool examinations for parasites were negative. Since the patient still had gastrointestinal discomfort, we decided to give a further therapy with triclabendazole (700 mg, single dose). Five weeks after the second treatment the patient was almost free of symptoms and stool examinations for parasites remained negative. CONCLUSION: Dicrocoeliasis can be associated with chronic diarrhea. Stool examinations for parasites are very important in patients with gastrointestinal symptoms.

Treatment of Egyptian dicrocoeliasis in man and animals with Mirazid.

Two human cases with dicrocoeliasis dendriticum were successfully treated one with Praziquantel (25mg/kg 3 times daily after meals, for four successive days) and second with Mirazid (2 capsules of 300 mg. each, daily an hour before breakfast, for six successive days) as indicated clinically and parasitologically. On the other hand, one imported sheep and two locally bred goats naturally infected with D. dendriticum were successfully treated with Oleo-resin solution (dose of 6 ml of 10 gm% equal to 2 Mirazid capsules before breakfast) per os once daily for four successive days. The animals were slaughtered on 5th day. Mirazid (capsule or Oleo-resin solution) was effective against dicrocoeliasis in man and animal respectively.

[Dicrocoeliasis in New World camelids]. / Dikrozöliose bei Neuweltkameliden.

Natural infections with the lancet fluke (Dicrocoelium dendriticum) were detected in a group of seven diseased or dead/euthanized South American Camelids (five Llamas, two Alpacas) from Switzerland and Southern Germany. Clinical findings in almost all the animals revealed an acute decline of general condition followed by recumbency, decreased body temperature and a varying degree of anaemia. Concurrently, all animals showed an average to poor nutritional status. All liver enzyme activities analysed in serum biochemistry conformed to the reference values and therefore offered no diagnostic clues for this disease. Necropsy however, disclosed major alterations in the liver in the form of cirrhosis, abscesses, granulomas, and a massive infestation with D. dendriticum. The coprological investigations performed at the outset of the examinations revealed eggs of the lancet fluke in only two animals. This suggests that clinical findings alone permit at best only a provisional diagnosis. Repeated coprologic follow-ups showed that the presence of eggs of D. dendriticum can be diagnosed accurately and that clinical signs appear with an excretion rate above 1000 eggs per gram faeces (EpG). In these cases, praziquantel in a single dose of 50 mg/kg per os was given. This treatment was well tolerated and achieved a quite acceptable 90% reduction of eggs in the faeces.

Human dicrocoeliasis. Report on 208 cases from Saudi Arabia.

In 3 years, Dicrocoelium dendriticum ova were detected in 208 patients at the Armed Forces Hospital, Riyadh, Saudi Arabia during 1984-1986. At least 7 of these patients had a true infection and at least 34 patients had spurious infection as they gave a history of eating raw liver. 23% of the 208 patients were under 14 years of age. The peak incidence was between October and November in each of the 3 years. 134 of these patients were symptomatic. 16 patients had disturbed liver functions and 13 had eosinophilia. 10 patients had gall bladder or biliary tree disease and in at least 2 of which it was due to D. dendriticum. Malabsorption occurred in one patient. Praziquantel was used in 9 patients and was successful in treating 4 of these patients.

Activity of luxabendazole against liver flukes, gastrointestinal roundworms, and lungworms in naturally infected sheep.

The anthelmintic potential of luxabendazole was investigated in sheep harboring mixed naturally acquired helminth infections. Results were assessed by comparing worm counts of the treated groups (seven animals each) on days 7-8 posttreatment with those of the nontreated control group, except for protostrongylid lungworms, for which the changes in pre- and posttreatment group mean larval counts/g feces were assessed for intensity effect. A single oral treatment at doses of 10.0 or 12.5 mg/kg body wt removed 97.6% of the adult Fasciola hepatica and 63.2%-83.8% of the Dicrocoelium dendriticum. Luxabendazole at 7.5, 10.0, and 12.5 mg/kg proved 100% effective in removing adult worms of the genera Haemonchus, Ostertagia, Trichostrongylus, Cooperia and Nematodirus as well as tissue-associated larval stages of gastrointestinal nematodes of the abomasal mucosa. The drug showed an intensity effect of 79.7%-87.6% against Strongyloides papillosus. Luxabendazole removed all Dictyocaulus filaria and reduced the fecal excretion of larvae of protostrongylid species (Protostrongylus rufescens, Neostrongylus linearis, Cystocaulus ocreatus, Muellerius capillaris) by 97.8%-99.6%. The efficacy of luxabendazole compared favorably with that of Diplin Kombi (oxyclozanide and levamisole), which was used as a reference drug.