Fascioliasis and intestinal parasitoses affecting schoolchildren in Atlixco, Puebla State, Mexico: epidemiology and treatment with nitazoxanide - PubMed (original) (raw)

Fascioliasis and intestinal parasitoses affecting schoolchildren in Atlixco, Puebla State, Mexico: epidemiology and treatment with nitazoxanide

José Lino Zumaquero-Ríos et al. PLoS Negl Trop Dis. 2013.

Abstract

Background: The Atlixco municipality, Puebla State, at a mean altitude of 1840 m, was selected for a study of Fasciola hepatica infection in schoolchildren in Mexico. This area presents permanent water collections continuously receiving thaw water from Popocatepetl volcano (5426 m altitude) through the community supply channels, conforming an epidemiological scenario similar to those known in hyperendemic areas of Andean countries.

Methodology and findings: A total of 865 6-14 year-old schoolchildren were analyzed with FasciDIG coproantigen test and Lumbreras rapid sedimentation technique, and quantitatively assessed with Kato-Katz. Fascioliasis prevalences ranged 2.94-13.33% according to localities (mean 5.78%). Intensities were however low (24-384 epg). The association between fascioliasis and the habit of eating raw vegetables was identified, including watercress and radish with pronouncedly higher relative risk than lettuce, corncob, spinach, alfalfa juice, and broccoli. Many F. hepatica-infected children were coinfected by other parasites. Entamoeba histolytica/dispar, Giardia intestinalis, Blastocystis hominis, Hymenolepis nana and Ascaris lumbricoides infection resulted in risk factors for F. hepatica infection. Nitazoxanide efficacy against fascioliasis was 94.0% and 100% after first and second treatment courses, respectively. The few children, for whom a second treatment course was needed, were concomitantly infected by moderate ascariasis burdens. Its efficacy was also very high in the treatment of E. histolytica/E. dispar, G. intestinalis, B. hominis, H. nana, A. lumbricoides, Trichuris trichiura, and Enterobius vermicularis. A second treatment course was needed for all children affected by ancylostomatids.

Conclusions: Fascioliasis prevalences indicate this area to be mesoendemic, with isolated hyperendemic foci. This is the first time that a human fascioliasis endemic area is described in North America. Nitazoxanide appears as an appropriate alternative to triclabendazole, the present drug of choice for chronic fascioliasis. Its wide spectrum efficacy against intestinal protozooses and helminthiasis, usually coinfecting liver fluke infected subjects in human endemic areas, represents an important added value.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. Maps showing the geographical distribution of localities surveyed in Atlixco municipality, Puebla, Mexico.

A) Map of Mexico; B) Map of Puebla State; C) Map of Atlixco municipality showing Atlixco city and localities of the schools surveyed: 1 = Tenextepec; 2 = Alta Vista; 3 = Almazán; 4 = Huilotepec; 5 = San Juan Casstillotla; 6 = Juan Uvera; 7 = La Trinidad Tepango; 8 = San Felipe Xonacayucan; 9 = San Jerónimo Caleras; 10 = San Esteban Zoapiltepec.

Figure 2. Human fascioliasis transmission and epidemiology in Atlixco municipality, Puebla, Mexico.

A) permanent water collection inhabited by freshwater lymnaeid snails, just in front of school (note red school roof in the background); B) permanent water collection inhabited by freshwater lymnaeid snails showing nearby snow-capped Popocatepetl volcano in the background; C) water channel inside school playground with water coming from outside pond illustrated in A; D) women washing in water channel inhabited by lymnaeid vectors, accompanied by small children.

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Fascioliasis and intestinal parasitoses affecting schoolchildren in Atlixco, Puebla State, Mexico: epidemiology and treatment with nitazoxanide - PubMed (original) (raw)