Treatment of Fasciolopsis buski Infection
Praziquantel at a single dose of 15 mg/kg body weight is the recommended treatment for Fasciolopsis buski infection. 1
Clinical Background
Fasciolopsis buski is the largest intestinal fluke that can infect humans. Infection occurs when humans consume raw or undercooked aquatic plants contaminated with metacercariae of the parasite. The parasite primarily affects the small intestine, particularly the duodenum and jejunum.
Diagnosis
Diagnosis is made through:
- Identification of characteristic operculated eggs in stool specimens (eggs measure approximately 140 x 72.5 μm) 2
- In heavy infections, adult flukes may be passed in stool
Treatment Algorithm
First-line Treatment
- Praziquantel: Single oral dose of 15 mg/kg body weight 1
- Timing: Preferably administered at bedtime to minimize side effects
- Efficacy: 100% cure rate demonstrated at this dosage
- Mechanism: Causes tegumental damage to the parasite leading to its expulsion
Alternative Regimens
- Higher doses of praziquantel (25 mg/kg or 40 mg/kg) have also shown 100% efficacy 1, 3
- However, higher doses are associated with more frequent side effects without improved efficacy
Treatment Considerations
- No need for repeated dosing as single-dose therapy is sufficient 1, 3
- Follow-up stool examination should be performed 2-3 weeks after treatment to confirm cure
- Patients may pass damaged flukes in stool for 2-3 days after treatment 4
Side Effects and Management
- Side effects of praziquantel are generally mild and transient 1
- May include:
- Abdominal discomfort
- Nausea
- Dizziness
- Headache
- Side effects are more common with higher doses, supporting the use of the lower effective dose (15 mg/kg) 1
Prevention Strategies
After successful treatment, prevention measures should be emphasized:
- Avoid consumption of raw aquatic plants from endemic areas
- Thoroughly wash and cook aquatic vegetables before consumption
- Improve sanitation practices to prevent contamination of water bodies
- Health education, particularly for school children in endemic areas 5
Special Populations
- Children: Same dosage as adults (15 mg/kg as a single dose)
- Pregnant women: Limited data available; treatment should be deferred until after delivery unless benefits outweigh risks
Treatment Monitoring
- Patients should be monitored for:
- Resolution of symptoms (abdominal discomfort, diarrhea)
- Passage of adult flukes in stool following treatment
- Improvement in nutritional status and resolution of anemia if present
Public Health Considerations
In endemic areas, a comprehensive approach is needed:
- Case finding and treatment
- Health education about transmission and prevention
- Improvement of sanitation facilities
- Regular surveillance to monitor infection rates 5
The successful treatment with praziquantel, combined with preventive measures, can effectively control Fasciolopsis buski infection both at individual and community levels.