ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ KẾT QUẢ ĐIỀU TRỊ BỆNH SÁN LÁ GAN TẠI BỆNH VIỆN ĐẠI HỌC Y HÀ NỘI

Abstract

Liver fluke disease, including Fasciola spp. and Clonorchis/Opisthorchis spp, is a parasitic disease transmitted through food and drink that is quite common in Vietnam. The clinical picture is diverse, diagnosis is often difficult due to non-specific symptoms and the sensitivity of different parasite detection methods. The disease can cause complications, especially Clonorchis/Opisthorchis spp can lead to biliary tract cancer. Currently, specific drugs (Triclabendazole for Fasciola spp infection and Praziquantel for Clonorchis/Opisthorchis spp infection) are highly effective, but there are still cases that require multiple treatments to kill all parasites. Objective: Describe the clinical and paraclinical characteristics of liver fluke disease and evaluate the treatment results of liver fluke disease at Hanoi Medical University Hospital. Subjects and methods: Cross-sectional descriptive study on 103 patients with liver flukes (Fasciola spp. and/or Clonorchis/ Opisthorchis spp) at Hanoi Medical University Hospital. Diagnosis of liver fluke infection (Fasciola spp. and/or Clonorchis/Opisthorchis spp) according to the guidelines for diagnosis and treatment of some parasitic diseases of the Ministry of Health 2022. Information on medical history, risk factors, clinical manifestations, blood and stool tests, ultrasound and MRI results (calculated as percentage, mean value ± standard deviation, tested according to statistical algorithms). Results: The average age of the study group was 47.3 ± 13.5; 51.5% were male. High risk factors: 84% ate raw vegetables or fish salad. The most common clinical symptoms were digestive disorders (fullness, loss of appetite) 51.5%, right hypochondriac pain 47.6%, fever 19.4%. ELISA detected 77 (74.8%) cases positive for Fasciola spp and 71 (68.9%) cases positive for Clonorchis/ Opisthorchis spp, 45 patients (43.7%) were positive for both. In 71 patients infected with Clonorchis/ Opisthorchis spp, 1 patient (1.4%) was diagnosed with cholangiocarcinoma. Ultrasound detected liver lesions including liver abscesses and biliary tract abnormalities in 91/103 patients (86.4%), mainly abscess images (78.6%), lesions mainly occurred in the right liver (70%). 77 cases were treated with Triclabendazole for Fasciola spp and 71 patients were treated with Praziquantel for Clonorchis/Opisthorchis spp) initially showed high efficacy. Only 6 cases (5.8%) had to undergo drainage or aspiration of liver abscesses. Conclusion: A study of 103 cases of fascioliasis at Hanoi Medical University Hospital showed that the clinical picture was often nonspecific. Laboratory findings were prominent with elevated eosinophils; definitive diagnosis was mainly based on positive serum ELISA and characteristic liver lesions on ultrasound/MRI: Triclabendazole (for Fasciola spp) and Praziquantel (for Clonorchis/Opisthorchis spp) regimens help >96% of patients significantly improve symptoms.