الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Human fasciolosis is an increasing problem for which there is no adequate treatment. Many drugs have been tried for treatment of human fasciolosis. Unfortunately, the optimal drug is still to be found. Triclabendazole has promising value in treatment of human fasciolosis. The present work was designed to evaluate triclabendazole as a drug for human fasciolosis by using different haematological, biochemical, immunological and parasitological techniques. Patients emolled in this study were divided into three groups: GROUP A: fourteen patients with acute fasciolosis. GROUP B: twenty six patients with chronic fasciolosis . GROUP C: six patients with mixed acute and chronic fasciolosis. Twenty healthy individuals were included as normal corresponding controls. All patients were treated with triclabendazole. Follow up studies were done after one and three months ftom the start of drug administration. All individuals under study were subj ected to the following: A. HaematQ!ill!ical stu~ Haemoglobin level, absolute eosinophilic count and complete blood picture including erythrocyte count to evaluate the mean corpuscular haemoglobin (MCR). B. Liver function tests: Total serum bilirubin, serum alkaline phosphatase(ALP) and serum aminotransferases( AL T and AS T). I . I I £Jar,asitoloeical studies: Urine and stool exanrinations by simple sedimentation techniques. Egg count by Kato-Katz technique was used to determine Fasciola worm D.Immunoloeical studies: CeIlul~ T -cells were studied, regarding their count and their response to mitogen stimulation in vitro. By using E- rosette formation technique and ~Iast transformation technique. Humora~ Immuni~ By using Indirect Haemagglutination Test (ilIA T) and Indirect Fluorescent Antibody T echnique(IF AT). The results It’ our stutl..l/ can be sumntamed in: 1.Haematolo~: l.a. Anaemia: Most of fasciolosis cases were anaemic. Anaemia was not of the iron deficiency type. The highest percentage of the anaemic patients was found in acute cases, followed by mixed fasciolosis, then chronic cases. The association between fasciolosis and anaemia may be due to: feeding of the fluke on the necrosed liver cells and blood during their migration through the liver, haemorrhages and blood loss in the biliary tree ~aemobilia) in established fasciolosis, direct and indirect effect of the fluke toxins on bone marrow leading to suppression of erythropoiesis, and destruction of red blood cells by antibodies. In chronic cases and in cases with mixed fasciolosis, there was an increase in the number of anaemic cases after treatment. This increase rould be due to death of worms with release oftoxin(s), and/or noxious manifestations of the drug. J.b. Absolute Eosinophilic Count: Eosinophilia was one of the prominent findings that mostly lCCompany fasciolosis, especially in acute stage when worms were migrating from the intestine through the liver to the bile ducts. However, Msinophilia was found in some patients with chronic fasciolosis, but it was of lower level than that in the acute migratory phase. There was a gadual decrease in number of patients with eosinophilia after treatment. These findings could be explained by direct and indirect stimulant effects of Fasciola spp. antigens especially those of larvae on bone marrow. ~Liver function tests: 2.a. Serum Aminotransferases AL T and AST : Elevated levels of serum aminotransferases (AL T and AST) were found in some cases of fasciolosis especially in the acute stage. This is may be due to affection of the liver cells integrity and/or the associated nepatic necrosis in some areas. One month after treatment, a slight temporary increase in AST levels of some chronic patients was found. This might point to a momentary noxious effect of the drug on the liver. 1,b. Serum Bilirubin: Serum bilirubin levels were within the normal range in different ~tages of human fasciolosis. One month after treatment, only one case with mixed fasciolosis was above the normal range, then became normal three months after treatment. This could be due to mechanical obstruction of the bile duct by dead worms in a patient with relatively high worm burden. l.c, Serum Alkaline Phosuhat!!§.dALPl,;, Serum alkaline phosphatase levels were above the normal range in JOIDe patients enrolled in our study, the highest percentage of cases with iDnormal levels of ALP was found in cases with mixed fasciolosis, rollowed by cases with acute fasciolosis, then chronic cases. In acute cases wd in cases with mixed fasciolosis, there was a gradual decrease in number of patients with abnormal levels of ALP after treatment. On the oilier hand, one month after treatment, there was a slight increase in the number of chronic patients with abnormal levels of ALP. However, after iliree months the number of chronic patients with abnormal levels of ALP returned to their pre-treatment values. This might point to a transient noxious effect of the drug on the liver. The mechanism by which ALP rises in patients with fasciolosis differs according to the stage of infection. The elevated levels ALP during me established stage was suggested to be due to relative biliary narrowing evoked by the worm and its products through hyperplasia of the biliary epithelium. On the other hand in incubating patients the rised level of ALP was suggested to be due to the relative liver enlargement which sometimes accompany this stage.