Update on the diagnosis and treatment of food-borne trematode infections.

PURPOSE OF REVIEW: More than 40 million people are affected by food-borne trematode infections. Diagnosis is unsatisfactory and there are only two drugs available for treatment and control: praziquantel and triclabendazole. This review provides an update on recent developments in the diagnosis and treatment of food-borne trematodiases.

RECENT FINDINGS: The trematocidal properties of tribendimidine and peroxidic drugs (e.g. artemisinins and synthetic trioxolanes) have been characterized, including in-vitro and in-vivo studies, elucidating structure-activity relationships and pharmacokinetics and their efficacies have been evaluated in large animal models. Tribendimidine achieved high worm burden reductions against Opisthorchis viverrini and Clonorchis sinensis harboured in rodents and the antimalarial drug mefloquine showed promising opisthorchicidal activity in vivo. Advances have been made with immunological and molecular diagnostics. Metabolic profiling investigations in rodents experimentally infected with Fasciola hepatica and Echinostoma caproni yielded parasite-specific candidate biomarkers, which might give rise to novel diagnostic targets. The FLOTAC technique showed a higher sensitivity and efficiency for detecting F. hepatica eggs in rat faecal samples than the sedimentation method.

SUMMARY: Progress has been registered with trematocidal drug candidates that need to be studied in greater detail preclinically, with the most promising ones progressing into proof-of-concept trials. Drug development research should go hand-in-hand with innovation and application into new and improved diagnostic tools.