Reinfection by Opisthorchis Viverrini after Treatment with Praziquantel


Background: The prevalence of infection by the liver fluke, Opisthorchis viverrini (O. viverrini), has remained high in Northeast Thailand where it is a major risk factor for the eventual development of cholangiocarcinoma (CCA). The infection is acquired by the consumption of dishes containing unsafely prepared freshwater fish, a dietary tradition which has proved resistant to change. Since many people are aware that dosing with praziquantel (PZQ) is a successful treatment for an episode of the infection, there is a risk that, to avoid the long term consequences, they will engage in a cycle of infection, dosing and reinfection.
Objectives: There is a dearth of studies of reinfection by O. viverrini, and the aims of this study were to assess re-infection rates in a typical province of Northeastern Thailand where O. viverrini infection is likely and to investigate factors associated with reinfection. Materials and
Methods: A total of infected 607 villagers were treated with PZQ, and those found to be no longer infected were followed up at six-monthly intervals over 12 months.
Results: At the end of this period data on 457 subjects were available for analysis using descriptive statistics and logistic regression, and 50 were found to have become reinfected, giving a cumulative reinfection rate of 10.9%. The results of a multiple logistic regression analysis showed that the only factor found to be associated with reinfection was past use of PZQ.
Conclusions: Recommendations are made for future larger scale and better designed reinfection studies in the light of limitations of the current study. Further efforts are needed to discourage people from eating fish dishes likely to contain viable metacariae.