{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T01:39:58Z","timestamp":1773452398638,"version":"3.50.1"},"reference-count":20,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,2,25]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:p>Fascioliasis is a trematode flatworm infection caused by <jats:italic>Fasciola hepatica<\/jats:italic>. Humans are incidental hosts, and the infection is most often acquired by eating watercress grown in contaminated water in livestock-rearing areas. Triclabendazole is the only highly effective treatment, with a reported cure rate of &gt;90%. Treatment failure may be due to several factors, though resistance is rare in humans and scarcely reported, most probably a reflection of the widespread use of anthelmintics in livestock. There are three papers describing cases of treatment failure, possibly due to resistance, in the Netherlands, Chile and Peru. We document for the first time one case of failure after multiple treatment courses with triclabendazole in Portugal, probably due to resistance to the anthelmintic. Our aim is to alert for the emergence of resistance across continents, with consequent predictable difficulties in the management of the disease and encourage more investigation in the field.<\/jats:p>","DOI":"10.1136\/bcr-2019-232299","type":"journal-article","created":{"date-parts":[[2020,3,19]],"date-time":"2020-03-19T05:30:31Z","timestamp":1584595831000},"page":"e232299","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Treatment failure after multiple courses of triclabendazole in a Portuguese patient with fascioliasis"],"prefix":"10.1136","volume":"13","author":[{"given":"Elsa Alves","family":"Branco","sequence":"first","affiliation":[{"name":"Infectious Diseases Department, Centro Hospitalar de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7449-1338","authenticated-orcid":false,"given":"Rogerio","family":"Ruas","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Centro Hospitalar de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"}]},{"given":"Jo\u00e3o","family":"Nuak","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Centro Hospitalar de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"}]},{"given":"Ant\u00f3nio","family":"Sarmento","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Centro Hospitalar de S\u00e3o Jo\u00e3o EPE, Porto, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2020,3,18]]},"reference":[{"key":"2025082711330211000_13.3.e232299.1","doi-asserted-by":"publisher","DOI":"10.1079\/JOH2005296"},{"key":"2025082711330211000_13.3.e232299.2","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/0950-3528(87)90006-6","article-title":"5 diseases caused by liver flukes and cholangiocarcinoma","volume":"1","author":"Chan","year":"1987","journal-title":"Bailli\u00e8re's Clinical Gastroenterology"},{"key":"2025082711330211000_13.3.e232299.3","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1995.52.532"},{"key":"2025082711330211000_13.3.e232299.4","doi-asserted-by":"publisher","DOI":"10.1017\/S0022149X09321173"},{"key":"2025082711330211000_13.3.e232299.5","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e3282a95e39"},{"key":"2025082711330211000_13.3.e232299.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004361","article-title":"Treatment failure after multiple courses of Triclabendazole among patients with fascioliasis in cusco, Peru: a case series","volume":"10","author":"Cabada","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"2025082711330211000_13.3.e232299.7","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.4067\/S0034-98872014001000014","article-title":"Fascioliasis hep\u00e1tica humana: resistencia al tratamiento Con triclabendazol","volume":"142","author":"Gil","year":"2014","journal-title":"Revista m\u00e9dica de Chile"},{"key":"2025082711330211000_13.3.e232299.8","unstructured":"Guerrant R , Walker D , Weller P , et al . Tropical Infectious Diseases: Principles, Pathogens, and Practice. 3rd Edition; Section II, Part K - Trematode Infections, chapter 123. 44(2). Elsevier \/ Saunders, 2011. ISBN: 9780702039355."},{"key":"2025082711330211000_13.3.e232299.9","unstructured":"Bennett J , Dolin R , Blaser M , et al . Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th edition; volume 3, part J \u2013 diseases due to helminths, chapter 290. Elsevier \/ Saunders, 2015. ISBN: 978-1-4557-4801-3."},{"key":"2025082711330211000_13.3.e232299.10","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v17.i44.4899"},{"key":"2025082711330211000_13.3.e232299.11","doi-asserted-by":"publisher","DOI":"10.1517\/13543784.14.12.1513"},{"key":"2025082711330211000_13.3.e232299.12","unstructured":"WHO . Fascioliasis Diagnosis, Treatment and Control Strategy [Internet]. Who.int, 2018. Available: http:\/\/www.who.int\/foodborne_trematode_infections\/fascioliasis\/fascioliasis_diagnosis\/en\/ [Accessed 12 Dec 2018]."},{"key":"2025082711330211000_13.3.e232299.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0001285","article-title":"Efficacy and safety of artemether in the treatment of chronic fascioliasis in Egypt: exploratory phase-2 trials","volume":"5","author":"Keiser","year":"2011","journal-title":"PLoS Negl Trop Dis"},{"key":"2025082711330211000_13.3.e232299.14","doi-asserted-by":"crossref","first-page":"388","DOI":"10.4269\/ajtmh.2008.78.388","article-title":"A randomized controlled pilot study of artesunate versus triclabendazole for human fascioliasis in central Vietnam","volume":"78","author":"Hien","year":"2008","journal-title":"Am J Trop Med Hyg"},{"key":"2025082711330211000_13.3.e232299.15","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1007\/s10620-009-0850-0","article-title":"Endoscopic management of biliary parasitic diseases","volume":"55","author":"Bekta\u015f","year":"2010","journal-title":"Dig Dis Sci"},{"key":"2025082711330211000_13.3.e232299.16","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s12664-010-0029-9","article-title":"Endoscopic ultrasound in biliary fasciolosis","volume":"29","author":"Gandhi","year":"2010","journal-title":"Indian J Gastroenterol"},{"key":"2025082711330211000_13.3.e232299.17","doi-asserted-by":"publisher","DOI":"10.3201\/eid1806.120302"},{"key":"2025082711330211000_13.3.e232299.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.pt.2016.03.002"},{"key":"2025082711330211000_13.3.e232299.19","doi-asserted-by":"publisher","DOI":"10.1007\/s00436-003-1003-6"},{"key":"2025082711330211000_13.3.e232299.20","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.vetpar.2013.03.007","article-title":"Effect of the P-glycoprotein inhibitor, R(+)-verapamil on the drug susceptibility of a triclabendazole-resistant isolate of Fasciola hepatica","volume":"195","author":"Savage","year":"2013","journal-title":"Vet Parasitol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-232299","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:33:07Z","timestamp":1756319587000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-232299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":20,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,3,18]]},"published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1136\/bcr-2019-232299"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-232299","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3]]}}}