NTDs also in Japan: Experiences of doctors who treated fasciola hepatitis

Fasciola hepatitis is classified as NTDs as one of the food-borne trematode infections. Ingestion of contaminated food infects flukes and affects the liver, lungs and intestines. The following is a summary of the experiences of the doctor in charge of patients with fasciolosis that occurred in Japan. The interview was conducted at the end of December 2021.

It was 2019 when I (the attending physician) first saw a patient with fasciolosis. I had a fever and abdominal pain for about two months, and even when I visited a nearby doctor, I couldn't make a diagnosis. A blood test and a CT test showed findings of a parasite infection in the liver, so I suspected roundworm and administered a therapeutic drug called albendazole. At this time, I requested a detailed examination from a specialized institution, but I could not reach a definitive diagnosis. After that, I was referred to another hospital, where I was diagnosed with fasciolosis by diagnostic imaging.

Triclabendazole, a treatment for fasciolosis, is an unapproved drug in Japan and should be ordered on a research basis. However, this drug is only available to hospitals that have undergone pre-screening and participate in the study. The hospital I work for has not undergone this review and was unable to use the medicine. Therefore, I was introduced to a hospital in the neighboring prefecture, and the patient was treated there.

I think it took about two months from the time the patient first visited the hospital to the time he received treatment. It takes about 4 months from the onset of symptoms to the start of treatment. It was my first time to have fasciolosis, so it took a lot of time and effort. The patient would have been very anxious about not knowing what the illness was until the diagnosis was made. Since it may be a pet-related illness, it seems that the disposal of pets was also considered, and I think that the psychological burden was considerable.

Based on this experience, the hospital where I work was able to establish a system such as obtaining approval for the use of unapproved drugs. I think this will reduce the burden on patients to go to other prefectures. However, when diagnosing such a rare illness, it is necessary to submit various documents, which also puts a burden on the medical staff. In addition, it seems that the response depends on the situation as to who will bear the cost of unapproved drugs. In one case, I heard that the hospital paid for the drug, but in another case, some patients ordered the drug at their own expense. I think the problem is that there is a difference in the financial burden on patients even when treating the same illness. Although it is rare, it is an infectious disease that occurs in about 10 cases a year in many years in Japan, so I think it is necessary to establish a system that allows patients to receive treatment without financial or psychological anxiety. increase.