Dose finding double-blind clinical trial with praziquantel in schistosomiasis japonica patients

A double-blind clinical trial with praziquantel was carried out. A total of 400 cases was treated with four different dosages, namely, 60, 50, 40 and 30 mg/kg body weight of praziquantel. The drug was given in one day divided into two doses. Identical placebo tablets were used to make up a total of 60 mg/kg. Tolerance was good in all with the exception of one case suffering from asthmatic attack with papule rashes over large area of the body surface. 394 patients were able to be followed up parasitologically six months post-treatment. 79.8%, 71.7%, 78.8% and 70.1% of the patients were negative in the groups with the total dose of 60, 50, 40 and 30 mg/kg respectively. The cure rates as well as the side effects were similar for the four groups. The efficacy was lower than that reported by other authors and the possibility of reinfection was incriminated. In villages with few snails the negative hatching rates in aforementioned four groups were 89.1%, 91.1%, 88.9% and 81.8%, while in villages with abundant snails the rates were 68.2%, 46.5%, 66.7% and 54.8%. The difference between the two areas was statistically significant. Higher efficacy was observed in adults with an average cure rate of 80.0% than in children under 15 years of age, the average cure rate being 57.1%.(ABSTRACT TRUNCATED AT 250 WORDS)     

蒿甲醚与吡喹酮联合治疗急性日本血吸虫病临床研究

目的用蒿甲醚与吡喹酮联合治疗急性日本血吸虫病,评估联合用药的临床疗效和安全性.方法96例急性日本血吸虫病人完全随机分为2组,治疗组45例口服蒿甲醚6 mg/kg加吡喹酮120 mg/kg联合治疗,对照组51例口服安慰剂加吡喹酮120 mg/kg.比较两组治愈率、治后21、45天粪便虫卵阴转率及减卵率、用药后不良反应发生率.试验采用双盲法.结果治疗组与对照组治愈率分别为97.7%和95.7%,治后45天粪便减卵率分别为99.1%和97.7%,治疗后平均发热天数分别为5.1 d和4.5 d,平均住院天数分别为9.4 d和8.9 d,差异均无显著性(P均＞0.05).治疗组2例病人口服蒿甲醚后腹部和背部出现荨麻疹,对症处理后症状消失;1例出现呕吐.结论蒿甲醚与吡喹酮联合治疗急性血吸虫病安全,无明显不良反应,治疗效果与单用吡喹酮无明显差异.     

国外吡喹酮防治血吸虫病的进展

吡喹酮是一种对人体5种主要血吸虫病(曼氏、埃及、湄公、间插与日本血吸虫病)都非常有效的药物。全球已对1亿多例血吸虫感染者及有疫水接触史的可能感染者用吡喹酮进行了治疗,积累了极为丰富的经验。该文概述自吡喹酮问世以来国外用吡喹酮治疗几种血吸虫病的效果、副反应及吡喹酮在几个主要流行国家(埃及、巴西、老挝、印度尼西亚、菲律宾)防治规划中的应用。     

脑型血吸虫病的临床表现与吡喹酮化疗

脑型血吸虫病指血吸虫卵肉芽肿病变发生于或者成虫寄居于中枢神经系统造成的疾病。脑型血吸虫病是一种比较严重的疾病,临床诊断有一定难度,以往常有患者被误诊为脑瘤。自从吡喹酮广泛用于治疗血吸虫病以后,只要能明确诊断,予以吡喹酮化疗,治疗效果十分明显。收集1993年以来全国     

Treatment and re-treatment strategies for schistosomiasis control in different epidemiological settings: a review of 10 years' experiences

This paper reviews 10 years' experience with schistosomiasis control in different endemic settings in Africa, Asia and the Americas. Research projects, pilot programs and long-term large-scale programs with the objective of controlling morbidity have been included in the review. Major advances in diagnostic tools and rapid assessment techniques have evolved during the decade making it possible to follow changes in pathology after treatment and to get baseline epidemiological information at very low cost. At the same time prices of drugs like praziquantel has declined dramatically (to 相似文献   

Chemotherapy-based control of schistosomiasis haematobia. II. Metrifonate vs. praziquantel in control of infection-associated morbidity

To determine the relative efficacy of metrifonate and praziquantel in controlling urinary tract morbidity due to Schistosoma haematobium infection, a random allocation treatment trial was performed among 1,813 school age S. haematobium-infected children from the Msambweni area of Coast Province, Kenya. Following baseline examination for infection, hematuria, proteinuria, and ultrasonographic urinary tract abnormalities, oral treatment with either metrifonate (10 mg/kg, repeated at 4 month intervals) or praziquantel (1 dose of 40 mg/kg) was given to infected subjects. Prevalence of morbidity was reassessed 12 months later for each treatment group. Results indicated equivalent patient improvement in response to either regimen: prevalence of hematuria fell from 75% to 17% after either praziquantel or metrifonate therapy. Similarly, prevalence of proteinuria was significantly reduced from 73% to 29% (metrifonate) or 27% (praziquantel) after therapy. Metrifonate and praziquantel caused similar reductions in bladder granulomata and bladder thickening; however, no reduction in hydronephrosis was noted with either drug. Analysis of outcomes in population subgroups defined by age, sex, pretreatment intensity of infection, or severity of pretreatment morbidity showed no consistent advantage for either drug. In this endemic area, both agents provide effective control of morbidity due to urinary schistosomiasis.     

Advances in pathophysiology of schistosomiasis japonica: a review.

Schistosomiasis is a chronic granulomatous disease caused by a delayed type of hypersensitivity reaction to eggs deposited or trapped in the tissues. Granuloma formation, depending on extent, if in the liver will lead to portal hypertension while if in the lungs, will lead to pulmonary hypertension and cor pulmonale.     

Immunodiagnosis and its role in schistosomiasis control in China: a review

Parasitological techniques (stool examination and/or urine filtration) are still the diagnosis of choice in national schistosomiasis control programmes the world over. However, the success of current control efforts, mainly due to the large-scale administration of praziquantel, emphasises the need for a more sensitive approach. In addition, microscopy is labour-intensive and time-consuming, while declining compliance rates after repeated chemotherapy make good coverage for the long-term increasingly problematic. China's success in the control of schistosomiasis is contributing to an enhanced understanding of the need for better and more sensitive screening methods. Immunodiagnostic techniques have a high sensitivity, are easy to perform and are an excellent epidemiological tool for the screening of target populations in schistosome-endemic areas. These assays are also useful for the surveillance of cure after chemotherapy, and for periodic control of transmission of the infection after it has been eliminated in an area. A succinct historical background of using immunodiagnosis for schistosomiasis japonica in China is given, together with a review and evaluation of the relative efficacy of the main techniques applied, i.e. the intradermal test, the circumoval precipitation test, the indirect hemagglutination assay, the dye dipstick immunoassay and different kinds of enzyme-linked immunosorbent assay applications. The important role of immunodiagnosis in the screening for schistosomiasis in China is discussed.     

Effects of the praziquantel-based control of schistosomiasis japonica in China

In 2000-2002, the effects of the praziquantel-based control of Schistosoma japonicum (in which each subject found infected in the October of each year is given a single dose of the drug) were examined at 20 or 21 surveillance sites across China. The pre- and post-treatment prevalences and intensities of infection were compared at each site and after pooling using a random-effects method. One year after treatment, in the communities that had the higher prevalences of infection (> 10%) before treatment, the mean prevalence of infection was found to have fallen by 20.15% [95% confidence interval (CI)=6.95%-31.48%] and the geometric mean intensities of infection (measured as eggs/g faeces) in the currently infected individuals and the entire study cohort were found to have fallen, by 22.91% (CI=14.69%-30.34%) and 33.93% (CI=11.69%-50.68%), respectively (P<0.05 for each). In the communities that had lower prevalences of infection pre-treatment, however, no statistically significant reductions in the intensity of infection were observed, although the prevalences in the communities that had pre-treatment prevalences of 6%-10% did fall significantly post-treatment, by a mean of 24.50% (CI=5.35%-39.83%; P<0.05). These observations indicate that the current annual surveys for infection, in which those found infected are each given a single dose of praziquantel, should help keep the prevalence of human infection with S. japonicum low in China, although chemotherapy alone is unlikely to eradicate the parasite.     

吡喹酮化疗在血吸虫病防治中的作用

本文阐述了吡喹酮化疗在控制传染源和血吸虫病防治中的作用,同时提出了值得思考和关注的问题。     

Agro-engineering and sanitation improvement in the control of schistosomiasis japonica in the Philippines: a review.

Measures that would change the habitat of the snails were found to prevent its breeding. Among these are clearing and drainage of waterlogged areas; filling of depressions where filling materials are available; ponding of areas which cannot be drained, and improved rice culture. The degree of success in snail control depends to a large extent on the amount of change brought about in the habitat. The more radical the change, the greater the reduction in snail density. It can be expected that improvement in sanitation in the form of toilet construction and use, provision of safe water supply, building of footbridges and the control of stray animals will bring a further decline in the transmission of the disease. Studies have shown that perfect sanitation in the form of toilet construction and use will reduce transmission by about 75%, the other 25% being contributed by lower mammals. Agro-engineering control measures are presently being carried out intensively in 7 town of Leyte, with food assistance from the UN/FAO World Food Program being given to volunteer workers as incentives for them to work. Snail evaluation after 2 years has shown a snail reduction by 72% in the areas covered. It may be mentioned here that sanitation improvement, especially latrine construction, is an ongoing program of the Department of Health in all rural areas.     

Hepatosplenic morbidity in schistosomiasis japonica: evaluation with Doppler sonography.

In Southeast Asia, schistosomiasis japonica is an important cause of hepatic fibrosis and gastrointestinal hemorrhage. Reliable methods to investigate portal hypertension (PHT) clinically and epidemiologically on community level are lacking. Doppler sonography is an established tool for investigating PHT in hospital settings. In Leyte, The Philippines, 137 individuals underwent color Doppler sonography, stool examination, and serology for hepatitis B and C, liver cell injury and cholestasis. A total of 85% of the study population had been infected with Schistosoma japonicum. Sonographically, periportal liver fibrosis was seen in 25% and reticular echogenicities (network pattern) in 44%. Portal blood flow was decreased or portosystemic collaterals were present in 10% (adults throughout) and correlated with periportal fibrosis, but not with network lesions. Chronic viral hepatitis was rare. Thus, hepatic lesions are frequent in adults but not in children in areas endemic for S. japonicum. Periportal liver fibrosis indicates a risk of PHT, and network pattern fibrosis apparently does not. Doppler sonography is suitable for research under tropical field conditions.     

Developing strategies to control schistosomiasis morbidity in nonenrolled school-age children: experience from Egypt

Schistosomiasis is a major health problem in school-age children in much of the tropical world. They harbour the most intense infections for both Schistosoma mansoni and S. haematobium. In Egypt, the Ministry of Health and Population (MOHP) has implemented a successful school-based treatment programme in which children are screened and those found to be infected treated with praziquantel. High nonenrolment rates in some rural areas have a negative impact on the coverage of this programme and on its ability to reduce transmission in the community. The main aim of our study was to introduce and test a simple intervention to extend treatment to nonenrolled children using the routine MOHP schistosomiasis treatment programme. Twenty villages or ezbas in Tamia district, Fayoum governorate, with 8 schools and 1901 nonenrolled children were targeted. 88.5% of nonenrolled children attended schools to avail themselves of treatment. Coverage rates were significantly higher for girls (P < 0.001). These results are important for countries where schistosomiasis is endemic. They suggest that offering interventions in schools may not only improve the health of school attendees but also be an affordable way of extending services to out-of-school children.     

Ankylosing spondylitis in Shantou,China: 15 years' clinical experience

OBJECTIVE: To study the clinical features of ankylosing spondylitis (AS) in Shantou, China, and assess the therapeutic effect of slow acting antirheumatic drugs (SAARD). METHODS: Clinical and laboratory data as well as the results of SAARD treatment were analyzed in 370 consecutive cases (46 female) seen in the period 1983-97. All patients met the modified New York criteria for AS. HLA-B27 was present in 83 of 89 (93.3%) patients tested. RESULTS: Insidious onset was seen in 94.3% of the cases studied: 33.5% with disease onset prior to age 20 years, 53.5% between ages 20-30 years, and 98.1% of all under age 40. Low back pain/discomfort, peripheral arthritis, positive "4" test, and tenderness over the sacroiliac joints/lumbar spine were the most frequent symptoms and signs. With some exceptions, the extent of sacroiliitis and involvement of the hip and spine were closely related to disease duration. Average disease duration was shorter among patients diagnosed after 1989 than before. A total of 107 cases have been followed for more than 3 years, of which 57 patients persisted with SAARD treatment for more than 3 years. Forty-four of the 57 cases (11.9% of the total of 370 cases) resulted in a good prognosis. CONCLUSION: Early diagnosis of AS in Shantou, China, improved in the 1990s. SAARD were effective in the treatment of AS at least in a small portion of the patients. Patient compliance and longterm treatment were essential to obtain a better outcome.     

吡喹酮治疗急性血吸虫病致过敏性哮喘1例

患者占某，女，45岁，荆门市掇刀区农民。既往身体健康，否认有哮喘病史和心脏病史，无药物过敏史。患者于2004年6月10日曾到血吸虫病疫区下水劳动10余天。于2004年7月15日开始出现发热、畏寒，最高时体温为38．8℃，傍晚高热，次晨退热大汗，无咳嗽、咳痰，无腹痛、腹泻，曾在当地医院就诊，拟诊为“上呼吸道感染”，经口服抗感冒药及静滴“先锋V”治疗10余天无效，于8月3号转入湖北省荆州市血吸虫病防治所医院。     

青蒿琥酯与吡喹酮联合应用治疗急性血吸虫病38例

吡喹酮是目前日本血吸虫病病原治疗的首选药物,在临床治疗中部分急性血吸虫病患者经吡喹酮治疗后出现病情再燃的现象,需进行双疗程治疗,究其原因可能与吡喹酮对血吸虫童虫的杀虫作用弱有关。青蒿琥酯能杀灭宿主体内尚未发育成熟的日本血吸虫童虫[1],有效弥补了吡喹酮治疗的不足     

Seroepidemiology of schistosomiasis japonica by ELISA in the Philippines. III. Selective mass chemotherapy with praziquantel in a control program

After a pre-control (pre-treatment) prevalence rate of schistosomiasis japonica was established by stool examination and by ELISA in about 400 school children in school year 1979, annual prevalence rates were measured in the following 3 assessment years. From 54-80% of children found infected primarily by stool examination were treated with praziquantel 3-9 months before the assessment examinations. Both stool examination and ELISA showed statistically significant reductions of prevalence from the 1st to the 3rd assessment years (average reduction of 50% measured by stool examination and average reduction of 19% measured by ELISA). These reductions were expected as a result of the biologic activity of the effective schistosomicide; they are therefore not acceptable evidence of reduced transmission levels. By decreasing human sources of snail infection, an effective schistosomicide may have the epidemiologic impact of reducing transmission; assessment prevalence rates can be relevant indices of transmission levels only if the biologic effect of the schistosomicide is dissociated from its epidemiologic impact in a control program in which selective mass chemotherapy plays a dominant role. This dissociation was accomplished in this study by measurements in an essentially untreated group of "new" pupils, i.e., those who entered the school at the beginning of each assessment year. Overall prevalence rates among the "new" pupils did not show a significant reduction until the 3rd assessment year as measured by stool examination (reduction by 36% of pre-control level); as measured by ELISA, a significant reduction (by 15-17%) was detected in the 2nd and 3rd assessment years. The youngest children, and girls more than boys, were the most sensitive indicators of change.(ABSTRACT TRUNCATED AT 250 WORDS)