Abstract
BackgroundPraziquantel is the drug of choice in preventive chemotherapy targeting schistosomiasis. Increasing large-scale administration of praziquantel requires monitoring of drug efficacy to detect early signs of development of resistance. Standard protocols for drug efficacy monitoring are necessary. Here, we determined the optimal time point for praziquantel efficacy assessment against Schistosoma haematobium and studied the dynamics of infection parameters following treatment.MethodsNinety school-aged children from south Côte d’Ivoire with a parasitologically confirmed S. haematobium infection were treated with a single oral dose of praziquantel (40 mg/kg) and followed up for 62 days post-treatment. Urine samples were collected on 23 schooldays during this period and were subjected to visual examination (macrohaematuria), urine filtration and microscopy (S. haematobium eggs) and reagent strip testing (microhaematuria, proteinuria and leukocyturia).ResultsObserved cure and egg reduction rates were highly dependent on the time point post-treatment. Egg reduction rates were high (>97%) in weeks 3–9 post-treatment. Cure rates were highest in weeks 6 (92.9%) and 9 (95.0%) post-treatment. The prevalence of infection-associated parameters decreased after treatment, reaching a minimum of 2.4% in weeks 5 (proteinuria) and 7 (leukocyturia) post-treatment, and 16.3% at the end of week 8 (microhaematuria). Macrohaematuria disappeared between weeks 3 and 6 post-treatment.ConclusionsFor monitoring praziquantel efficacy against S. haematobium, we recommend that the cure rate is assessed at week 6 post-treatment. The egg reduction rate can be evaluated earlier, from day 14 post-treatment onwards. Reagent strips are a useful additional tool for evaluating treatment outcomes in areas with high endemicity, preferably at weeks 5 and 6 post-treatment. The delayed decrease of microhaematuria confirms that lesions in the urinary tract persist longer than egg excretion post-treatment.
Highlights
Praziquantel is the drug of choice in preventive chemotherapy targeting schistosomiasis
Schistosomiasis is characterized by chronic inflammation around schistosome eggs that are trapped in host tissues
Prior to the current study, the village of Grand Moutcho had not been targeted by preventive chemotherapy with praziquantel against schistosomiasis
Summary
Praziquantel is the drug of choice in preventive chemotherapy targeting schistosomiasis. Increasing large-scale administration of praziquantel requires monitoring of drug efficacy to detect early signs of development of resistance. We determined the optimal time point for praziquantel efficacy assessment against Schistosoma haematobium and studied the dynamics of infection parameters following treatment. Schistosomiasis is caused by blood flukes of the genus Schistosoma. The largest proportion of infected people (>90%), live in sub-Saharan Africa, where schistosomiasis is considered a major public health problem [2,3,4]. Schistosomiasis is characterized by chronic inflammation around schistosome eggs that are trapped in host tissues. Schistosoma haematobium is found in the veins of the small pelvis, causing urogenital schistosomiasis. Chronic schistosomiasis is associated with anaemia, growth stunting and reduced physical fitness [12,13]
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