Oral Praziquantel Research Articles

Use of a commercial oral moxidectin plus praziquantel combination for treatment of the respiratory nematode Crenosoma striatum in rescued Southern white-breasted hedgehogs (Erinaceus concolor)

BackgroundCrenosoma striatum lungworm infestation is common in many free-ranging hedgehogs. This report describes the clinical experience when using a commercial moxidectin/praziquantel combination against natural C. striatum infestation in rescued Southern white-breasted hedgehogs (Erinaceus concolor). MethodsIn total, 24 hedgehogs received this 1.2 mg per kg and 7.0 mg per kg bodyweight orally after showing C. Striatum larvae in their feces. Weekly fecal rechecks were performed over 4 weeks. ResultsThere were no apparent adverse responses, and nearly all treated hedgehogs (96%) had increased their body weights before their release to the wild. When compared to their initial positive check, none of the treated hedgehogs had showed C. striatum larvae in their last fecal recheck. Conclusion and Clinical RelevanceBased on our observations, a single oral administration of moxidectin/praziquantel is safe and effective for treatment of C. striatum lungworm infestation in Southern white-breasted hedgehogs.

Percutaneous drainage and combined praziquantel-albendazole therapy: a novel approach for the treatment of simple echinococcal liver cysts.

Cystic echinococcosis (CE) is a worldwide helminthic zoonosis causing serious disease in humans. The WHO Informal Working Group on Echinococcosis recommends a stage-specific treatment approach of hepatic CE that facilitates the decision on what therapy option is most appropriate. Percutaneous aspiration, instillation of a scolicide, e.g., ethanol or hypertonic saline, and subsequent re-aspiration (PAIR) have been advocated for treating medium-size unilocular WHO-stage CE1 cysts. PAIR can pose a risk of toxic cholangitis because of spillage of ethanol in the case of a cysto-biliary fistula or of life-threatening hypernatriaemia when hypertonic saline is used. The purpose of our study is to develop an alternative, safe, minimally invasive method to treat CE1 cysts, avoiding the use of toxic topic scolicides.We opt for percutaneous drainage (PD) in four patients: the intrahepatic drainage catheter is placed under CT-fluoroscopy, intracystic fluid is aspirated, and the viability of intracystic echinococcal protoscolices is assessed microscopically. Oral praziquantel (PZQ) is added to albendazole (ABZ) instead of using topical scolicidals.Protoscolices degenerate within 5 to 10 days after PZQ co-medication at a cumulative dosage of 250 to 335 mg/kg, and the cysts collapse. The cysts degenerate, and no sign of spillage nor relapse is observed in the follow-up time of up to 24 months post-intervention.In conclusion, PD combined with oral PZQ under ABZ coverage is preferable to PAIR in patients with unilocular echinococcal cysts.

Testicular schistosomiasis: a clinico-pathological presentation of three pediatric cases and review of literature

Schistosomiasis is an important communicable disease in developing countries and an important cause of morbidity in the tropics and subtropics. It is a very rare cause of painless testicular swelling that tend to mimic malignancy and cause a diagnostic dilemma. Though histopathologic analysis confirms diagnosis, a high index of suspicion is required especially for patients presenting from endemic areas. We aim to present the clinicopathological features of three pediatric cases of Testicular Schistosomiasis (TS) and to highlight the role of high index of suspicion, incisional biopsy and histopathologic diagnosis in prevention of unwarranted orchiectomy and preservation of testicular function. We report three cases of TS in patients aged 5 years, 12 years and 14 years, who presented with progressive testicular swellings. The diagnoses were made by histopathological analysis and the patients were treated with oral praziquantel. TS should always be considered an important differential in all male children and adults presenting with testicular masses especially when they live in endemic regions. Incisional biopsy, proper histopathologic evaluation and treatment could prevent unwarranted orchiectomy and thus preserve testicular function.

Pediatric Spinal Neuroschistosomiasis in Yemen: An Overlooked Dilemma in an Endemic Region.

Neurological involvement in schistosomiasis presents a significant and serious complication. While the disease is generally considered treatable during the early stages, the rarity of this condition often leads to delays in diagnosis and treatment. This study aims to report the clinical characteristics of pediatric patients with spinal neuroschistosomiasis (NS) in an endemic area to the disease. A retrospective cross-sectional review was conducted at Althora General Hospital in Ibb, Yemen, from January 2016 to January 2021. The study examined confirmed pediatric cases of spinal NS, analyzing their clinical characteristics, laboratory and radiological data, treatment approaches, and complications. The study identified 10 cases of spinal NS with a mean age of 10.1± 3.2 years. The majority (90%) were male and from rural areas, all with a history of freshwater exposure, a known risk factor for schistosomiasis. The average time from presentation to treatment was 33.4± 45.6 days (7-150 days). Common symptoms observed in all patients were bladder dysfunction and paresthesia (100%). Intestinal dysfunction was prevalent in 90% of cases, while 80% exhibited limb weakness or inability to walk. The diagnosis was confirmed through cerebrospinal fluid (CSF) serology in 80% of cases, and stool and urine exams yielded positive results in 90% and 30% of cases, respectively. Magnetic Resonance Imaging findings revealed medullary lesions in 50% of cases, cauda equina lesions in 20%, and multiple lesions in 30%. All patients received oral praziquantel and high-dose steroids for at least three days as part of their initial treatment. During the average follow-up period of 5.6±1.7 months, one patient experienced lower extremity paraplegia, while two cases (20%) showed partial improvement with residual deficits includingurinary and fecal incontinence. Complete resolution of symptoms was achieved in seven cases (70%). Schistosomiasis should be considered in pediatric patients with myeloradicular manifestations, especially in endemic areas. Early identification can be achieved through history, prompt imaging, and CSF serology. In the absence of immediate test results, expert-guided presumptive therapy should be considered to minimize neurological complications.

Efficacy, safety, and palatability of arpraziquantel (L-praziquantel) orodispersible tablets in children aged 3 months to 6 years infected with Schistosoma in Côte d'Ivoire and Kenya: an open-label, partly randomised, phase 3 trial

WHO has underlined the need for a child-friendly treatment for schistosomiasis, a prevalent parasitic disease in low-income and middle-income countries. After successful phase 1 and 2 trials, we aimed to evaluate the efficacy, safety, palatability, and pharmacokinetics of arpraziquantel (L-praziquantel) orodispersible tablets for preschool-aged children. This open-label, partly randomised, phase 3 study was conducted at two hospitals in Côte d'Ivoire and Kenya. Children with a minimum bodyweight of 5 kg in those aged 3 months to 2 years and 8 kg in those aged 2-6 years were eligible. In cohort 1, participants aged 4-6 years infected with Schistosoma mansoni were randomly assigned (2:1) to receive a single dose of oral arpraziquantel 50 mg/kg (cohort 1a) or oral praziquantel 40 mg/kg (cohort 1b) using a computer-generated randomisation list. Cohorts 2 (aged 2-3 years) and 3 (aged 3 months to 2 years) infected with S mansoni, and the first 30 participants in cohort 4a (aged 3 months to 6 years) infected with Schistosoma haematobium, received a single dose of oral arpraziquantel 50 mg/kg. After follow-up assessments, arpraziquantel was increased to 60 mg/kg (cohort 4b). Laboratory personnel were masked to the treatment group, screening, and baseline values. S mansoni was detected using a point-of-care circulating cathodic antigen urine cassette test and confirmed using the Kato-Katz method. The primary efficacy endpoint was clinical cure rate at 17-21 days after treatment in cohorts 1a and 1b, measured in the modified intention-to-treat population and calculated using the Clopper-Pearson method. This study is registered with ClinicalTrials.gov, NCT03845140. Between Sept 2, 2019, and Aug 7, 2021, 2663 participants were prescreened and 326 were diagnosed with S mansoni or S haematobium. 288 were enrolled (n=100 in cohort 1a, n=50 in cohort 1b, n=30 in cohort 2, n=18 in cohort 3, n=30 in cohort 4a, and n=60 in cohort 4b), but eight participants received antimalarial drugs and were excluded from the efficacy analyses. The median age was 5·1 years (IQR 4·1-6·0) and 132 (47%) of 280 participants were female and 148 (53%) were male. Cure rates with arpraziquantel were similar to those with praziquantel (87·8% [95% CI 79·6-93·5] in cohort 1a vs 81·3% [67·4-91·1] in cohort 1b). No safety concerns were identified during the study. The most common drug-related treatment-emergent adverse events were abdominal pain (41 [14%] of 288 participants), diarrhoea (27 [9%]), vomiting (16 [6%]), and somnolence (21 [7%]). Arpraziquantel, a first-line orodispersible tablet, showed high efficacy and favourable safety in preschool-aged children with schistosomiasis. The Global Health Innovative Technology Fund, the European and Developing Countries Clinical Trials Partnership, and the healthcare business of Merck KGaA, Darmstadt, Germany (CrossRef Funder ID: 10.13039/100009945).

Granulomatous Cholecystitis in a Patient with Schistosoma Mansoni Infection: A Case Report

Case summary: A 20-year-old man presented with three-month history of dull ache RT hypochondrial pain, nausea, vomiting and dyspeptic symptoms. Abdominal ultrasound showed multiple gallbladder polyps which was treated with open cholecystectomy. Histopathology results showedschistosomal granulomatous cholecystitis. The patient had an uneventful postoperative course and was treated with oral praziquantel and follow up of 6 month interval he remain asymptomatic. Review of different aspect of gallbladder schistosomasis are discussed.

Repurposing the anthelmintic praziquantel to treat psoriasis.

The anthelmintic drug praziquantel has been used as a standard treatment for schistosomiasis for over 40 years. This study aimed to repurpose praziquantel to treat psoriasis. Psoriasis-like skin inflammation was induced in mice (C57 and Balb/C) by topical application of imiquimod or intradermal injection of recombinant IL-23. Praziquantel was either orally or topically administered during the psoriasis induction period. Mice treated with either oral or topical praziquantel exhibited markedly improved psoriasiform skin symptoms when compared with control mice, as judged by disease severity score, epidermal thickening, inflammatory cell infiltration and spleen size. Flow cytometric analysis of infiltrating immune cells from mouse skin displayed reduced infiltration of Th17 cells. In vitro experiments revealed that praziquantel inhibited STAT3 phosphorylation and RORγt expression in splenic CD4+ T-cells. Praziquantel also decreased STAT3 phosphorylation in HEK-A/F cells. Down-regulation of STAT3 phosphorylation in these cells accounts for the decreased number of Th17 cells and keratinocytes. These results provide the first preclinical evidence that praziquantel may effectively treat psoriasis, and suggest that praziquantel alleviates symptoms in mice by inhibiting STAT3 phosphorylation, thereby suppressing Th17 immune responses.

Evaluation of Praziquantel Efficacy against Zeuxapta seriolae Infections in Greater Amberjack, Seriola dumerili

The aim of this study was to evaluate the efficacy of dietary praziquantel (PZQ), a promising fish anthelminthic, against Zeuxapta seriolae, a lethal ectoparasite of greater amberjack (Seriola dumerili Risso) farmed in the Mediterranean and elsewhere. The trial was carried out in small cages (3 m3) in situ, harbouring fish (125 ± 14 g) naturally infected with Z. seriolae, at 25 ± 1 °C water temperature. Praziquantel-medicated diet (150 mg PZQ/kg fish) was delivered for three days against a control group. Measurement of both adults and oncomiracidia of Z. seriolae in sampled gill arches revealed significant differences between the tested groups (PZQ: 19.3 ± 9.8 vs. Control: 3.8 ± 6.3). Considering an estimated efficacy of 80.4% in the medicated fish, the present study indicates that oral PZQ treatments can confront Z. seriolae infections considerably in farmed greater amberjack and, perhaps, replace the commonly used hydrogen peroxidase baths.

Efficacy of Oral Artemisinin and Praziquantel Chemotherapy on Schistosoma mansoni Infected Mice by Means of Parasitological Parameters

Aim: Praziquantel-based chemotherapy is generally effective in the control of morbidity, decline in the prevalence and intensity of Schistosoma mansoni infections. Nevertheless, the potential emergence of praziquantel resistance in S. mansoni posses danger in the elimination of this neglected tropical disease in Africa. Therefore, this study was designed to evaluate the in-vivo efficacy of Praziquantel and Artemisinin using mice infected with S. Mansoni cercariae.
 Methods: Infected mice with S. mansoni were treated with different doses of Artemisinin and Praziquantel from day 42 post infection to assess its efficacy on adult worms and eggs. A 2-day Protocol: artemisinin 400 mg/kg with Praziquantel of 500 mg/kg daily, 4-day protocol: artemisinin 200 mg/kg with praziquantel of 250 mg/kg daily, 6-day protocol: artemisinin 100 mg/kg with praziquantel of 125 mg/kg daily were used. A value of p <0.05 was considered as the level of significance using statistical package for social sciences (SPSS) version 21.
 Results: Of the 150 snails collected, 60(40%) were confirmed to be Biomphalaria, while 50(33.3%) and 40(26.3%) were Bulinus and Intercalatum respectively. Highest reduction of 66.3% was found in group II, compared with 58.8% and 56.5% significant reductions in groups I and III, respectively. Also, there were 77.8% and 74.2% significant reductions in eggs per gram of the small intestinal tissue noted in groups I and II respectively as against 63.1% reduction in group III. A significant decline in the percentage of total immature stages of 6.14% in group I was observed when compared to 66.14% in the control. Furthermore, a statistically significant boost of 57.57% was found in the protocol of Artemisinin 100 mg/kg with Praziquantel 125 mg/kg daily (6-day protocol) causing decreases of 43.9% and 42.4% in the total and female worm loads, respectively. The combination decreased intestinal tissue egg loads ranging from 63.1% to 77.8% and liver egg loads ranging from 56.5% to 66.3% rates.
 Conclusion: Combined effect of the drugs has confirmed some level of efficacy on experimental S. Mansoni with significant reduction in tissue egg burden.

Metabolomic profiles and pathways of praziquantel in crucian carp

Praziquantel (PZQ) is a drug commonly used to treat some parasitic infections in animals. This study aimed to apply a reliable and simple method to identify important biological metabolites relevant to PZQ in crucian carp (Carassius auratus) to decipher the metabolic pathways and provide a basis for developing new anti-parasite drugs. The experimental group of crucian carp was administered oral PZQ at a dose of 10 mg kg−1 via a stomach feed tube. All biological blood samples were analysed using liquid chromatography electrospray ionization/quadrupole time-of-flight mass spectrometry (LC ESI/Q-TOF MS). MetPA analysis was used to identify relevant pathways for PZQ in crucian carp. Thirty-five potential metabolic pathways were revealed by MetPA network software. Furthermore, the chemical structures of the related metabolites and pathways were identified by comparison with data obtained from free online databases. Forty-four significantly differentially abundant endogenous metabolites were found in the PZQ-treated crucian carp. The changes in metabolomic profiles and pathways induced by PZQ played a role in inhibiting pathogenesis.

Chronic urticaria associated with schistosomiasis

Schistosomiasis is a tropical disease caused by fluke worms of genus Schistosoma. It can present as acute schistosomiasis and present as fever, cough, headaches, urticaria and cercarial dermatitis and this vary according to the infecting Schistosoma species (Jaureguiberry et al. 2010). Twenty-seven (27) year old female presented to the allergy clinic in Kuala Lumpur Hospital with chronic urticaria for past one year. She presented with persistent severe itchy maculopapular skin eruptions, mostly at the trunk and lower limbs, sparing the face and neck and not associated with angioedema. She had sought treatment from several general practitioners and dermatologists. She was treated with antihistamines, montelukast, and corticosteroid cream but she had temporary relief of her symptoms. She worked as an executive officer in a firm, and she has history of travelling to Cambodia and Thailand regularly for work. She gave history of eating raw salad and seafood in both places. Total Immunoglobulin E (IgE) was elevated (232ku/l). Low specific IgE to seafood. Parasitologic enzyme-linked immunosorbent assay (ELISA) test showed positive titer Immunoglobulin G (IgG) 0.311 to schistosomiasis. Urine microscopy and direct stool microscopy showed negative schistosomiosis eggs. Full blood picture was normal. Ultrasound of abdomen showed normal liver, spleen, kidney, and urinary system. She was given one dose of oral Praziquantel and antihistamines. For about a month, her urticaria and pruritus were less. After 6 months of treatment with praziquantel, a repeat parasitologic ELISA test to IgG was negative to schistosomiasis. Repeated urine microscopy and direct stool microscopy were negative to schistosomiosis. In summary, this woman had presented with chronic urticaria, with history of travelling to endemic areas for schistosomiasis and eating raw food perhaps with contaminated water, it is worthwhile to do some parasitic screening test for common parasitic helminthes, even though it is rarely associated with urticaria. However, cercarial dermatitis due to schistosomiasis have been reported by Folster-Holst R, et al (2001), S.J. Fraser et al (2008), and Kolarova L, et al (1999). To date, schistosomiasis is still considered as one of the main neglected tropical diseases by World Health Organization (WHO).

Praziquantel - chitosan nanoformulation against murine Schistosoma mansoni infection

Abstract The aim of the present work was to design praziquantel (PZQ) loaded chitosan nanoparticles (PZQ-Cs) to improve the oral bioavailability and overcome the drawbacks of conventional PZQ therapy. The synthesized chitosan nanoparticles (CsNPs) were physico-chemically characterized by TEM and dynamic light scattering (DLS) with the calculation of the encapsulation efficiency (EE). PZQ was loaded into CsNPs in three different doses; reduced dose (250 mg/kg), high dose (500 mg/kg) and fully effective dose (1000 mg/ kg). Infected treated groups received either oral PZQ-Cs or oral PZQ alone 42 days post-infection and were sacrificed 2 weeks post-treatment. The current study revealed that PZQ-Cs induced a significant anti-schistosomal effect, compared to the infected non-treated control. However, on comparison with conventional PZQ treatment at the corresponding doses, oral PZQ-Cs showed a lower anti-schistosomal potential as reflected by the total worm burden, tissue ova count and oogram pattern. PZQ-Cs was significantly effective in attenuating the oxidative insult associated with S. mansoni infection, compared to the infected non-treated and PZQ treated groups. Genotoxicity assessment proved the safety of CsNPs, as they did not induce a significant DNA fragmentation in non-infected mice treated with blank CsNPs. The present work highlights CsNPs as safe, effective anti-inflammatory and antioxidant agents that could find a clinical use in the treatment of schistosomiasis induced oxidative stress and hepatic dysfunction. Further studies are recommended, however, to investigate how PZQ-Cs could be further modified to increase its anti-schistosomal potential.

A case report: 1-year follow-up of cerebral sparganosis mansoni with a stroke-like onset

BackgroundSparganosis mansoni is a parasitic disease caused by infection with the larvae of Spirometra spp. tapeworms. Its clinical manifestations and severity depend on the migration and the location of the parasites. The proportion of cerebral sparganosis in all Spirometra mansoni infections is 13.5% in Thailand and 12.4% in China. In the clinical setting, cerebral sparganosis is often misdiagnosed due to atypical characteristics, irregular intracranial location, and atypical epidemiology.Case presentationThe patient in the case study suffered from an acute paroxysmal attack of lateral numbness, accompanied with focal epilepsy. He was admitted to the neurology department as a stroke patient but was later diagnosed with cerebral sparganosis mansoni following lab and radiology investigations. He was fully recovered and free of Spirometra mansoni one year after initial consultation following several courses of oral praziquantel. The current report focuses on the diagnosis, treatment and follow up of this patient.ConclusionsA case of cerebral sparganosis mansoni with a stroke-like onsetsuggests that in the clinical diagnosis, neurologists should pay attention to brain lesions and look out for the possibility of neuroparasitic infections when dealing with patients with stroke-like onset accompanied by epilepsy. Detections of relevant antibodies in blood and cerebrospinal fluid may be necessary. The combination of the epidemiological history, clinical manifestations, detection of parasite antibody, head radiology, pathological biopsy, and identification of parasites will help us in diagnosis and differential diagnosis.

Therapeutic potential effect of bone marrow-derived mesenchymal stem cells on chronic liver disease in murine Schistosomiasis Mansoni.

Some reports have shown that mesenchymal stem cells (MSCs) therapy could ameliorate chemically-induced hepatic fibrosis. This research assesses the therapeutic action of bone marrow mesenchymal stem cells (BM-MSCs) on chronic diseased liver in Schistosoma mansoni infected mice. All infected female mice divided into three groups, one group (15 mice) treated with oral praziquantel (PZQ), second group (15 mice) received intravenous injection of BM-MSCs and third group (15 mice) treated with both MSCs + PZQ. Two control groups (15 mice each) subdivided into one infected and second healthy one. BM-MSCs were obtained from bones of both femur and tibia of male mice (30 mice), then cultured and characterized morphologically by detection of CD105 by flow cytometer. Liver tissues for all groups were examined histopathologically. Measuring of the collagen 1 gene expression was done by real-time PCR and immunohistochemical study to detect stem cells differentiation for detection of MSCs engraftments in liver tissue. MSCs treatment caused marked improvement and regression of fibrosis, and prevents deposition of collagen and reduced the expression of collagen 1 gene in infected mice on their liver tissues, especially when used with PZQ in mice treatment. It can be concluded that, MSCs is a good therapeutic method for liver fibrosis caused by S. mansoni infection.

Diphyllobothrium latum Mimicking Subacute Appendicitis

Diphyllobothrium latum (D. latum) infection in human is uncommon in the United States. Although there has been a drastic decline in the report of D. latum infection in this region, physicians should be aware of an uncommon presentation and its clinical relevance. We report a case of 55-year-old female of Ecuadorian/Peruvian origin who presented with an unknown cause of chronic right lower quadrant abdominal pain for two months without other particular symptoms. Initial workup revealed evidence of iron deficiency anemia and stool occult blood test was positive. She was scheduled for a colonoscopy to assess the source of occult gastrointestinal bleeding. During her bowel preparation she passed 25 cm long white tapeworm material confirmed microscopically. Despite passing a worm she continued to have abdominal pain. During the colonoscopy, another worm was found logged in the appendiceal orifice. The colonoscopic images revealed a segmented tapeworm showing contractile motility, approximately 12 cm in length, 6 mm wide in the appendiceal orifice. The scope was unsuccessfully in removing the worm. The parasitological and microbiological examination of the passed worm was positive for D. latum. D. latum a fish tapeworm that infects humans after the ingestion of raw or undercooked fish. The patient had a history of often eating lightly marinated raw fish “ceviche” in Peru several months before presentation. It is uncommon for D. latum infection to present with iron-deficiency anemia. As the worm absorbs approximately 80 percent of dietary vitamin B12, prolonged D. latum infection usually causes vitamin B12 deficiency and megaloblastic anemia, which is reported to affect about 40 percent of cases. Abdominal pain related to mechanical obstruction is reported but this case is unique in that the worm preferentially attached to the appendiceal lumen causing focal subacute appendicitis pain. She was treated with a single dose of oral praziquantel. After the treatment, she developed minor cramping for the next two days which resolved by day three and recalled passing half-inch sized pieces of white tissue and subsequently improved. Although D. latum infection is an uncommon cause of chronic abdominal pain with iron deficiency anemia, it is crucial to consider because of the potentially treatable outcome.Figure: A segmented tapeworm showing contractile motility in the appendiceal orifice.Figure: A segmented tapeworm.

Clinical Report: Schistosomiasis Exposure in U.S. Service Personnel During Whitewater Rafting on the Nile River in Jinja, Uganda.

Schistosomiasis is a known risk after exposure to freshwater in tropical parts of the world. In March 2014, 28 off-duty U.S. service members went on a water adventure in the Nile River in Jinja, Uganda. In April 2014, 10 of the 28 service members returned for a second water adventure. Twelve weeks after freshwater exposure, schistosomiasis enzyme-linked immunosorbent assay testing was performed. Twenty-five percent had elevated Schistosomiasis mansoni immunoglobulin G (7 positive of 28 exposed); all had negative pre-exposure serology. The serology-positive service members were treated with oral praziquantel 60 mg/kg in divided doses. Our report is the first schistosomiasis report among U.S. service members deployed to Africa since World War II. The absence of reports among U.S. service members and several reports among deployed foreign military units and tourists in sub-Saharan Africa suggest a lack of postexposure testing. We recommend schistosomiasis testing of prior and future U.S. military units deployed to sub-Saharan Africa with fresh water exposure. Unit commanders and medical personnel should discourage unnecessary fresh water contact in sub-Saharan Africa.

Wharton's jelly-derived mesenchymal stem cells combined with praziquantel as a potential therapy for Schistosoma mansoni-induced liver fibrosis.

Liver fibrosis is one of the most serious consequences of S. mansoni infection. The aim of the present study was to investigate the potential anti-fibrotic effect of human Wharton’s jelly-derived mesenchymal stem cells (WJMSCs) combined with praziquantel (PZQ) in S. mansoni-infected mice. S. mansoni-infected mice received early (8th week post infection) and late (16th week post infection) treatment with WJMSCs, alone and combined with oral PZQ. At the 10th month post infection, livers were collected for subsequent flow cytometric, histopathological, morphometric, immunohistochemical, gene expression, and gelatin zymographic studies. After transplantation, WJMSCs differentiated into functioning liver-like cells as evidenced by their ability to express human hepatocyte-specific markers. Regression of S. mansoni-induced liver fibrosis was also observed in transplanted groups, as evidenced by histopathological, morphometric, and gelatin zymographic results besides decreased expression of three essential contributors to liver fibrosis in this particular model; alpha smooth muscle actin, collagen-I, and interleukin-13. PZQ additionally enhanced the beneficial effects observed in WJMSCs-treated groups. Our results suggest that combining WJMSCs to PZQ caused better enhancement in S. mansoni-induced liver fibrosis, compared to using each alone.

Cerebral Sparganosis in Children: Epidemiologic and Radiologic Characteristics and Treatment Outcomes: A Report of 9 Cases

Pediatric cerebral sparganosis has been seldom reported. In the current study, we retrospectively reviewed the clinicopathologic records of 9 consecutive pediatric cases of cerebral sparganosis and analyzed their epidemiologic characteristics and clinical outcomes. Our cases included 6 boys and 3 girls, all from rural areas, and their median age at diagnosis was 9.4 (range, 5.8-12.9) years. The median duration of symptoms from onset to definite diagnosis was 21 months (range, 1 week to 3.7 years). Enzyme-linked immunosorbent assay revealed that serum anti-sparganosis antibody was positive in 9 of 9 patients and cerebrospinal fluid anti-sparganosis antibody was positive in 4 of 6 patients. Eight patients underwent craniotomy the removal of worms. The patients also received oral praziquantel. They were followed up for 2.2 years to 4.4 years. One patient died, and 8 patients survived. Three cases had poor outcomes whereas the outcome of the remaining 5 cases was satisfactory. Children are more at risk for sparganosis and cerebral sparganosis may be missed because of unclear epidemiologic history and nonspecific manifestations. Cerebrospinal fluid eosinophil counts and enzyme-linked immunosorbent assay for anti-sparganosis antibody and computed tomography/magnetic resonance imaging scans may be relied on for an early and accurate diagnosis before surgery.

Clinical Features of Pulmonary Sparganosis

Sparganosis is an infectious disease caused by the sparganum of Spirometra species, which seldom invades the respiratory system. The aim was to describe the clinical features and outcomes of pulmonary sparganosis. A total of 40 patients with pulmonary sparganosis were reviewed, including 12 cases known from this experience and 28 cases reported in the literature. Among these 40 patients at an average age of 45.4 ± 11.1 years (men 29), 34 (85%) had a history of ingesting raw or undercooked meat (mainly frogs or snakes). The top 3 symptoms were coughing (60.0%), fever (57.5%) and chest pain (42.5%). Peripheral blood eosinophilia was found in 30 cases (75%). Lesions were located in lung parenchyma, airway, pleura and pulmonary vessels of the patients. Thirty-one patients (77.5%) had pleural effusion. The diagnosis was established by antisparganum antibody test in 30 cases (75%) and by pathology in 9 cases (22.5%); 1 case was not mentioned. Among the 35 cases with follow-up information, 2 treated with complete surgical removal and 31 with oral administration of praziquantel had no recurrence; the remaining 2 died without effective treatments. As an extremely rare and life-threatening parasitic zoonosis, pulmonary sparganosis should be diagnosed by combining the epidemiology, patient history, eosinophilia and the positive antisparganum antibody test result together if no worm was detected. Oral praziquantel is considered to be an effective treatment.

Efficacy of praziquantel in the treatment of Schistosoma haematobium infection among school-age children in rural communities of Abeokuta, Nigeria.

BackgroundChemotherapy with praziquantel (PZQ) has been the cornerstone of schistosomiasis control over the last two decades. Being the only available drug for the treatment of over 200 million people worldwide, continuous monitoring of PZQ efficacy under the pressure of widespread use is therefore advocated.MethodsThe efficacy of taking two doses of oral PZQ for the treatment of Schistosoma haematobium was examined among school children in Nigeria. Urine specimens were collected from 350 school children and examined using the filtration technique. Blood was collected for packed cell volume (PCV) estimation, and the weight and height of each child were estimated. S. haematobium egg positive pupils were treated with two oral doses of PZQ at 40 mg/kg with a four-week interval in between. Drug efficacy was determined based on the egg reduction rate (ERR).ResultsAmong 350 school children, 245 (70.0%) – of which 132 were males and 113 were females, with an age range of 4 to 15 years – were diagnosed with S. haematobium. All the 245 infected children received a single oral dose of 40 mg/kg PZQ twice with a four-week interval in between and were followed up for 12 weeks. At four, eight and twelve weeks post treatment, the ERR was 57.1%, 77.6% and 100%, respectively. The ERR was significantly higher among the children with a light infection compared to those with a heavy infection. One hundred and twenty-one children were egg negative at four weeks post treatment, among which 1 (6.3) and 120 (52.4%) had heavy and light infections, respectively. Following the second round of treatment, the cure rate at eight weeks and twelve weeks was 85.3% and 100%, respectively.ConclusionThis study demonstrated the efficacy of taking two doses of oral PZQ for the treatment of urinary schistosomiasis among school children in Nigeria.