RESUMO
BACKGROUND: The successive reports of Platynosomum illiciens in Neotropical captive primates have increased interest in platynosomosis; however, its treatment is little known. METHODS: Callithrix penicillata (n = 10) naturally and chronically infected with P. illiciens were treated with praziquantel (25 mg/kg BW, three s.c. doses at 24 hours intervals), and coproparasitological tests performed over 67 days. The proportions of primates with a reduction in fecal egg counts (FEC) or negative results progressively increased after treatment, and at the last fecal tests, marmosets were negative. RESULTS AND CONCLUSIONS: Although all primates tolerated the initial days of study well, 40% (4/10) of them died between the 8th and 16th days after the onset of treatment. Clinical signs and necropsies indicated the occurrence of hepatic involvement, biliary obstruction, and cholangitis. Marmosets with a higher previous FEC were more likely to die after treatment. Use of praziquantel should be considered carefully on a case-by-case basis.
Assuntos
Antiplatelmínticos/efeitos adversos , Callithrix , Dicrocoeliidae/efeitos dos fármacos , Doenças dos Macacos/tratamento farmacológico , Praziquantel/efeitos adversos , Infecções por Trematódeos/veterinária , Animais , Animais de Zoológico , Brasil , Feminino , Masculino , Doenças dos Macacos/parasitologia , Infecções por Trematódeos/tratamento farmacológico , Infecções por Trematódeos/parasitologiaRESUMO
INTRODUCTION AND AIM: The carcinogenesis of tubular and papillary cholangiocarcinoma (CCA) differ. The available epidemiologic studies about risk factors for CCA do not differentiate between the tubular and papillary type. The current study investigated the relationship between the number of repeated use of Praziquantel (PZQ) treatments and each type of CCA. MATERIAL AND METHODS: This was a hospital-based, matched, case-control study of patients admitted to Srinagarind Hospital, Khon Kaen University. The patients were 210 pathologically-confirmed cases of CCA, while the controls were 840 subjects diagnosed with other diseases. The 4 controls were individually matched with each case by sex, age, and date of admission. The cases were classified according to location (intrahepatic vs. extrahepatic) and cell type (papillary vs. tubular). Multivariable conditional logistic regression was used for the analysis. RESULTS: After adjusting for confounders, there were statistically significant associations between intrahepatic and papillary CCA and repeated use of PZQ treatment. The respective odds of developing intrahepatic CCA for those who used PZQ once, twice, or more was 1.54 (95%CI:0.92-2.55 ), 2.28 (95%CI:0.91-5.73), and 4.21 (95%CI:1.61-11.05). The respective odds of developing papillary CCA for those who used PZQ once, twice, or more was 1.45 (95%CI:0.80-2.63), 2.96 (95%CI:1.06-8.24), and 3.24 (95%CI:1.09-9.66). There was no association between number of uses of PZQ treatment and developing extrahepatic or tubular CCA. CONCLUSION: The current study found an association between papillary and intrahepatic CCA and repeated use of PZQ treatment. We suggest further study on the risk factors for papillary and tubular CCA should be performed separately.
Assuntos
Anti-Helmínticos/efeitos adversos , Neoplasias dos Ductos Biliares/induzido quimicamente , Carcinoma Papilar/induzido quimicamente , Colangiocarcinoma/induzido quimicamente , Praziquantel/efeitos adversos , Anti-Helmínticos/administração & dosagem , Neoplasias dos Ductos Biliares/epidemiologia , Neoplasias dos Ductos Biliares/patologia , Biópsia , Carcinoma Papilar/epidemiologia , Carcinoma Papilar/patologia , Estudos de Casos e Controles , Colangiocarcinoma/epidemiologia , Colangiocarcinoma/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Praziquantel/administração & dosagem , Medição de Risco , Fatores de Risco , Tailândia/epidemiologiaRESUMO
BACKGROUND: Giardia parasites cause gastrointestinal disease in humans, dogs, and many other animals worldwide. The treatment of dogs for giardiasis requires further investigation to ascertain levels of drug efficacy and the possibility of adverse side effects. Nitazoxanide (NTZ) has shown good clinical anti-Giardia activity in humans, yet it has not been evaluated for the treatment of giardiasis in dogs. METHODS: Thirty-five dogs, naturally infected with Giardia were divided into five groups (n = 7): dogs in group NTZ1, NTZ2, and NTZ3 were treated with a single oral dose of 37.5 mg/kg, 75 mg/kg, and 150 mg/kg, respectively, of NTZ on days 0 and 14. The fourth group was treated with a commercially available regimen that includes a combination of pyrantel, praziquantel, and febantel (FEB) administered orally for three consecutive days. Additionally, an untreated control group was established. Giardia cysts from the stool of each dog were quantified on days -3, 0, 5, 7, 9, 11, 14, 18, 25, and 28. Biochemical parameters were evaluated in all dogs, before the first treatment and after concluding the experiment. RESULTS: Shedding of Giardia cysts was reduced in all treated groups when compared to untreated controls (P < 0.01). However, NTZ2, NTZ3, and FEB had a lower risk during the study. Furthermore, NTZ was also effective against another protozoan, Cryptosporidium spp. at doses of 75 mg/kg and 150 mg/kg, in contrast to the combination of febantel + pyrantel + praziquantel. Biochemical parameters of treated animals, namely, aspartate transaminase and alanine transaminase enzymes, remained within physiological ranges. CONCLUSIONS: Based on these results, the implementation of NTZ as a treatment for giardiasis in dogs is proposed. The administration of a single dose is an important advantage of NTZ because it reduces workload, particularly in animals placed in shelters and kennels, where handling of large numbers of animals is required, and personnel is frequently scarce.
Assuntos
Antiprotozoários/uso terapêutico , Doenças do Cão/tratamento farmacológico , Giardíase/veterinária , Tiazóis/efeitos adversos , Tiazóis/uso terapêutico , Administração Oral , Alanina Transaminase/sangue , Animais , Antiprotozoários/administração & dosagem , Antiprotozoários/efeitos adversos , Aspartato Aminotransferases/sangue , Criptosporidiose/tratamento farmacológico , Cryptosporidium/efeitos dos fármacos , Doenças do Cão/parasitologia , Cães , Fezes/parasitologia , Giardia/efeitos dos fármacos , Giardia/isolamento & purificação , Giardia/fisiologia , Giardíase/tratamento farmacológico , Giardíase/parasitologia , Guanidinas/administração & dosagem , Guanidinas/efeitos adversos , Guanidinas/uso terapêutico , Humanos , Nitrocompostos , Praziquantel/administração & dosagem , Praziquantel/efeitos adversos , Praziquantel/uso terapêutico , Pamoato de Pirantel/administração & dosagem , Pamoato de Pirantel/efeitos adversos , Pamoato de Pirantel/uso terapêutico , Tiazóis/administração & dosagemRESUMO
BACKGROUND: Scleroderma is a rare chronic disease of connective tissues that may affect the skin in humans. Although still unclear, its aetiology may be related to drug reactions. To date, scleroderma has been reported in only a few dogs and one cat. CASE REPORT: Localized (morphea-like) scleroderma was diagnosed in a 3-year-old intact male Persian cat that developed a nonpruritic, well-demarcated alopecic plaque a few days after topical application of a 'spot-on' solution containing praziquantel and emodepside. The lesion occurred at the site of application at the dorsal cervical region, and was characterized histologically by fibrosing dermatitis. There was no response to systemic treatment with pentoxifylline. Following topical therapy with minoxidil 5% for 30 days, hair regrowth occurred, and the lesion had completely disappeared after 60 days. CONCLUSIONS AND CLINICAL IMPORTANCE: The relationship between the alopecic plaque and the topical application of the spot-on solution cannot be proved; however, according to the Naranjo scale, which estimates the probability of adverse drug reactions, this case could be classified as a 'possible' reaction to one of the components of the product. Sclerodermoid reactions have not been described as a cutaneous drug eruption in veterinary medicine, so this case may possibly represent the first such idiosyncratic reaction to one of the applied substances. Furthermore, to the best of the authors' knowledge, this is the second report of a morphea-like lesion in a cat.
Assuntos
Anti-Helmínticos/efeitos adversos , Doenças do Gato/induzido quimicamente , Depsipeptídeos/efeitos adversos , Praziquantel/efeitos adversos , Esclerodermia Localizada/veterinária , Administração Tópica , Animais , Anti-Helmínticos/administração & dosagem , Gatos , Depsipeptídeos/administração & dosagem , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/veterinária , Masculino , Praziquantel/administração & dosagem , Esclerodermia Localizada/induzido quimicamente , Esclerodermia Localizada/patologia , Pele/efeitos dos fármacos , Pele/patologiaRESUMO
INTRODUCTION: Neurocysticercosis (NCC) is considered to be the most common cause of acquired epilepsy worldwide. Formerly restricted to palliative measures, therapy for NCC has advanced with the advent of two drugs that are considered to be effective: praziquantel (PZQ) and albendazole (ALB). AREAS COVERED: All available articles regarding research related to the treatment of NCC were searched. Relevant articles were then reviewed and used as sources of information for this review. EXPERT OPINION: Anticysticercal therapy has been marked by intense controversy. Recent descriptions of spontaneous resolution of parenchymal cysticercosis with benign evolution, risks of complications and reports of no long-term benefits have reinforced the debate over the usefulness and safety of anticysticercal therapy. High interindividual variability and complex pharmacological interactions will require the close monitoring of plasma concentrations of ALB and PZQ metabolites in future trials. Given the relative scarcity of clinical trials, more comparative interventional studies - especially randomized controlled trials in long-term clinical evolution - are required to clarify the controversy over the validity of parasitic therapy in patients with NCC.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Encefalopatias/tratamento farmacológico , Neurocisticercose/tratamento farmacológico , Praziquantel/uso terapêutico , Albendazol/administração & dosagem , Albendazol/efeitos adversos , Albendazol/sangue , Animais , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/efeitos adversos , Anti-Helmínticos/sangue , Encefalopatias/complicações , Encefalopatias/parasitologia , Encefalopatias/cirurgia , Humanos , Estágios do Ciclo de Vida/efeitos dos fármacos , Imageamento por Ressonância Magnética , Neurocisticercose/complicações , Neurocisticercose/parasitologia , Neurocisticercose/cirurgia , Praziquantel/administração & dosagem , Praziquantel/efeitos adversos , Praziquantel/sangue , Convulsões/etiologia , Convulsões/prevenção & controle , Taenia solium/efeitos dos fármacos , Taenia solium/fisiologiaRESUMO
BACKGROUND: Praziquantel at 40 mg/kg in a single dose is the WHO recommended treatment for all forms of schistosomiasis, but 60 mg/kg is also deployed nationally. METHODOLOGY/PRINCIPAL FINDINGS: Four trial sites in the Philippines, Mauritania, Tanzania and Brazil enrolled 856 patients using a common protocol, who were randomised to receive praziquantel 40 mg/kg (nâ =â 428) or 60 mg/kg (nâ =â 428). While the sites differed for transmission and infection intensities (highest in Tanzania and lowest in Mauritania), no bias or heterogeneity across sites was detected for the main efficacy outcomes. The primary efficacy analysis was the comparison of cure rates on Day 21 in the intent-to-treat population for the pooled data using a logistic model to calculate Odd Ratios allowing for baseline characteristics and study site. Both doses were highly effective: the Day 21 cure rates were 91.7% (86.6%-98% at individual sites) with 40 mg/kg and 92.8% (88%-97%) with 60 mg/kg. Secondary parameters were eggs reduction rates (ERR), change in intensity of infection and reinfection rates at 6 and 12 months. On Day 21 the pooled estimate of the ERR was 91% in both arms. The Hazard Ratio for reinfections was only significant in Brazil, and in favour of 60 mg/kg on the pooled estimate (40 mg/kg: 34.3%, 60 mg/kg: 23.9%, HR â=â 0.78, 95% CIâ =â[0.63;0.96]). Analysis of safety could not distinguish between disease- and drug-related events. 666 patients (78%) reported 1327 adverse events (AE) 4 h post-dosing. The risk of having at least one AE was higher in the 60 than in the 40 mg/kg group (83% vs. 73%, p<0.001). At 24 h post-dosing, 456 patients (54%) had 918 AEs with no difference between arms. The most frequent AE was abdominal pain at both 4 h and 24 h (40% and 24%). CONCLUSION: A higher dose of 60 mg/kg of praziquantel offers no significant efficacy advantage over standard 40 mg/kg for treating intestinal schistosomiasis caused by either S. mansoni or S. japonicum. The results of this study support WHO recommendation and should be used to inform policy decisions in the countries.
Assuntos
Anti-Helmínticos/administração & dosagem , Praziquantel/administração & dosagem , Esquistossomose mansoni/tratamento farmacológico , Dor Abdominal/induzido quimicamente , Adolescente , Anti-Helmínticos/efeitos adversos , Brasil , Criança , Feminino , Humanos , Incidência , Masculino , Mauritânia , Contagem de Ovos de Parasitas , Filipinas , Praziquantel/efeitos adversos , Prevenção Secundária , Tanzânia , Resultado do Tratamento , Adulto JovemRESUMO
The efficacy of oral praziquantel in the treatment of schistosomiasis has been considered low by most public health institutions. In this paper, we compared the efficacy of two dosages of praziquantel (80 mg/kg vs. 50 mg/kg) in patients with chronic schistosomiasis mansoni. Two hundred eighty-eight patients with schistosomiasis from a community in Brazil were randomly divided into two groups: 145 patients (Group 1) received 80 mg/kg body weight of oral praziquantel divided in two equal doses with 1 h interval and 143 patients (Group 2) received 50 mg/kg body weight of oral praziquantel. To keep the study masked, patients in Group 2 received placebo 1 h after the first dose. All patients were subjected to clinical and ultrasonographic examination. Cure assessment was performed by repeating two stool examinations, by a quantitative method, at 30, 90 and 180 days after treatment. The morbidity of schistosomiasis was low, with a few cases of light periportal thickening and 16 cases of mild splenomegaly. The cure rates were 89.7% for Group 1 and 83.9% for Group 2. There was no difference in the efficacy of both therapeutic dosages of praziquantel assayed. The adverse reactions were more frequent with higher dosage.
Assuntos
Praziquantel/administração & dosagem , Esquistossomose mansoni/tratamento farmacológico , Esquistossomicidas/administração & dosagem , Administração Oral , Adulto , Doença Crônica , Relação Dose-Resposta a Droga , Fezes/parasitologia , Feminino , Humanos , Masculino , Contagem de Ovos de Parasitas , Praziquantel/efeitos adversos , Esquistossomicidas/efeitos adversos , Fatores de TempoRESUMO
The efficacy of oral praziquantel in the treatment of schistosomiasis has been considered low by most public health institutions. In this paper, we compared the efficacy of two dosages of praziquantel (80 mg/kg vs. 50 mg/kg) in patients with chronic schistosomiasis mansoni. Two hundred eighty-eight patients with schistosomiasis from a community in Brazil were randomly divided into two groups: 145 patients (Group 1) received 80 mg/kg body weight of oral praziquantel divided in two equal doses with 1 h interval and 143 patients (Group 2) received 50 mg/kg body weight of oral praziquantel. To keep the study masked, patients in Group 2 received placebo 1 h after the first dose. All patients were subjected to clinical and ultrasonographic examination. Cure assessment was performed by repeating two stool examinations, by a quantitative method, at 30, 90 and 180 days after treatment. The morbidity of schistosomiasis was low, with a few cases of light periportal thickening and 16 cases of mild splenomegaly. The cure rates were 89.7 percent for Group 1 and 83.9 percent for Group 2. There was no difference in the efficacy of both therapeutic dosages of praziquantel assayed. The adverse reactions were more frequent with higher dosage.
Assuntos
Adulto , Feminino , Humanos , Masculino , Praziquantel , Esquistossomose mansoni , Esquistossomicidas , Administração Oral , Doença Crônica , Relação Dose-Resposta a Droga , Fezes , Contagem de Ovos de Parasitas , Praziquantel/efeitos adversos , Esquistossomicidas/efeitos adversos , Fatores de TempoRESUMO
BACKGROUND: Conflicting reports have caused controversy on whether cysticidal drugs modify the natural course of neurocysticercosis. PURPOSE: To perform a meta-analysis of randomized trials assessing the effect of cysticidal drugs on neuroimaging and clinical outcomes of patients with neurocysticercosis. DATA SOURCES: Search of MEDLINE, Cochrane Database of Systematic Reviews, and Literatura Latino-Americana y del Caribe en Ciencias de la Salud (LILACS) between 1979 and 2005. There were no language restrictions. STUDY SELECTION: Randomized trials of cysticidal drug therapy for neurocysticercosis that met predefined criteria designed to allow characterization of the disease and objective evaluation of therapy. The authors independently reviewed articles. Abstracted data included study design, number of randomly assigned patients and withdrawals, intervention, adverse events, timing of neuroimaging studies, and outcomes. DATA SYNTHESIS: Eleven studies met the inclusion criteria. Six trials randomly assigned 464 patients with cystic lesions (vesicular cysticerci), and 5 trials randomly assigned 478 patients with enhancing lesions (colloidal cysticerci). Parasites were located in the brain parenchyma or subarachnoid space at the convexity of the cerebral hemispheres. Cysticidal drug therapy was associated with complete resolution of cystic lesions (44% vs. 19%; P = 0.025). Trials on enhancing lesions showed a trend toward lesion resolution favoring the use of cysticidal drugs (72% vs. 63%; P = 0.38) that became statistically significant when an outlier trial was excluded from the analysis (69% vs. 55%; P = 0.006). Risk for seizure recurrence was lower after cysticidal treatment in patients with enhancing lesions (14% vs. 37%; P < 0.001). The single trial evaluating the frequency of seizures in patients with cystic lesions showed a 67% reduction in the rate of generalized seizures with treatment (P = 0.006). LIMITATIONS: Not all studies focused on the control of seizures as an outcome. CONCLUSIONS: Cysticidal drug therapy results in better resolution of colloidal and vesicular cysticerci, lower risk for recurrence of seizures in patients with colloidal cysticerci, and a reduction in the rate of generalized seizures in patients with vesicular cysticerci.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Neurocisticercose/tratamento farmacológico , Praziquantel/uso terapêutico , Albendazol/efeitos adversos , Anti-Helmínticos/efeitos adversos , Humanos , Neurocisticercose/complicações , Neurocisticercose/diagnóstico por imagem , Praziquantel/efeitos adversos , Radiografia , Prevenção Secundária , Convulsões/etiologia , Convulsões/prevenção & controle , Espaço Subaracnóideo/parasitologiaRESUMO
Therapy for neurocysticercosis has advanced during the last 20 years with the advent of albendazole (Zentel) and praziquantel (Cysticide). Albendazole is the current medication of choice for the treatment of neurocysticercosis and is recommended for symptomatic patients with multiple viable cysts in the brain parenchyma. Albendazole may also be useful in extraparenchymal cysticercosis, especially in the subarachnoid racemose form, when complete surgical resection of the cysts is usually impracticable. Currently, there is an intense debate over the value and safety of anticysticercal therapy. Causes for failure of anticysticercal therapy include high inter-individual variability in plasma concentration of albendazole sulfoxide and the complex interactions of several drugs with the albendazole metabolite. Furthermore, albendazole sulfoxide is an enantiomeric mixture of (+)- and (-)-albendazole sulfoxide with accumulation of the (+)-enantiomer in the cerebrospinal fluid. However, the question over which enantiomer is effective against cysticerci remains to be clarified.