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Lovis L, Mak TK, Phongluxa K, Ayé Soukhathammavong P, Vonghachack Y, Keiser J, Vounatsou P, Tanner M, Hatz C, Utzinger J, Odermatt P, Akkhavong K. Efficacy of praziquantel against Schistosoma mekongi and Opisthorchis viverrini: a randomized, single-blinded dose-comparison trial. PLoS Negl Trop Dis 2012; 6:e1726. [PMID: 22848766 PMCID: PMC3404075 DOI: 10.1371/journal.pntd.0001726] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 05/25/2012] [Indexed: 11/25/2022] Open
Abstract
Background Schistosomiasis and opisthorchiasis are of public health importance in Southeast Asia. Praziquantel (PZQ) is the drug of choice for morbidity control but few dose comparisons have been made. Methodology Ninety-three schoolchildren were enrolled in an area of Lao PDR where Schistosoma mekongi and Opisthorchis viverrini coexist for a PZQ dose-comparison trial. Prevalence and intensity of infections were determined by a rigorous diagnostic effort (3 stool specimens, each examined with triplicate Kato-Katz) before and 28–30 days after treatment. Ninety children with full baseline data were randomized to receive PZQ: the 40 mg/kg standard single dose (n = 45) or a 75 mg/kg total dose (50 mg/kg+25 mg/kg, 4 hours apart; n = 45). Adverse events were assessed at 3 and 24 hours posttreatment. Principal Findings Baseline infection prevalence of S. mekongi and O. viverrini were 87.8% and 98.9%, respectively. S. mekongi cure rates were 75.0% (95% confidence interval (CI): 56.6–88.5%) and 80.8% (95% CI: 60.6–93.4%) for 40 mg/kg and 75 mg/kg PZQ, respectively (P = 0.60). O. viverrini cure rates were significantly different at 71.4% (95% CI: 53.4–84.4%) and 96.6% (95% CI: not defined), respectively (P = 0.009). Egg reduction rates (ERRs) against O. viverrini were very high for both doses (>99%), but slightly lower for S. mekongi at 40 mg/kg (96.4% vs. 98.1%) and not influenced by increasing diagnostic effort. O. viverrini cure rates would have been overestimated and no statistical difference between doses found if efficacy was based on a minimum sampling effort (single Kato-Katz before and after treatment). Adverse events were common (96%), mainly mild with no significant differences between the two treatment groups. Conclusions/Significance Cure rate from the 75 mg/kg PZQ dose was more efficacious than 40 mg/kg against O. viverrini but not against S. mekongi infections, while ERRs were similar for both doses. Trial Registration Controlled-Trials.com ISRCTN57714676 Parasitic worm infections are of public health importance in Southeast Asia. Particularly, the blood-dwelling Schistosoma mekongi worm, which is acquired by skin contact with the infectious cercariae in freshwater, can lead to liver enlargement. An infection with Opisthorchis viverrini is obtained by consumption of undercooked freshwater fish, and this infection increases the risk of developing cholangiocarcinoma. A single oral dose of 40 mg/kg praziquantel is recommended for mass treatment of schistosomiasis and opisthorchiasis, while at the individual level, a total dose of 75 mg/kg divided into three doses, is currently common practice to treat O. viverrini infection. Diagnosis is based on stool examination under a microscope for detection of worm eggs, but is limited by the low sensitivity of the widely used Kato-Katz technique. In this study, we showed that a 75 mg/kg total dose of praziquantel (50 mg/kg+25 mg/kg given 4 hours apart) cleared significantly more O. viverrini infections than a single 40 mg/kg dose, but no difference was observed for S. mekongi. Solicited adverse event profiles were mainly mild and similar in both groups. Repeated stool examination before and after treatment was essential for an accurate assessment of drug efficacy in terms of cure rate, but showed no effect on assessing egg reduction rates.
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Affiliation(s)
- Leonore Lovis
- Laboratory of Parasitology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Tippi K. Mak
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Khampheng Phongluxa
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- National Institute of Public Health, Vientiane, Lao People’s Democratic Republic
| | - Phonepasong Ayé Soukhathammavong
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- National Institute of Public Health, Vientiane, Lao People’s Democratic Republic
| | - Youthanavanh Vonghachack
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Parasitology Unit, Faculty of Basic Sciences, University of Health Sciences, Vientiane, Lao People’s Democratic Republic
| | - Jennifer Keiser
- University of Basel, Basel, Switzerland
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Penelope Vounatsou
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Marcel Tanner
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christoph Hatz
- University of Basel, Basel, Switzerland
- Department of Medical Services and Diagnostic, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Peter Odermatt
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Kongsap Akkhavong
- National Institute of Public Health, Vientiane, Lao People’s Democratic Republic
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Houston S, Kowalewska-Grochowska K, Naik S, McKean J, Johnson ES, Warren K. First Report ofSchistosoma mekongiInfection with Brain Involvement. Clin Infect Dis 2004; 38:e1-6. [PMID: 14679467 DOI: 10.1086/379826] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2003] [Accepted: 08/18/2003] [Indexed: 11/03/2022] Open
Abstract
We describe, to our knowledge, the first reported case of Schistosoma mekongi infection with brain involvement. S. mekongi is a distinct species most closely related to Schistosoma japonicum that is endemic in a defined area of the Mekong River in Laos and Cambodia and characteristically associated with hepatosplenic disease. The patient had an excellent response to praziquantel therapy but required repeated courses of corticosteroid therapy to suppress recrudescent neurological symptoms.
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Affiliation(s)
- Stan Houston
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Basset D, Hennequin C, Mainguene C, Chauvenet L, Lagrange P. Atteinte Hepatique Mixte A Opistorchis Viverrini Et Schistosoma Mekongi Asymptomatique Depuis Plus De 12 Ans Chez Un Laotien. Med Mal Infect 1990. [DOI: 10.1016/s0399-077x(05)81167-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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