Exudative polyserositis and acute respiratory failure following praziquantel therapy

Suspected adverse reactions to oral administration of a praziquantel-pyrantel combination in captive cheetahs (Acinonyx jubatus)

OBJECTIVE To characterize adverse reactions to oral administration of a combination of praziquantel and pyrantel embonate or pyrantel pamoate, with or without oxantel embonate, in captive cheetahs (Acinonyx jubatus). DESIGN Retrospective case series and case-control study. ANIMALS 16 captive cheetahs with signs of adverse reaction to oral administration of praziquantel and pyrantel, with or without oxantel embonate (affected group), and 27 cheetahs without such reactions (unaffected group), all from 3 independent facilities. PROCEDURES Medical records and postmortem findings for affected cheetahs were reviewed and compared with those of unaffected animals. Anthelmintic doses administered, age, and sex of cheetahs were compared between groups. RESULTS 3 reactions in affected cheetahs were fatal, whereas the remainder ranged from mild to severe. Postmortem examination failed to reveal any disease processes or conditions to explain the deaths. No differences in anthelmintic dose were identified between affected and unaffected cheetahs for all facilities combined, and no correlation existed between dose and reaction severity. No association with sex was detected, but affected cheetahs were significantly younger than unaffected cheetahs. This difference was not significant after controlling for facility. CONCLUSIONS AND CLINICAL RELEVANCE Cheetahs were concluded to have had an adverse reaction to the praziquantel-pyrantel combination because of temporal proximity of onset of clinical signs to dose administration, similarity of signs to those reported for toxicosis in other species for these drugs, and a lack of other disease process or environmental explanatory factors. A highly cautious approach to the use of this drug combination is recommended for cheetahs.

Pulmonary schistosomiasis

Schistosoma infection is one of the most common infectious diseases, limited in the past only to the endemic countries. With the enormous increase in migration and travel, we encounter more and more cases in developed, nonendemic countries. Although the disease has been known for many years from studies in the endemic countries, the new patient population of nonimmune travelers presents with a different clinical pattern that requires further investigation. One of the features of the disease in the nonendemic population is pulmonary involvement that seems to be much more common than previously suspected. The differences between the nonimmune population with the early pulmonary involvement and the population of endemic areas with late pulmonary involvement are summarized in Table 1. Clinicians in the Western countries have a higher chance of encountering the early (acute) form of the disease, although immigrants from endemic countries may present with late (chronic) schistosomiasis. In the differential diagnosis of pulmonary pathology, especially when accompanied by eosinophilia, schistosomal infection should be considered. The travel history of the patient is mandatory for an evaluation.