Adverse effects of praziquantel treatment of Schistosoma japonicum infection: involvement of host anaphylactic reactions induced by parasite antigen release

Development of acute pancreatitis after oral administering a praziquantel, pyrantel pamoate, and febantel combination in a dog: A case report

Oral praziquantel, pyrantel pamoate, and febantel combination (PPFC) is a highly safe anthelmintic treatment commonly administered for the purpose of canine gastrointestinal parasites with mild adverse effects such as anorexia, vomiting, lethargy, or diarrhea. A 12-year-old castrated Chihuahua was brought to our hospital for a periodic health examination. Although his general physical examination showed no abnormalities, blood test results showed increase in the liver enzyme, lipase activity, total bile acid, total cholesterol, and triglyceride concentration. Moreover, the dog had underlying tricuspid regurgitation that was not treated. PPFC was prescribed on the suspicion of gastrointestinal tract parasites. Following the oral administration of PPFC at home, anorexia and lethargy were found, and vomiting and diarrhea were noted after 30 h. The dog was diagnosed with acute pancreatitis based on clinical course of the disease and subsequent pathology results. Although intravenous drip was initiated upon hospitalization, the treatment was discontinued owing to financial reasons. The onset of acute pancreatitis can be considered an adverse effect of PPFC. Although the association between PPFC administration and the onset of acute pancreatitis could not be clarified in this case, the onset of acute pancreatitis may have been associated with a decrease in liver function and/or increase in the false activity of lipase. PPFC has been considered highly safe in dogs, although care should be taken when administering medications to dogs suspected of having an underlying disorder.

Anaphylactic reaction to praziquantel following schistosomiasis treatment

Praziquantel (PZQ) is a medication used to treat several parasitic infections, including human schistosomiasis. Although this drug commonly causes transient adverse effects, severe hypersensitivity is rare, and only eight cases have been reported worldwide. Herein we report a case of a 13-year-old Brazilian female who developed anaphylaxis, a severe hypersensitive reaction, after taking praziquantel to treat Schistosoma mansoni infection. During a mass drug administration event in a socially vulnerable endemic area of Bahia (Brazil), after taking 60 mg/kg of praziquantel the patient developed rash and generalized edema an hour later, evolving to somnolence and hypotension. Following the anaphylactic episode, she received adequate treatment and recovered approximately 1 day later. Although praziquantel is considered safe, health professionals should be aware of potential life-threatening adverse events.

Investigations on the interplays between Schistosoma mansoni, praziquantel and the gut microbiome

Background

Schistosomiasis is a neglected tropical disease burdening millions of people. One drug, praziquantel, is currently used for treatment and control. Clinically relevant drug resistance has not yet been described, but there is considerable heterogeneity in treatment outcomes, ranging from cure to only moderate egg reduction rates. The objectives of this study are to investigate potential worm-induced dysbacteriosis of the gut microbiota and to assess whether a specific microbiome profile could influence praziquantel response.

Methods

Using V3 and V4 regions of 16S rRNA genes, we screened the gut microbiota of 34 Schistosoma mansoni infected and uninfected children from Côte d’Ivoire. From each infected child one pre-treatment, one 24-hour and one 21-day follow-up sample after administering 60 mg/kg praziquantel or placebo, were collected.

Results

Overall taxonomic profiling and diversity indicators were found to be close to a “healthy” gut structure in all children. Slight overall compositional changes were observed between S. mansoni-infected and non-infected children. Praziquantel treatment was not linked to a major shift in the gut taxonomic profiles, thus reinforcing the good safety profile of the drug by ruling out off-targets effects on the gut microbes.16S rRNA gene of the Fusobacteriales order was significantly more abundant in cured individuals, both at baseline and 24 hours post-treatment. A real-time qPCR confirmed the over-abundance of Fusobacterium spp. in cured children. Fusobacterium spp. abundance could also be correlated with treatment induced S. mansoni egg-reduction.

Conclusions

Our study suggests that neither a S. mansoni infection nor praziquantel administration triggers a significant effect on the microbial composition and that a higher abundance of Fusobacterium spp., before treatment, is associated with higher efficacy of praziquantel in the treatment of S. mansoni infections.

Trial registration

International Standard Randomised Controlled Trial, number ISRCTN15280205.

Electronic supplementary material

The online version of this article (10.1186/s13071-018-2739-2) contains supplementary material, which is available to authorized users.

Albendazole and Praziquantel: Review and Safety Monitoring in Korea

Albendazole (ADZ) and praziquantel (PZQT) have been used as anthelmintics for over 30 years. Worldwide, hundreds of millions tablets are administered to people and livestock every year. ADZ is poorly orally absorbed (<5%), and its uptake is enhanced by high-fat meals, while PZQT is well absorbed (>75%) and uptake is enhanced by carbohydrate-rich meals. Both ADZ and PZQT are safe, but not recommended for children <2 years or for women in the first trimester of pregnancy. Serious adverse events occur following high dose and prolonged administration of these drugs for treatment of echinococcosis or neurocysticercosis, especially in patients with poor liver function. The adverse events may be induced by the drugs, or by the dead worms themselves. The Korea Institute of Drug Safety & Risk Management monitors drug-related adverse events in Korea, and its database included 256 probable or possible ADZ-associated events and 108 PZQT-associated events between 2006 and 2015. Such low incidence rates in Korea are due to the low single dose treatments of ADZ, and the short-term use of PZQT. The number of serious adverse events due to drug interaction induced by ADZ and PZQT were six and two, respectively. We conclude that ADZ and PZQT are generally safe drugs, but they must be used with caution in people with poor liver function or those being comedicated for gastroesophageal reflux disease.

Comparative analysis of knowledge on schistosomiasis japonica in the local people in the former endemic area in Yamanashi Prefecture, Japan: comparisons among the background of age and occupation

Eradication of schistosomiasis japonica in Yamanashi Prefecture was officially declared in 1996, and all surveillance and health campaign were finished by the end of 2001. Schistosomiasis control had been carried out by strong collaboration among local Government, local people and academia, thought which knowledge and experiences of the disease control were accumulated among the local people. It is 20^th anniversary of the disease eradication in Yamanashi. We planned to analyze the current situation whether the local people still keep the knowledge of schistosomiasis or not. There was no more knowledge kept in the middle school students, to whom the local Government did not educate about schistosomiasis. Among adult individuals, elderly people who have experienced endemic condition still know about it at almost comparable level as in the past. However, younger people who learned it in the primary school but no experience of the disease transmission started losing the knowledge. Those situations of the adult local people were compared with the veterinarian group. It was confirmed that the veterinarian group had correct and proper knowledge of schistosomiasis japonica not only in elderly groups, but also in younger age group. Considering that methods for control and prevention of infectious diseases are common to some extent, their knowledge and experiences would be applicable for other infectious diseases in future. Therefore, the knowledge would be worth keeping in the local people. Taken together, individuals with specialty, such as veterinarians, are expected to play roles in public health for promotion of health and welfare.

Real-time PCR demonstrates high prevalence of Schistosoma japonicum in the Philippines: implications for surveillance and control

Background

The Philippines has a population of approximately 103 million people, of which 6.7 million live in schistosomiasis-endemic areas with 1.8 million people being at risk of infection with Schistosoma japonicum. Although the country-wide prevalence of schistosomiasis japonica in the Philippines is relatively low, the prevalence of schistosomiasis can be high, approaching 65% in some endemic areas. Of the currently available microscopy-based diagnostic techniques for detecting schistosome infections in the Philippines and elsewhere, most exhibit varying diagnostic performances, with the Kato-Katz (KK) method having particularly poor sensitivity for detecting low intensity infections. This suggests that the actual prevalence of schistosomiasis japonica may be much higher than previous reports have indicated.

Methodology/Principal Findings

Six barangay (villages) were selected to determine the prevalence of S. japonicum in humans in the municipality of Palapag, Northern Samar. Fecal samples were collected from 560 humans and examined by the KK method and a validated real-time PCR (qPCR) assay. A high S. japonicum prevalence (90.2%) was revealed using qPCR whereas the KK method indicated a lower prevalence (22.9%). The geometric mean eggs per gram (GMEPG) determined by the qPCR was 36.5 and 11.5 by the KK. These results, particularly those obtained by the qPCR, indicate that the prevalence of schistosomiasis in this region of the Philippines is much higher than historically reported.

Conclusions/Significance

Despite being more expensive, qPCR can complement the KK procedure, particularly for surveillance and monitoring of areas where extensive schistosomiasis control has led to low prevalence and intensity infections and where schistosomiasis elimination is on the horizon, as for example in southern China.

Schistosomiasis is caused by infection with trematode blood flukes of the genus Schistosoma. Schistosoma japonicum is the causative agent of schistosomiasis in the Philippines, China and parts of Indonesia. In the Philippines, 6.7 million people live in endemic areas and 1.8 million are at risk of infection whereas concerted control efforts over the past 50 years in China have reduced the number of infected individuals considerably. Currently used microscopic techniques for diagnosis, notably the Kato-Katz (KK) technique, lack sensitivity in areas with low intensity schistosome infections. We have used a molecular diagnostic approach (qPCR), to assess the prevalence of S. japonicum in humans from six barangays in Northern Samar, the Philippines. The qPCR performed considerably better than the KK as a diagnostic procedure and could be an important tool in the future for surveillance and monitoring of areas where extensive schistosomiasis control has led to low prevalence and intensity infections and where schistosomiasis elimination is possible.

Hypersensitive reaction to praziquantel in a clonorchiasis patient

Praziquantel is the drug of choice for clonorchiasis. Since clonorchiasis is endemic in most river basins, praziquantel has been widely used for 30 years in Korea. A 54-year-old Korean woman suffered from hypersensitive reactions, such as nausea, dyspnea, rash, and urticaria after taking the first dose of praziquantel to treat clonorchiasis. She ingested one dose again and the same symptoms appeared, and she was treated at a clinic with anti-histamines. She tried one more dose with anti-histamines but found the same symptoms. Later, she was found to pass eggs of Clonorchis sinensis and medicated with flubendazole. The hypersensitive reaction to praziquantel is rare but occurs. This is the 5th case report in the world.

A paragonimiasis patient with allergic reaction to praziquantel and resistance to triclabendazole: successful treatment after desensitization to praziquantel

Paragonimiasis is an infectious disease caused by trematodes of the genus Paragonimus. This trematode can be treated successfully with praziquantel in more than 90% of the cases. Although praziquantel is generally well tolerated, anaphylactic reactions to this drug have been reported in a few cases. We report here a 46-year-old Korean female with paragonimiasis, presumed to be due to Paragonimus westermani, who displayed an allergic reaction to praziquantel and resistance to triclabendazole treatment. The patient was successfully treated with praziquantel following a rapid desensitization procedure. Desensitization to praziquantel could be considered when no alternative drugs are available.

On the Rearrangement in Dioxane/Water of (Z)-Arylhydrazones of 5-Amino-3-benzoyl-1,2,4-oxadiazole into (2-Aryl-5-phenyl-2H-1,2,3-triazol-4-yl)ureas: Substituent Effects on the Different Reaction Pathways

We have recently evidenced an interesting differential behavior in the reactivity in dioxane/water between the (Z)-2,4-dinitrophenylhydrazone (1a) and the (Z)-phenylhydrazone (1b) of 5-amino-3-benzoyl-1,2,4-oxadiazole. The former rearranges into the relevant triazole 2a only at pS+ > 4.5 while undergoing hydrolysis at high proton concentration (pS+ < 3.5); on the contrary, the latter rearranges into 2b in the whole pS+ range examined (0.1 < or = pS+ < or = 14.9). Thus, for a deeper understanding of these differences we have now collected kinetic data on the rearrangement in dioxane/water of a series of 3- or 4-substituted (Z)-phenylhydrazones (1c-l) of 5-amino-3-benzoyl-1,2,4-oxadiazole in a wide range of proton concentrations (pS+ 0.1-12.3) with the aim of gaining information about the effect of the substituent on the course of the reaction. All of the (Z)-arylhydrazones studied rearrange via three different reaction routes (specific-acid-catalyzed, uncatalyzed, and general-base-catalyzed), and the relevant results have been examined by means of free energy relationships.

Schistosomiasis--an unusual cause of ureteral obstruction: a case history and perspective

A male, 32 years of age, presented with dysuria and abdominal pain, but no gross hematuria. He emigrated three years earlier from Somalia, East Africa, and was currently employed as a poultry processor in a rural Wisconsin community. The patient denied any trauma, sexual activity, or family history of significant illness. Abdominal and genitourinary exams were normal with negative tests for gonococcus and chlamydia. Urinalysis demonstrated microhematuria. A urogram and retrograde pyelogram revealed a mildly dilated right ureter down to the ureterovesical junction. Cystoscopy showed punctate white lesions on the bladder urothelium. Ureteroscopy was used to biopsy abnormal tissue in the distal ureter and bladder. Biopsy tissue demonstrated deposits of Schistosoma haematobium eggs. No ova were seen in collected urine specimens. The patient was successfully treated with praziquantel and will be monitored for sequelae of the disease. Schistosomiasis (Bilharziasis) can be expected to be seen with increasing frequency in the United States with the continuing influx of immigrants and refugees, as well as the return of travelers and soldiers from endemic areas. While no intermediate snail host exists for the transmission of Schistosoma sp. in the United States, the continued importation of exotic animals including snails from Africa, as well as the ability of schistosomes to shift host species warrants concern. Additionally, increasing disease associated with non-human bird schistosomes of the same genus seen in the midwestern United States is occurring throughout Europe. One should be aware that praziquantel may not always be available or effective in the treatment of schistosomiasis. It behooves the practicing clinician to remain updated on the status of this widespread zoonosis.