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d'Orchymont F, Hess J, Panic G, Jakubaszek M, Gemperle L, Keiser J, Gasser G. Synthesis, characterization and biological activity of organometallic derivatives of the antimalarial drug mefloquine as new antischistosomal drug candidates. MEDCHEMCOMM 2018; 9:1905-1909. [PMID: 30568758 PMCID: PMC6256353 DOI: 10.1039/c8md00396c] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022]
Abstract
We present the design, synthesis, characterization and biological evaluation of new ferrocenyl and ruthenocenyl derivatives of the organic antimalarial mefloquine, a drug also known for its antischistosomal activity. The two metallocenyl derivatives prepared (3 and 4) demonstrated comparable activity to mefloquine against adult-stage Schistosoma mansoni in vitro. Importantly, both compounds were found to have lower toxicity in all cell lines than mefloquine itself. Administration of a 200 mg kg-1 oral dose of 3 and 4 to S. mansoni-infected mice did not significantly reduce worm burden, contrary to mefloquine.
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Affiliation(s)
- Faustine d'Orchymont
- Department of Chemistry , University of Zurich , Winterthurerstrasse 190 , CH-8057 Zurich , Switzerland
| | - Jeannine Hess
- Department of Chemistry , University of Zurich , Winterthurerstrasse 190 , CH-8057 Zurich , Switzerland
| | - Gordana Panic
- Department of Medical Parasitology and Infection Biology , Swiss Tropical and Public Health Institute , CH-4051 , Basel , Switzerland .
- University of Basel , P.O. Box , CH-4003 Basel , Switzerland
| | - Marta Jakubaszek
- Laboratory for Inorganic Chemical Biology , Chimie ParisTech , PSL University , F-75005 Paris , France .
| | - Lea Gemperle
- Department of Chemistry , University of Zurich , Winterthurerstrasse 190 , CH-8057 Zurich , Switzerland
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology , Swiss Tropical and Public Health Institute , CH-4051 , Basel , Switzerland .
- University of Basel , P.O. Box , CH-4003 Basel , Switzerland
| | - Gilles Gasser
- Laboratory for Inorganic Chemical Biology , Chimie ParisTech , PSL University , F-75005 Paris , France .
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Portes MC, De Moraes J, Véras LMC, Leite JR, Mafud AC, Mascarenhas YP, Luz AEV, De Lima FCDA, Do Nascimento RR, Petrilli HM, Pinto PLS, Althoff G, Ferreira AMDC. Structural and spectroscopic characterization of epiisopiloturine-metal complexes, and anthelmintic activity vs. S. mansoni. J COORD CHEM 2016. [DOI: 10.1080/00958972.2016.1182162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Marcelo Cecconi Portes
- Departamento de Química Fundamental, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | - Josué De Moraes
- Faculdade de Ciências de Guarulhos (FACIG), Núcleo de Pesquisas em Doenças Negligenciadas, Guarulhos, Brazil
| | - Leiz Maria Costa Véras
- Núcleo de Pesquisa em Biodiversidade e Biotecnologia, BIOTEC, Campus de Parnaíba, Universidade Federal do Piauí, Parnaíba, Brazil
| | - José Roberto Leite
- Núcleo de Pesquisa em Biodiversidade e Biotecnologia, BIOTEC, Campus de Parnaíba, Universidade Federal do Piauí, Parnaíba, Brazil
| | - Ana Carolina Mafud
- Departamento de Física e Ciência Interdisciplinar, Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos, Brazil
| | - Yvonne Primerano Mascarenhas
- Departamento de Física e Ciência Interdisciplinar, Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos, Brazil
| | - Adamor Eleiel Virgino Luz
- Departamento de Física dos Materiais e Mecânica, Instituto de Física, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Helena Maria Petrilli
- Departamento de Física dos Materiais e Mecânica, Instituto de Física, Universidade de São Paulo, São Paulo, Brazil
| | | | - Gerhard Althoff
- Bruker Instruments, NMR Applications Group, Rheinstetten, Germany
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Abstract
Human schistosomiasis--or bilharzia--is a parasitic disease caused by trematode flukes of the genus Schistosoma. By conservative estimates, at least 230 million people worldwide are infected with Schistosoma spp. Adult schistosome worms colonise human blood vessels for years, successfully evading the immune system while excreting hundreds to thousands of eggs daily, which must either leave the body in excreta or become trapped in nearby tissues. Trapped eggs induce a distinct immune-mediated granulomatous response that causes local and systemic pathological effects ranging from anaemia, growth stunting, impaired cognition, and decreased physical fitness, to organ-specific effects such as severe hepatosplenism, periportal fibrosis with portal hypertension, and urogenital inflammation and scarring. At present, preventive public health measures in endemic regions consist of treatment once every 1 or 2 years with the isoquinolinone drug, praziquantel, to suppress morbidity. In some locations, elimination of transmission is now the goal; however, more sensitive diagnostics are needed in both the field and clinics, and integrated environmental and health-care management will be needed to ensure elimination.
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Affiliation(s)
- Daniel G Colley
- Center for Tropical and Emerging Global Disease & Department of Microbiology, University of Georgia, Athens, GA, USA.
| | - Amaya L Bustinduy
- Liverpool School of Tropical Medicine, Department of Parasitology, Liverpool, UK
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
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Webster JP, Molyneux DH, Hotez PJ, Fenwick A. The contribution of mass drug administration to global health: past, present and future. Philos Trans R Soc Lond B Biol Sci 2014; 369:20130434. [PMID: 24821920 DOI: 10.1098/rstb.2013.0434] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mass drug administration (MDA) is a means of delivering safe and inexpensive essential medicines based on the principles of preventive chemotherapy, where populations or sub-populations are offered treatment without individual diagnosis. High-coverage MDA in endemic areas aims to prevent and alleviate symptoms and morbidity on the one hand and can reduce transmission on the other, together improving global health. MDA is the recommended strategy of the World Health Organisation to control or eliminate several neglected tropical diseases (NTDs). More than 700 million people now receive these essential NTD medicines annually. The combined cost of integrated NTD MDA has been calculated to be in the order of $0.50 per person per year. Activities have recently been expanded due, in part, to the proposed attempt to eliminate certain NTDs in the coming two decades. More than 1.9 billion people need to receive MDA annually across several years if these targets are to be met. Such extensive coverage will require additional avenues of financial support, expanded monitoring and evaluation focusing on impact and drug efficacy, as well as new diagnostic tools and social science strategies to encourage adherence. MDA is a means to help reduce the burden of disease, and hence poverty, among the poorest sector of populations. It has already made significant improvements to global health and productivity and has the potential for further successes, particularly where incorporated into sanitation and education programmes. However logistical, financial and biological challenges remain.
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Affiliation(s)
- Joanne P Webster
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College Faculty of Medicine, , St Mary's Campus, London W2 1PG, UK
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Lu P, Wang W, Dai J, Liang Y. Imported African schistosomiasis: is it an emerging public health concern in China? J Travel Med 2014; 21:72-3. [PMID: 24383656 DOI: 10.1111/jtm.12073_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ping Lu
- Key Laboratory of Technology on Parasitic Disease Prevention and Control, Jiangsu Institute of Parasitic Diseases, Ministry of Health, Wuxi, China
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Mekonnen A, Legesse M, Belay M, Tadesse K, Torben W, Teklemariam Z, Erko B. Efficacy of Praziquantel against Schistosoma haematobium in Dulshatalo village, western Ethiopia. BMC Res Notes 2013; 6:392. [PMID: 24073761 PMCID: PMC3849756 DOI: 10.1186/1756-0500-6-392] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 09/25/2013] [Indexed: 11/15/2022] Open
Abstract
Background Praziquantel (PZQ) is the drug of choice for treatment of all human schistosomes. It is used in population based targeted or mass deworming strategies in several countries. The effect of PZQ on S. hematobium has not been studied in Ethiopia. The objective of this study was to determine the efficacy of PZQ against S. haematobium in Dulshatalo village, western Ethiopia. Methods A prospective study was conducted from October to December, 2007. Urine samples from 341 residents were collected and screened for haematuria and proteinuria using urinalysis dipstick. S. haematobium eggs were detected and quantified using filtration techniques. The participants who were positive for haematuria were treated with a standard dose of PZQ (40 mg/kg). Data on pre and 24 hours post treatment symptoms were collected via questionnaire. Urine samples were also collected 7 weeks after treatment and examined to assess the cure and the egg reduction rates. Results The prevalence of S. haematobium among the study participants was 57.8% (197/341). Haematuria was detected in 234 (68.6%) of the study participants. For PZQ efficacy asessment, 152 of the treated participants were considered. The presence of S. haemetaobium eggs showed statistically significant association (p < 0.05) with haematuria and proteinuria. Seven weeks post treatment, the extent of haematuria and proteinuria decreased from 100% to 40.8% and 94.07% to 48.7%, respectively. The cure and the parasitological egg reduction rates seven weeks post treatment were 86% and 85%, respectively. Post treatment symptoms revealed a wide range of side effects including straining, abdominal pain, nausea and headache. Conclusions There were marked cure and egg reduction rates, together with mild and short lived side effects of PZQ for treatment of S. haematobium, in this study.
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Affiliation(s)
- Asaye Mekonnen
- School of Medical Laboratory Sciences, Medical faculty, Addis Ababa University, P,O, Box 180056, Addis Ababa, Ethiopia.
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Wang W, Liang YS, Hong QB, Dai JR. African schistosomiasis in mainland China: risk of transmission and countermeasures to tackle the risk. Parasit Vectors 2013; 6:249. [PMID: 23985040 PMCID: PMC3765897 DOI: 10.1186/1756-3305-6-249] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/24/2013] [Indexed: 11/10/2022] Open
Abstract
Schistosomiasis is a major disease of public health importance in humans occurring in 76 countries of the tropics and sub-tropics. In China, schistosomiasis japonica is one of the highest priorities in communicable disease control defined by the central government. Since 1970s, the habitats of Biomphalaria straminea, an intermediate host of Schistosoma mansoni in South America, have been identified in Hong Kong Special Administrative Region and Shenzhen city, Guangdong province of China. With the sharp growth in the China-aided projects in Africa and labor services export to Africa, a gradual rise in the cases infected with S. haematobium or S. mansoni is reported in those returning from Africa to China. The existence of intermediate snail hosts and import of infectious source of schistosomiasis results in concern about the transmission of African schistosomiasis in mainland China in the context of global climate change. This paper evaluates the risk of transmission of African schistosomiasis in China, and proposes countermeasures and research priorities to tackle the risk.
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Affiliation(s)
- Wei Wang
- Jiangsu Institute of Parasitic Diseases, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
- Key Laboratory on Technology for Parasitic Disease Prevention and Control, Ministry of Health, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
- Jiangsu Provincial Key Laboratory of Molecular Biology of Parasites, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
| | - You-Sheng Liang
- Jiangsu Institute of Parasitic Diseases, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
- Key Laboratory on Technology for Parasitic Disease Prevention and Control, Ministry of Health, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
- Jiangsu Provincial Key Laboratory of Molecular Biology of Parasites, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
| | - Qing-Biao Hong
- Jiangsu Institute of Parasitic Diseases, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
- Key Laboratory on Technology for Parasitic Disease Prevention and Control, Ministry of Health, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
- Jiangsu Provincial Key Laboratory of Molecular Biology of Parasites, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
| | - Jian-Rong Dai
- Jiangsu Institute of Parasitic Diseases, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
- Key Laboratory on Technology for Parasitic Disease Prevention and Control, Ministry of Health, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
- Jiangsu Provincial Key Laboratory of Molecular Biology of Parasites, 117 Yangxiang, Meiyuan, Wuxi, Jiangsu Province 214064, People’s Republic of China
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Thétiot-Laurent SAL, Boissier J, Robert A, Meunier B. Chemotherapie gegen Schistosomiasis. Angew Chem Int Ed Engl 2013. [DOI: 10.1002/ange.201208390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Thétiot-Laurent SAL, Boissier J, Robert A, Meunier B. Schistosomiasis chemotherapy. Angew Chem Int Ed Engl 2013; 52:7936-56. [PMID: 23813602 DOI: 10.1002/anie.201208390] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Indexed: 01/08/2023]
Abstract
After malaria, schistosomiasis (or bilharzia) is the second most prevalent disease in Africa, and is occurring in over 70 countries in tropical and subtropical regions. It is estimated that 600 million people are at risk of infection, 200 million people are infected, and at least 200,000 deaths per year are associated with the disease. All schistosome species are transmitted through contact with fresh water that is infested with free-swimming forms of the parasite, which is known as cercariae and produced by snails. When located in the blood vessels of the host, larval and adult schistosomes digest red cells to acquire amino acids for growth and development. Vaccine candidates have been unsuccessful up to now. Against such devastating parasitic disease, the antischistosomal arsenal is currently limited to a single drug, praziquantel, which has been used for more than 35 years. Because the question of the reduction of the activity of praziquantel was raised recently, it is thus urgent to create new and safe antischistosomal drugs that should be combined with praziquantel to develop efficient bitherapies.
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Affiliation(s)
- Sophie A-L Thétiot-Laurent
- Laboratoire de Chimie de Coordination du CNRS, 205 route de Narbonne, BP 44099, 31077 Toulouse cedex 4, France
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Sabra ANA, Botros SS. Response of Schistosoma mansoni isolates having different drug sensitivity to praziquantel over several life cycle passages with and without therapeutic pressure. J Parasitol 2008; 94:537-41. [PMID: 18564758 DOI: 10.1645/ge-1297.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The stability of praziquantel (PZQ)-insusceptible S. mansoni isolates and the possible selection of PZQ-insusceptible parasites upon applying therapeutic pressure were examined over several life cycle passages (snails to mice). To test isolate stability, 3 PZQ-susceptible and 7 PZQ-insusceptible isolates were used to establish infection in mice, and they were passaged each for 2-5 life cycles. After each passage, 6 groups of mice were used to assess the PZQ dose at which the worm burden was decreased by 50% (ED50). Five of them were treated with doses of PZQ (12.5, 25, 50, 100, and 200 mg/kg for 5 days) 7 wk after infection; the last group represented infected, but untreated, controls. Possible selection of PZQ-insusceptible parasites under therapeutic pressure was examined by subjecting 1 PZQ-susceptible and 1 PZQ-insusceptible S. mansoni isolate to therapeutic pressure by PZQ for 8 passages. After the final passage, PZQ ED50 was estimated. All PZQ-susceptible S. mansoni isolates showed stable susceptibility to PZQ (mean PZQ ED50 = 85 mg/kg) over all passages. Two of the 7 PZQ-insusceptible S. mansoni isolates (847 and ER5) showed normal sensitivity to PZQ in 1-2 passages (although not the last passage, and without a declining ED50 profile), whereas the remaining passages kept a sustained insusceptibility to the drug (mean PZQ ED50 = 217 mg/kg). Worm maturity and sex were irrelevant to variability in drug ED50 within an individual isolate over different passages, revealing the heterogeneous nature of the parasite. Therapeutic pressure for limited life cycle passages did not result in a significant increase in drug ED50. The fact that reversion of some of the PZQ-insusceptible S. mansoni isolates to normal drug-sensitive state is not long lasting and that the therapeutic pressure by PZQ in the field is not comparable with that in the laboratory (unlimited), make monitoring the response of patients to the drug in the field an integral part of schistosomiasis control measures.
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Affiliation(s)
- Abdel Nasser A Sabra
- Department of Pharmacology, Theodor Bilharz Research Institute, Warrak el-Hadar, Imbaba, P.O. Box 30, Giza 12411, Egypt
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Webster JP, Gower CM, Norton AJ. Evolutionary concepts in predicting and evaluating the impact of mass chemotherapy schistosomiasis control programmes on parasites and their hosts. Evol Appl 2008; 1:66-83. [PMID: 25567492 PMCID: PMC3352399 DOI: 10.1111/j.1752-4571.2007.00012.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Accepted: 12/05/2007] [Indexed: 11/28/2022] Open
Abstract
Schistosomiasis is a parasitic disease of significant medical and veterinary importance in many regions of the world. Recent shifts in global health policy have led towards the implementation of mass chemotherapeutic control programmes at the national scale in previously 'neglected' countries such as those within sub-Saharan Africa. Evolutionary theory has an important role to play in the design, application and interpretation of such programmes. Whilst celebrating the rapid success achieved to date by such programmes, in terms of reduced infection prevalence, intensity and associated human morbidity, evolutionary change in response to drug selection pressure may be predicted under certain circumstances, particularly in terms of the development of potential drug resistance, evolutionary changes in parasite virulence, transmission and host use, and/or competitive interactions with co-infecting pathogens. Theoretical and empirical data gained to date serve to highlight the importance of careful monitoring and evaluation of parasites and their hosts whenever and wherever chemotherapy is applied and where parasite transmission remains.
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Affiliation(s)
- Joanne P Webster
- Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine Norfolk Place, London, UK
| | - Charlotte M Gower
- Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine Norfolk Place, London, UK
| | - Alice J Norton
- Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine Norfolk Place, London, UK
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Kabatereine NB, Kemijumbi J, Ouma JH, Sturrock RF, Butterworth AE, Madsen H, Ornbjerg N, Dunne DW, Vennnervald BJ. Efficacy and side effects of praziquantel treatment in a highly endemicSchistosoma mansoni focus at Lake Albert, Uganda. Trans R Soc Trop Med Hyg 2003; 97:599-603. [PMID: 15307437 DOI: 10.1016/s0035-9203(03)80044-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of the study was to assess the efficacy and side effects following single and repeated (6 weeks apart) praziquantel treatment (40 mg/kg) in a Schistosoma mansoni-endemic focus with long-standing transmission at Lake Albert in Uganda between December 1996 and January 1997. The results were based on 482 individuals, randomly representing all age and both gender groups. The cure rate following the first and second treatments was 41.9% and 69.1%, respectively. The cure rate was higher in adults than in children, irrespective of intensity of infection. In addition, the cure rate declined markedly with increasing intensity of infection. The reduction in intensity of infection was marked, being 97.7% and 99.6% after the first and second treatments, respectively. A pre- and post-treatment symptom questionnaire revealed a broad range of side effects, including abdominal pain and diarrhoea. However, no serious or long-lasting complications affecting compliance were observed. The marked reductions in faecal egg excretion and the acceptable level of side effects point to a single praziquantel treatment (40mg/kg) as the strategy of choice in such a highly endemic S. mansoni focus.
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Affiliation(s)
- N B Kabatereine
- Vector Control Division, Ministry of Health, Kampala, Uganda
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Doenhoff MJ, Kusel JR, Coles GC, Cioli D. Resistance of Schistosoma mansoni to praziquantel: is there a problem? Trans R Soc Trop Med Hyg 2002; 96:465-9. [PMID: 12474468 DOI: 10.1016/s0035-9203(02)90405-0] [Citation(s) in RCA: 169] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Evidence for resistance to praziquantel (PZQ) in Schistosoma mansoni has been sought in parasites taken from treated, but uncured human patients, and in a laboratory isolate of S. mansoni subjected to successive passages under drug pressure. Patients from villages in Egypt and Senegal have yielded isolates that can tolerate higher dosages of PZQ than other ostensible control isolates when passaged and subjected to drug treatment in mice. In vitro tests on these and the laboratory-selected isolate support the conclusion that a degree of resistance to PZQ can occur in S. mansoni, but the levels of drug resistance found so far are low. Preliminary studies have begun on these isolates to identify genetic, physiological and morphological characteristics associated with PZQ resistance and some of these may find use as markers for monitoring whether or not resistance is developing in endemic areas where the drug is used. More intensive application of PZQ can be expected in future, particularly in other parts of Africa, and vigilance will be needed to ensure that it continues to be useful as a drug for treatment of schistosomiasis. Further work is needed to elucidate the mode of action of PZQ and there is already a need for alternative drugs to treat PZQ-resistant schistosomiasis, such as already exists in northern Senegal.
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Affiliation(s)
- Michael J Doenhoff
- School of Biological Sciences, University of Wales, Bangor, Deiniol Road, Bangor, Gwynedd LL57 2UW, Wales, UK.
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Gomes CM, Trigo-Rocha F, Arap MA, Gabriel AJ, Alaor de Figueiredo J, Arap S. Schistosomal myelopathy: urologic manifestations and urodynamic findings. Urology 2002; 59:195-200. [PMID: 11834384 DOI: 10.1016/s0090-4295(01)01508-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the clinical and urodynamic features of patients with voiding dysfunction secondary to schistosomal myelopathy. Schistosomiasis mansoni is an endemic fluke infection in South America, the Caribbean, and Africa. In the United States and Europe, people may be infected mainly through travel to endemic areas and immigration of infected individuals. Clinical involvement of the spinal cord is a well-recognized complication of the disease. The typical manifestations are those of an acute transverse myelitis, with sudden onset of lower extremity neuropathy associated with bladder and bowel dysfunction. METHODS We reviewed the records and urodynamic studies of 14 consecutive patients (10 men and 4 women, age range 23 to 49 years) with schistosomal myelopathy confirmed by cerebrospinal fluid serology for S. mansoni, who were referred for evaluation of voiding dysfunction during a 2-year period. At the time of the urologic evaluation, 9 patients had chronic neurologic and urinary symptoms and 5 had recent onset of acute symptoms. The voiding function history, urologic complications, and outcomes after therapy for schistosomiasis were reviewed. RESULTS Of the patients with acute disease (5 patients), the urologic symptoms included urinary retention (3 patients) and incontinence (2 patients). Three of them had concurrent lower back pain and lower limb neurologic deficits. Urodynamic studies were performed in 3 patients and revealed bladder areflexia in 2 patients and detrusor hyperreflexia with external sphincter dyssynergia in 1 patient. The patients were started on clean intermittent catheterization and received praziquantel and corticosteroids. Three patients had complete resolution of their symptoms, one recovered normal voiding function but the neurologic deficits persisted, and one had no clinical improvement. All patients with chronic schistosomal myelopathy presented with lower limb neurologic deficits of varying degrees and urinary symptoms, including difficulty emptying the bladder (7 patients), urinary incontinence (6 patients), and urgency and frequency (2 patients). Laboratory and radiographic evaluation of patients with chronic disease revealed urinary tract infection in 5 patients, hydronephrosis in 2 patients, and bladder calculi in 2 patients. Urologic management consisted of antibiotics, clean intermittent catheterization, anticholinergic medication, and stone removal, as appropriate. In 1 patient, conservative treatment failed and that patient required ileocystoplasty. CONCLUSIONS Schistosomal myelopathy is a potential cause of severe voiding dysfunction secondary to spinal cord disease. A high index of suspicion is paramount because early medical intervention can abort the progression of neurologic deterioration.
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Affiliation(s)
- Cristiano M Gomes
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Abstract
BACKGROUND Schistosomiasis is a parasite that is carried by freshwater snails. The intestinal form infects the intestine, liver and spleen and can be fatal. OBJECTIVES The objective of this review was to assess the effects of oxamniquine or praziquantel for treating Schistosomiasis mansoni SEARCH STRATEGY We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Lilacs and reference lists of articles. The Revista da Sociedade Brasileira de Medicina Tropical and Brazilian Tropical Medicine Congress abstracts were handsearched SELECTION CRITERIA Randomised and quasi-randomised trials comparing oxamniquine and/or praziquantel to placebo for the treatment of Schistosomiasis mansoni. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS Thirteen trials met the inclusion criteria. Praziquantel and oxamniquine were effective in curing Schistosoma mansoni infection when compared to placebo. In Africa, praziquantel 40 mg/Kg is more effective than oxamniquine 15 mg/Kg in individuals older than 14 years (OR 3.54, 95%CI 1.70, 7.38), but no difference was found when compared with oxamniquine 30 mg/Kg (OR 0.29, 95%CI 0.08, 1.01). In Brazil, praziquantel was equally effective when compared with oxamniquine in individuals older than 14 years (OR 1.70, 95%CI 0.83, 3.49). Both drugs appear safe. There was no difference in reinfection rate between zinc supplementation and placebo (OR 0.82, 95%CI 0.47, 1.41). REVIEWER'S CONCLUSIONS IPraziquantel and oxamniquine both appear to be effective for the treatment of Schistosomiasis mansoni, although lower doses of oxamniquine (less than 30 milligrams per kilogram) may not be as effective.
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Affiliation(s)
- H Saconato
- Clinical Medicine, Universidade Federal do Rio Grande do Norte, Rua Ewerton Cortez, 1483 - Tirol, Natal, Rio Grande do Norte, Brazil, 59. 020-620.
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El-Subbagh HI, Al-Badr AA. Praziquantel. ANALYTICAL PROFILES OF DRUG SUBSTANCES AND EXCIPIENTS 1998. [DOI: 10.1016/s0099-5428(08)60760-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Araújo N, de Souza CP, Passos LK, Simpson AJ, Dias Neto E, Pereira TR, Cerutti Júnior C, de Alencar FE, Dietze R, Katz N. [Susceptibility to chemotherapeutic agents of Schistosoma mansoni isolates from patients treated with oxamniquine and praziquantel and not cured]. Rev Soc Bras Med Trop 1996; 29:467-76. [PMID: 8966311 DOI: 10.1590/s0037-86821996000500010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Ten inhabitants of Itaquara, Bahia, Brazil treated with oxamniquine and subsequently praziquantel were not cured. Schistosoma mansoni isolates derived from these patients were studied. Snails were infected with miracidia derived from the feces of these patients and the cercariae produced used to infect albino mice. The animals were then treated with a single oral dose of oxamniquine (25, 50 and 100mg/kg) or praziquantel (100, 200 and 400 mg/kg). The response to chemotherapy was significantly different in some of the isolates although it was not possible to characterize any of them as resistant. In addition, DNA analysis of the isolates by means of "Random Amplified Polymorphic DNA" indicated a low degree of variability as compared with a laboratory strain, LE. Thus, it was not possible to characterize these organisms at a genetic level as a distinct strain.
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Affiliation(s)
- N Araújo
- Centro de Pesquisas Universidade Federal de Mínas Gerais, Belo Horizonte
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Ramírez RM, Ceballos E, Alarcón de Noya B, Noya O, Bianco N. The immunopathology of human Schistosomiasis-III. Immunoglobulin isotype profiles and response to praziquantel. Mem Inst Oswaldo Cruz 1996; 91:593-9. [PMID: 9137744 DOI: 10.1590/s0074-02761996000500010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
Immunoglobulin (Ig) isotype (IgG, IgG1, IgG2, IgG3, IgG4, IgM, IgD and IgE) levels were investigated, both pre- and post-treatment with praziquantel (PZQ), in 43 adults and children chronically infected with Schistosoma mansoni, by means of a two-site, isotype-specific immunoenzymometric assay. The patients were classified as responders (R) or non-responders (NR) on the basis of their circumoval precipitin test (COPT) results 12 months after treatment. In comparison with controls, pre-treatment R children showed significantly higher levels of IgG, IgG1, IgG4 (p < 0.001) and IgE (p < 0.01); and diminished IgG2 (p < 0.05), while NR children showed significantly elevated levels only of IgE (p < 0.05). Twelve months after therapy, R children maintained significantly lower levels of IgG2, but showed significantly decreased levels of IgG, IgG1, IgG4, and IgE, while the Ig isotype profile of NR children was unaltered. Adult R and NR showed similar isotype profiles before chemotherapy, with the exception of significantly elevated IgM levels in R. Twelve months after therapy, R adults showed significantly decreased levels of IgG, IgG1, and IgG4, while NR adults showed only diminished IgG4 levels. These results reveal different Ig isotype profiles in untreated adults and children chronically infected with S. mansoni. The results further show that the pre-treatment Ig isotype profile may be significantly modified after an effective R to chemotherapy, accounted for by down regulation of the IgG1 isotype in association with negative seroconversion of the COPT in R patients. The COPT reaction has been associated with the highly specific egg glycoprotein antigen omega 1, which shows a significant reduction in reactivity six months after treatment. IgG1 may thus play a main role in the response against the omega 1 antigen.
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Affiliation(s)
- R M Ramírez
- Instituto de Inmunología, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
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Fallon PG, Tao LF, Ismail MM, Bennett JL. Schistosome resistance to praziquantel: Fact or artifact? ACTA ACUST UNITED AC 1996; 12:316-20. [PMID: 15275183 DOI: 10.1016/0169-4758(96)10029-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Praziquantel is the current drug of choice for human schistosomiasis. Recent reports from laboratory and field studies concerning reduced praziquantel efficacy against Schistosoma mansoni have generated some controversy. The prevailing question is whether the emergence of strains of schistosome resistant to praziquantel is a fact, or an artifact resulting from erroneous field or laboratory experimentation. In this article, Padraic Fallon, Liang-feng Tao, Magdi Ismail and James Bennett examine the available evidence for schistosome resistance to praziquantel. Contributory factors to the schistosomicidal activity of praziquantel, which may interfere with evaluation of drug efficacy or resistance, are also considered.
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Affiliation(s)
- P G Fallon
- Department of Pathology, University of Cambridge. Tennis Court Road, Cambride, UK.
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Morcos SH, Mansour MM, Khayyal MT, Saleh S, Ishak EA, Girgis NI. Evaluation of hepatic fibrosis after oxamniquine therapy of murine schistosomiasis. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1992; 86:511-6. [PMID: 1288432 DOI: 10.1080/00034983.1992.11812700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chemical and histological indices of liver fibrosis were measured after eight, 18 and 28 weeks in mice infected with Schistosoma mansoni and treated at eight weeks with oxamniquine, in mice infected with S. mansoni and not treated and in mice not infected with S. mansoni. Total worm burdens and liver egg counts were determined in the infected mice to determine severity of infection. Treatment with oxamniquine resulted in near total eradication of S. mansoni worms after 10 weeks and in their complete killing and marked reduction of eggs in the liver at 10 and 20 weeks. Liver fibrosis 10 weeks after oxamniquine treatment was not significantly different than in the untreated, infected group but there was no progression between 10 and 20 weeks after oxamniquine treatment. Fibrosis did however increase between 10 and 20 weeks in the untreated infected group. In the murine model, oxamniquine is an effective treatment for S. mansoni and prevents progression of liver fibrosis.
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Affiliation(s)
- S H Morcos
- United States Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt
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