Schistosomiasis medical therapy: Difference between revisions

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{{Schistosomiasis}}
{{Schistosomiasis}}
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{{CMG}} ; {{AE}} {{ADG}}  


==Overview==
==Overview==
The mainstay of treatment for schistosomiasis is pharmacotherapy. Praziquantel is the drug of choice in treating schistosomiasis. Corticosteroids should be administered in addition to praziquantel in patients with symptoms due to neuro-schistosomiasis and patients with severe Katayama fever. The goals of treatment of schistosomiasis are to eradicate the helminth and correct any sequelae of infection. While Praziquantel is safe and highly effective in curing an infected patient, it does not prevent re-infection by cercariae and is thus not an optimum treatment for people living in endemic areas.
The mainstay of treatment for schistosomiasis is [[pharmacotherapy]]. [[Praziquantel]] is the drug of choice in treating schistosomiasis. [[Corticosteroids]] should be administered in addition to [[praziquantel]] in patients with symptoms due to neuro-schistosomiasis and patients with severe [[katayama fever]]. The goals of [[Treatment centre|treatment]] of schistosomiasis are to eradicate the [[helminth]] and correct any [[sequelae]] of [[infection]]. While [[praziquantel]] is safe and highly effective in curing an infected patient, it does not prevent re-infection by [[Cercaria|cercariae]] and is thus not an optimum treatment for people living in endemic areas.


==Medical Therapy==
==Medical Therapy==
[[Antimony]] has been used in the past to treat the disease.  In low doses, this [[toxic]] metalloid bonds to [[sulfur]] atoms in [[enzymes]] used by the parasite and kills it without harming the host.  This treatment is not referred to in present-day peer-review scholarship; [[Praziquantel]] is universally used. Outside of the US, there is a second drug available for treating ''Schistosoma mansoni'' (exclusively) called [[Oxamniquine]].
Mirazid, a new Egyptian drug, is under investigation for oral treatment of the disease.
Experiments have shown medicinal [[Castor oil]] as an oral anti-penetration agent to prevent Schistosomiasis and that praziquantel's effectiveness depended upon the vehicle used to administer the drug (e.g., Cremophor / Castor oil).<ref>{{cite web | title=Schistosoma mansoni: experimental chemoprophylaxis in mice using oral anti-penetration agents. | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=2507345&query_hl=1itool=pubmed_docsum | format=| publisher=pubmed | accessdate=2007-01-25}}</ref>
Additionally Dr Chidzere of Zimbabwe researched the Gopo Berry (''Phytolacca dodecandra'') during the 1980's and found that the Gopo Berry could be used in the control of the freshwater snails which carry the bilharzia disease (Schistosomiasis parasite). Dr Chidzere in his interview to Andrew Blake (1989) reported concerns of muti-national chemical companies keen to rubbish the Gopu Berry alternative for snail control <ref> The Gopu Berry p33. Part 4 School Journal number.2 1989 Dept of Education Wellington N.Z </ref>. Reputedly Gopo Berries from hotter Ethiopia climates yield the best results. Later studies were between 1993-95 by the Danish Research Network for international health. <ref> http://enrecahealth.ku.dk/postgrad_dbl_en/chihaka_abs/ </ref>
Schistosomiasis is readily treated using a single oral dose of the drug [[praziquantel]] annually.<ref name="STreat">{{Cite web | author= The Carter Center| title=How is Schistosomiasis Treated?|url=http://www.cartercenter.org/health/schistosomiasis/treatment.html|accessdate=2008-07-17 | postscript= <!--None--> |archiveurl = http://web.archive.org/web/20080225084801/http://www.cartercenter.org/health/schistosomiasis/treatment.html <!-- Bot retrieved archive --> |archivedate = 2008-02-25}}</ref> As with other major parasitic diseases, there is ongoing and extensive research into developing a [[schistosomiasis vaccine]] that will prevent the parasite from completing its life cycle in humans. In 2009, [[Eurogentec]] Biologics developed a vaccine against bilharziosis in partnership with [[INSERM]] and researchers from the [[Pasteur Institute]].<ref>{{ cite web | url = http://www.eurogentec.com/news/104-bilhvax-a-vaccine-against-bilharziose-a-world-first-.html | date =  20 April 2009 |title= BILHVAX — A VACCINE AGAINST BILHARZIOSE, A world first!  }}</ref><ref>{{ cite web | url = http://www.lameuse.be/regions/basse_meuse/2009-04-20/liege-eurogentec-vaccin-extraordinaire-697330.shtml | date = 20 April 2009 |title= 300.000 morts évitées grâce au vaccin liégeois! }}</ref><ref>{{ cite web | url = http://www.lalibre.be/actu/gazette-de-liege/article/497184/un-important-vaccin-produit-a-liege.html | date = 22 April 2009 |title= Eurogentec, la société de biotechnologie située au Sart Tilman, produit et produira le vaccin contre la bilharziose.}}</ref>
The World Health Organization has developed guidelines for community treatment of schistosomiasis based on the impact the disease has on children in endemic villages:<ref name="STreat"/>
*When a village reports more than 50 percent of children have blood in their urine, everyone in the village receives treatment.<ref name="STreat"/>
*When 20 to 50 percent of children have bloody urine, only school-age children are treated.<ref name="STreat"/>
*When less than 20 percent of children have symptoms, mass treatment is not implemented.<ref name="STreat"/>
The [[Bill & Melinda Gates Foundation]] has recently funded an operational research program---the [http://www.ctegd.uga.edu/score.php Schistosomiasis Consortium for Operational Research and Evaluation (SCORE)] to answer strategic questions about how to move forward with schistosomiasis control and elimination. The focus of SCORE is on development of tools and evaluation of strategies for use in mass drug administration campaigns.
[[Antimony]] has been used in the past to treat the disease. In low doses, this [[toxic]] [[metalloid]] bonds to [[sulfur]] atoms in [[enzymes]] used by the parasite and kills it without harming the host. This treatment is not referred to in present-day [[peer-review]] scholarship; praziquantel is universally used. Outside of the U.S., there is a drug available exclusively for treating ''Schistosoma mansoni'' ([[oxamniquine]]) and one exclusively for treating ''S.hematobium'' ([[metrifonate]]). While metrifonate has been discontinued for use by the British [[National Health Service]], a Cochrane review found it equally effective in treating urinary schistosomiasis as the leading drug, praziquantel.<ref>{{cite journal |author=Danso-Appiah A, Utzinger J, Liu J, Olliaro P |title=Drugs for treating urinary schistosomiasis |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD000053 |year=2008 |doi=10.1002/14651858.CD000053.pub2 |url=http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD000053/frame.html |editor1-last=Danso-Appiah |editor1-first=Anthony}}</ref>
Mirazid, an [[Egypt]]ian drug made from [[myrrh]], was under investigation for oral treatment of the disease up until 2005.<ref>See, for example, {{cite journal |author=Soliman OE, ''et al.'' |title=Evaluation of myrrh (Mirazid) therapy in fascioliasis and intestinal schistosomiasis in children: immunological and parasitological study |journal=J Egypt Soc Parasitol |volume=34 |issue=3 |pages=941–66 |date=December 2004 |doi= |pmid=15587320}}</ref> The efficacy of praziquantel was proven to be about 8 times than that of Mirazid and therefore Mirazid was not recommended as a suitable agent to control schistosomiasis.<ref>{{cite journal |journal=Am J Trop Med Hyg |volume=72 |issue=2 |year=February 2005 |pmid=15741544 |url=http://www.ajtmh.org/cgi/content/full/72/2/119 |last1=Botros |first1=S |last2=Sayed |first2=H |last3=El-Dusoki |first3=H |last4=Sabry |first4=H |last5=Rabie |first5=I |last6=El-Ghannam |first6=M |last7=Hassanein |first7=M |last8=El-Wahab |first8=YA |last9=Engels |first9=D |title=Efficacy of mirazid in comparison with praziquantel in Egyptian Schistosoma mansoni-infected school children and households |pages=119–23}}</ref>
===Antimicrobial Regimen===
===Antimicrobial Regimen===
:*'''1. Schistosoma mansoni, S. haematobium, S. intercalatum'''<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
:*'''1. Schistosoma mansoni, S. haematobium, S. intercalatum'''<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
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::*Alternative regimen (2): [[Artemisinin]] no dose is established yet<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
::*Alternative regimen (2): [[Artemisinin]] no dose is established yet<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
::*Alternative regimen (3): [[Mefloquine]] 250 mg PO single dose
::*Alternative regimen (3): [[Mefloquine]] 250 mg PO single dose
::*Note: There is no benefit in associating the alternative therapies to Praziquantel.
::*'''Note''': There is no benefit in associating the alternative therapies to praziquantel.
::*Note: Praziquantel is not effective against larval/egg stages of the disease.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref>
::*'''Note''': [[Praziquantel]] is not effective against larval/egg stages of the disease.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref>


:*'''2. S. japonicum, S. mekongi'''<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
:*'''2. S. japonicum, S. mekongi'''<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
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::*Alternative regimen (1): [[Artemisinin]] no dose is established yet
::*Alternative regimen (1): [[Artemisinin]] no dose is established yet
::*Alternative regimen (2): [[Mefloquine]] 250 mg PO single dose
::*Alternative regimen (2): [[Mefloquine]] 250 mg PO single dose
::*Note: There is no benefit in associating the alternative therapies to Praziquantel.
::*'''Note''': There is no benefit in associating the alternative therapies to [[Praziquantel]].


:*'''3. Katayama Fever'''
:*'''3. Katayama Fever'''
::*Preferred regimen: Prednisone 20-40 mg/day PO for 5 days, {{then}} Praziquantel<ref name="pmid20222897">{{cite journal| author=Jauréguiberry S, Paris L, Caumes E| title=Acute schistosomiasis, a diagnostic and therapeutic challenge. | journal=Clin Microbiol Infect | year= 2010 | volume= 16 | issue= 3 | pages= 225-31 | pmid=20222897 | doi=10.1111/j.1469-0691.2009.03131.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20222897  }} </ref>
::*Preferred regimen: [[Prednisone]] 20-40 mg/day PO for 5 days, {{then}} [[Praziquantel]]<ref name="pmid20222897">{{cite journal| author=Jauréguiberry S, Paris L, Caumes E| title=Acute schistosomiasis, a diagnostic and therapeutic challenge. | journal=Clin Microbiol Infect | year= 2010 | volume= 16 | issue= 3 | pages= 225-31 | pmid=20222897 | doi=10.1111/j.1469-0691.2009.03131.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20222897  }} </ref>
::*Note: Praziquantel should be used after 4-6 weeks of exposure, because it cannot kill the larvae stages of the Schistosoma. Praziquantel should be used after acute schistosomiasis syndrome symptoms have resolved always together with corticosteroids, only when ova are detected in stool or urine samples.<ref name="pmid19292640">{{cite journal| author=Jauréguiberry S, Paris L, Caumes E| title=Difficulties in the diagnosis and treatment of acute schistosomiasis. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 8 | pages= 1163-4; author reply 1164-5 | pmid=19292640 | doi=10.1086/597497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19292640  }} </ref>
::*[[Praziquantel]] should be used after 4-6 weeks of exposure because it cannot kill the larvae stages of the Schistosoma.  
::*[[Praziquantel]] should be used after acute schistosomiasis syndrome symptoms have resolved.
::*[[Praziquantel]] together with [[corticosteroids]], only when ova are detected in stool or urine samples.<ref name="pmid19292640">{{cite journal| author=Jauréguiberry S, Paris L, Caumes E| title=Difficulties in the diagnosis and treatment of acute schistosomiasis. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 8 | pages= 1163-4; author reply 1164-5 | pmid=19292640 | doi=10.1086/597497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19292640  }} </ref>
 
====Praziquantel====
*[[Praziquantel]] is first-line therapy for infection with all five Schistosoma species.
*[[Praziquantel]] is also used as part of mass chemotherapy campaigns in endemic areas to decrease individual worm burden.
*Not effective against immature schistosomes (schistosomules).
*Not useful for treatment of [[cercarial]] [[dermatitis]] (i.e, cutaneous schistosomiasis or swimmer's itch) caused by transient, self-limited infection with Austrobilharzia species.
*Very well tolerated; adverse effects are usually mild and transient and do not require treatment.
*Women who are breastfeeding should not breastfeed on the day of treatment.
*[[Rifampin]] significantly reduces the bioavailability of [[praziquantel]] and, thus, should be discontinued 4 weeks before treatment.
*Schistosome eggs may take weeks to pass out of the intestinal and bladder wall; therefore, egg passage continues for approximately a month after treatment.
 
====Corticosteroids====
*[[Corticosteroids]] are indicated as an adjunctive treatment (in addition to [[praziquantel]]) in patients with symptoms due to:
**Neuro-schistosomiasis ([[transverse myelitis]], [[seizures]], or other symptoms of increased [[intracranial pressure]])
**Patients presenting with severe [[Katayama fever]]
*[[Corticosteroids]] help to alleviate acute allergic reactions and mass effects caused by excessive granulomatous inflammation in the [[CNS]].
====Artemisinin compounds====
*[[Artemisinin]] compounds are employed in the eradication of migrating schistosome larvae in recently infected patients.
*[[Artemether]] also may provide chemoprophylactic protection against [[Schistosoma mansoni|''S.mansoni'']] and [[Schistosoma haematobium|''S haematobium'']].


==References==
==References==
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[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Neglected diseases]]
[[Category:Neglected diseases]]
[[Category:Infectious disease]]

Latest revision as of 18:44, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

The mainstay of treatment for schistosomiasis is pharmacotherapy. Praziquantel is the drug of choice in treating schistosomiasis. Corticosteroids should be administered in addition to praziquantel in patients with symptoms due to neuro-schistosomiasis and patients with severe katayama fever. The goals of treatment of schistosomiasis are to eradicate the helminth and correct any sequelae of infection. While praziquantel is safe and highly effective in curing an infected patient, it does not prevent re-infection by cercariae and is thus not an optimum treatment for people living in endemic areas.

Medical Therapy

Antimicrobial Regimen

  • 1. Schistosoma mansoni, S. haematobium, S. intercalatum[1]
  • Preferred regimen: Praziquantel 40 mg/kg per day PO in qd or bid for one day
  • Alternative regimen (1): Oxamniquine 20 mg/kg PO single dose[2][3]
  • Alternative regimen (2): Artemisinin no dose is established yet[1]
  • Alternative regimen (3): Mefloquine 250 mg PO single dose
  • Note: There is no benefit in associating the alternative therapies to praziquantel.
  • Note: Praziquantel is not effective against larval/egg stages of the disease.[4]
  • 2. S. japonicum, S. mekongi[1]
  • Preferred regimen: Praziquantel 60 mg/kg per day PO bid for one day
  • Alternative regimen (1): Artemisinin no dose is established yet
  • Alternative regimen (2): Mefloquine 250 mg PO single dose
  • Note: There is no benefit in associating the alternative therapies to Praziquantel.
  • 3. Katayama Fever

Praziquantel

  • Praziquantel is first-line therapy for infection with all five Schistosoma species.
  • Praziquantel is also used as part of mass chemotherapy campaigns in endemic areas to decrease individual worm burden.
  • Not effective against immature schistosomes (schistosomules).
  • Not useful for treatment of cercarial dermatitis (i.e, cutaneous schistosomiasis or swimmer's itch) caused by transient, self-limited infection with Austrobilharzia species.
  • Very well tolerated; adverse effects are usually mild and transient and do not require treatment.
  • Women who are breastfeeding should not breastfeed on the day of treatment.
  • Rifampin significantly reduces the bioavailability of praziquantel and, thus, should be discontinued 4 weeks before treatment.
  • Schistosome eggs may take weeks to pass out of the intestinal and bladder wall; therefore, egg passage continues for approximately a month after treatment.

Corticosteroids

Artemisinin compounds

References

  1. ↑ 1.0 1.1 1.2 Colley DG, Bustinduy AL, Secor WE, King CH (2014). "Human schistosomiasis". Lancet. 383 (9936): 2253–64. doi:10.1016/S0140-6736(13)61949-2. PMID 24698483.
  2. ↑ National Center for Biotechnology Information. PubChem Compound Database; CID=4612, https://pubchem.ncbi.nlm.nih.gov/compound/4612 (accessed July 16, 2015).
  3. ↑ BINA, J. C. and PRATA, A.. Tratamento da esquistossomose com oxamniquine (xarope) em crianças. Rev. Soc. Bras. Med. Trop.[online]. 1975, vol.9, n.4 [cited 2015-07-16], pp. 175-178 . Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86821975000400002&lng=en&nrm=iso>. ISSN 0037-8682. http://dx.doi.org/10.1590/S0037-86821975000400002.
  4. ↑ Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G (2014). "Invasive fungal infections in the ICU: how to approach, how to treat". Molecules. 19 (1): 1085–119. doi:10.3390/molecules19011085. PMID 24445340.
  5. ↑ Jauréguiberry S, Paris L, Caumes E (2010). "Acute schistosomiasis, a diagnostic and therapeutic challenge". Clin Microbiol Infect. 16 (3): 225–31. doi:10.1111/j.1469-0691.2009.03131.x. PMID 20222897.
  6. ↑ Jauréguiberry S, Paris L, Caumes E (2009). "Difficulties in the diagnosis and treatment of acute schistosomiasis". Clin Infect Dis. 48 (8): 1163–4, author reply 1164-5. doi:10.1086/597497. PMID 19292640.
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