Efficacy of nitazoxanide against toxocara canis: larval recovery and humoral immune response in experimentally infected mice / Eficácia da nitazoxanida contra Toxocara canis: recuperação larvária e resposta imune humoral em camundongos experimentalmente infectados

SUMMARYThe efficacy of nitazoxanide (NTZ) against toxocariasis was investigated in an experimental murine model and results were compared to those obtained using mebendazole. Sixty male BALB/c mice, aged six to eight weeks-old, were divided into groups of 10 each; fifty were orally infected with 300 larvaed eggs of T. canisand grouped as follows, G I: infected untreated mice; G II: infected mice treated with MBZ (15 mg/kg/day) 10 days postinfection (dpi); G III: infected mice treated with NTZ (20 mg/kg/day) 10 dpi; G IV: infected mice treated with MBZ 60 dpi; G V: infected mice treated with NTZ 60 dpi; GVI: control group comprising uninfected mice. Mice were bled via retro-orbital plexus on four occasions between 30 and 120 dpi. Sera were processed using the ELISA technique to detect IgG anti- Toxocaraantibodies. At 120 dpi, mice were sacrificed for larval recovery in the CNS, liver, lungs, kidneys, eyes and carcass. Results showed similar levels of anti- ToxocaraIgG antibodies among mice infected but not submitted to treatment and groups treated with MBZ or NTZ, 10 and 60 dpi. Larval recovery showed similar values in groups treated with NTZ and MBZ 10 dpi. MBZ showed better efficacy 60 dpi, with a 72.6% reduction in the parasite load compared with NTZ, which showed only 46.5% reduction. We conclude that administration of these anthelmintics did not modify the humoral response in experimental infection by T. canis. No parasitological cure was observed with either drug; however, a greater reduction in parasite load was achieved following treatment with MBZ.

RESUMOFoi investigada a eficácia da nitazoxanida (NTZ) na toxocaríase murina experimental e os resultados comparados com os obtidos usando mebendazol (MBZ). Sessenta camundongos BALB/c machos, com idade entre seis e oito semanas foram divididos em grupos de 10 cada, 50 foram infectados oralmente com 300 ovos larvados de T. canise agrupados a seguir: GI: camundongos infectados não tratados; GII: camundongos infectados tratados com MBZ (15 mg/kg/dia) 10 dias pós-infecção (dpi); GIII: camundongos infectados tratados com NTZ (20 mg/kg/dia) 10 dpi, GIV: camundongos infectados tratados com MBZ 60 dpi; GV: camundongos infectados tratados com NTZ 60 dpi; GVI: controle não infectado. Os camundongos foram sangrados via plexo retro orbitário em quatro ocasiões entre o 30º e 120º dpi. Os soros foram processados pela técnica de ELISA para detecção de anticorpos IgG anti- Toxocara.Aos 120 dpi, os animais foram sacrificados para a recuperação larvária do SNC, fígado, pulmões, rins, olhos e carcaça. Os resultados mostraram níveis similares de anticorpos IgG anti- Toxocaraentre os camundongos infectados mas não submetidos a tratamento e os grupos infectados e tratados com MBZ ou NTZ, aos 10 e 60 dpi. Os valores da recuperação larval foram similares nos grupos tratados com NTZ e MBZ 10 dpi. MBZ mostrou melhor eficácia aos 60 dpi, com redução de 72,6% da carga parasitária comparada com NTZ, que mostrou redução somente de 46,5%. Concluímos que a administração destes anti-helmínticos não modificou a resposta humoral na infecção experimental por T. canis. Não foi observada cura parasitológica com nenhuma das drogas; porém maior redução na carga parasitária foi obtida após o tratamento com MBZ.

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.

Pelvic Hydatid Disease: CT and MRI Findings Causing Sciatica

Pelvic masses, especially hydatid disease, rarely present with sciatica (1, 2). We present the computed tomography (CT) and the magnetic resonance imaging (MRI) findings of a 49-year-old female patient with presacral hydatid disease, who was evaluated for her sciatica. We also want to emphasize the importance of assessing the pelvis of patients with symptoms and clinical findings that are inconsistent and that cannot be satisfactorily explained by the spinal imaging findings.

Appreciation of school deworming program by parents in Ha Giang Province (Vietnam).

School-based deworming programs are one of the most cost-effective public health strategies to reach children with anthelminthics and health education. However, despite their low cost and high health impact, they are not implemented on a large scale. The present survey investigated a school-based deworming program in Ha Giang Province, Vietnam, to assess the community perception and support towards these programs. Information from 81 households, 88 primary school students, 25 teachers and 9 people in charge of commune health stations was collected by structured questionnaires. The survey displayed complete satisfaction and a high level of support within all 4 questioned groups. In addition 96.1% of all parents noticed an improvement in their children's health. The great appreciation of the deworming program by the community is an additional argument to convince decision makers to implement and scale up these programs. Even teachers that did not receive any specific training were able to distribute the drug successfully following the page of written instructions accompanying the drug.

Evaluation of coverage of deworming interventions in Vietnam.

In 2004-2005, the school deworming program in Vietnam targeted 2,400,000 school-children in 25 provinces. A questionnaire survey of a random sample of schools throughout the country was organized to validate the teacher feedback, assess the real coverage of the program and estimate the occurrence of side-effects. A total of 91 schools in four different provinces were visited few days after drug distribution. A total of 2,323 children and 80 teachers were questioned. The total cost of the monitoring has been estimated at US dollar 7,000 (less than 10% of the deworming program). The survey demonstrated a coverage of 95% for school-children and of 86.3% for teachers (on average a coverage 2% lower than the one reported by the teachers through forms on the day of drug administration). Approximately 0.4% of those interviewed reported side-effects after deworming, while the occurrence of side effects through routine reports was 0.15%. In both cases, the side effects were described as mild forms of nausea, abdominal pain, or headaches that did no required pharmacological treatment. The survey confirmed the positive results of routine reporting; we consider the survey a cost-effective activity to maintain the control activities under monitoring.

El tratamiento antihelmíntico selectivo frente al tratamiento masivo: experiencia en dos comunidades hiperendémicas / Selective vs. mass treatment with antihelminthic drugs: experience in two hyperendemic communities

OBJETIVO: Evaluar la prevalencia e intensidad de las infecciones por geohelmintos en niños de dos comunidades hiperendémicas tratadas con técnicas antihelmínticas diferentes: una con tratamiento selectivo o individual, y la otra con tratamiento masivo reiterado. MÉTODOS: La población estuvo compuesta por 909 niños de uno u otro sexo, con edades entre 2 y 13 años, que vivían en dos comunidades marginales de la ciudad: Las Lomas y El Abasto, Santa Fe, Argentina. Se realizó un trabajo prospectivo longitudinal, cuasiexperimental, de comunidades. Durante los 22 meses del estudio se llevaron a cabo 5 controles parasitológicos, evaluados desde el punto de vista cualitativo y cuantitativo, y se dispensaron tratamientos antihelmínticos después de los controles 0, 2, 3 y 4. En Las Lomas se aplicó el tratamiento selectivo a los casos con diagnóstico parasitológico positivo que integraban la muestra A (n = 55) y en El Abasto, tratamiento masivo a todos los niños, incluidos los integrantes de la muestra B (n = 50). Ambas muestras fueron escogidas para realizar los controles. RESULTADOS: Se comprobó una prevalencia e intensidad de la infección por Ascaris lumbricoides significativamente mayor en El Abasto. No se detectaron diferencias para Trichuris trichiura. Al comparar las prevalencias y cargas parasitarias de A. lumbricoides entre los controles realizados dentro de una misma comunidad (inicio y final del estudio) no se observaron diferencias significativas en la muestra A, aunque sí en la muestra B. En cuanto a T. trichiura, se detectaron diferencias significativas entre ambos controles en las dos muestras. CONCLUSIONES: Solo el tratamiento masivo y reiterado logró disminuir eficaz y significativamente la prevalencia y la carga parasitaria de A. lumbricoides durante el período estudiado

Efficacy of multiple dose mebendazole against trichuriasis in Thai and Karen patients.

Treatment of trichuriasis with mebendazole 500 mg for three days, and 100 mg twice daily for three days, yielded cure rates of 93.9 and 88.9% in Thai patients, while the cure rates in Karen patients were 96.2 and 95.5% respectively. The total number of Thai and Karen trichuriasis patients were 60 and 48, when tested by modified cellophane thick smear Kato-Katz technique. There were no significant differences among the two groups of patients and doses of treatment (p > 0.05).

Prevalence of enterobiasis and its incidence after blanket chemotherapy in a male orphanage.

A prospective observational study was conducted in a male orphanage to find out the prevalence of enterobiasis and its incidence after blanket chemotherapy using mebendazole. We found that the prevalence of enterobiasis was 28.9%. The incidence density of enterobiasis after blanket chemotherapy was 379.82 per 1,000 person-years which was quite high. We suggest that blanket chemotherapy should be repeated at every 6 months interval to control enterobiasis in orphanages.

Tricocefalosis masiva en un adulto diagnosticada por colonoscopía / Massive trichuriasis in an adult diagnosed by colonoscopy

A case of massive trichuriasis in a 37 year old female from a rural locality of the Metropolitan Region of Chile, with antecedentes of alcoholism, chronic hepatic damage and portal cavernomatosis, is presented. Since 12 year ago she has had geophagia. In the las six months she has frequently presented liquid diarrhea, colic abdominal pains, tenesmus and sensation of abdminal distention. Clinical and laboratory test confirmed her hepatic affection associated with a celiac disease with anemia and hypereosinophilia. Within a week diarrhea became worse and dysentery appeared. A colonoscopy revealed and impressive and massive trichuriasis. The patient was succesfully treated with two cures of 200 mg tablets of mebendazole twice daily for three days with a week interval. After the first cure she evacuated a big amount of tricuris trichiura, fecal evacuations became normal, geophagia disappeared and recovered 4 kg of body weight

Minimum effective doses of mebendazole in treatment of soil-transmitted helminths.

Three hundred and fifteen primary school children infected with soil-transmitted helminths were divided into 5 groups. Three groups were treated with 25, 50 and 75 mg mebendazole (MBZ) single dose. One group was given MBZ conventional dose of 100 mg twice daily for 3 days and another group was given albendazole (ABZ) standard dose of 400 mg single dose. Every trial lower MBZ dose 75 mg, 50 mg and 25 mg regimen were highly effective against Ascaris lumbricoides but only moderately effective against Trichuris trichiura and Necator americanus.

Routine use of mebendazole in pregnancy.

INTRODUCTION: The Ministry of Health has recommended the routine administration of a broad spectrum anthelmintic to all pregnant women after completion of the first trimester of pregnancy. OBJECTIVE: To estimate prevalence and intensity of geohelminth infections in pregnant women attending an antenatal clinic in Ragama and determine the use of anthelmintics by them. METHODS: Women on their first visit to antenatal clinics of the University Obstetrics Unit, General Hospital Colombo North, Ragama, during July-August 1995, were recruited for the study. Demographic details, duration of pregnancy and a history of using anthelmintics during the current pregnancy were noted. A stool sample was obtained and examined using modified Kato-Katz technique. RESULTS: 309 pregnant women were studied [mean age 26.6 years (SD 5.3)]. 94 (30.4%) had taken an anthelmintic during the current pregnancy. 78 (25.2%) had taken it in the second trimester, 9 (2.9%) in the third, 6 (1.8%) in the first, and one was uncertain of the timing. Stool samples were obtained from 181 women giving a compliance rate of 58.6%. Prevalence of geohelminth infections were: whipworm 10%, hookworm 2.2%, roundworm 1.1%. The intensities of the infections were mild. 157 (86.7%) did not have any geohelminth infection. Of the 181 women whose stools were examined, 52 had taken an anthelmintic. There was no significant difference in the prevalence of geohelminth infections between this group (6/52; 11.2%) and those who had not taken an anthelmintic (18/129; 13.9%) (Chi-square test). CONCLUSION: It may not be necessary to treat all pregnant women in Sri Lanka with anthelmintics, as some areas have a low prevalence of infection. Routine anthelmintic therapy could-be limited to areas where prevalence rates are known to be high.

The efficacy of three anthelmintic drugs given in a single dose.

OBJECTIVE: To compare the efficacy of a single dose mebendazole 500 mg from the original manufacturer and a formulation locally produced by State Pharmaceuticals Manufacturing Corporation of Sri Lanka and albendazole 400 mg in mass treatment of soil-transmitted nematode infections. DESIGN: Randomised trial. SETTING: Government owned plantations in low-country regions of Sri Lanka with poor sanitary facilities. SUBJECTS: 399 children 3 to 15 years of age infected with at least one type soil-transmitted nematode. INTERVENTION: Mebendazole 500 mg or albendazole 400 mg given as single dose treatment. MEASUREMENTS: Cure rates and egg reduction rates calculated from egg counts of pre- and post-treatment stool samples using the quantitative Kato-Katz technique. RESULTS: All three drugs were effective against Ascaris infection with cure rates above 95%. The efficacy against Trichuris trichuria was uniformly poor. For hookworm infection albendazole appeared to be more effective in a single dose with cure rates of 77.9% compared with 28.7% and 35.8% for the two mebendazole formulations; corresponding egg reduction rates were 95.4% compared with 72.0% and 74.5%. CONCLUSION: Albendazole is the drug of choice for mass deworming where hookworm disease is prominent. There was no statistically significant difference between the original and locally produced mebendazole.

Alopecia areata universalis following high dose mebendazole therapy for hydatid disease

Alopecia following mebendazole treatment, is considered to be rare and self-limited. We found this complication in 3 of a total of 57 patient during a 7 year period from 1989 to 1995. Their hair regrew, but its color and quality changed somewhat and remained so for at least one year in 2 patients. The third patient died earlier

Estudio comparativo de la eficacia terapéutica del mebendazol a dósis única versuss mebendazol a dósis convencional en una población escolar de Pedro Vicente Maldonado, 1995

Fueron seleccionados 40 pacientes al azar de un grupo de niños escolares de los dos sexos, que acudieron al subcentro de salud de Pedro Vicente Maldonado para controll rutinario de peso y talla. A todos se les realizó un examen coproparasitario seriado a los ocho y quinde días. El 100 por ciento de los 40 pacientes tuvieron resultados positivos, siendo el parásito más frecuentemente encontrado el ascaris lumbricoides, anquilostoma duodenale y tricocéfalos. Se les dividió en dos subgrupos al azar. Al grupo I n=20, se le administró mebendazol en dósis única de 600 mg y al grupo II n=20, 100 mg BID durante 3 días. Se evaluó con examen coproparasitario el efecto terapéutico del mebendazol a los ocho y quince días. No existieron direrencias significativas en los porcentajes de negativización parasitológica entre ambos grupos. Los efectos colaterales de los que recibieron la monodósis fueron casi nulos...

Evaluation of hookworm control program in southern Thailand.

An intensive hookworm control program providing the rural population of southern Thailand with mass treatment with 300 mg Mebendazole and health education commenced in 1989 with a yearly budget of over US$ 1.2 million. The current research aimed to evaluate the coverage of health education and mass treatment, the effectiveness of mass treatment and the administrative process of the control program, two years after its commencement. This evaluation consisted of three studies. In the first study, 120 villages were randomly selected, from which 840 school children, 843 adults aged between 15-59 and 844 subjects aged over 60 years were interviewed to assess awareness of hookworm, latrine availability, receipt of and compliance with antihelminthics provided, and self-treatment. In the second study, 8 villages from each of the 14 provinces were randomly chosen. Stool samples from randomly selected 4,434 subjects were examined. The third study consisted of interviewing key health planners in Bangkok and 71 health officers/workers from 32 samples villages of 8 sampled provinces. Latrine availability was 80%. Percentages of subjects who had ever heard of hookworm ranged from 70 to 95 in school children, 55 to 80 in adults and 25 to 58 in the older age group. While 63 to 85% had latrines in their homes, 27% to 47% admitted defecation outside in the past month. Percentages of coverage of drug treatment ranged from 82 to 91 in school children, 68 to 80 in adults and 54 to 59 in the older age group.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative study on the efficacy of albendazole and mebendazole in the treatment of ascariasis, hookworm infection and trichuriasis.

A comparative study of the efficacy of albendazole and mebendazole was carried out in Pattani Province in the southern part of Thailand. One hundred and ninety-six patients with single or multiple infections with Ascaris, hookworm, and Trichuris were randomized into 4 groups for different treatments. Stool examination by Kato-Katz technique were done before and on day 14 after treatment. Results of the study showed that (1) a single dose of 300 mg mebendazole (locally produced) resulted in cure rates of 50%, 0% and 0% and egg reduction rates of 87.3%, -15.3%, and 28.3%, for ascariasis, hookworm infection and Trichuris respectively; (2) a single dose of 300 mg mebendazole (original) resulted in cure rates of 100.0%, 9.1%, and 43.3%, and egg reduction rates of 100.0%, 72.0%, and 77.9%, for Ascaris, hookworm, and Trichuris respectively; (3) a single dose 500 mg mebendazole (original) resulted in cure rates of 100.0%, 30.2%, and 70.3%, and egg reduction rates of 100.0%, 70.4% and 89.9%, for Ascaris, hookworm, and Trichuris respectively and (4) a single dose of 400 mg albendazole (original) resulted in cure rates of 100.0%, 84.3%, and 67.4%, and egg reduction rates of 100.0%, 96.0% and 87.0%, for Ascaris, hookworm, and Trichuris respectively. Both mebendazole and albendazole are safe and no side effects were observed. The results of this study suggested that albendazole is the preferred benzimidazole derivative for mass treatment of multiple infections with Ascaris, hookworm, and Trichuris.

Efficacy of single-dose mebendazole, polymorphic forms A and C, in the treatment of hookworm and Trichuris infections.

A therapeutic trial of single mebendazole, 300 mg polymorph A, 300 mg polymorph C and 500 mg polymorph C, in the treatment of hookworm and Trichuris infections was carried out at primary schools in Southern Thailand. The total of 958 children were randomly allocated in seven treatment groups including the placebo control and the standard dose control (100 mg polymorph C bid for 3 days). The egg reduction rates and the cure rates of 300 mg and 500 mg polymorph C were similar, but inferior to those of the standard dose in both hookworm and Trichuris infections. The efficacy of single dose 300 mg polymorph A was not different from that of the placebo control (alpha = 0.05) in both infections.