Materiały źródłowe

• #1 Clinical Care of Schistosomiasis | Schistosomiasis | CDC

  https://www.cdc.gov/schistosomiasis/hcp/treatment/index.html

  Praziquantel is effective at treating infections with all major Schistosoma species. […] The timing of treatment is important since praziquantel is most effective against the adult worm and requires the presence of a mature antibody response to the parasite. […] For travelers, treatment should occur at least 6 to 8 weeks after last exposure to potentially contaminated freshwater. […] Thus, praziquantel remains the drug of choice for treatment of schistosomiasis. […] The immune response in lightly infected patients may be less robust and repeat treatment may be needed after 2 4 weeks to increase effectiveness. […] If the pre-treatment stool or urine examination was positive for schistosome eggs, follow up examination at 1 2 months post-treatment is suggested to help confirm successful cure.

• #1 Schistosomiasis (Bilharzia) Medication: Anthelmintics

  https://emedicine.medscape.com/article/228392-medication

  Praziquantel is usually well tolerated. It is used for the treatment of individual patients and for mass community treatment programs. The drug’s mechanism of action is complex; it induces ultrastructural changes resulting in increased permeability to calcium ions. Calcium ions accumulate in the parasite cytosol, leading to muscle contractions and ultimate paralysis of adult worms. The worm’s tegument membrane (the natural covering of the worm body) is damaged, exposing the worm to the patient’s immune response, which leads to worm death. The cure rate with praziquantel is 85% or greater. In persons not cured, the egg burden is markedly decreased. […] Oxamniquine is no longer available in the United States. Its mechanism of action is complex. The drug is metabolized into an ester by schistosomes. It damages the tegument of male schistosome worms so that the patient’s immune system is able to kill the organisms. It also stops female worms from producing eggs. Oxamniquine is effective only against S mansoni. The cure rate with the drug is 60-90%.

• #1 Therapeutic and prophylactic drug interventions for Schistosomiasis japonicum

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6513098/

  To assess the effects of different dosing regimens of praziquantel in terms of clinical cure, parasitological cure, and parasite egg reduction. […] To assess the effects of artemisinin derivatives compared to praziquantel alone or in combination, in terms of clinical cure, parasitological cure, and parasite egg reduction. […] To assess the effects of praziquantel and artemisinin derivatives, alone or in combination, in preventing S. japonicum infections among at risk population groups. […] Praziquantel is the recommended drug of choice for the treatment of acute and chronic schistosomiasis in adults and children. […] The usual dose is 60 mg/kg body weight for one day in two to three divided doses at four, six or eight hour intervals. […] Praziquantel is generally well tolerated, with adverse effects occurring more frequently with the single dose regimens.

• #1 Schistosomiasis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/trematodes-flukes/schistosomiasis

  Treatment is with praziquantel. […] Single-day oral treatment with praziquantel (20 mg/kg twice a day for S. haematobium, S. mansoni, and S. intercalatum; 20 mg/kg 3 times a day for S. japonicum and S. mekongi) is recommended. […] Praziquantel is effective against adult schistosomes, but not developing schistosomula, which are present early in infection. […] For asymptomatic travelers who have had exposure in potentially contaminated fresh water, treatment is delayed for 6 to 8 weeks after the last exposure. […] Adverse effects of praziquantel are generally mild and include abdominal pain, diarrhea, headache, and dizziness. […] Treatment of acute schistosomiasis (Katayama fever) is based on limited data. […] Corticosteroids can ameliorate severe symptoms; treatment with prednisone 20 to 40 mg daily for 5 days in adults is usually effective.

• #1 Schistosomiasis (Bilharzia) Treatment & Management: Approach Considerations, Corticosteroids, Outpatient Care

  https://emedicine.medscape.com/article/228392-treatment

  Prehospital care should include treating acute complications, such as acute intestinal bleeding. Stabilize patients who have acute complications. If appropriate, include schistosomiasis as one of the differential diagnoses. […] Patients should receive antischistosomal drugs and corticosteroids, especially if acutely ill. Steroids reduce inflammation and help suppress changes that result from killing of the parasites. As maturing schistosomes are less susceptible to therapy than adult worms, a second course of treatment is necessary. This is given several weeks after the first course of therapy. […] The drug of choice for treating all species of schistosomes is praziquantel. Cure rates of 65-90% have been described after a single treatment with praziquantel. In individuals not cured, the drug causes egg excretion to be reduced by 90%.

• #1 Praziquantel is an effective drug for the treatment of Schistosoma Mansoni infection among school-aged children in Northwest Ethiopia | Tropical Medicine and Health | Full Text

  https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-020-00204-z

  Praziquantel is the appropriate drug for the treatment of schistosomiasis. […] The aim of this study was to evaluate the effectiveness of praziquantel for Schistosoma mansoni treatment. […] After 4 weeks of administration of praziquantel, the cure rate was 86.9% with egg reduction rate of 78.3%. […] Praziquantel is an effective drug for the treatment of S. mansoni. […] This high prevalence of S. mansoni requires mass drug administration of praziquantel. […] For this study, praziquantel (PZQ) is the appropriate drug of choice due to its safety, low cost, patient compliance, and effective treatment for all five schistosome species. […] Currently, the drug is administered at the standard single oral dose of 40mg/kg body weight and is the mainstay drug recommended by WHO for chemo-preventive therapy. […] The overall CR of S. mansoni infected individuals was 86.9% 4 weeks post-treatment. […] Overall, high prevalence of S. mansoni infection in Elementary school children was observed. In this study, praziquantel showed a CR of 86.9% and an overall ERR of 78.6% 4 weeks post-treatment.

• #1 Efficacy of single dose praziquantel against Schistosoma mansoni in East Africa: a systematic review and meta-analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-84621-8

  PZQ treatment produced normal cure rates (78-88%) for individuals from the area temporarily living in an urban area without transmission, with re-treatment after three weeks for those from the area who were not cured. […] In Ethiopia, S. mansoni infections had a pooled cure rate of 89.2% with 40 mg/kg PZQ. […] PZQ pooled cure rate was determined to be 86.65%. […] In the present review, the efficacy of PZQ against S. mansoni from 2000 to 2007 and 2008-2015 years against S. mansoni were 72.3% and 77.1%, respectively according to WHO guideline. […] In contrast, the efficacy of PZQ against S. mansoni from 2016 to 2023 years, was 91.4%, which is satisfactory efficacious against S. mansoni. […] In East Africa, the efficacy of PZQ against S. mansoni infection is decreases from the standard. PZQ is found to be highly efficient against S. mansoni in Ethiopia and Rwanda, but less effective against S. mansoni in Kenya, Tanzania, and Uganda based on the WHO cut off value. Therefore, utilizing re-doses PZQ and periodic efficacy evaluation might be important in East African countries like Ethiopia and Rwanda.

• #1 Schistosomiasis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/22631-schistosomiasis

  Schistosomiasis is treated with the prescription medication praziquantel (Biltricide). The drug, provided in pill form, belongs to a class of medications called anthelmintics. These types of drugs kill worms. […] You should take praziquantel with water and food. It’s usually taken for one day, either as a single larger dose, or three smaller doses in one day. […] You may have side effects from the infection itself or from the medication and the worms dying off, or both. These might include: Headache. Fever. Stomach pain or nausea. Dizziness. Itching. Malaise (just not feeling well). […] If you are treated, you can expect to be cured. If you live in a location where these parasites are active, you’ll need to take care to avoid freshwater bodies of water that may be infected. You can be infected again. There’s no vaccine to prevent infection.

• #1 Clinical Care of Schistosomiasis | Schistosomiasis | CDC

  https://www.cdc.gov/schistosomiasis/hcp/treatment/index.html

  Oral praziquantel is available for human use in the United States. […] However, this drug has been distributed widely in mass drug administration programs and the World Health Organization (WHO) now recommends that children at least 2 years of age and women who are pregnant should be treated as part of those campaigns based on extensive experience with the drug and review of the veterinary and human evidence. […] Similarly, WHO reports growing evidence that infected children as young as 1-year-old can be effectively treated with praziquantel without serious side effects. […] Praziquantel is a pregnancy category B drug. […] In MDA campaigns for which the World Health Organization (WHO) has determined that the benefit of treatment outweighs the risk, WHO encourages the use of praziquantel in any stage of pregnancy.

• #1 Schistosomiasis (Bilharzia) Treatment & Management: Approach Considerations, Corticosteroids, Outpatient Care

  https://emedicine.medscape.com/article/228392-treatment

  Praziquantel can be used in pregnant and lactating individuals. […] Treatment of schistosomiasis affecting the CNS consists of praziquantel with glucocorticoids. In CNS disease, corticosteroids are used to reduce inflammation and edema around eggs. […] Surgical care includes removal of tumor masses, ligation of esophageal varices, and porta-caval shunt surgeries. […] The symptoms of Katayama syndrome often require administration of corticosteroids to suppress the inflammatory process, but no consensus exists regarding proper antihelminthic treatment. […] Persons with CNS involvement should be given corticosteroids to prevent inflammation and edema around eggs. […] Response to treatment is evaluated by counting the amount of decrease in egg excretion. […] WHO recommends giving praziquantel to pregnant and lactating individuals to decrease the disease burden and improve the pregnancy and fetal outcomes.

• #1 Neuroschistosomiasis

  https://practicalneurology.com/articles/2020-may/neuroschistosomiasis

  Mr. M was admitted to the hospital, and on the third day of his stay, while awaiting further testing, methylprednisolone 1 g/day was started empirically and continued for 5 days with no improvement in neurologic symptoms. […] Mr. M was readmitted and treated with a 5-day course of praziquantel 50 mg/kg/day in 3 divided doses, 7 days of intravenous (IV) methylprednisolone 15 mg / kg, and then a 4-week prednisone taper for presumptive neuroschistosomiasis. […] Although established treatment regimens exist for more common manifestations of systemic schistosomal infection (eg, swimmers itch and Katayama fever), there are no consensus guidelines or randomized controlled trials for the treatment of neuroschistosomiasis. […] Praziquantel is the antiparasitic of choice for schistosomiasis because of a reported cure rate of 70% to 90% for parasitic infections.

• #1 Schistosomiasis. Bilharzia

  https://dermnetnz.org/topics/schistosomiasis

  All individuals with schistosomiasis should receive treatment even if they are symptom-free. […] The anthelmintic, praziquantel, is the drug most commonly used worldwide for the treatment of schistosomiasis (but is not registered in New Zealand). […] Severe Katayama fever may require treatment with systemic corticosteroids to manage the acute hypersensitivity reaction. Praziquantel is less effective for Katayama fever and can worsen symptoms due to antigen release. It may be useful to either delay treatment with praziquantel therapy or co-administer with corticosteroids and give a second course of praziquantel after 3-6 months.

• #1 Schistosomiasis (Bilharzia) Medication: Anthelmintics

  https://emedicine.medscape.com/article/228392-medication

  The aim of chemotherapy is 2-fold. The first goal is to cure the disease or at least minimize morbidity. The second goal is to control transmission of the parasite in the endemic areas. Praziquantel and oxamniquine (no longer available in the United States) commonly are used, but praziquantel is the treatment of choice for all species of schistosomiasis. Clinical studies show that artemether, which is used as antimalarial treatment, is active against all 3 major schistosome parasites (mainly schistosomula). […] In addition, the combination of artemether and praziquantel can kill schistosomula during the first 3 weeks of infection and is synergistic with praziquantel in killing adult worms. […] The high efficacy of mefloquine-artesunate against S haematobium warrants further investigation. Individuals co-infected with Plasmodium and Schistosoma who are treated with a mefloquine-artesunate combination against malaria may experience a dual benefit: clearance of malaria parasitemia and reduction of schistosomiasis-related morbidity.

• #1 Treatment of Schistosoma mansoni with miltefosine in vitro enhances serological recognition of defined worm surface antigens | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005853

  Miltefosine, an anti-cancer drug that has been successfully repositioned for treatment of Leishmania infections, has recently also shown promising effects against Schistosoma spp targeting all life cycle stages of the parasite. […] This study reveals a novel mode of action of miltefosine as an anti-schistosome agent. […] Miltefosine, a repurposed anti-cancer drug for treatment of Leishmania infection, was shown to have activity against Schistosoma in animal models at all the parasites life cycle stages. […] The current study examined the effect of treating Schistosoma mansoni adult worms with miltefosine on exposure of worm surface antigens in vitro. […] Recent studies by Eissa et al. demonstrated significant effectiveness of miltefosine against Schistosoma mansoni (S. mansoni) and Schistosoma haematobium in vitro and against different developmental stages of S. mansoni in vivo.

• #1 Treatment of Schistosoma mansoni with miltefosine in vitro enhances serological recognition of defined worm surface antigens | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005853

  The drug exhibited an advantage over PZQ by clearing the infection at the invasive, immature and adult parasite stages. […] The efficacy of alkyl-phospholipids was reported earlier to depend on the drugs contact time with the cell membrane, which could last for days. […] Miltefosine was conversely found to have lower effects on the S. mansoni strain LE in a study by Yepes et al. at the same doses we tested, though interestingly, the authors demonstrated a higher susceptibility to PZQ than that reported here. […] The present data showed that miltefosine is effective in vitro against adult worms of a Puerto Rican isolate of S. mansoni at concentrations of 10-40 g/ml within 24-96 hours. […] The schistosomicidal effects of miltefosine progressed slowly over 96 hours of incubation of the worms and were intensified using higher concentrations of the drug, consistent with earlier findings.

• #1 Therapeutic and prophylactic drug interventions for Schistosomiasis japonicum

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6513098/

  Use of artemisinin derivatives in combination with praziquantel is especially attractive given the rising issue of decreased susceptibility of schistosome parasites to praziquantel. […] Randomized controlled trials on the efficacy of combination praziquantel plus artemether versus praziquantel alone for the treatment of S. japonicum infection have been done in China. […] Schistosomiasis prevention and control are directed towards the reduction of disease prevalence, morbidity, and disease transmission. […] Mass drug administration or preventive (anthelminthic) chemotherapy is the use of anthelminthic drugs, either alone or in combination, as a public health tool. […] Current issues have been raised regarding the use of praziquantel to treat schistosomiasis. […] The threat of drug resistance emergence, and the limited efficacy of praziquantel against newly acquired infection and immature schistosomes has spurred interest in developing treatment alternatives, including the use of combination of drugs incorporating praziquantel.

• #1 A Recent Advance in the Diagnosis, Treatment, and Vaccine Development for Human Schistosomiasis

  https://www.mdpi.com/2414-6366/9/10/243

  Besides PZQ, antimalarial artemisinin derivatives are also effective against immature larval forms of schistosomes. One major drawback of this drug is that it is not known how much time a cercaria has to be exposed to the drug for enhanced effectiveness. However, a combination of PZQ+ antimalarial artemisinin has shown higher effectiveness and a rate of cure against schistosomiasis. One study used a combination of PZQ with dihydroartemisinin-piperaquine (DHP), which demonstrated superior effectiveness, significantly increasing systemic PZQ exposure and potentially improving treatment efficacy. […] Furthermore, snail management could also be one of the preventive measures to lower the transmission of schistosomiasis, which is possible by using linalool or Cinnamomum camphora (L) extracts. Linalool-treated snails developed gill disintegration and cell degradation, so it is also used for the treatment of S. japonicum infection. Recently, several attempts were made in which instead of a single drug, a combination of drugs was administered to the patient against schistosomiasis. For instance, in a study, PZQ + moxidectin was given against both S. mansoni and S. haematobium infections. Both drugs have different modes of action against parasitic worms, where the former damages the worm’s tegument, which exposes it to the host’s immune system and leads to its expulsion, while the latter interferes with the worm’s nervous system, causing paralysis and death. The combined regime was well tolerated and effective, and it was found that such a combination could offer a broader spectrum of activity against different Schistosoma species.

• #1 A Recent Advance in the Diagnosis, Treatment, and Vaccine Development for Human Schistosomiasis

  https://www.mdpi.com/2414-6366/9/10/243

  In another study, artesunate-based regimens were used for the treatment of schistosomiasis, where a promising result was obtained for artesunate–PZQ against S. mansoni. In another study, artesunate–mefloquine was effectively used for the treatment of S. haematobium infection. Several investigators suggested alternative delivery methods of the current drugs for their enhanced effect. For instance, in a study, PZQ was given intradermally to a patient. The result showed good tolerability and potential for improved adherence compared to oral administration. In another study, investigators used long-acting injectable (LAI) PZQ formulations and suggested that such formulations could simplify treatment regimens and improve adherence by providing sustained drug release over extended periods, particularly in mass drug administration programs.

• #1 Schistosomiasis (Bilharzia) Treatment & Management: Approach Considerations, Corticosteroids, Outpatient Care

  https://emedicine.medscape.com/article/228392-treatment

  Cases of Pulmonary schistosomiasis have resolved completed on praziquantel treatment. […] Antischistosomal drugs inhibit egg-laying by adult worms. Therefore, patients stool and urine should be tested for 6 months after treatment. Treatment is repeated for those excreting eggs. […] No vaccine or prophylactic chemotherapy for schistosomiasis is available. However, clinical trials involving human volunteers are underway to develop an effective vaccine against schistosomiasis. […] Travelers to endemic areas should avoid contact with fresh water. […] Topical lipid formulations of N,N-diethyl-m-toluamide (DEET), such as LipoDEET, are effective in killing schistosome cercariae. […] Population-based preventive chemotherapy – WHO recommends preventive chemotherapy for at-risk populations in endemic areas.

• #1 Schistosomiasis – Wikipedia

  https://en.wikipedia.org/wiki/Schistosomiasis

  Other possible treatments include a combination of praziquantel with metrifonate, artesunate, or mefloquine. A Cochrane review found tentative evidence that when used alone, metrifonate was as effective as praziquantel. Mefloquine, which has previously been used to treat and prevent malaria, was recognised in 2008-2009 to be effective against schistosomes. […] Post-treatment monitoring Osteopontin (OPN) is a promising tool for monitoring praziquantel efficacy and post-treatment fibrosis regression as (OPN) expression is modulated by S. mansoni egg antigens and its levels correlate with the severity of schistosomiasis fibrosis and portal hypertension in mice and humans. Praziquantel pharmacotherapy reduces systemic OPN levels and liver collagen content in mice.

• #1 Schistosomiasis (Snail Fever) Causes, Symptoms, Treatment, Diagnosis, Prevention

  https://www.medicinenet.com/schistosomiasis/article.htm

  Ocular schistosomiasis should not be treated with this praziquantel. Other organs with heavy parasite infections may not function well and require supportive care until the hyperimmune response abates after drug administration. Other drugs (oxamniquine, metrifonate, artemisinins, and trioxolanes) have been used in some patients but have limited effectiveness. New drugs are in development. Infectious disease specialists, ophthalmologists, and surgeons may treat someone with a schistosomiasis infection. […] Surgical care may include removal of tumor masses, ligation of esophageal varices, shunt surgeries, and granuloma removal.

• #1 Schistosomiasis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/schistosomiasis-pro

  Emergency treatment may be required for acute complications – eg, acute intestinal bleeding. […] Endoscopy and sclerotherapy can treat oesophageal varices. A ventriculoperitoneal shunt and corticosteroids are required to treat hydrocephalus and raised intracranial pressure in cerebral schistosomiasis.

• #1 Schistosomiasis in children: a major public health problem | Pediatric Praziquantel Consortium

  https://www.pediatricpraziquantelconsortium.org/what-we-do/schistosomiasis-children-major-public-health-problem

  Preschool-age children have a high risk of infection with schistosomiasis, and there is a pressing need to treat them. […] An estimated 50 million preschool-age children are at risk of schistosomiasis. It’s essential to treat this high-risk group as an early childhood development intervention against accumulated morbidities. […] The existing drug of choice for the treatment of schistosomiasis is praziquantel, developed in the 1970s. A WHO-recommended global strategy to control schistosomiasis already exists: preventive chemotherapy involves yearly administration of praziquantel to entire populations at risk. […] More importantly, an appropriate treatment with praziquantel for these children using the optimal dosing, and that encourages compliance, does not yet exist. […] The Pediatric Praziquantel Consortium has developed a potential new treatment option that is suitable for preschool-age children, 3 months to 6 years of age. The new treatment option is a small (150 mg), dispersible or orodispersible tablet with an acceptable taste.

• #1 Safety, efficacy and acceptability of praziquantel in the treatment of Schistosoma haematobium in pre-school children of Kwale County, Kenya | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006852

  The recommended strategy for control of schistosomiasis is preventive chemotherapy with praziquantel (PZQ). […] 400 PSC were enrolled, from 10 randomly selected ECDE Centers in Kwale County, Kenya where children were treated with crushed PZQ tablets mixed with orange juice, at a single dose of 40 mg/kg. […] The study revealed that crushed PZQ is safe and effective in the treatment of urogenital schistosomiasis in this age group. It is therefore recommended that PZQ should be administered to the PSC in Kwale County. […] Control of schistosome infections is through treatment of infected people with a single dose of the anti-helminth drug praziquantel (PZQ) which is safe, highly efficacious, and can reverse schistosome-related morbidity particularly in the early stages of disease progression.

• #1 New WHO guidelines for schistosomiasis | Pediatric Praziquantel Consortium

  https://www.pediatricpraziquantelconsortium.org/what-we-do/new-who-guidelines-schistosomiasis

  In endemic communities with prevalence of schistosoma infection of more than 10%, annual preventive chemotherapy should take place with a single dose of praziquantel with more than 75% treatment coverage in all age groups from 2 years old. […] Health facilities need to provide access to treatment with praziquantel to control morbidity due to schistosomiasis in all infected individuals regardless of age, including infected pregnant and lactating women (excluding the first trimester) and preschool-age children.

• #1 Schistosomiasis – Wikipedia

  https://en.wikipedia.org/wiki/Schistosomiasis

  Schistosomiasis is treatable by taking a single dose of the drug praziquantel by mouth annually. […] Praziquantel eliminates the adult schistosomes but does not kill the eggs and immature worms. Live eggs can be excreted by the infected individuals for weeks after treatment with praziquantel. The immature worms can survive and grow into adult schistosomes after praziquantel therapy. Thus, it is important to have repeated schistosomiasis testing of the stool and/or urine around 4-6 weeks after praziquantel therapy. Praziquantel treatment may be repeated to ensure complete parasite elimination. […] The WHO has developed guidelines for community treatment based on the impact the disease has on children in villages in which it is common: […] When a village reports more than 50 percent of children have blood in their urine, everyone in the village receives treatment. […] When 20 to 50 percent of children have bloody urine, only school-age children are treated. […] When fewer than 20 percent of children have symptoms, mass treatment is not implemented.

• #1 Schistosomiasis Treatment | NIAID: National Institute of Allergy and Infectious Diseases

  https://www.niaid.nih.gov/diseases-conditions/schistosomiasis-treatment

  Praziquantel is the only drug available to treat schistosomiasis and has been used for decades in mass administration programs targeting entire populations. […] The lack of alternatives to praziquantel is a concern because the parasites could develop resistance to the drug, resulting in no effective treatment for schistosomiasis. […] Information gained could be used to develop new and improved treatments that disrupt similar protein receptors in schistosome flatworms. […] Additional screens will be used to separate out those compounds that are the most potent, specific and safe, and that could serve as the basis for new drug therapies. […] They are now applying the technique to synthesizing proteasome inhibitors that act against S. mansoni parasites.

• #1 Drug-Resistant Schistosomiasis: Resistance to Praziquantel and Oxamniquine Induced in Schistosoma Mansoni in Mice is Drug Specific in: The American Journal of Tropical Medicine and Hygiene Volume 51 Issue 1 (1994)

  https://www.ajtmh.org/abstract/journals/tpmd/51/1/article-p83.xml

  Schistosoma mansoni infections in mice were treated with subcurative multiple doses of either praziquantel (PZQ) or oxamniquine (OX). […] Eighty percent of the worms of the sixth passage selected for PZQ resistance survived three doses of 300 mg/kg of PZQ given between days 28 and 37 after infection, and 93% of those of the seventh passage survived the same drug dose. […] Therefore, the results indicate that S. mansoni subjected to drug pressure may develop resistance to schistosomicidal drugs over the course of relatively few passages, but that cross-resistance between PZQ and OX does not occur. […] This is the first demonstration of drug resistance to PZQ, the current drug of choice for human schistosomiasis.

• #1 SciELO Brasil – Therapeutic failure of praziquantel in the treatment of Schistosoma haematobium infection in Brazilians returning from Africa Therapeutic failure of praziquantel in the treatment of Schistosoma haematobium infection in Brazilians returnin

  https://www.scielo.br/j/mioc/a/BBrVJ4gCZrQygVmcVF3JZcQ/

  Several cases of therapeutic failure of praziquantel used for the treatment of urinary schistosomiasis have been reported. […] In this study, we demonstrated a low efficacy of praziquantel in the treatment of schistosomiasis haematobia, and the necessity of the urinary bladder biopsy as criterion of cure. […] Nevertheless, failure of praziquantel treatment of various proportions has been reported. […] The aim of this study is to evaluate the efficacy of praziquantel in infected individuals who visited endemic areas, and swam in the Licungo river (Mozambique, Africa). […] The first control cystoscopy performed 6 months post-treatment with a single dose of 40 mg/kg praziquantel showed the following results: presence of granulomas in 46.2% (12/26) of the individuals and absence of granulomas in 53.8% (14/26).

• #1 A Recent Advance in the Diagnosis, Treatment, and Vaccine Development for Human Schistosomiasis

  https://www.mdpi.com/2414-6366/9/10/243

  Few investigators optimized the existing regimens of the drugs against schistosomiasis, like single versus multiple PZQ doses, where the investigators compared the efficacy and economics of single versus multiple PZQ doses for different Schistosoma spp. and infection intensities. Increasing the dose to 80 mg/kg or administering multiple doses can enhance treatment outcomes, particularly in preschool-aged children, where the standard dose may be insufficient. Some of the investigators optimized the treatment timing and integration with other interventions (water sanitation and hygiene programs). Research is exploring the optimal timing of treatment for schistosomiasis, as well as its integration with other interventions, to maximize impact and prevent reinfection. […] In some of the most recent attempts, new treatment options were explored against schistosomiasis, which includes synthesizing next-generation PZQ derivatives for the treatment of schistosomiasis. Such modified versions of the PZQ have improved efficacy and potentially longer-lasting effects against various types of schistosomes.

• #1 University of Illinois Chicago

  https://pharmacy.uic.edu/news-stories/new-treatment-schistosomiasis/

  A team of UIC College of Pharmacy scientists along with their collaborators at Rush University, the University of LAquila, the University of Grenoble Alpes, and University of Arizona have discovered a novel approach for the treatment of schistosomiasis, which is considered the second most socially and economically devastating parasitic disease after malaria. […] The only drug currently available to treat schistosomiasis, Praziquantel, has a relatively low cure rate (often less than 50%), doesnt prevent reinfection, and is ineffective against juvenile parasites. […] In a new paper in Nature Communications, the team of scientists outline a promising new treatment that targets a specific enzyme (thioredoxin glutathione reductase) essential for the parasites survival inside the human host.

• #1 Botanical Products in the Treatment and Control of Schistosomiasis: Recent Studies and Distribution of Active Plant Resources According to Affected Regions

  https://www.mdpi.com/2079-7737/9/8/223

  Despite the historical use of these schistosomicides, side effects such as metallic taste in the mouth, abdominal pain, diarrhea, asthenia, headache, dizziness, decreased therapeutic efficacy, and resistance have been reported. […] The control of the malacological population is an alternative way to prevent parasitic diseases that have mollusks in the life cycle of the parasite. The practice of combating natural breeding sites of intermediate hosts through the use of molluscicides has been one of alternative ways to decrease the incidence of some diseases such as schistosomiasis. […] Clinical treatment, prophylaxis, and prevention are performed in countries susceptible to schistosomiasis. In many cases, prevention methods such as reducing Schistosoma intermediate hosts (Biomphalaria and Oncomelania, for example) are important in controlling the disease, when combined with other strategies, such as the improvement of water sanitation, education, and access to clean water. […] Given the limitation in available resources and the fact that there is no available vaccine for this disease, there is a dire need to develop alternative medicines that are both cost-effective and treatment-effective for this disease.

• #1 Strategies and achievements in controlling and eliminating schistosomiasis from Egypt | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-024-00339-2

  Despite the presence of hot spots transmission foci with a 10% incidence rate in 2006, the number of hot spots increased to 136 in 2010, then reduced to 88 in 2013. […] For moving forward, sustained commitment and funding are crucial to maintain achievements and tackle remaining challenges. […] An integrated control strategy that combines preventive chemotherapy with additional complementing interventions is necessary to eliminate schistosomiasis in hotspots. […] Finally, Egypt can achieve its goal of schistosomiasis elimination by continuous health awareness, mass treatment of patients, and vaccine development can cut the Schistosoma life cycle and write a fitting end for this dramatic story in Egypt.

• #1 Schistosomiasis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-018-0013-8

  Schistosomiasis elimination will require a multifaceted approach, including: treatment; snail control; information, education and communication; improved water, sanitation and hygiene; accurate diagnostics; and surveillance-response systems that are readily tailored to social-ecological settings. […] The anti-schistosomal drug praziquantel is safe and efficacious against adult worms of all the six Schistosoma spp. infecting humans; however, it does not prevent reinfection and the emergence of drug resistance is a concern. […] This systematic review and geostatistical meta-analysis describes the use of advanced Bayesian-based geostatistical modelling to produce high-resolution risk estimates of infection with Schistosoma spp. in sub-Saharan Africa. Additionally, through the use of gridded population estimates, the authors determined the annualized numbers of doses of praziquantel treatment needed to prevent morbidity in sub-Saharan Africa countries for spatial targeting of schistosomiasis control interventions.

• #1 Strategies and achievements in controlling and eliminating schistosomiasis from Egypt | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-024-00339-2

  Schistosomiasis is an old parasitic disease in Egypt primarily caused by Schistosoma mansoni, transmitted through infected water canals, and disproportionately affects rural areas. […] Among the recent control measures: (a) mass drug administration with large-scale, biannual administration of praziquantel, which remains the cornerstone of the control program targeting the interruption of vector transmission cycles. […] The transition from disease control to elimination requires meticulous planning and vigilance. […] Robust surveillance systems, enhanced case management, and continued community engagement are vital for such elimination. […] Strengthening research on drug resistance, snail control methods, and innovative diagnostics would further support elimination efforts. […] Overall, eliminating schistosomiasis can be achieved using a combination of different measures, including improved diagnosis, vector control, proper treatment, vaccination, and raising disease awareness (of patients and decision makers).

• #2 Schistosomiasis: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/schistosomiasis-treatment-and-prevention

  Schistosomiasis: Treatment and prevention […] The treatment and prevention of schistosomiasis will be reviewed here. […] Treatment of schistosomiasis serves three purposes: reversing acute or early chronic disease, preventing complications associated with chronic infection, and preventing neuroschistosomiasis. The goal of treatment is reduction of egg production via reduction of worm load; this reduces morbidity and mortality even in the absence of complete worm eradication. […] In endemic areas, repeated treatment is essential for schistosomiasis elimination. […] Benefits of treatment include reversal of hydronephrosis and regression of periportal fibrosis in its early stage. However, anthelmintic treatment has little effect on reversing late-stage fibrosis of the hepatic or urinary tract or reversing secondary complications such as portal hypertension with esophageal varices or cor pulmonale.

• #2

  https://www.who.int/news-room/fact-sheets/detail/schistosomiasis

  Schistosomiasis control focuses on reducing disease through periodic, large-scale population treatment with praziquantel; a more comprehensive approach including potable water, adequate sanitation, and snail control would also reduce transmission. […] The WHO strategy for schistosomiasis control focuses on reducing disease through periodic, targeted treatment with praziquantel through the large-scale treatment (preventive chemotherapy) of affected populations. […] WHO recommends treatment of infected preschool aged children based on diagnostic and clinical judgment and their inclusion in large-scale treatment using the paediatric praziquantel formulation. […] Praziquantel is the recommended treatment against all forms of schistosomiasis. It is effective, safe and low-cost. […] Schistosomiasis control has been successfully implemented over the past 40 years in several countries, including Brazil, Cambodia, China, Egypt, Mauritius, Islamic Republic of Iran, Oman, Jordan, Saudi Arabia, Morocco, Tunisia and others.

• #2 Schistosomiasis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/trematodes-flukes/schistosomiasis

  Treatment is with praziquantel. […] Single-day oral treatment with praziquantel (20 mg/kg twice a day for S. haematobium, S. mansoni, and S. intercalatum; 20 mg/kg 3 times a day for S. japonicum and S. mekongi) is recommended. […] Praziquantel is effective against adult schistosomes, but not developing schistosomula, which are present early in infection. […] For asymptomatic travelers who have had exposure in potentially contaminated fresh water, treatment is delayed for 6 to 8 weeks after the last exposure. […] Adverse effects of praziquantel are generally mild and include abdominal pain, diarrhea, headache, and dizziness. […] Treatment of acute schistosomiasis (Katayama fever) is based on limited data. […] Corticosteroids can ameliorate severe symptoms; treatment with prednisone 20 to 40 mg daily for 5 days in adults is usually effective.

• #2 Schistosomiases | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/schistosomiases-16689787.html

  An antiparasitic treatment should be administered to reduce the risk of severe lesions, even if there is a likelihood of re-infection. […] praziquantel may be administered to pregnant women. […] S. haematobium, S. mansoni, S. intercalatum: 40 mg/kg single dose or 2 doses of 20 mg/kg administered 4 hours apart […] S. japonicum, S. mekongi: 2 doses of 30 mg/kg or 3 doses of 20 mg/kg administered 4 hours apart.

• #2 Efficacy of single dose praziquantel against Schistosoma mansoni in East Africa: a systematic review and meta-analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-84621-8

  PZQ treatment produced normal cure rates (78-88%) for individuals from the area temporarily living in an urban area without transmission, with re-treatment after three weeks for those from the area who were not cured. […] In Ethiopia, S. mansoni infections had a pooled cure rate of 89.2% with 40 mg/kg PZQ. […] PZQ pooled cure rate was determined to be 86.65%. […] In the present review, the efficacy of PZQ against S. mansoni from 2000 to 2007 and 2008-2015 years against S. mansoni were 72.3% and 77.1%, respectively according to WHO guideline. […] In contrast, the efficacy of PZQ against S. mansoni from 2016 to 2023 years, was 91.4%, which is satisfactory efficacious against S. mansoni. […] In East Africa, the efficacy of PZQ against S. mansoni infection is decreases from the standard. PZQ is found to be highly efficient against S. mansoni in Ethiopia and Rwanda, but less effective against S. mansoni in Kenya, Tanzania, and Uganda based on the WHO cut off value. Therefore, utilizing re-doses PZQ and periodic efficacy evaluation might be important in East African countries like Ethiopia and Rwanda.

• #2 Prevention and control of schistosomiasis: a current perspective | RRTM

  https://www.dovepress.com/prevention-and-control-of-schistosomiasis-a-current-perspective-peer-reviewed-fulltext-article-RRTM

  Of the 78 countries where schistosomiasis is endemic, 52 countries and territories required large-scale treatment for the disease in 2012, comprising treatment for approximately 250 million people. Praziquantel, a pyrazinosoquinolone derivative, is an anthelminthic drug targeting a broad range of parasitic infections, and thus is advocated by the World Health Organization (WHO) for population-based mass chemotherapy. Its anthelminthic activity was discovered in 1972 and it was initially developed for use in animals. Subsequently, it has been shown to be effective against all the various schistosome species known to infect humans and against cestodes, and is well tolerated by humans. Approximately 80% of the drug is rapidly absorbed from the gastrointestinal tract. […] Multicenter trials conducted by the WHO and Bayer found a single dose of 40 mg/kg body weight to be effective against S. haematobium and S. mansoni, and two doses of 30 mg/kg body weight for S. japonicum, with cure rates of 75%100%. Studies of praziquantel against S. mansoni and S. haematobium among schoolchildren, at a dosage of 40 mg/kg body weight, resulted in cure rates of 60.9%88.6% and 39.8%88.9%, respectively.

• #2 Schistosomiasis (Bilharzia) Treatment & Management: Approach Considerations, Corticosteroids, Outpatient Care

  https://emedicine.medscape.com/article/228392-treatment

  Praziquantel can be used in pregnant and lactating individuals. […] Treatment of schistosomiasis affecting the CNS consists of praziquantel with glucocorticoids. In CNS disease, corticosteroids are used to reduce inflammation and edema around eggs. […] Surgical care includes removal of tumor masses, ligation of esophageal varices, and porta-caval shunt surgeries. […] The symptoms of Katayama syndrome often require administration of corticosteroids to suppress the inflammatory process, but no consensus exists regarding proper antihelminthic treatment. […] Persons with CNS involvement should be given corticosteroids to prevent inflammation and edema around eggs. […] Response to treatment is evaluated by counting the amount of decrease in egg excretion. […] WHO recommends giving praziquantel to pregnant and lactating individuals to decrease the disease burden and improve the pregnancy and fetal outcomes.

• #2 Neuroschistosomiasis

  https://practicalneurology.com/articles/2020-may/neuroschistosomiasis

  Mr. M was admitted to the hospital, and on the third day of his stay, while awaiting further testing, methylprednisolone 1 g/day was started empirically and continued for 5 days with no improvement in neurologic symptoms. […] Mr. M was readmitted and treated with a 5-day course of praziquantel 50 mg/kg/day in 3 divided doses, 7 days of intravenous (IV) methylprednisolone 15 mg / kg, and then a 4-week prednisone taper for presumptive neuroschistosomiasis. […] Although established treatment regimens exist for more common manifestations of systemic schistosomal infection (eg, swimmers itch and Katayama fever), there are no consensus guidelines or randomized controlled trials for the treatment of neuroschistosomiasis. […] Praziquantel is the antiparasitic of choice for schistosomiasis because of a reported cure rate of 70% to 90% for parasitic infections.

• #2 Neuroschistosomiasis

  https://practicalneurology.com/diseases-diagnoses/ms-immune-disorders/neuroschistosomiasis/31662/

  Mr. M was readmitted and treated with a 5-day course of praziquantel 50 mg/kg/day in 3 divided doses, 7 days of intravenous (IV) methylprednisolone 15 mg / kg, and then a 4-week prednisone taper for presumptive neuroschistosomiasis. […] Although established treatment regimens exist for more common manifestations of systemic schistosomal infection (eg, swimmers itch and Katayama fever), there are no consensus guidelines or randomized controlled trials for the treatment of neuroschistosomiasis. […] Praziquantel is the antiparasitic of choice for schistosomiasis because of a reported cure rate of 70% to 90% for parasitic infections. […] In addition to praziquantel, steroids are typically administered. […] For our case, we chose 7 days of IV methylprednisolone 15 mg/kg followed by a 4-week prednisone taper, again based on reported regimens outlined in other case reports. […] Surgery is typically reserved for people with neuroschistosomiasis who have severe neurologic symptoms and evidence of CSF flow obstruction.

• #2 Schistosomiasis. Bilharzia

  https://dermnetnz.org/topics/schistosomiasis

  All individuals with schistosomiasis should receive treatment even if they are symptom-free. […] The anthelmintic, praziquantel, is the drug most commonly used worldwide for the treatment of schistosomiasis (but is not registered in New Zealand). […] Severe Katayama fever may require treatment with systemic corticosteroids to manage the acute hypersensitivity reaction. Praziquantel is less effective for Katayama fever and can worsen symptoms due to antigen release. It may be useful to either delay treatment with praziquantel therapy or co-administer with corticosteroids and give a second course of praziquantel after 3-6 months.

• #2 Schistosomiasis

  https://www.rch.org.au/immigranthealth/clinical/Schistosomiasis/

  Treatment is curative in ~ 85%. Treatment is not necessarily effective in treating late stage complications such as oesophageal varices or cor pulmonale. […] Note: Katayama fever – treatment is mainly supportive and may include glucocorticoids (+/- praziquantel or antimalarials). The patient should be retreated with praziquantel 2-3 months later to eliminate any remaining worms. Seek specialist advice.

• #2 Schistosomiasis – Wikipedia

  https://en.wikipedia.org/wiki/Schistosomiasis

  Two drugs, praziquantel and oxamniquine, are available for the treatment of schistosomiasis. They are considered equivalent in relation to efficacy against S. mansoni and safety. Historically, antimony potassium tartrate remained the treatment of choice for schistosomiasis until the development of praziquantel in the 1980s. Because of praziquantel’s lower cost per treatment, and oxaminiquine’s lack of efficacy against the urogenital form of the disease caused by S. haematobium, in general praziquantel is considered the first option for treatment. Praziquantel can be safely used in pregnant women and young children. The treatment objective is to cure the disease and prevent the progression of the acute to chronic form of the disease. All cases of suspected schistosomiasis should be treated regardless of presentation because the adult parasite can live in the host for years.

• #2 Therapeutic and prophylactic drug interventions for Schistosomiasis japonicum

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6513098/

  Use of artemisinin derivatives in combination with praziquantel is especially attractive given the rising issue of decreased susceptibility of schistosome parasites to praziquantel. […] Randomized controlled trials on the efficacy of combination praziquantel plus artemether versus praziquantel alone for the treatment of S. japonicum infection have been done in China. […] Schistosomiasis prevention and control are directed towards the reduction of disease prevalence, morbidity, and disease transmission. […] Mass drug administration or preventive (anthelminthic) chemotherapy is the use of anthelminthic drugs, either alone or in combination, as a public health tool. […] Current issues have been raised regarding the use of praziquantel to treat schistosomiasis. […] The threat of drug resistance emergence, and the limited efficacy of praziquantel against newly acquired infection and immature schistosomes has spurred interest in developing treatment alternatives, including the use of combination of drugs incorporating praziquantel.

• #2 A Recent Advance in the Diagnosis, Treatment, and Vaccine Development for Human Schistosomiasis

  https://www.mdpi.com/2414-6366/9/10/243

  Besides PZQ, antimalarial artemisinin derivatives are also effective against immature larval forms of schistosomes. One major drawback of this drug is that it is not known how much time a cercaria has to be exposed to the drug for enhanced effectiveness. However, a combination of PZQ+ antimalarial artemisinin has shown higher effectiveness and a rate of cure against schistosomiasis. One study used a combination of PZQ with dihydroartemisinin-piperaquine (DHP), which demonstrated superior effectiveness, significantly increasing systemic PZQ exposure and potentially improving treatment efficacy. […] Furthermore, snail management could also be one of the preventive measures to lower the transmission of schistosomiasis, which is possible by using linalool or Cinnamomum camphora (L) extracts. Linalool-treated snails developed gill disintegration and cell degradation, so it is also used for the treatment of S. japonicum infection. Recently, several attempts were made in which instead of a single drug, a combination of drugs was administered to the patient against schistosomiasis. For instance, in a study, PZQ + moxidectin was given against both S. mansoni and S. haematobium infections. Both drugs have different modes of action against parasitic worms, where the former damages the worm’s tegument, which exposes it to the host’s immune system and leads to its expulsion, while the latter interferes with the worm’s nervous system, causing paralysis and death. The combined regime was well tolerated and effective, and it was found that such a combination could offer a broader spectrum of activity against different Schistosoma species.

• #2 Schistosomiasis (Snail Fever) Causes, Symptoms, Treatment, Diagnosis, Prevention

  https://www.medicinenet.com/schistosomiasis/article.htm

  Ocular schistosomiasis should not be treated with this praziquantel. Other organs with heavy parasite infections may not function well and require supportive care until the hyperimmune response abates after drug administration. Other drugs (oxamniquine, metrifonate, artemisinins, and trioxolanes) have been used in some patients but have limited effectiveness. New drugs are in development. Infectious disease specialists, ophthalmologists, and surgeons may treat someone with a schistosomiasis infection. […] Surgical care may include removal of tumor masses, ligation of esophageal varices, shunt surgeries, and granuloma removal.

• #2 Schistosomiasis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/schistosomiasis-pro

  Emergency treatment may be required for acute complications – eg, acute intestinal bleeding. […] Endoscopy and sclerotherapy can treat oesophageal varices. A ventriculoperitoneal shunt and corticosteroids are required to treat hydrocephalus and raised intracranial pressure in cerebral schistosomiasis.

• #2 Safety, efficacy and acceptability of praziquantel in the treatment of Schistosoma haematobium in pre-school children of Kwale County, Kenya | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006852

  Treatment of children is also likely to be more successful in averting the development of subsequent, more serious disease sequelae because earlier stages of infection-induced pathology may be reversible if treated promptly. […] World Health Organization (WHO) recommends that young children living in endemic areas be considered for treatment with PZQ during child health campaigns at the standard dose of 40mg/kg. […] In conclusion, the present study showed that crushed praziquantel administered to preschool children at a dose of 40 mg/kg is safe and effective in the treatment of urogenital schistosomiasis.

• #2 SciELO Brasil – Therapeutic failure of praziquantel in the treatment of Schistosoma haematobium infection in Brazilians returning from Africa Therapeutic failure of praziquantel in the treatment of Schistosoma haematobium infection in Brazilians returnin

  https://www.scielo.br/j/mioc/a/BBrVJ4gCZrQygVmcVF3JZcQ/

  The cases presenting viable eggs detected by cystoscopy after treatment were considered to be therapeutic failures and corresponded to 34.6% (9/26) of the individuals treated and reassessed. […] Although praziquantel is the drug of choice for the treatment of S. haematobium infections, cases of treatment failure have been frequently reported, probably due to a progressive increase in the resistance of the parasite to the drug. […] The criterion of cure should be established on the basis of the absence of alterations in the vesical mucosa and, in the case of mucosal changes, biopsy and histopathological examination should be performed to identify lesion activity and the presence of viable eggs. […] We verified therapeutic failure with single dose of 40 mg/kg weight praziquantel in 9 patients, since that the first aim of treatment is the parasitological cure with single dose. […] After retreatment with 3 doses of praziquantel (15 days intervals), we are evaluating again and we have 4 patients with normal cystoscopy (6 months post-retreatment).

• #2 Schistosomiasis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-018-0013-8

  This paper describes the outcomes of a 2013 meeting co-sponsored by the National Institute of Allergy and Infectious Diseases and the Bill Melinda Gates Foundation and concludes that an integrated, multifaceted approach involving chemotherapy; water, sanitation and hygiene (WASH); snail control; vaccines and other innovative tools will be necessary to have a permanent effect on schistosomiasis. […] This paper discusses current thinking regarding the mechanism of action of praziquantel and the potential for widespread drug resistance. […] This personal view argues that current praziquantel-based schistosomiasis control programmes are not effective or sustainable in the long term, whereas multifaceted, integrated control options would have a greater and longer lasting effect in reducing morbidity and on disease transmission. […] This paper considers the potential consequences of the current extensive MDA programmes for schistosomiasis, which, although curing infection, could have profound effects in the future on schistosome biology, immunoepidemiology and public health.

• #3 Schistosomiases | MSF Medical Guidelines

  https://medicalguidelines.msf.org/en/viewport/CG/english/schistosomiases-16689787.html

  An antiparasitic treatment should be administered to reduce the risk of severe lesions, even if there is a likelihood of re-infection. […] praziquantel may be administered to pregnant women. […] S. haematobium, S. mansoni, S. intercalatum: 40 mg/kg single dose or 2 doses of 20 mg/kg administered 4 hours apart […] S. japonicum, S. mekongi: 2 doses of 30 mg/kg or 3 doses of 20 mg/kg administered 4 hours apart.

Zobacz więcej