Reduction of morbidity in hepatosplenic Schistosomiasis mansoni after treatment with praziquantel: a long term study

Domingues, Ana Lúcia C.; Coutinho, Amaury D.

doi:10.1590/S0037-86821990000200007

Abstracts

Forty-two with hepatosplenic patients treated with praziquantel and followed up for 5 years. One half of the patients received a single 30 mg/kg dose and the other half, two doses of 25 mg/kg given 4 hrs apart. According to Hoffman and Kato-Katz stool exams, an 83.3% cure rate, was observed after twelve months. Stool egg counts in cases of incomplete cure were greatly reduced. Liver function, as assessed by serum levels of aspartate aminotransferase, alanine aminotransferase, gamma glutamyltransferase and alkaline phosphatase activities as well as albumin and gamma globulin showed marked improvement after one year. Hepatomegaly was reduced in 81.0% of patients and splenomegaly in 78.8%. Spleen regression was complete in 15.1% of the total, and in 18.5% of those with compensated hepatosplenic disease. As a result of these observations, the authors recomend early treatment with anti-schistosomal medication, either oxamniquine or praziquantel, to halt progression of disease and reduce splenomegaly.

Hepatosplenic Schistosomiasis mansoni; Treatment; Reversion

Quarenta e dois pacientes esquistossomóticos hepatosplênícos, tratados com praziquantel, foram acompanhados por cinco anos. Metade dos pacientes recebeu uma dose simples de 30mg/kg; a outra metade, recebeu duas doses de 25mg/kg dadas com intervalos de 4 horas. A taxa de cura, de acordo com os exames de fezes pelos métodos de Hoffman cols e de Kato-Katz, durante 12 meses foi de 83,3%. Nos casos com cura incompleta, os ovos contados nas fezes foram muito reduzidos. A função hepática, estimada pelo nível, no soro, de aspartato aminotransferase,, alamina aminotransferase, gama glutamiltransferase e fosfatase alcalina bem como, de albumina e gama globulina mostrou acentuada melhora após um ano. Hepatomegalia foi reduzida em 81,0% dos pacientes e esplenomegalia em 78,8%. A regressão do baço foi completa em 15,1% do total e em 18,5% daqueles com forma hepatosplênica compensada. Como resultado destas observações, os autores recomendam tratamento precoce com medicação antiesquistossomótica com oxamniquine ou praziquantel para interromper a progressão da doença e reduzir hepatomegalia e esplenomegalia.

Esquistossomose mansoni hepatosplênica; Tratamento; Reversão

ARTICLES

Reduction of morbidity in hepatosplenic Schistosomiasis mansoni after treatment with praziquantel: a long term study

Ana Lúcia C. Domingues; Amaury D. Coutinho

^{Adress to correspondence} Adress to correspondence: Dr. Amaury D. Coutinho. Centro de Pesquisas " Aggeu Magalhães". FIOCRUZ. CP: 7472 50730 Recife, PE, Brasil.

ABSTRACT

Forty-two with hepatosplenic patients treated with praziquantel and followed up for 5 years. One half of the patients received a single 30 mg/kg dose and the other half, two doses of 25 mg/kg given 4 hrs apart. According to Hoffman and Kato-Katz stool exams, an 83.3% cure rate, was observed after twelve months. Stool egg counts in cases of incomplete cure were greatly reduced. Liver function, as assessed by serum levels of aspartate aminotransferase, alanine aminotransferase, gamma glutamyltransferase and alkaline phosphatase activities as well as albumin and gamma globulin showed marked improvement after one year. Hepatomegaly was reduced in 81.0% of patients and splenomegaly in 78.8%. Spleen regression was complete in 15.1% of the total, and in 18.5% of those with compensated hepatosplenic disease. As a result of these observations, the authors recomend early treatment with anti-schistosomal medication, either oxamniquine or praziquantel, to halt progression of disease and reduce splenomegaly.

Keywords: Hepatosplenic Schistosomiasis mansoni. Treatment. Reversion.

RESUMO

Quarenta e dois pacientes esquistossomóticos hepatosplênícos, tratados com praziquantel, foram acompanhados por cinco anos. Metade dos pacientes recebeu uma dose simples de 30mg/kg; a outra metade, recebeu duas doses de 25mg/kg dadas com intervalos de 4 horas. A taxa de cura, de acordo com os exames de fezes pelos métodos de Hoffman cols e de Kato-Katz, durante 12 meses foi de 83,3%. Nos casos com cura incompleta, os ovos contados nas fezes foram muito reduzidos. A função hepática, estimada pelo nível, no soro, de aspartato aminotransferase,, alamina aminotransferase, gama glutamiltransferase e fosfatase alcalina bem como, de albumina e gama globulina mostrou acentuada melhora após um ano. Hepatomegalia foi reduzida em 81,0% dos pacientes e esplenomegalia em 78,8%. A regressão do baço foi completa em 15,1% do total e em 18,5% daqueles com forma hepatosplênica compensada. Como resultado destas observações, os autores recomendam tratamento precoce com medicação antiesquistossomótica com oxamniquine ou praziquantel para interromper a progressão da doença e reduzir hepatomegalia e esplenomegalia.

Palavras-chave: Esquistossomose mansoni hepatosplênica. Tratamento. Reversão.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Recebido para publicação em 21/06/90.

Department of Internal Medicine of the Universidade Federal of Pernambuco, Recife, PE, Brazil.

1. Abdallah A, Saif M, Koura M. The roleof chemotherapy in the control of schistosomiasis: experience in Egypt. Brasília Médica 11:49-54, 1975.
2. Almeida MAC, Andrade ZA. Effect of chemotherapy on experimental pulmonary schistosomiasis. The American Journal of Tropical Medicine and Hygiene 32:1049- 1054, 1983.
3. Andrade ZA, Brito PA. Evolution of schistosomal hepatic vascular lesions after specific chemotherapy. The American Journal of Tropical Medicine and Hygiene 30:1223-1227, 1981.
4. Bassily S, Farid Z, Dunn M, el-Masry Is A, Stek Jr M. Praziquantel for treatment of schistosoniasis in patients with advanced hepatosplenomegaly. Annals of Tropical Medicine and Parasitology 79:629-634, 1985.
5. Bina JC, Prata A. Possibilidade de prevenção das formas graves da esquistossomose mansoni: papel da terapêutica específica. In: Prata A (ed) Situação e Perspectivas do controle das doenças infecciosas e parasitárias. Editora Universidade de Brasília, Brasília, p. 45-56, 1981.
6. Bina JC, Prata A. Regressão da hepatosplenomegalia pelo tratamento específico da esquistossomose. Revista da Sociedade Brasileira de Medicina Tropical 16:213- 218, 1983.
7. Butterworth AE, Capron M, Cordingley JS, Dalton PR, Dunne DW, Kariuki HC, Kimani G, Koech D, Mugambi M, Ouma JH, Prentice MA, Richardson BA, Arap Siongok TK, Sturrock RF, Tayla DW. Immunity after treatment of human Schistosomiasis mansoni II Identification of resistant individuals and analysis of their immune responses. Transactions of the Royal Society of Tropical Medicine and Higyene 79:393-408, 1985.
8. Cameron GR, Ganguly NC. An experimental study of the pathogenesis and reversibility of schistosomal hepatic fibrosis. The Journal of Pathology and Bacteriology 87:217-237, 1964.
9. Cheever AW, Dewitt WB, Warren KS. Repeated infection and treatment of mice with Schistosoma mansoni: functional, anatomic and immunologic observations. The American Journal of Tropical Medicine and Hygiene 14:239-253, 1965.
10. Cook JA, Baker ST, W arren KS, Jordan P. A controlled study of morbidity of Schistosomiasis mansoni in St Lucian children, based on quantitative egg excretion. The American Journal of Tropical Medicine and Hygiene 23:625-633, 1974.
11. Coutinho A. Clinical laboratory manifestations due to the death of worms after specific treatment of Schistosomiasis. Brasília Médica 11:69-80, 1975.
12. Coutinho A, Barreto FT. Treatment of hepatosplenic Schistosomiasis mansoni with niridazole: relationships among liver function, effective dose and side effects. Annals of the New York Academy of Sciences 160:612- 628, 1969.
13. Coutinho A, Domingues ALC. Evaluation of the treatment of severe forms of Schistosomiasis mansoni with oxamniquine. Revista do Instituto de Medicina Tropical de São Paulo 22 (Supl. 4):41-51, 1980.
14. Coutinho A, Domingues ALC. Esquistossomose mansoni. In: Dani R, PaulaCastro L(ed). Gastroenterologia Clínica, (2? edição). GuanabaraKoogan, Riode Janeiro, p. 1361-1386, 1988.
15. Coutinho A, Domingues ALC, Bonfim JR. Treatmentof Schistosomiasis mansoni with oxamniquine. Revista do Instituto de Medicina Tropical de São Paulo 15:15-34, 1973.
16. Coutinho AD, Domingues ALC, Florêncio JN, Almeida ST. Tratamento da esquistossomose mansônica hepatosplênica com praziquantel. Revista dó Instituto de Medicina Tropical de São Paulo 26:38-50, 1984.
17. Cunha AS, Cançado JR, Rezende GL. Therapeutical evaluation of different dose regimens of praziquantel in Schistosomiasis mansoni, based on the quantitative oogram technique. Revista do Instituto de Medicina Tropical de São Paulo 29:295-304, 1987.
18. Dietze R, Prata A. Rate of reversion of hepatosplenic schistosomiasis after specific therapy. Revista da Sociedade Brasileira de Medicina Tropical 19:69-73, 1986.
19. Farid Z, Higashi GI, Bassily S, Trabolsi B, Watten RH. Treatment of advanced hepatosplenic schistosomiasis with oxamniquine. Transactions of the Royal Society of Tropical Medicine and Hygiene 74:400-401, 1980.
20. Hoffman WA, Pons JA, Janer JL. The sedimentation concentration method in Schistosomiasis mansoni Puerto Rico. Journal of Public Health and Tropical Medicine 9:283-291, 1934.
21. Katz N. Experiências com quimioterapia em grande escala no controle da esquistossomose no Brasil. Revista do Instituto de Medicina Tropical de São Paulo 22:40- 51, 1980.
22. Katz N, Chaves A, Pellegrino J. A simples device for quantitative stool thick smear technique in Schistosomiasis mansoni Revista do Instituto de Medicina Tropical de São Paulo 14:397-400, 1972.
23. Katz N, Zicker F, Rocha RS, Oliveira VB. Re-infection of patients in Schistosomiasis mansoni endemic areas after specific treatment 1-Influence of age and worm burden. Revista do Instituto de Medicina Tropical de São Paulo 20:273-278, 1978.
24. Klóetzel K. Splenomegaly in Schistosomiasis mansoni The American Journal of Tropical Medicine and Hygiene 11:472-476, 1962.
25. Klóetzel K. A suggestion for the prevention of severe clinical forms of Schistosomiasis mansoni Bulletin of the World Health Organization 37:686-687, 1967.
26. Lehman JS, Mott KE, Morrow Jr RH, Muniz TM, Boyer MH. The intensity and effects of infection with Schistosoma mansoni in a rural community in Northeast Brazil. The American Journal of Tropical Medicine and Hygiene 25:285-294, 1976.
27. Morcos SH, Khayyal MT, Mansour MM, Saleh S, Ishak EA, Girgis NI, Dunn MA. Reversal of hepatic fibrosis after praziquantel therapy of murine schistosomiasis. The American Journal of Tropical Medicine and Hygiene 34:314-321, 1985.
28. Mousa AH, Ata AA, El Rooby A, El Garem A, Abdel MF, El Raziky E. Clinics pathological aspects of hepatosplenic bilharziasis. In: FK Mostofi (ed) Bilharziasis. Spring Verlag, p. 15-29, 1967.
29. Prata A, Castro CN, Silva AE, Paiva M, Macedo V, Junqueira Jr LF. Praziquantel no tratamento da esquistossomose mansoni. Revista do Instituto de Medicina Tropical de São Paulo 24:95-103, 1982.
30. Sadun EH, Lichtenberg FV, Erickson DG, Cheever AW, Bueding EE, Anderson JS. Effects of chemotherapy on the evaluation of Schistosomiasis japonica in chimpanzees. The American Journal of Tropical Medicine and Hygiene 23:639-661, 1974.
31. Schiller EL, Haese WH. Histologic processes of healing in hepatic injury due to eggs of S. chistosoma mansoni in mice following curative chemotherapy. The American Journal of Tropical Medicine and Hygiene 22:211-214, 1973.
32. Sette H. O tratamento da esquistossomose mansoni à luz da patologia hepática. Thesis, Facuidade de Medicina de Pernambuco, Recife, 1953.
33. Silva LC, Sette H, Christo CH, Saez-Alquezar A, Carneiro CRW, Lacet CM, Ohtsuki N, Raid S. Praziquantel in the treatment of the hepatosplenic form of Schistosomiasis mansoni Arzneimittel-Forschung Research 31(supl. l):601-603, 1981.
34. SiongokTKA, Mahmoud AAF, Ouma JH, Warren KS, Muller AS, Handa AK, Houser HB. Morbidity in Schistosomiasis mansoni in relation to intensity of infection: study of a community in Machakos, Kenya. The American Journal of Tropical Medicine and Hygiene 25:273-284, 1976.
35. Sturrock RF, Bensted-Smith R, Butterworth AE, Dalton PR, Kariuki HC, Koech D, Mugambi M, Ouma JH, Arap Siongok TK. Immunity after treatment of human Schistosomiasis mansoni Ill Long-term effects of treatment and retreatment Transactions of the Royal Society of Tropical Medicine and Hygiene 81:303-314, 1987.
36. Warren KS, The influence of treatment on the development and course of murine hepatosplenic Schistosomiasis mansoni Transactions of the Royal Society of Tropical Medicine and Hygiene 56:510-519, 1962.
37. Warren KS, Klein L. Chronic murine hepatosplenic Schistosomiasis mansoni: relative irreversibility after treatment. Transactions of the Royal Society of Tropical Medicine and Hygiene 63:333-337, 1969.

Adress to correspondence:

Dr. Amaury D. Coutinho.

Centro de Pesquisas " Aggeu Magalhães".

FIOCRUZ. CP: 7472

50730

Recife, PE, Brasil.

Publication Dates

Publication in this collection
24 May 2013
Date of issue
June 1990

History

Accepted
21 June 1990
Received
21 June 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Abdallah A, Saif M, Koura M. The roleof chemotherapy in the control of schistosomiasis: experience in Egypt. Brasília Médica 11:49-54, 1975.

[2] 2. Almeida MAC, Andrade ZA. Effect of chemotherapy on experimental pulmonary schistosomiasis. The American Journal of Tropical Medicine and Hygiene 32:1049- 1054, 1983.

[3] 3. Andrade ZA, Brito PA. Evolution of schistosomal hepatic vascular lesions after specific chemotherapy. The American Journal of Tropical Medicine and Hygiene 30:1223-1227, 1981.

[4] 4. Bassily S, Farid Z, Dunn M, el-Masry Is A, Stek Jr M. Praziquantel for treatment of schistosoniasis in patients with advanced hepatosplenomegaly. Annals of Tropical Medicine and Parasitology 79:629-634, 1985.

[5] 5. Bina JC, Prata A. Possibilidade de prevenção das formas graves da esquistossomose mansoni: papel da terapêutica específica. In: Prata A (ed) Situação e Perspectivas do controle das doenças infecciosas e parasitárias. Editora Universidade de Brasília, Brasília, p. 45-56, 1981.

[6] 6. Bina JC, Prata A. Regressão da hepatosplenomegalia pelo tratamento específico da esquistossomose. Revista da Sociedade Brasileira de Medicina Tropical 16:213- 218, 1983.

[7] 7. Butterworth AE, Capron M, Cordingley JS, Dalton PR, Dunne DW, Kariuki HC, Kimani G, Koech D, Mugambi M, Ouma JH, Prentice MA, Richardson BA, Arap Siongok TK, Sturrock RF, Tayla DW. Immunity after treatment of human Schistosomiasis mansoni II Identification of resistant individuals and analysis of their immune responses. Transactions of the Royal Society of Tropical Medicine and Higyene 79:393-408, 1985.

[8] 8. Cameron GR, Ganguly NC. An experimental study of the pathogenesis and reversibility of schistosomal hepatic fibrosis. The Journal of Pathology and Bacteriology 87:217-237, 1964.

[9] 9. Cheever AW, Dewitt WB, Warren KS. Repeated infection and treatment of mice with Schistosoma mansoni: functional, anatomic and immunologic observations. The American Journal of Tropical Medicine and Hygiene 14:239-253, 1965.

[10] 10. Cook JA, Baker ST, W arren KS, Jordan P. A controlled study of morbidity of Schistosomiasis mansoni in St Lucian children, based on quantitative egg excretion. The American Journal of Tropical Medicine and Hygiene 23:625-633, 1974.

[11] 11. Coutinho A. Clinical laboratory manifestations due to the death of worms after specific treatment of Schistosomiasis. Brasília Médica 11:69-80, 1975.

[12] 12. Coutinho A, Barreto FT. Treatment of hepatosplenic Schistosomiasis mansoni with niridazole: relationships among liver function, effective dose and side effects. Annals of the New York Academy of Sciences 160:612- 628, 1969.

[13] 13. Coutinho A, Domingues ALC. Evaluation of the treatment of severe forms of Schistosomiasis mansoni with oxamniquine. Revista do Instituto de Medicina Tropical de São Paulo 22 (Supl. 4):41-51, 1980.

[14] 14. Coutinho A, Domingues ALC. Esquistossomose mansoni. In: Dani R, PaulaCastro L(ed). Gastroenterologia Clínica, (2? edição). GuanabaraKoogan, Riode Janeiro, p. 1361-1386, 1988.

[15] 15. Coutinho A, Domingues ALC, Bonfim JR. Treatmentof Schistosomiasis mansoni with oxamniquine. Revista do Instituto de Medicina Tropical de São Paulo 15:15-34, 1973.

[16] 16. Coutinho AD, Domingues ALC, Florêncio JN, Almeida ST. Tratamento da esquistossomose mansônica hepatosplênica com praziquantel. Revista dó Instituto de Medicina Tropical de São Paulo 26:38-50, 1984.

[17] 17. Cunha AS, Cançado JR, Rezende GL. Therapeutical evaluation of different dose regimens of praziquantel in Schistosomiasis mansoni, based on the quantitative oogram technique. Revista do Instituto de Medicina Tropical de São Paulo 29:295-304, 1987.

[18] 18. Dietze R, Prata A. Rate of reversion of hepatosplenic schistosomiasis after specific therapy. Revista da Sociedade Brasileira de Medicina Tropical 19:69-73, 1986.

[19] 19. Farid Z, Higashi GI, Bassily S, Trabolsi B, Watten RH. Treatment of advanced hepatosplenic schistosomiasis with oxamniquine. Transactions of the Royal Society of Tropical Medicine and Hygiene 74:400-401, 1980.

[20] 20. Hoffman WA, Pons JA, Janer JL. The sedimentation concentration method in Schistosomiasis mansoni Puerto Rico. Journal of Public Health and Tropical Medicine 9:283-291, 1934.

[21] 21. Katz N. Experiências com quimioterapia em grande escala no controle da esquistossomose no Brasil. Revista do Instituto de Medicina Tropical de São Paulo 22:40- 51, 1980.

[22] 22. Katz N, Chaves A, Pellegrino J. A simples device for quantitative stool thick smear technique in Schistosomiasis mansoni Revista do Instituto de Medicina Tropical de São Paulo 14:397-400, 1972.

[23] 23. Katz N, Zicker F, Rocha RS, Oliveira VB. Re-infection of patients in Schistosomiasis mansoni endemic areas after specific treatment 1-Influence of age and worm burden. Revista do Instituto de Medicina Tropical de São Paulo 20:273-278, 1978.

[24] 24. Klóetzel K. Splenomegaly in Schistosomiasis mansoni The American Journal of Tropical Medicine and Hygiene 11:472-476, 1962.

[25] 25. Klóetzel K. A suggestion for the prevention of severe clinical forms of Schistosomiasis mansoni Bulletin of the World Health Organization 37:686-687, 1967.

[26] 26. Lehman JS, Mott KE, Morrow Jr RH, Muniz TM, Boyer MH. The intensity and effects of infection with Schistosoma mansoni in a rural community in Northeast Brazil. The American Journal of Tropical Medicine and Hygiene 25:285-294, 1976.

[27] 27. Morcos SH, Khayyal MT, Mansour MM, Saleh S, Ishak EA, Girgis NI, Dunn MA. Reversal of hepatic fibrosis after praziquantel therapy of murine schistosomiasis. The American Journal of Tropical Medicine and Hygiene 34:314-321, 1985.

[28] 28. Mousa AH, Ata AA, El Rooby A, El Garem A, Abdel MF, El Raziky E. Clinics pathological aspects of hepatosplenic bilharziasis. In: FK Mostofi (ed) Bilharziasis. Spring Verlag, p. 15-29, 1967.

[29] 29. Prata A, Castro CN, Silva AE, Paiva M, Macedo V, Junqueira Jr LF. Praziquantel no tratamento da esquistossomose mansoni. Revista do Instituto de Medicina Tropical de São Paulo 24:95-103, 1982.

[30] 30. Sadun EH, Lichtenberg FV, Erickson DG, Cheever AW, Bueding EE, Anderson JS. Effects of chemotherapy on the evaluation of Schistosomiasis japonica in chimpanzees. The American Journal of Tropical Medicine and Hygiene 23:639-661, 1974.

[31] 31. Schiller EL, Haese WH. Histologic processes of healing in hepatic injury due to eggs of S. chistosoma mansoni in mice following curative chemotherapy. The American Journal of Tropical Medicine and Hygiene 22:211-214, 1973.

[32] 32. Sette H. O tratamento da esquistossomose mansoni à luz da patologia hepática. Thesis, Facuidade de Medicina de Pernambuco, Recife, 1953.

[33] 33. Silva LC, Sette H, Christo CH, Saez-Alquezar A, Carneiro CRW, Lacet CM, Ohtsuki N, Raid S. Praziquantel in the treatment of the hepatosplenic form of Schistosomiasis mansoni Arzneimittel-Forschung Research 31(supl. l):601-603, 1981.

[34] 34. SiongokTKA, Mahmoud AAF, Ouma JH, Warren KS, Muller AS, Handa AK, Houser HB. Morbidity in Schistosomiasis mansoni in relation to intensity of infection: study of a community in Machakos, Kenya. The American Journal of Tropical Medicine and Hygiene 25:273-284, 1976.

[35] 35. Sturrock RF, Bensted-Smith R, Butterworth AE, Dalton PR, Kariuki HC, Koech D, Mugambi M, Ouma JH, Arap Siongok TK. Immunity after treatment of human Schistosomiasis mansoni Ill Long-term effects of treatment and retreatment Transactions of the Royal Society of Tropical Medicine and Hygiene 81:303-314, 1987.

[36] 36. Warren KS, The influence of treatment on the development and course of murine hepatosplenic Schistosomiasis mansoni Transactions of the Royal Society of Tropical Medicine and Hygiene 56:510-519, 1962.

[37] 37. Warren KS, Klein L. Chronic murine hepatosplenic Schistosomiasis mansoni: relative irreversibility after treatment. Transactions of the Royal Society of Tropical Medicine and Hygiene 63:333-337, 1969.