Schistosomiasis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Schistosomiasis is readily treated using a single oral dose of the drug Praziquantel. While Praziquantel is safe and highly effective in curing an infected patient, it does not prevent re-infection by cercariae and is thus not an optimum treatment for people living in endemic areas. As with other major parasitic diseases, there is ongoing and extensive research into developing a vaccine that will prevent the parasite from completing its life cycle in humans.
Medical Therapy
Antimony has been used in the past to treat the disease. In low doses, this toxic metalloid bonds to sulfur atoms in enzymes used by the parasite and kills it without harming the host. This treatment is not referred to in present-day peer-review scholarship; Praziquantel is universally used. Outside of the US, there is a second drug available for treating Schistosoma mansoni (exclusively) called Oxamniquine.
Mirazid, a new Egyptian drug, is under investigation for oral treatment of the disease.
Experiments have shown medicinal Castor oil as an oral anti-penetration agent to prevent Schistosomiasis and that praziquantel's effectiveness depended upon the vehicle used to administer the drug (e.g., Cremophor / Castor oil).[1]
Additionally Dr Chidzere of Zimbabwe researched the Gopo Berry (Phytolacca dodecandra) during the 1980's and found that the Gopo Berry could be used in the control of the freshwater snails which carry the bilharzia disease (Schistosomiasis parasite). Dr Chidzere in his interview to Andrew Blake (1989) reported concerns of muti-national chemical companies keen to rubbish the Gopu Berry alternative for snail control [2]. Reputedly Gopo Berries from hotter Ethiopia climates yield the best results. Later studies were between 1993-95 by the Danish Research Network for international health. [3]
Schistosomiasis is readily treated using a single oral dose of the drug praziquantel annually.[4] As with other major parasitic diseases, there is ongoing and extensive research into developing a schistosomiasis vaccine that will prevent the parasite from completing its life cycle in humans. In 2009, Eurogentec Biologics developed a vaccine against bilharziosis in partnership with INSERM and researchers from the Pasteur Institute.[5][6][7]
The World Health Organization has developed guidelines for community treatment of schistosomiasis based on the impact the disease has on children in endemic villages:[4]
- When a village reports more than 50 percent of children have blood in their urine, everyone in the village receives treatment.[4]
- When 20 to 50 percent of children have bloody urine, only school-age children are treated.[4]
- When less than 20 percent of children have symptoms, mass treatment is not implemented.[4]
The Bill & Melinda Gates Foundation has recently funded an operational research program---the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) to answer strategic questions about how to move forward with schistosomiasis control and elimination. The focus of SCORE is on development of tools and evaluation of strategies for use in mass drug administration campaigns.
Antimony has been used in the past to treat the disease. In low doses, this toxic metalloid bonds to sulfur atoms in enzymes used by the parasite and kills it without harming the host. This treatment is not referred to in present-day peer-review scholarship; praziquantel is universally used. Outside of the U.S., there is a drug available exclusively for treating Schistosoma mansoni (oxamniquine) and one exclusively for treating S.hematobium (metrifonate). While metrifonate has been discontinued for use by the British National Health Service, a Cochrane review found it equally effective in treating urinary schistosomiasis as the leading drug, praziquantel.[8]
Mirazid, an Egyptian drug made from myrrh, was under investigation for oral treatment of the disease up until 2005.[9] The efficacy of praziquantel was proven to be about 8 times than that of Mirazid and therefore Mirazid was not recommended as a suitable agent to control schistosomiasis.[10]
Antimicrobial Regimen
- 1. Schistosoma mansoni, S. haematobium, S. intercalatum
- Preferred regimen: Praziquantel 40 mg/kg per day PO in two divided doses for one day[11]
- 2. S. japonicum, S. mekongi
- Preferred regimen: Praziquantel 60 mg/kg per day PO in three divided doses for one day[12]
References
- ↑ "Schistosoma mansoni: experimental chemoprophylaxis in mice using oral anti-penetration agents". pubmed. Retrieved 2007-01-25.
- ↑ The Gopu Berry p33. Part 4 School Journal number.2 1989 Dept of Education Wellington N.Z
- ↑ http://enrecahealth.ku.dk/postgrad_dbl_en/chihaka_abs/
- ↑ 4.0 4.1 4.2 4.3 4.4 The Carter Center. "How is Schistosomiasis Treated?". Archived from the original on 2008-02-25. Retrieved 2008-07-17.
- ↑ "BILHVAX — A VACCINE AGAINST BILHARZIOSE, A world first!". 20 April 2009.
- ↑ "300.000 morts évitées grâce au vaccin liégeois!". 20 April 2009.
- ↑ "Eurogentec, la société de biotechnologie située au Sart Tilman, produit et produira le vaccin contre la bilharziose". 22 April 2009.
- ↑ Danso-Appiah A, Utzinger J, Liu J, Olliaro P (2008). Danso-Appiah, Anthony, ed. "Drugs for treating urinary schistosomiasis". Cochrane Database Syst Rev (3): CD000053. doi:10.1002/14651858.CD000053.pub2.
- ↑ See, for example, Soliman OE; et al. (December 2004). "Evaluation of myrrh (Mirazid) therapy in fascioliasis and intestinal schistosomiasis in children: immunological and parasitological study". J Egypt Soc Parasitol. 34 (3): 941–66. PMID 15587320.
- ↑ Botros, S; Sayed, H; El-Dusoki, H; Sabry, H; Rabie, I; El-Ghannam, M; Hassanein, M; El-Wahab, YA; Engels, D (February 2005). "Efficacy of mirazid in comparison with praziquantel in Egyptian Schistosoma mansoni-infected school children and households". Am J Trop Med Hyg. 72 (2): 119–23. PMID 15741544.
- ↑ "Parasites - Schistosomiasis".
- ↑ "Parasites - Schistosomiasis".