SciELO - Scientific Electronic Library Online

 
vol.26 issue1Nuclear basophilia and anisotropy in cells of mice treated with oxamniquineTherapeutical investigation of praziquantel in human infection due to Schistosoma mansoni author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Revista do Instituto de Medicina Tropical de São Paulo

On-line version ISSN 1678-9946

Rev. Inst. Med. trop. S. Paulo vol.26 no.1 São Paulo Jan./Feb. 1984

https://doi.org/10.1590/S0036-46651984000100007 

Tratamento da esquistossomose mansônica hepatesplênica com praziquantel

 

Treatment of hepatosplenic schistosomiasis mansoni with praziquantel

 

 

Amaury D. CoutinhoI; Ana Lúcia C. DominguesII; Jane N. FlorêncioIII; Suzana T. AlmeidaII

IProfessor Titular de Clínica Médica da Universidade Federal de Pernambuco
IIProfessoras Assistentes de Clínica Médica — Gastrenterologia
IIIProfessora Adjunta de Clínica Médica

Endereço para correspondencia

 

 


RESUMO

Noventa e quatro pacientes, 22 do sexo masculino e 72 do feminino, com idades variando de 11 a 71 anos, média de 25, apresentando a forma hepatesplênica da esquistossomose mansônica, foram tratados com uma nova droga antiesquistossomótica — praziquantel — objetivando-se investigar sua eficácia e tolerância. Duas doses orais — 1 x 30 e 2 x 25 mg/kg — foram comparadas. Efeitos colaterais foram verificados durante os primeiros dois dias seguintes à administração da droga, mas usualmente de média intensidade e curta duração. Os mais freqüentes e, por vezes, mais severos foram: dor ou desconforto abdominal, diarréia, tontura, cefaléia e náusea. Febre esteve presente em 19,2% dos casos e urticaria e prurido em dois pacientes. A investigação laboratorial mostrou, em alguns casos, ligeiras alterações enzimáticas (AST, ALT, γ-GT) 24 horas após a medicação. Nenhuma modificação da urinálise, da glicose sangüínea e dos dados hematológicos foi detectada, exceto o aumento comumente observado dos eosinófilos nos 7." e 30.° dias, relacionado à morte dos parasitas dentro do organismo. Da mesma forma, nenhuma anormalidade foi verificada no estudo eletroencefalográfico. Na eletrocardiografia, observou-se, em duas pacientes, uma ligeira e transitória alteração na repolarização ventricular. No que diz respeito à cura parasitológica, constatou-se, em 62 pacientes que concluíram seis meses de controle, um porcentual global de cura de 80,6%, sendo de 76,7% com a dose de 30 mg/lkg e de 84,4% com a de 2 x 25 mg/kg. Os pacientes não curados tiveram, por outro lado, uma acentuada redução no número de ovos do S. mansoni eliminados nas fezes. Além disso, cinco pacientes não curados, foram retratados seis ou mais meses depois, com a mesma dose inicial, obtendo-se 100°/o de negatividade nos exames de fezes. Os Autores acreditam que com a administração de doses um pouco mais altas como, por exemplo, 60 mg/kg, se possa obter um maior porcentual de cura, sem prejuízo da boa tolerância. A melhora clínica e laboratorial a longo prazo, isto é, seis ou mais meses após a medicação, foi marcante em todos os parâmetros estudados.


SUMMARY

Ninety-four patients, 22 males and 72 females, from 11 to 71 years old, with an average of 25 years, presenting the hepatosplenic form of Schistosomiasis mansoni were treated with a new anthelmintic drug — praziquantel — to investigate its efficacy and tolerance.
In addition to the hepatosplenic form of the disease, 14 patients had the cardio-pulmonary hypertensive or cyanotic form and 16 had already been submitted to splenectomy. Two oral doses — 1 x 30 and 2 x 25 mg/kg body weight — were compared.
Side-effects were noticed during the first two days following the drug administration but usually of mild intensity and short duration. The most frequent and, at times, more severe were abdominal pain or discomfort, diarrhea, headache, dizziness and nausea. Fever was present in 19.2% of the cases and urticaria and pruritus in two patients.
The laboratorial investigation of liver function showed, in some cases, slight enzymatic alterations (AST, ALT, y GT) 24 hours after medication, but without any major significance. No urinary, blood glucose or hematological changes have been detected, except, for the commonly seen increase of eosinophyls on the 7th and 30th day, related to the death of parasites inside the organism. Likewise, no abnormality was noticed in the electroencephalografic study. In the electrocardiogram it was observed in two patients a slight and transitory modification on the ventricular repolarization.
With regard to the parasitological cure, it was observed in 62 patients Who have finished the 6 months control period, a total cure rate of 80.6%. With 30 mg/kg single dose this cure rate was 76.7% and with 25 mg/kg b.i.d. 84.4%. The non-cured patients, on the other hand, have shown a marked reduction in the number of S. mansoni eggs eliminated in the feces. Furthermore, five of these patients Were retreated six or more months afterwards with the same initial dose, achieving 100% negative stool examinations. The Authors believe that administering a higher dose, like 60 mg/kg, it would be possible to accomplish, in addition to good tolerance, a greater percentage of parasitological cure.
The long-term clinical and laboratory improvement, observed 6 and 12 months after treatment, is worthy of note.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

REFERÊNCIAS BIBLIOGRÁFICAS

1. BARTSCH, H. et al. — Absence of mutagenicity of praziquantel, a new, effective, anti-schistosomal agent, in bacteria, yeast, insects and mammalian cells. Mutation Research 58: 133-142, 1978.         [ Links ]

2. BERTI, J. J.; de MOLINA, B. P. & DOMMERQUE, F. S. — Experiências clínicas con praziquantel en el tratamiento de la Schistossomiasis mansoni. Tribuna Med. (Venezuela) 54: 10-12, 1981.         [ Links ]

3. BRANCHINI, M. L. M. et al. — Double-blind clinical trial comparing praziquantel with oxamniquine in the treatment of patients with Schistosomiasis mansoni. Rev. Inst. Med. trop. São Paulo 24: 315-321, 1982.         [ Links ]

4. BÜHRING, K. U. et al. — Metabolism of praziquantel in man. Eur. J. Drug Metb. Pharm. 3: 179-180, 1978.         [ Links ]

5. CAMARGO, S. — Tratamento com praziquantel de portadores de esquistossomose, em área endêmica, com persistência de positividade após sucessivas administrações de oxamniquine. Rev. Inst. Med. trop. São Paulo 24: 180-187, 1982.         [ Links ]

6. COLES, G. C — The effect of praziquantel in Schistosoma mansoni. J. Helmint. 53: 31-33, 1979.         [ Links ]

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

8. COUTINHO, A. & DOMINGUES, A. L. C. — Esquistossomiase mansoni, Cap. 77, 1113-1140, Livro de Gastrenterologia, DANI & PAULA CASTRO. Rio de Janeiro, Guanabara, 1981.         [ Links ]

9. DAVIS, A.; BILES, J. E. & ULRICH, A. M. — Initial experiences with praziquantel in the treatment of human infections due to Schistosoma haematobium. Bull. WId. Hlth. Org. 57: 773-779, 1979.         [ Links ]

10. FROHBERG, H. & SCHENCKING, M. S. — Toxicological profile of praziquantel, a new drug against cestode and schistosoma infections, as compared to some other schistosomicides. Arzneim. Forsch. 31: 555-565, 1981.         [ Links ]

11. GONNERT, R. & ANDREWS, P. — Praziquantel, a new broad-spectrum antischistosomal agent. Z. Parasitenk. 52: 129-150, 1977.         [ Links ]

12. ISHIZAKI, T.; KAMO, E. & BOEHME, K. — Double-blind studies of tolerance to praziquantel in Japanese patients with Schistosoma japonicum infections. Bull. Wld. Hlth. Org. 57: 787-791, 1979.         [ Links ]

13. JAMES, C; WEBBE, G. & NELSON, G. S. — The susceptibility to praziquantel of Schistosoma haematobium in vervet monkey (Cercopithecus aethiope). Z. Parasitenk. 52: 179-194, 1977.         [ Links ]

14. KATZ, N.; CHAVES, A. & PELLEGRINO, J. — A simple device for quantitative stool thick-smear technique in Schistosomiasis mansoni. Rev. Inst. Med. trop. São Paulo 14: 397-400, 1972.         [ Links ]

15. KATZ, N.; ROCHA, R. S. & CHAVES, A. — Preliminary trials with praziquantel in human infections due to Schistosoma mansoni. Bull. Wld. Hlth. Org. 57: 781-785, 1979.         [ Links ]

16. KATZ, N.; ROCHA, R. S. & CHAVES, A. — Clinical trials with praziquantel in Schistosomiasis mansoni. Rev. Inst. Med. trop. São Paulo 23: 72-78, 1981.         [ Links ]

17. KATZ, N. & ROCHA, R. S. — Double-blind clinical trial comparing praziquantel with oxamniquine in Schistosomiasis mansoni. Rev. Inst. Med. trop. São Paulo 24: 310-314, 1982.         [ Links ]

18. LEOPOLD, G. et al. — Clinical pharmacology in normal volunteers of praziquantel, a new drug against schistosomes and cestodes. Eur. J. Clin. Pharmacol. 14: 281-291, 1978.         [ Links ]

19. MACHEMER, L. & LORKE, D. — Mutagenicity studies with praziquantel, a new anthelmintic drug in mammalian systems. Arch. Toxicol. 39: 187-197, 1978.         [ Links ]

20. McMAHON, J. E. & KOLSTRUP, N. — Praziquantel: a new schistosomicide against Schistosome haematobium. Brit. Med. J. 2: 1396-1399, 1979.         [ Links ]

21. OBERMEIER, J. & FROHBERG, H. — Mutagenicity studies with praziquantel, a new anthelmintic drug: tissue, host and urine-mediated mutagenicity assays. Arch. Toxicol. 38: 149-161, 1977.         [ Links ]

22. PELLEGRINO, J. et al. — Experimental chemotherapy of Schistosomiasis mansoni. Z. Parasitenk. 52: 151-168, 1977.         [ Links ]

23. SANTOS, A. T. et al. — Preliminary clinical trials with praziquantel in Schistosoma japonicum infections in the Philippines. Bull. Wld. Hlth. Org. 57: 793-799, 1979.         [ Links ]

24. SILVA, L. C. da et al. — Praziquantel in the treatment of the hepatosplenic form of Schistosomiasis mansoni. Drug Res 31: 601-603, 1981.         [ Links ]

25. WEBBE, C. & JAMES, C. — A comparison of the susceptibility to praziquantel of Schistosoma haematobium, S. japonicum, S. mansoni, S. intercalatum and mansoni. Drug. Res. 31: 601-603, 1981.         [ Links ]

 

 

Endereço para correspondencia:
Rua Sabino Pinho, 184
Madalena 50.000 — RECIFE, PE — Brasil

Recebido para publicação em 12/05/1983.

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License