Cysticercosis treatment

This dmg was used prior to the availabiUty of niclosamide and is considered less satisfactory for the treatment of tapeworms than niclosamide (24). It causes more side effects and produces severe nausea. Quinacrine, however, is preferred by some clinicians for the treatment of Taenia solium infection because, unlike niclosamide, it expels the worms intact, thus reducing the theoretical risk of cysticercosis (25). 

Tapeworm infections (T. saginata and T. solium) are treated with praziquantel 5 to 10 mg/kg as a single dose (use the same dose for adults and pediatric patients).3 The treatment for cysticercosis and neurocysticercosis may include surgery, anticonvulsants (neurocysticercosis can cause seizures), and anthelmintic therapy. The anthelmintic therapy of choice is albendazole 400 mg twice daily for 8 to 30 days. The pediatric dose of albendazole is 15 mg/kg (maximum 800 mg) in two divided doses for 8 to 30 days. The doses for both adults and pediatric subjects can be repeated if necessary. Praziquantel is an alternative therapy.3... 

The most serious complication of cysticercosis is neurocys-ticercosis that can cause strokes and seizures. Treatment of neurocysticercosis with anthelmintic treatment remains controversial. 

Albendazole, a broad-spectrum oral antihelminthic, is the drug of choice and is approved in the USA for treatment of hydatid disease and cysticercosis. It is also used in the treatment of pinworm and hookworm infections, ascariasis, trichuriasis, and strongyloidiasis. 

A single 2 g dose of niclosamide results in cure rates of over 85% for D latum and about 95% for T saginata. It is probably equally effective against T solium. Cysticercosis can theoretically occur after treatment of T solium infections, because viable ova are released into the gut lumen after digestion of segments, but no such cases have been reported. 

Most patients treated with niclosamide for H diminuta and Dipylidium caninum infections are cured with a 7-day course of treatment a few require a second course. Praziquantel is superior for Hymenolepis (dwarf tapeworm) infection. Niclosamide is not effective against cysticercosis or hydatid disease. 

Praziquantel is effective in the treatment of schistosome infections of all species and most other trematode and cestode infections, including cysticercosis. The drug s safety and effectiveness as a single oral dose have also made it useful in mass treatment of several infections. 

Note Albendazole is approved in the USA for the treatment of cysticercosis and hydatid disease. 

Garcia HH et al A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med 2004 350 249. [PMID 14724304]... 

One parenteral cestode that is widely accepted as a model for cysticercosis caused by T. solium in humans is Taenia crassiceps, which is found as an adult in foxes and has a rodent intermediate host. Larval T. crassiceps reproduce by budding in the peritoneal cavity of mice and can be serially transferred from mouse to mouse. The immune response, which controls larval growth, relies on T cell-mediated immune mechanisms (Lopez-Briones et al., 2001) and treatments resulting in increased delayed type hypersensitivity led to greater resistance, while AB production was unaffected (Bojalil eta/., 1993). 

Time-response curve of oxfendazole in the treatment of swine cysticercosis. American Journal of Tropical Medicine and Hygiene 59, 832-836. 

Sarti, E., Schantz, P.M., Avila, G., Ambrosio, J., Medina-Santillan, R. and Flisser, A. (2000) Mass treatment against human taeniasis for the control of cysticercosis a population-based intervention study. Transactions of the Royal Society of Tropical Medicine and Hygiene 94, 85-89. 

Gonzales, A.E., Garcia, H.H., Gilman, R.H., Gavidia, C.M., Tsang, V.C., Bernal, T., Falcon, N., Romero, M. and Lopez-Urbina, M.T. (1996) Effective, single-dose treatment or porcine cysticercosis with oxfenda-zole. American Journal of Tropical Medicine and Hygiene 54, 391-394. 

Schantz PM. Progress in diagnosis, treatment and elimination of echinococcosis and cysticercosis. Parasitol Int. 2006 55(suppl) S7-S13. 

Praziquantel is effective in human cysticercosis in doses of 10-100 mg/kg for 3-21 days (1). Initially, longer courses of praziquantel were advocated, but even shorter treatment regimens are equally effective a complete course can be administered in a single day with comparable efficacy as conventional therapy of 15 days. Praziquantel was originally introduced as a racemic mixture there is evidence that the levorotatory isomer is relatively more effective, but has the same incidence of adverse reactions (2). 

Pretell EJ, Garcia HH, Gilman RH, Saavedra H, Martinez M. Cysticercosis Working Group in Peru. Failure of one-day praziquantel treatment in patients with multiple neurocysticercosis lesions. Clin Neurol Neurosurg 2001 103(3) 175-7. 

The treatment of cerebral or neurocysticercosis with praziquantel evokes some inflammatory problems related to the CSF reaction syndrome, which is characterised by headache, meningismus, fever and neurological problems. These side effects may be alleviated by simultaneous use of corticosteroids and praziquantel [87,88,91,96]. Accordingly more and more workers prefer to use corticosteroides, while treating cysticercosis of the brain with praziquantel. This combination protects the patients from the CSF reaction syndrome [97,98]. 

Pharmacological considerations may be linked with the character of the chemical compound include absorption from the gastrointestinal tract distribution of the compound metabolism and elimination. This includes questions of penetration into various compartments of the body and cells this may vary greatly and have a substantial influence on the efficacy of therapy. For example, agents directed to the treatment of cysticercosis must penetrate not only the tissue compartments, including the brain, where the parasite resides, but must also penetrate the cyst within which the parasite is located. 

Low doses of praziquantel can be used successfully to treat intestinal infections with adult cestodes (e.g., a single oral dose of 25 mg/kg for H. nana and 10—20 mg/kg for D. lamm, T. sagi-nata, or T. soUum). Retreatment after 7—10 days is advised for individuals heavily infected with H. nana. While albendazole is preferred for therapy of human cysticercosis, the tissue infection with intermediate cyst larvae of T. soUum, prolonged high-dose therapy with praziquantel remains an alternative treatment. Neither the cystic nor alveolar hydatid diseases caused by larval stages of Echinococcus tapeworms respond to praziquantel here, too, albendazole is effective. 

Information seems to be limited but the pharmacokinetic interaction would appear to be established. Just how much it affects the outcome of treatment for systemic worm infections such as cysticercosis is unknown because the optimum praziquantel levels are still uncertain, and it is possible that the metabolites of praziquantel might be active. The authors of one report suggest that dexamethasone should not be given continuously with praziquantel but only used transiently to resolve inflammatory reactions to praziquantel treatment. Alternatively, limited information suggests the addition of cimetidine may allow dexamethasone to be used. Intravenous methylprednisolone has also been used for acute corticosteroid therapy with praziquantel, and oral prednisone has been used longterm to prevent further tissue damage associated with inflammation but the effect of these corticosteroids on the plasma levels of praziquantel do not appear to have been studied. 

---