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More than one thousand of patients with more than two thousand of Echinococcus granulosus hydatid cysts were observed during the last 20 years. The therapeutic approach ranged from chemotherapy with benzimidazole carbamates (mebendazole and albendazole) to surgery, percutaneous non conventional treatment, and a "wait and see" approach, on the basis of the clinical picture, of the compliance and of the socio-economic background of each patient. The observed results, mainly those regarding chemotherapy, were briefly summarized and discussed. Most important point to underline is the need of data about a more prolonged follow-up on wider casuistries of patients both treated (with chemotherapy, with surgery, with percutaneous non conventional treatment) and not treated, to obtain a more suitable evaluation of the long-term outcome of the performed clinical approach. Moreover, a multidisciplinary approach is advisable to assure a better clinical management to patients with cystic echinococcosis.
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Monogeneans which parasitize fish are still treated by bathing the fish in solutions of simple chemicals or staining dyes. In the early 1960s an insecticide, trichlorphon, replaced to a large extent the formerly used simple chemicals. Its success was greater specificity against monogeneans and other ectoparasites, and to its great tolerance by the fish. The fact that the number of important monogenean species (i.e. Pseudodactylogyrus anguillae, P. bini, Gyrodactylus salaris) which cannot be treated sufficiently with simple chemicals or even trichlorphon is increasing, led to the need for systemically acting, novel chemotherapeutics. In laboratory and small scale trials praziquantel, levamisole, mebendazole and toltrazuril have been tested for efficacy against a broad spectrum of monogenean species.
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One hundred thirty children (65-95 mo old) from a low-socioeconomic neighborhood of Guatemala City participated in a randomized, double-blind, controlled trial of zinc supplementation. One group received 10 mg Zn/d (n = 65) and the other group received a placebo (n = 65); 90 +/- 9.2 doses were given over 120-150 d. Stools were examined for prevalence and intensity of helminths and prevalence of protozoa at the beginning and end of the study. The initial prevalence was 42% for helminths and 18% for protozoa, with no differences between groups. Mebendazole was administered to all children, and protozoal infections were treated specifically at the beginning of the study. The reinfection rates were 17% (11 of 65) for helminths and 12.3% (8 of 65) for protozoa in the zinc group and 15% (10 of 65) and 10.7% (7 of 65), respectively, in the placebo group (P > 0.05). Analysis by specific parasites revealed no treatment effect. We conclude that neither plasma or hair zinc status nor oral zinc supplementation had an effect on parasite status in children.
We report a case of left-sided extended pelvic infestation of hydatid disease. The destruction of the hip joint, os pubis, larger parts of os ileum and the femoral head made pelvic resection and prosthetic replacement necessary. Recurrence of a hydatid cyst 5 years later in the left groin originating in the femur was treated with a second femoral resection and total hip replacement. Because of instability, the pelvic replacement also had to be changed to a custom-made CAD replacement. This surgical procedure was combined with chemotherapy by mebendazole. The need for radical resection in osseal hydatid disease is discussed.
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Avermectin B1a was found active against the pre-cardiac stage of Dirofilaria immitis in ferrets. The drug was given orally, at 0.2 mg/kg, on days 38--42 of infection. At necropsy, 5 1/2 months after inoculation, worms were almost totally absent from the hearts of these ferrets. The efficacy of melarsoprol against developing Dirofilaria, which has been demonstrated in dogs by other workers, was demonstrated in ferrets given oral doses, at 100 mg/kg, on days 38--42 of infection. The reported efficacy of mebendazole was not evident in the ferret host in this study, probably because the treatment (100 mg/kg, orally, on days 38--42) was shorter and later than that reported for dogs.
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Seasonal variation in a particular area may influence the occurrence of helminth infections and determining such fluctuations may help to maximize the beneficial effects of mass treatment. This study determined the seasonal variations in infection levels of Ascaris lumbricoides between March 2000 and June 2001 in two selected low-country plantations. Four hundred and seventy seven persons aged between 2 and 74 years (median 13) participated. Stools were tested using the Kato-Katz method and the prevalence and intensity of infection determined. All persons were treated with a single dose of mebendazole. Monthly follow-ups were undertaken with similar stool examinations and treatment given if found positive. Infection and re-infection rates were calculated each month. Rainfall and temperature were recorded each day. Total rainfall, number of wet-days and mean temperature was calculated for each month. The prevalence of Ascaris infection was 53.4% and 51.0% at Maliboda and Ayr estates respectively. Highest infection and re-infection rates at Maliboda (37.7%, 37.2%) occurred in June and at Ayr (13.3%, 25.9%) in October 2000 respectively. During the study period, the mean rainfall was 28.1 cm (range 7.4-63.9 cm) and mean temperature 27.6 degrees C (range 22.1 degrees -34.4 degrees C). Significant correlations (P<0.05) were found between the re-infection rate and rainfall, temperature and the number of wet-days. Similar correlations were observed with the infection rate and temperature and the number of wet-days. Ascaris infections were found to correlate significantly only with the number of wet-days in a month (P<0.01). Thus, the number of wet-days appears to be a better indicator of Ascaris infections than total rainfall or mean temperature.
We have tested the ability of the nematode Trichinella to infect young and old (NZB x NZW) F1 (BWF1) mice. We report the capacity of these mice to respond to the parasite antigens containing the epitope phosphorylcholine. The values obtained in adult worm intestinal retention rates and in the number of encysted larvae on the 35th day postinfection showed that the old BWF1 mice are more susceptible than young BWF1 and control (BALB/c x CBA/j)F1 (BCF1) mice to Trichinella infection. However, unlike the BCF1 mice, young BWF1 mice were unable to produce a good anti-phosphorylcholine plaque-forming cell response after the killing of Trichinella larvae by the anthelminthic mebendazole. Old BWF1 mice presented a discrete response which is discussed. Finally, our results seem to indicate that the lack of anti-phosphorylcholine response in young BWF1 mice after mebendazole treatment may be related to the high susceptibility of these mice to the suppressive properties of encysted Trichinella larvae against their own antigens.
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We extracted data from the hospital records of 30 patients hospitalized for trichinellosis contracted after eating poorly cooked pork that came from two wild pigs killed in the Golan Heights, and contacted them for follow-up 5-6 weeks and 6 months after hospital discharge.
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In a preliminary communication we reported that mebendazole, a vermicide, decreased plasma glucose and free fatty acid concentrations and increased plasma C peptide concentrations in both type II diabetic patients. Therefore, we suggested that mebendazole was an insulin secretagogue. However, these were uncontrolled studies, and improved metabolic control in these patients due to spontaneous remission rather than drug-induced insulin secretion was a possibility. To investigate the direct effect of mebendazole on insulin secretion we used intact islets isolated from normal rat pancreata. Mebendazole in concentrations as low as 10 to 20 mumol/L caused a twofold to threefold increase in acute-phase insulin release from isolated perifused rat islets. This heightened insulin release occurred in the presence of glucose-stimulated insulin secretion.
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We treated strongyloidiasis patients and obtained the following results: Of the 299 patients (184 males and 115 females), 81 patients (27.1%) had no complaints before treatment, 218 patients complaints of some symptoms, including arthralgia and/or lumbago (28.4%), abdominal pain and/or borborygmus (19.3%), numbness of extremities (18.1%), constipation (16.3%) and itching (15.7). We treated 219 patients with mebendazole and symptoms improved after treatment described below: Thirty-seven of the 63 patients (58.7%) with arthralgia and/or lumbago improved. Twenty-seven of the 36 patients (75.0%) with numbness of extremities improved. Thirty-one of the 32 patients (96.9%) with heartburn improved. We treated 26 patients with mebendazole plus thiabendazole and twelve of 14 patients (85.7%) with abdominal pain and/or borborygmus were improved after treatment. We treated 54 patients with ivermectin and five of 18 patients (27.8%) with arthralgia and/or lumbago were improved after treatment.
Enterobius vermicularis infection remains one of the most common parasitic infections, particularly prevalent in children. Enterobiasis, although not usually dangerous, may cause significant morbidity. Elimination of the parasite from a family or an institution often poses problems, either because of an incomplete cure or re-infection. While there have been limited reports of ectopic enterobiasis throughout the world, ours is probably one of the rarest reports of recurrent vaginal E. vermicularis infection in the absence of any gastrointestinal symptoms despite complete treatment. A 4-year-old girl presented with recurrent episodes of vulval itching on 3-4 occasions over 2 years. There was no pruritis ani nor urinary/gastrointestinal complaints. The vulva was inflamed with 4-5 living worms, 6-7 mm in length, emerging from the anterior vaginal fornix, but with no vaginal discharge. Direct microscopic examination of vaginal swabs revealed adult worms of Enterobius but no eggs. Repeated stool samples from the patient, parents and a sibling were negative. The patient was treated orally with 100 mg of mebendazole for 3 days followed by two more courses at 3-week intervals over a period of 3 months. Recurrent vaginal enterobiasis despite complete treatment and in the absence of any gastrointestinal involvement suggests that the vagina is a potential reservoir for E. vermicularis, which supports the theory of rare ectopic enterobiasis through the ascending pathway of the female genital tract.
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Large-scale deworming interventions, using anthelminthic drugs, are recommended in areas where the prevalence of soil-transmitted helminth infection is high. Anthelminthic safety has been established primarily in school-age children. Our objective was to provide evidence on adverse events from anthelminthic use in early childhood. A randomized multi-arm, placebo-controlled trial of mebendazole, administered at different times and frequencies, was conducted in children 12 months of age living in Iquitos, Peru. Children were followed up to 24 months of age. The association between mebendazole administration and the occurrence of a serious or minor adverse event was determined using logistic regression. There was a total of 1,686 administrations of mebendazole and 1,676 administrations of placebo to 1,760 children. Eighteen serious adverse events (i.e., 11 deaths and seven hospitalizations) and 31 minor adverse events were reported. There was no association between mebendazole and the occurrence of a serious adverse event (odds ratio [OR] = 1.21; 95% confidence interval [CI] = 0.47, 3.09) or a minor adverse event (OR = 0.84; 95% CI = 0.41, 1.72). Results from our trial support evidence of safety in administering mebendazole during early childhood. These results support World Health Organization deworming policy and the scaling up of interventions to reach children as of 12 months of age in endemic areas.
Trichinellosis is an anthropozoonosis caused by Trichinella spiralis. Central nervous system complications can occur during the course of this disease. This paper presents a case of neurotrichinellosis, assayed by using indirect immunofluorescence test.
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An otherwise well 46-year-old woman presented to her general practitioner with intermittent abdominal pain that had been present for several months. The only abnormality found at the initial consultation was moderate tenderness in the right upper abdomen. The laboratory tests that were ordered showed elevated parameters of inflammation. Sonography suggested the presence of an echinococcal cyst in segment VIII of the liver. Computed tomography confirmed this finding and showed no other cysts. On the basis of serological tests and the clinical findings, a diagnosis of Echinococcus granulosus infection was made. The patient was therefore admitted to hospital for surgical removal of the cyst. Her postoperative recovery was without complication and she remained free of symptoms.
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We report a case of porocephalosis in a 35-year-old Congolese adult who habitually ate large amounts of snake. The principal nonspecific clinical sign was abdominal pain. Diagnosis was based on X-ray examination of the abdomen without preparation and abdominal ultrasound scan.
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An intensive hookworm control program providing the rural population of southern Thailand with mass treatment with 300 mg Mebendazole and health education commenced in 1989 with a yearly budget of over US$ 1.2 million. The current research aimed to evaluate the coverage of health education and mass treatment, the effectiveness of mass treatment and the administrative process of the control program, two years after its commencement. This evaluation consisted of three studies. In the first study, 120 villages were randomly selected, from which 840 school children, 843 adults aged between 15-59 and 844 subjects aged over 60 years were interviewed to assess awareness of hookworm, latrine availability, receipt of and compliance with antihelminthics provided, and self-treatment. In the second study, 8 villages from each of the 14 provinces were randomly chosen. Stool samples from randomly selected 4,434 subjects were examined. The third study consisted of interviewing key health planners in Bangkok and 71 health officers/workers from 32 samples villages of 8 sampled provinces. Latrine availability was 80%. Percentages of subjects who had ever heard of hookworm ranged from 70 to 95 in school children, 55 to 80 in adults and 25 to 58 in the older age group. While 63 to 85% had latrines in their homes, 27% to 47% admitted defecation outside in the past month. Percentages of coverage of drug treatment ranged from 82 to 91 in school children, 68 to 80 in adults and 54 to 59 in the older age group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Albendazole (Abz) and Mebendazole (Mbz) analogues have been synthesized and in vitro tested against the protozoa Giardia lamblia, Trichomonas vaginalis and the helminths Trichinella spiralis and Caenorhabditis elegans. Results indicate that compounds 4a, 4b (Abz analogues), 12b and 20 (Mbz analogues) are as active as antiprotozoal agents as Metronidazole against G. lamblia. Compound 9 was 58 times more active than Abz against T. vaginalis. Compounds 8 and 4a also shown high activity against this protozoan. Compounds 4b and 5a were as active as Abz. None of the Mbz analogues showed activity against T. vaginalis. The anthelmintic activity presented by these compounds was poor.
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Platelets are part of body defence system, especially the antiparasite immunologic response. Platelets manifest their functions only after their activation. Thrombin activates platelets inducing change of their shape and causing secretion of certain substances. This study was designed to estimate blood platelets morphology as an indicator of their activation and effectiveness of antiparasite therapy. The study was conducted in group of 21 patients infected with T.spiralis before treatment (T1) and group of 19 patients after two weeks of treatment (T2). The diagnosis of trichinellosis was established on the bases of epidemiologic history, clinical picture and immunologic investigations. In the course of trichinellosis and after antiparasitic treatment increase of blood platelet count was observed. The decreased mean platelets volume observed in trichinellosis may be connected with their activation and releasing platelet factor 4 and beta-thromboglobulin. We suggest that T.spiralis activates platelets and the degree of their activation determines their morphologic parameters.
Efficacy of Ivermectin in combating Strongyloides westeri infection of foal. The efficacy of Ivermectin and Mebendazol in combating spontaneous Strongyloides westeri infections in foals has been tested by examining faecal egg output reduction. Ivermectin as a paste formulation was given to sucking foals and pregnant mares in a single dosage of 200 micrograms/kg bodyweight by oral administration. A high efficacy of Ivermectin in combating patent Strongyloides westeri infection could be demonstrated; no side effects have been observed. Mebendazol at a dosage rate of 8 mg/kg did not yield satisfactory results.
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A multicentre, randomized trial was carried out to compare the efficacy of two single-dose treatments for ascariasis: mebendazole 200 mg, and pyrantel 10 mg/kg. Each centre enrolled 200 patients with a suspected diagnosis of ascariasis, 100 for each treatment, and the treatments were randomized for each centre. To confirm the diagnosis, stools were examined for eggs of Ascaris lumbricoides by Kato's thick smear method. Efficacy was evaluated by stool examination repeated three weeks after treatment by a "blind" technician using two methods, viz. Kato's thick smear method and the zinc sulfate flotation method. Cure was defined as absence of ascaris eggs in the stools by both methods. Of the 600 enrolled patients, 32 were excluded from analysis as their initial stool examination was negative, and 568 completed the trial: 284 on each treatment. The cure rate was 80 per cent in the mebendazole group and 90 per cent in the pyrantel group (P less than 0.01). Thus pyrantel was found to be significantly more efficacious than mebendazole for single-dose treatment of ascariasis.
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The anthelmintic effects of anti-tapeworm drugs, bithionol, paromomycin sulphate, flubendazole and mebendazole on immature and mature Hymenolepis nana in mice were compared. Immature worms were not affected by paromomycin sulphate or flubendazole administered for 12 consecutive days (days one to 12 after infection) at 100 mg/kg/day but 48% and 100% of H. nana were eliminated from mice by bithionol and mebendazole respectively, at the same dosage regimen. Bithionol, paromomycin sulphate, flubendazole and mebendazole given at 100 mg/kg/day for five consecutive days (days 12 to 16 after infection) eliminated 32%, 29%, 36% and 100% of mature worms respectively. 10 and 20 mg of mebendazole/kg/day for five consecutive days (days 12 to 16 after infection) had little effect on mature worms whereas 50 and 100 mg/kg/day for the same period eliminated 99% and 100% of mature worms, respectively. ED50 of mebendazole in the elimination of mature H. nana was 14 or 15 mg/kg/day for five days from the reduction in dry weight or in number of worms recovered respectively. The effects of mebendazole given 2 to 4 days, 8 to 10 days or 13 to 15 days after infection at 100 mg/kg/day were compared. Very low, if any, activity of the drug given 2 to 4 days after infection was seen, whereas the drug given 8 to 10 days or 13 to 15 days after infection eliminated 84% and 86% of H. nana respectively.
Anthelmintics are commonly used in tropical areas, but are also prescribed in Western countries with other climates. However, pharmacoepidemiologic studies of these drugs are rare.
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Human enterobiasis is usually mild. Occasionally, however, an "ectopic" disease may occur with a more severe course. Two rare cases of eosinophilic ileocolitis due to Enterobius vermicularis infection are reported here.
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Epidemiological, clinical and laboratory data were collected during an outbreak of trichinellosis, which occurred in Izmir, Turkey, between January and March 2004. The source of the infection was raw meatballs made with a mixture of uncooked beef and pork. Of 474 persons who were admitted at the Ataturk Training and Research Hospital during this period with a history of raw meatball consumption, the diagnosis of trichinellosis was confirmed for 154 (32.5%, 87 males and 67 females; mean age 31 years, range 6-67 years). Among persons with a confirmed diagnosis, 79% had myalgia, 77% weakness and malaise, 63% arthralgia, 40% jaw pain, 68% fever, 63% periorbital and/or facial oedema, 49% oedema at the trunk and limb, 42% abdominal pain, 40% nausea and vomiting, 28% diarrhoea, 23% subconjunctival haemorrhage, 25% macular or petechial rash, 4% subungual haemorrhage, 15% cardiac complaints and 0.2% neurological complaints. Nine patients (5.8%) were hospitalised due to severe myalgia (n = 2), high fever (n = 3), neurological manifestations (n = 1), thrombophlebitis (n = 2) and palmar erythema (n = 1). Eosinophilia was present in 88% of the confirmed cases at the admission. Elevated levels of serum creatine phosphokinase, lactic dehydrogenase and aspartate aminotransferase were detected in 72%, 70% and 16% of the confirmed cases, respectively. The seroconversion occurred in most of the infected people between the 4th and 6th weeks after the infection. All of the confirmed cases were treated with mebendazole. People with severe symptoms were treated also with prednisolone (60 mg/day for three days) and those with a moderately severe clinical pattern received a non-steroid anti-inflammatory drug (naproxen sodium, 550 mg/day). All confirmed cases recovered without any clinical sequela.
The anthelmintic effects of flubendazole (methyl [5-(4-fluorobenzoyl)-1-H-benzimidazol-2-yl] carbamate) (Janssen Pharmaceutica) were evaluated in jirds (Meriones unguiculatus) and cats (Felis cattus) infected with Brugia pahangi. Flubendazole was macrofilaricidal at 5 x 2.5 mg/kg and 1 x 25 mg/kg in jirds and 1 x 100 mg/kg in cats when administered by subcutaneous injection. It also killed developing larvae in jirds. It was not microfilaricidal.
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After specifying that rupture of a hydatid cyst in the peritoneal cavity is one of the most serious and rarest complications of hepatic hydatidosis, attention is paid to the peritoneal hydatid (o chole-hydatid). The aetiopathogenetic mechanisms and the anatomo-pathological features of this type of lesion are described in brief. Finally, the personally employed diagnostic protocol and therapeutic strategy in the face of this feared complication are reported.
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Mebendazole was given to mice infected with Angiostrongylus costaricensis at a single dose of 5 mg/kg at 6, 11, 16 or 21 days post-infection (p.i.) and in five successive doses at 5 mg/kg daily at 6, 11 or 16 days p.i. The effects were comparatively assessed by examining various parameters in host mice and worms. As a whole, the effects of mebendazole were caused more conspicuously by five successive treatments than by a single treatment. In both treatment modalities, the effects were more remarkable in earlier treatments, and nearly complete effects were caused by five successive treatments before 15 days p.i. These results suggest that the inhibition of egg formation and/or oviposition will inhibit the pathological changes caused in the disease by A. costaricensis, especially before the onset of the changes.
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Benzimidazoles, namely albendazole (ABZ) and mebendazole, are the only drugs licensed for the treatment of inoperable alveolar echinococcosis. In addition, amphotericin B (AMB) has shown effect against Echinococcus multilocularis as salvage treatment in humans. Both benzimidazoles and AMB are only parasitostatic against E. multilocularis and toxicity may limit long-term use. In the present study we examined the effect of combined treatment between ABZ and AMB on E. multilocularis larvae in an in vitro model. Vesicles were grown in a tissue culture model of metacestodes and hepatocytes. Drugs were added to the culture and the destructive effect on the vesicles was visually observed. Sequential application of ABZ and AMB yielded effective destruction of vesicles which was faster than the application of AMB alone. However, simultaneous application of ABZ and AMB had an inhibitory effect on vesicle destruction. After discontinuation of drug application, regrowth of vesicles occurred, hereby proving the parasitostatic effect of combined treatment against E. multilocularis larvae. Due to an inhibitory effect between ABZ and AMB against E. multilocularis larvae, we discourage from the simultaneous application of both drugs. If our in vitro results hold true in vivo, sequential application of ABZ and AMB would be an effective means for long-term suppression of larval growth. Long-term tolerance of both drugs could be improved by a reduction of side effects.
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Hookworms are ubiquitous human parasites, infecting nearly one billion people worldwide, and are the leading cause of anemia and malnutrition in resource-limited countries. Current drug treatments rely on the benzimidazole derivatives albendazole and mebendazole, but there is emerging resistance to these drugs. As part of a larger screening effort, using a hamster-based ex vivo assay, anthelmintic activity toward Ancylostoma ceylanicum was observed in the crude extract of aerial parts of Dalea ornata. These studies have led to the isolation and characterization of phenolic metabolites 1-10. The structures were determined by 1D and 2D NMR spectroscopy, and the absolute configuration of 1 was assigned using electronic circular dichroism data. The new compound, (2S)-8-(3-methylbut-2-en-1-yl)-6,7,4'-trihydroxyflavanone (1), was weakly active at 7.3 μM, with 17% reduction in survival of the hookworms after 5 days. The rotenoids deguelin (9) and tephrosin (10), predictably perhaps, were the most active, with complete worm mortality observed by day 4 (or earlier) at 6.3 and 6.0 μM, respectively. The effects of 1-10 on hookworm motility and on toxicity to hamster splenocytes were also explored as important measures of treatment potential.