title: Comparative efficacies of albendazole and the Chinese herbal medicine long-dan-xie-gan-tan, used alone or in combination, in the treatment of experimental eosinophilic meningitis induced by Angiostrongylus cantonensis.
abstract: Angiostrongylus cantonensis, the rat lungworm, is the principal cause of human eosinophilic meningitis or meningoencephalitis world-wide. In the present study, the efficacies of early-stage treatment with the Chinese herbal medicine long-dan-xie-gan-tan (LDXGT) and albendazole, used alone or in combination, were evaluated in BALB/c mice with A. cantonensis-induced dysfunction of the blood-central-nervous-system barrier and eosinophilic meningo-encephalitis. Indicators of the therapeutic effect included worm recovery, histopathological scores for the meningitis, assays of tissue-type plasminogen activator (PA), urokinase-type PA and matrix metalloproteinase-9 (MMP-9) in the brain, the ratio between albumin concentrations in the cerebrospinal fluid (CSF) and serum, and counts of eosinophils in the CSF. Combined treatment with albendazole and LDXGT gave better results than monotherapy based on either drug, apparently inhibiting eosinophilic meningitis via antagonists of the PA/MMP-9 system. LDXGT may have a therapeutic role in reducing inflammatory reaction in the subarachnoid space. Monotherapy with such an anti-inflammatory drug may relieve the symptoms of mild infection and the host's immune responses to A. cantonensis larvae. In severe infection, however, co-therapy with an anthelmintic (to kill the larvae) and an anti-inflammatory agent (to provide symptomatic relief) is probably a better approach. The therapeutic strategy should be tailored to the severity of the illness and the numbers of eosinophils in the CSF.
authors.affiliation: Department of Parasitology, Chung Shan Medical University, Taichung 402, Taiwan.
authors.forename: S C
authors.initials: SC
authors.lastname: Lai
authors.forename: K M
authors.initials: KM
authors.lastname: Chen
authors.forename: Y H
authors.initials: YH
authors.lastname: Chang
authors.forename: H H
authors.initials: HH
authors.lastname: Lee
mesh_terms: D015766:Albendazole / Q000008:administration & dosage / Q000627:therapeutic use*; D017185:Angiostrongylus cantonensis; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage / Q000627:therapeutic use*; D004802:Eosinophilia / Q000188:drug therapy* / Q000469:parasitology; D007814:Larva; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D008590:Meningoencephalitis / Q000188:drug therapy*; D051379:Mice; D008807:Mice, Inbred BALB C; D023421:Models, Animal; D017206:Strongylida Infections / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000871:Anthelmintics; D004365:Drugs, Chinese Herbal; D020780:Matrix Metalloproteinase 9; D015766:Albendazole