Acute schistosomiasis, a diagnostic and therapeutic challenge.
In non-endemic countries, acute (invasive) schistosomiasis (AS) is typically seen in non-immune travellers, whereas chronic schistosomiasis is more frequently diagnosed in immigrants. Travellers with AS initially present with non-specific signs such as fever, cough, headache, and urticaria. Life-threatening cardiac and neurological complications may occur. The positive diagnosis of AS relies on seroconversion, which appears together with hypereosinophilia approximately 3 weeks after the onset of symptoms. When prescribed during AS, praziquantel usually does not prevent the chronic phase of the disease and is associated with exacerbation of signs and symptoms in approximately 50% of cases. According to the published literature, corticosteroids may be recommended alone or in association with praziquantel. When associated with corticosteroids, pharmacokinetic interactions may impair the efficacy of praziquantel. We suggest that corticosteroids should be restricted to use in patients with systemic complications of AS, whereas praziquantel should be initiated only when ova are detected in either stools or urine, depending on the culprit species.
Jauréguiberry
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Department of Infectious, Tropical Diseases and Parasitology-Mycology, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France. stephane.jaureguiberry@psl.aphp.fr
Paris
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Caumes
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D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000913:Antibodies, Protozoan / Q000097:blood; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D004347:Drug Interactions; D004802:Eosinophilia; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D011223:Praziquantel / Q000627:therapeutic use; D012552:Schistosomiasis / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D012698:Serologic Tests; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D000913:Antibodies, Protozoan; D000981:Antiprotozoal Agents; D007155:Immunologic Factors; D011223:Praziquantel