Treatment of dermal cysticercosis with praziquantel: a new cestocidal agent.

Rev. Inst. Med. trop. São Paulo 26(5) :259-266, setentbro-otttubro. 1984

TREATMENT OF DERMAL GYSTICERCOSIS WITH

PRAZIQUANTEL

(").

A

NEW CESTOCIDAL AGENT

Miroslau Constante BARANSKI (t)

SIJMMARY

Twenty adult patients presenting dermal cysticercosis without cerebral or

ocular involvement were treated with praziquantel. _The

_first

_{eleven cases} receiv-ed 60 rng,¡hglday and the last nine cases B0

mglkg/d4y.

rn

both

groups the

daily dose was

split into

three oral intakes

4 to

6 hours apart and

the

drug

administration lasted

for

6 consecutive

days.

The latter group

of

patients also

got dexamethasone,

3

mg daily,

from

one day before

until

four days after the

treatment period

with

praziquantel. The drug proved.

_to

be

r00vo efficacious as demonstrated histopatholqgically by the death of the cysticerci

of

Taenia

so-lium

(Çysticercus cellulosae)

in

serial biopsies taken

from

the 2nd week on

aft'er the end of treatment, as well as clinically by the steady disappearence of the dermal nodules during the

6

months following the

therapy.

Tolerance oî praziquantel was good as the incidence and severity

of

side-effects were not Íe-levant. The drug safety was confi¡meci through laboratory tests which failed. to

detect any abnor'rrral findings related

to

the

hematopoietic,

liver

and kidney functions.

UDC 6t6.995.1

INTRODUCTION

Praziquantel,

an

heterocyclic isoquinoline derivative, is a new synthetic cornpound highly

active

in

experimental and human infections caused

by

cestodes 1,8,72,73.74.

It

acts against Cysticærcus bovis,

the

larval stage

of

Taenia saginata, in naturally infected calves as well as

a,gainst Cysticercus cellulosae, the larval stage of Taenia solium, in naturally infected pigs2,s,rs. Extensive pharmacological

and

toxicological studies had demonstrated the tolerance and

sa-fety

of

praziquantel

in all

tested animal

spe-cies, including controlled trials involving health volunteers 4'7.

This clinical trial was carried out with the

aim of assessing the efficacy of this new cesto-cidal agent in the treatment

of

human dermal cysticercosis caused

by

Cysticercus cellulosae.

Trial subjecús and Methods

All twenty patients were treated at the De-partment

of

Infectious and Parasitic Diseases, Medicai School, Federal University

of

Paraná,

Curitiba,

B¡azil.

Thirteen cases were admitted

to

the

Hospital during

the

treatment perÍod whereas seven cases were treated

at

the

out-patient clinic. Praziquantel was administered

per os for six consecutive days. The daily dose was split into three intakes 4 to 6 hours apart. The

first

11 patients received 60 mg,4<g,/day and

the last nine patients half that dose. This

se-cond group also received 1 mg

of

dexametha-sone t.i.d. starting one day

prior

to the

prazi-quantel

intake.

The corticoid administration

was maintained until four days after finishing

the

treatment

with

praziquantei.

The

daily dose of dexamethasone wâs gradttally

decreas-(.)

(t) The CISTICID late Head _ MeIcK P¡ofessor,S.A.

raná, Curitiba, Brazil

Indúst¡ias Qufmicas

Infectious and Parasitic Diseases; Faculdade de Medicina, Universidade Federal do

BARANSKI, M. C. _- Treatment of dermal cystlcercosis with praziquantel. .4, ne$' cestocidal agent. Rey. Insú. Med. trop,

São Paulo 26:259-266, 1984.

Numbet of de¡mal nodules Before treatment

4to 9

No.

rAD!DI

Dis¿ribution of dermal nodules

10 to 19

20 to 29

-iJ Number of patients

30 or more

1 month

No.

Number of demal nodules

30.0

Total (in 20 câses)

(o/o')

Minimum

10.0

Maximm

After t¡eatment

3 months

Reduction

Before treatment

TÁ.BLE II Therapeutical response

to

_{the drug administration, there was a single}

remaining _{nodule and; one case initiâIlJ¡ with} 25 had two nodules left. These remanent nodu_ les were smaller and had a harder consistency than at the begining but they were still painless and moveable. Comparing 60 ând 30 mg/kg/day

no statisticalþ significant difference was found. between the two doses at the 6th month after

therapy.

The biopsy taken two weeks after the end

of

treatment already revealed

a

disintegrated

cysticercus. Macroscopically one sees a shrunk gelatinous cream-like mass of soft consistency.

Looking through the microscope, the tegument

is

disrupted

no

lor¡ger making

it

possible to identify its three layers. InsÍde the vesicle the

262

6 months No.

?0.0

lst month

(o/o)

13.1

After treatment

3rd month

G7.60/o

scolex

is

detached from the collum and d.epri-ved of hooks and suckers. The dead parasite is surrounded by a conspicuous lymphoplasmoci

tÍc inflammatory _{reaction ,with eosinophils also}

present Fig. 3.

One month after treatment the macro- and microscopic aspects are similar but the proces-ses of degeneration and reabsorption of the cys-ticercus are more advanced and signs

of

chro-nic

inflammatory and

fibrotic

reactions start

to appear Fig. 4.

The biopsy repeated

on the

third

month

following the therapy shows the dead cysticer-cus reduced to a lenticular tuberculum of hard

consistency. Under the microscope one obser-6th month

85.90/o

BARANSKI, M. C. _- Treatment of dermâl

São Paulo 26:259-266, 1984.

Meån nMber of dermal nodule6

cysticercosis tvith praziquantel. ,q, new cestocidal âgent. Rev. Inst. Meil. trop.

ves signs of chronic inflammation

_-

fibroblast

in

radial arrangement and giant cells t¡pical

of

foreign body granuloma

_-

and fibrosis in-duced by the death of the parasite Fig. 5.

In

the serum,

prior

to

the treatment, the complernent fixation was positive in 14 patients (mean and standard deviation,

7

:h 4.6 units)

and the indirect hem4gglutination in 12 patients (mean and standard deviation, 1: 163

t

1: 159).

In

six cases both reactions were negative. On the third month after therapy the complement

fixation contìnued

to

be positive

in

the same L4 cases

but

the mean value diminished to 1.1

I

0.2

units.

The indirect.hemagglutination became negative

in

5 cases and its mean titer

decreased to 1.34

a

1;9, Taþle

III.

-45.9 %

After treatment

GRAPIIIC 1-REDUCTION OF DERMAL NODULES FOLLOWING

PRAZIAUANTEL ADMINISTRATION

Regarding the occurrence

of

adverse drug reactions, only eight cases reported untoward

effects. Abdominal pain or disconfort was the

most common complaint (in 3 cases) then

nau-sea (in 2) and vomiting, general malaise,

dizzi-ness, drowsiness, headache (in

1).

These symp-toms started during the

first

3

days

of

drug

intake and lasted

for

about 6 days. \¡/hilst 7

patients treated with 60 mg/kg/day cornplained of side-effects, just 2 of those who received 30

mg/kg/day

had

cornplaints. However, there

was

no

statisticalþ significant

difference between the tolerance of both doses, Table IV.

It

was found no abnormalities

in

the

labo-ratof,y results indicative

of

toxic praziquantel

upon ùhe hematopoietic lÍver and kidney func-tions.

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11

8.

t2

L4

Recebido para publicação eñ 3/4/L984.

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