S U M M A R YTreatment with praziquantel (PZQ) has become virtually the sole basis of schistosomiasis control in sub-Saharan Africa and elsewhere, and the drug is reviewed here in the context of the increasing rate that it is being used for this purpose. Attention is drawn to our relative lack of knowledge about the mechanisms of action of PZQ at the molecular level, the need for more work to be done on schistosome isolates that have been collected recently from endemic areas rather than those maintained in laboratory conditions for long periods, and our reliance for experimental work mainly on Schistosoma mansoni, little work having been done on S. haematobium. There is no evidence that resistance to PZQ has been induced in African schistosomes as a result of its large-scale use on that continent to date, but there is also no assurance that PZQ and/ or schistosomes are in any way unique and that resistant organisms will not be selected as a result of widespread drug usage. The failure of PZQ to produce complete cures in populations given a routine treatment should therefore solicit considerable concern. With few alternatives to PZQ currently available and/or on the horizon, methods to monitor drug-susceptibility in African schistosomes need to be devised and used to help ensure that this drug remains effective for as long a time as possible.
SummaryThis paper summarizes and concludes in-depth ®eld investigations on suspected resistance of Schistosoma mansoni to praziquantel in northern Senegal. Praziquantel at 40 mg/kg usually cures 70±90% of S. mansoni infections. In an initial trial in an epidemic S. mansoni focus in northern Senegal, only 18% of the cases became parasitologically negative 12 weeks after treatment, although the reduction in mean egg counts was within normal ranges (86%). Among other hypotheses to explain the observed low cure rate in this focus, the possibility of drug resistance or tolerance had to be considered. Subsequent ®eld trials with a shorter follow-up period (6±8 weeks) yielded cure rates of 31±36%.Increasing the dose to 2´30 mg/kg did not signi®cantly improve cure rates, whereas treatment with oxamniquine at 20 mg/kg resulted in a normal cure rate of 79%. The ef®cacy of praziquantel in this focus could be related to age and pre-treatment intensity but not to other host factors, including immune pro®les and water contact patterns. Treatment with praziquantel of individuals from the area residing temporarily in an urban region with no transmission, and re-treatment after 3 weeks of non-cured individuals within the area resulted in normal cure rates (78±88%). The application of an epidemiological model taking into account the relation between egg counts and actual worm numbers indicated that the low cure rates in this Senegalese focus could be explained by assuming a 90% worm reduction after treatment with praziquantel; in average endemic situations, such a drug ef®cacy would result in normal cure rates. Laboratory studies by others on the presence or absence of praziquantel resistance in Senegalese schistosome strains have so far been inconclusive. We conclude that there is no convincing evidence for praziquantel-resistant S. mansoni in Senegal, and that the low cure rates can be attributed to high initial worm loads and intense transmission in this area.
Extensive water development has taken place in the north of Senegal over the last decade, resulting in a large increase in the amount of fresh water for irrigation. The objectives of the present study were to determine the prevalence and intensity of Schistosoma mansoni and S. haematobium in the Senegal river basin (SRB), and to ascertain the distribution of the snail species acting as intermediate hosts for both species of schistosomes. The schistosomiasis survey started in January 1994 and was completed in March 1995. Compared to studies before the construction of the Diama dam, there was a significant increase in both the prevalence and intensity of urinary and intestinal schistosomiasis in the human population in parts of the SRB. From the 9014 people who were registered from 180 villages and 4 towns (10 districts), 7750 were examined. S. mansoni was found in the lower valley (lower delta-Senegal river, lower delta-Lampsar river, upper delta, and diéré) but not in the middle valley. The mean prevalence ranged from 4.4% in the lower delta-Senegal River to 71.8% in the zone of Lac de Guiers, where prevalence and intensity of infection were higher on the eastern side of the lake (81.3% with a mean number of 2088 eggs/g of faeces) compared with the western side (50.3% with a mean 1111 eggs/g). S. haematobium was recorded throughout the area of study, ranging from a mean prevalence of 0.37% in diére (lower valley) to 41.5% in the lower valley (Lampsar river), where the mean egg count was 313/10 mL of urine. Physical and chemical changes to the environment have favoured the spread and increase in the populations of freshwater snails. The only snail involved in the transmission of S. mansoni was Biomphalaria pfeifferi. Five species of bulinid snails were present--Bulinus globosus, Bu. umbilicatus, Bu. senegalensis, Bu. forskalii and Bu. truncatus--but only the first 3 species were involved in the transmission of S. haematobium in the lower and middle valleys.
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