Acute Febrile Respiratory Reaction After Praziquantel Treatment During Asymptomatic Late Form of Acute Schistosomiasis: Table 1

Abstract

Paradoxical reactions (Jarish Herxheimer-like reactions) have been described in patients treated with praziquantel (PZQ) during acute schistosomiasis (infected≤ 3 mo), while PZQ treatment of chronic schistosomiasis is generally considered to be safe. We report an acute febrile reaction with respiratory decompensation following PZQ treatment in a 17-year-old male patient who had no potential (re)exposure to infection for at least 5 months and was therefore considered to have reached the chronic stage of disease. We speculate that the clinical manifestations in our patient constitute a very late paradoxical reaction in an unusually long acute phase of infection.

Schistosomiasis and soil-transmitted helminthiasis preventive chemotherapy: Adverse events in children from 2 to 15 years in Bengo province, Angola

“…The present study reported different proportions of AEs comparable to those found in other studies involving praziquantel and / or albendazole. However, there are variations that may occur due to the heterogeneous antecedents of the participating individuals, such as age, nutritional and immunological status, socioeconomic conditions, environmental exposure, prevalence and intensity of infection, stage of parasite development, etc [13,18,20,21,[31][32][33][34][35][36][37]. Zwang et al reviewed the efficacy and safety of PZQ (40mg/kg), and report that the main AEs experienced and their incidences are mainly abdominal pain (31.8%), muscle pain (29.2%), joint pain (20.2%), headache (13.6%), diarrhoea (12.9%), fatigue (9.6%), nausea (10.6%), dizziness (11.9%), vomiting (7.9%) and itching (9.8%) [18].…”

“…Zwang et al reviewed the efficacy and safety of PZQ (40mg/kg), and report that the main AEs experienced and their incidences are mainly abdominal pain (31.8%), muscle pain (29.2%), joint pain (20.2%), headache (13.6%), diarrhoea (12.9%), fatigue (9.6%), nausea (10.6%), dizziness (11.9%), vomiting (7.9%) and itching (9.8%) [18]. Additionally for ALB, there are reports of the occurrence of epigastric pain, dry mouth, fever and itching [18,21,32,[38][39][40]. However, the occurrence of AEs are reported to be associated with the proportion of dying S. haematobium worms, i.e., with the pharmacologic effect of the drug on the parasite (for example; abdominal pain is reported to be associated with the deposition of dead worms in the mesenteric veins), they can also occur due to the natural course of disease [19,32,37,41,42].…”

“…Neumayr et al mentions that symptomatic acute schistosomiasis or treatment-induced reactions can manifest themselves with identical symptoms [32]. This group and others further discuss that the exposure to a high level of parasite antigens, caused by larval migration and maturation (of helminth larvae) or early oviposition in symptomatic acute schistosomiasis, can lead to an immune overreaction, resulting in symptoms that are similar to those reported as AEs to PZQ, but totally independent from treatment [19,32,[43][44][45].…”

“…Neumayr et al mentions that symptomatic acute schistosomiasis or treatment-induced reactions can manifest themselves with identical symptoms [32]. This group and others further discuss that the exposure to a high level of parasite antigens, caused by larval migration and maturation (of helminth larvae) or early oviposition in symptomatic acute schistosomiasis, can lead to an immune overreaction, resulting in symptoms that are similar to those reported as AEs to PZQ, but totally independent from treatment [19,32,[43][44][45]. Although increasing the number of infections significantly reduced the chances of AE occurrence, we found that heavy S. haematobium infection was significantly associated with AEs occurrence, with odds ratio twice as high in individuals with this parasitic load in the second survey.Also, H. nana infections alone can cause headache, dizziness, abdominal pain and diarrhoea, A. lumbricoides can cause nausea, vomiting, diarrhoea and abdominal pain, T. trichiura can cause abdominal pain and diarrhoea, and S. stercoralis can cause erythema, itching, fever, abdominal pain and…”

Schistosoma haematobium in China, ex‐Africa: New Populations at Risk?

“…When used to treat acute schistosomiasis, praziquantel can precipitate a paradoxical worsening, including urticaria, bronchospasm, or encephalopathy, which may require adjunctive corticosteroids for severe complications. [16][17][18][19] Post-exposure prophylaxis with praziquantel did not prevent acute or chronic schistosomiasis when given early (2 weeks after exposure) but when given later (4-6 weeks after exposure), prevented acute but not chronic schistosomiasis. 17 Some recommendations suggest that treatment should be deferred until 12 weeks after last exposure, and repeated 2-4 weeks later if infection persists.…”