Failure of Mebendazole in the Treatment of Humans with Trichinella spiralis Infection at the Stage of Encapsulating Larvae

Pozio, Edoardo; Sacchini, D.; Sacchi, Luciano; Tamburrini, A.; Alberici, F.

doi:10.1086/318707

Cited by 88 publications

(54 citation statements)

References 12 publications

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“…During this period, the patient was treated at first with albendazole and then with mebendazole. Such course of seroconversion corresponds with findings of Schellenberg et al (2003) that in people infected with T. britovi the decline of antibody levels occurs with delay, unlike in patients infected with T. spiralis where the specific antibodies disappear already in two weeks after efficient therapy (Pozio et al, 2001). In trichinellosis caused by T. britovi, the decline begins after six months and all patients become seronegative after three years (Pozio et al, 1993).…”

Section: Discussionsupporting

confidence: 86%

Unusual clinical course of trichinellosis with relapse

et al. 2013

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SummaryDuring an outbreak of trichinellosis in Eastern Slovakia in 2008, 16 people were hospitalized, including 10 patients having specific anti-Trichinella antibodies. The disease relapse was seen in a 68-year-old woman two weeks after her discharge from hospital, where she was treated with albendazole and prednisone for 10 days. Clinical symptoms of trichinellosis, eosinophilia, elevated CRP and LDH levels were observed again with recorded elevation of aminotransferase levels during the relapse. Herein we discuss a potential cause of unusual relapse of trichinellosis with liver damage in a female patient with type II diabetes mellitus.

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Section: Discussionsupporting

confidence: 86%

Unusual clinical course of trichinellosis with relapse

et al. 2013

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“…Muscle biopsy samples collected 36 months p.i. from T. spiralisinfected donors were still positive for the presence of viable and mouse-infecting muscle larvae (data not shown) in spite of the mebendazole treatment (19).…”

Section: Discussionmentioning

confidence: 95%

Increased CD8⁺-T-Cell Expression and a Type 2 Cytokine Pattern during the Muscular Phase ofTrichinellaInfection in Humans

Morales¹,

Mele²,

Sanchez

et al. 2002

Infect Immun

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Cell-mediated immunity during the muscular phase of Trichinella infection in humans was studied. Cell proliferation, the phenotypic changes in the T-cell population, and expression and production of cytokines were examined by using peripheral blood mononuclear cells (PBMC) collected at different times postinfection from 10 individuals who had acquired Trichinella spiralis and five individuals who had acquired Trichinella britovi in two distinct outbreaks. T. spiralis and T. britovi crude worm extracts induced proliferation of PBMC from T. spiralis-and T. britovi-infected donors. Cytokine gene expression showed a predominant type 2 pattern for the entire period of infection studied, although gamma interferon (IFN-␥) was expressed. Interleukin-2 (IL-2), IL-5, IL-10, and IFN-␥ production was found in PBMC of all donors. There was a good correspondence between the cytokine expression and production patterns. Changes in PBMC composition, with a trend toward an increase in CD8 ؉ lymphocyte counts, were observed.The genus Trichinella is a group of nematodes which have a worldwide distribution and which cause trichinellosis in humans (15). Humans are infected by eating raw or undercooked meat or meat products (sausages, salami, etc.) from swine, horses, or game animals that are infected with larvae of these worms. In Italy, the main etiological agent of human trichinellosis is Trichinella britovi; however, some human infections have been attributed to consumption of products from imported animals infected with Trichinella spiralis (17).From 4 to 5 days after ingestion of infected meat, the larvae develop to the adult stage in a row of columnar epithelial cells in the small intestine. Six days after ingestion, the adult worms begin to reproduce, and the newborn larvae migrate across the lamina propria of the villus into the lymph and bloodstream. However, only the newborn larvae that reach striated muscles develop to the infective stage. In laboratory mice, the intestinal phase is longer for T. spiralis than for T. britovi and the female fecundity of T. spiralis is at least twice than that of T. britovi. These differences explain the different clinical pictures obtained for humans infected with these two species (20). Intestinal symptomatology (diarrhea, abdominal pain, and vomiting) occurs more frequently and lasts longer in human T. spiralis infections than in human T. britovi infections (20).When a larva penetrates a muscle cell, it causes the cell to become what is known as a nurse cell, and it becomes infective 15 to 16 days later (i.e., 21 to 22 days after ingestion of infected meat) (6).After ingestion of larvae, a host develops an immunity-mediated inflammatory response at the intestinal level, and this is followed by rapid expulsion of some of the larvae from the intestine (3). Studies conducted with mouse and rat models have suggested that antibodies play the most important role in this response, which depends on type Th2 cytokines derived from CD4 ϩ cells, and that mucosal mast cells also play an important rol...

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“…Diagnosis is suggested by the clinical history and the presence of eosinophilia; peripheral eosinophil counts are elevated starting in the second week of illness and may reach very high levels, with some cases with 50% eosinophils (181). Laboratory tests may also reveal leukocytosis, elevated immunoglobulin E, and increased muscle enzymes.…”

Section: Trichinella Sppmentioning

confidence: 99%

Bacterial, Fungal, Parasitic, and Viral Myositis

2008

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SUMMARY Infectious myositis may be caused by a broad range of bacterial, fungal, parasitic, and viral agents. Infectious myositis is overall uncommon given the relative resistance of the musculature to infection. For example, inciting events, including trauma, surgery, or the presence of foreign bodies or devitalized tissue, are often present in cases of bacterial myositis. Bacterial causes are categorized by clinical presentation, anatomic location, and causative organisms into the categories of pyomyositis, psoas abscess, Staphylococcus aureus myositis, group A streptococcal necrotizing myositis, group B streptococcal myositis, clostridial gas gangrene, and nonclostridial myositis. Fungal myositis is rare and usually occurs among immunocompromised hosts. Parasitic myositis is most commonly a result of trichinosis or cystericercosis, but other protozoa or helminths may be involved. A parasitic cause of myositis is suggested by the travel history and presence of eosinophilia. Viruses may cause diffuse muscle involvement with clinical manifestations, such as benign acute myositis (most commonly due to influenza virus), pleurodynia (coxsackievirus B), acute rhabdomyolysis, or an immune-mediated polymyositis. The diagnosis of myositis is suggested by the clinical picture and radiologic imaging, and the etiologic agent is confirmed by microbiologic or serologic testing. Therapy is based on the clinical presentation and the underlying pathogen.

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Failure of Mebendazole in the Treatment of Humans with Trichinella spiralis Infection at the Stage of Encapsulating Larvae

Abstract: Trichinella spiralis larvae infective for laboratory mice were collected from muscle biopsies performed at different times (from 1 day to 16 months) following the end of treatment, indicating the failure of mebendazole to kill Trichinella parasites when they are encapsulating in muscles.

Cited by 88 publications

References 12 publications

Unusual clinical course of trichinellosis with relapse

Unusual clinical course of trichinellosis with relapse

Increased CD8⁺-T-Cell Expression and a Type 2 Cytokine Pattern during the Muscular Phase ofTrichinellaInfection in Humans

Bacterial, Fungal, Parasitic, and Viral Myositis

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Failure of Mebendazole in the Treatment of Humans with Trichinella spiralis Infection at the Stage of Encapsulating Larvae

Abstract: Trichinella spiralis larvae infective for laboratory mice were collected from muscle biopsies performed at different times (from 1 day to 16 months) following the end of treatment, indicating the failure of mebendazole to kill Trichinella parasites when they are encapsulating in muscles.

Cited by 88 publications

References 12 publications

Unusual clinical course of trichinellosis with relapse

Unusual clinical course of trichinellosis with relapse

Increased CD8+-T-Cell Expression and a Type 2 Cytokine Pattern during the Muscular Phase ofTrichinellaInfection in Humans

Bacterial, Fungal, Parasitic, and Viral Myositis

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Increased CD8⁺-T-Cell Expression and a Type 2 Cytokine Pattern during the Muscular Phase ofTrichinellaInfection in Humans