Performance and Safety of Praziquantel for Treatment of Intestinal Schistosomiasis in Infants and Preschool Children

Abstract

BackgroundIn 2012 the WHO formally recognised that infants and preschool children are at significant risk of schistosomiasis and qualify for treatment with praziquantel (PZQ). Targeted surveys determining both the performance and safety of this drug are now needed in endemic areas. We have formally assessed parasitological cure and putative side-effects in a prospective cohort of Schistosoma mansoni-infected children (aged 5 months–7 years old) in lakeshore settings of Uganda.Methodology/Principal FindingsFrom a total of 369 children found to be egg-patent for intestinal schistosomiasis, 305 were followed-up three to four weeks after PZQ treatment and infection status re-assessed. Separately, a previously tested side-effect questionnaire was employed before and 24 hours after PZQ treatment to assess incidence and amelioration of symptoms in young children and their mothers. While the overall observed parasitological cure was 56.4%, a significant difference was found between a sub-set of children who had a history of multiple PZQ treatments (between one and four in an 18 month period), where cure rate was 41.7%, and those who had never received treatment (cure rate was 77·6%). PZQ proved to be safe, with only mild reported side effects which cleared within a month after treatment. Prevalence of reported symptoms was significantly lower in children than in mothers, and fewer side-effects were reported upon subsequent rounds of PZQ treatment.Conclusion/SignificanceOur findings show that PZQ treatment of young children resulted in satisfactory cure rates, and marked reduction in egg-output, with only mild and transient reported side-effects. However, the cure rate is clearly lower in younger children and those with history of previous treatment. Cure rate, but not egg reduction rate, was also lower in children with heavier pre-intervention infection intensity. With chemotherapy now recommended as a long-term strategy for disease control in young children, research into optimising the periodicity of targeted treatment strategies is now crucial.

Urinary schistosomiasis among preschool-age children in an endemic area of Kinondoni municipality, Dar es Salaam, Tanzania 2016

“…To our understanding, this is the first study in Tanzania mainland to attempt to examine the magnitude of S. haematobium infection in children excluding receiving praziquantel preventive chemotherapy campaigns. Although the prevalence of S. haematobium infection was low (1.9%) and all were light infections, the findings demonstrate that young children contribute to the burden of urinary schistosomiasis in the studied community as demonstrated in other sub-Saharan Africa countries [7,13,[19][20][21][22][23][24][25]. Early childhood infection undoubtedly contributes to pathology among preschool children in endemic areas, thus the finding of 12.0% prevalence of blood in urine indicates a probable cryptic morbidity of damage in the urinary tract due to S. haematobium infection despite the observed low prevalence (1.9%) of patent eggs count, all with a light intensity which is common in preschool age children [26].…”

Morbidity Associated with Schistosomiasis Before and After Treatment in Young Children in Rusinga Island, Western Kenya

“…However, children too young or small for MDA have considerable infection prevalences 5,6 in multiple African countries, where they can be exposed through bathing and other activities, 7,8 and they can be treated with no serious adverse events. [9][10][11][12][13] The morbidity pre-school-aged children (PSAC) experience from infection is not well defined, though: effects are known to include fecal occult bleeding, 14,15 hematuria, proteinuria, 16 ultrasound abnormalities, 17,18 and possibly anemia, 19,20 but clinical implications remain unclear. Thus, although these findings have prompted calls for including PSAC in MDA, 21 a 2010 WHO meeting concluded that more evidence was necessary.…”

Neurologic manifestations of the neglected tropical diseases

“…Although cases of schistosomiasis-associated CNS vasculitis and pelvic floor myopathy have been described, a causal relationship was not definitively confirmed [101][102][103][104]. Although randomized trials have demonstrated the benefits of praziquantel for nonneurologic manifestations of schistosomiasis such as intestinal or urinary tract involvement [105][106][107][108][109], the management of neuroschistosomiasis is described only in case series [110][111][112]. For the treatment of CNS involvement, experts recommend praziquantel with concurrent corticosteroids, both to treat neuro-inflammatory sequalae of schistosomiasis, and since anti-parasitic treatment can induce a hypersensitivity reaction with features including headache, hemiparesis, seizure, encephalopathy and cerebellar signs [99].…”