The Impact of Artesunate-Amodiaquine on Schistosoma mansoni Infection among Children Infected by Plasmodium in Rural Area of Lemfu, Kongo Central, Democratic Republic of the Congo

Abstract

Background Malaria and schistosomiasis remain life-threatening public health problems in sub-Saharan Africa. The infection pattern related to age indicates that preschool and school-age children are at the highest risk of malaria and schistosomiasis. Both parasitic infections, separately or combined, may have negative impacts on the haemoglobin concentration levels. The existing data revealed that artemisinin derivatives commonly used to cure malaria present also in antischistosomal activities. The current study investigated the impact of Artesunate-Amodiaquine (AS-AQ) on schistosomiasis when administered to treat malaria in rural area of Lemfu, DRC. Methodology A prospective longitudinal study including 171 coinfected children screened for anaemia, Schistosoma mansoni, and Plasmodium falciparum infections. The egg reduction rate and haemoglobin concentration were assessed four weeks after the treatment with AS-AQ, of all coinfected children of this series. Results One hundred and twenty-five (74.4%) out of 168 coinfected children treated and present during the assessment were found stool negative for S. mansoni eggs. Out of 43 (25.6%) children who remained positives, 37 (22%) showed a partial reduction of eggs amount, and no reduction was noted in 3.6% of coinfected. The mean of haemoglobin concentration and the prevalence of anaemia were, respectively, 10.74±1.5g/dl , 11.2±1.3g/dl, and 64.8%, 51.8%, respectively, before and after treatment, p<0.001. Conclusion The AS-AQ commonly used against Plasmodium allowed curing S. mansoni in coinfected children and increasing the Hb level. For the future, the randomized and multicentric clinical trials are needed for a better understanding of the effectiveness of AS-AQ against Schistosoma spp. The trial registration number was 3487183.

Evidence for in vitro and in vivo activity of the antimalarial pyronaridine against Schistosoma

“…Pyronaridine has an estimated terminal elimination half-life of around 14 days [39] in contrast to artesunate with approximately 1 h [40]. Clinical trials testing mefloquine [41] and ACTs like artesunate-amodiaquine [42], artesunate-sulfalene-pyrimethamine, or artemether-lumefantrine [43,44] in patients concomitantly infected with P. falciparum and Schistosoma spp. reported a beneficial secondary antischistosomal efficacy, e.g.…”

Efficacy and safety of praziquantel plus Artemisinin-based combinations in the treatment of Kenyan children withSchistosoma mansoniinfection: an open-label, randomized, head-to-head, non-inferiority (SCHISTOACT) trial

“…The combination treatment was administered for three days, with more adverse events expected due to longer treatment duration, and drug-drug interactions. In previous studies, fewer adverse events were observed in the ACT group than in the PZQ group [10–12,14].…”

Recent pharmacological advances in the repurposing of artemisinin drugs

“…N. El‐Beshbishi also found that the artemisinin–naphthoquine phosphate combination showed an outstanding effect on the Egyptian strain of S. mansoni and was able to kill all parasites at a dosage of 40 or 20 μg/ml within 48 or 72 h 50 . Meanwhile, synergistic effects of artesunate‐amodiaquine that could significantly kill S. mansoni in children were also observed in a clinical study 51 …”