Albendazole Treatment in Human Taeniasis

Home , Albendazole, Taeniasis, Taenia saginata

648

TRANSACTIONSOF THE ROYAL SOCIETY OF TROPICAL MEDICINE ANDHYGIENE (1991) 85, 64X-650

Albendazole treatment in human taeniasis Downloaded from https://academic.oup.com/trstmh/article/85/5/648/1878155 by Centers for Disease Control and Prevention user on 25 August 2020

Rina Girard de Kaminsky’ Direccibn de Investigacibn Cientifica, Universidad National Autdnoma de Honduras

Abstract who reported being aware of tapeworm infection were The results are presented of albendazole trials on requested to recover proglottids and bring them fixed human taeniasis infections in Honduras, involving 56 in 10% formalin in labelled vials for permanent of 68 individuals (2% of the inhabitants) found to be carmine staining for species identification. infected during surveys conducted in 15 rural com- All Kato and STPS preparations, as well as fixed munities. Of the 3 methods used for diagnosis of proglottids, were transported to the University hos- infection, the Kato cellophane thick smea; showed pital for microscopical examination. Usually 2 months 80% reliability, a combination of Kato and ‘Scotch’ elapsed between the survey and laboratory examina- taoe nerianal swab 88%. and clinical historv of tion. Infected individuals were offered treatment pkglo’ttid expulsion less than 50%. Individuals were immediately after positive results became available. treated with a dose of 400 mg of albendazole per day Each town was visited 3-4 times: for the initial for 3 d, followed for 5 d to verify tapeworm expul- survey; to offer treatment and recover the parasites; sion, and evaluated again at 60 and 90 d to assess and at 60 d and sometimesat 90 d thereafter to verify drug efficacy. All 56 treated individuals remained the effectiveness of the treatment. stool-negative after 60 and 90 d; a partial strobila or Individuals receiving treatment were given a com- segmentswere recovered from 21 of them (37.5%). Of plete physicial examination; the only reason for these, Taenia saginata was identified from 4, and T. treatment exclusion was pregnancy. One dose of soZiumfrom 15; 2 specimens could not be specifically 400 me (2 Zentel@tablets) was administered each dav identified. Based on negative stool examinations and for 3 &ecutive days. No fasting or purgatives were clinical history after 60 and 90 d, albendazole seems required. Treated individuals were asked to provide a to be a well tolerated, very effective drug for treating stool sample and STPS 5 consecutive days before infections with Taenza spp. However, confirmation of treatment to verify egg excretion; they were also these results is needed due to the difficulty of making instructed to collect 24 h stools daily for 5 d after a reliable diagnosis of such infections. initiation of treatment. The stools were then separate- ly washed through a sieve to collect tapeworms or Introduction segments; when present, these were lixed in 10% Albendazole is a relatively new broad spectrum formalin and stained with carmine. Treated indi- anthelmintic drug which is effective against most viduals were re-examined 60 d after treatment by at common intestinal helminths (COULAUD et al., 1982; least 2 Kato and 2 STPS preparations and were DICKSON, 1984; BOTEY, 1984), two species of larvae questioned about their awarenessof infection. Thirty nematodes (COULAUD et al., 1982; CLINE et al., 1984) natients 153%) agreed to a second verification of and a larval cestode(ESCOBEDO et al., 1988). Doses of beatmen< effect&ness after 90 d. 200 mg for children under 12 years old and higher doses of 400 mgid for 5 d and 800 mgid for 3 d are Results well tolerated by the patients and virtually free of side Sixty-eight individuals (2% of the population) were effects (COULAUDet al., 1982). Reports of cure rates found to be infected with Taenia SDD. during the in human tapeworm infections vary. A single 400 mg surveys; 48 (70.5%) were women. Twelve persons dose was 57% to 70% effective (MISRA et al., 1984; (18%) could not be treated: 3 pregnant women, one DICKSON, 1984), and a 400 mg dose for 3 consecutive mentally retarded person who refused, 5 who days increased the successrate to 100% (MISRAet al., travelled awav, 2 who had treated themselves, and one 1984). We now report the results of attempts to who was missed. confirm those findings during surveys on human Eleven infections (16%) were diagnosed bv both the taeniasis. Kato and STPS techniques; 46 -(67.7%)-were diagnosed by Kato alone and 8 (11.7%) by STPS only. Materials and Methods One person insisted he was passing proglottids Surveys were conducted during a 3 year period in although he did not produce any and his examinations 15 rural communities to detect individuals infected were negative. Two individuals were award of passing with tapeworm and to determine the prevalence of proglottids, which they produced; their stools were infection (KAMINSKY, 1991). A history of proglottid not examined. No other patient brought in proglottids exuulsion, stool examination bv the Kato cellonhane before treatment. thick smear technique and ‘Scotch’ tape perianal Of the 56 persons treated, not all provided samples swabs (STPS) were the methods chosen on arounds of 5 d before and 5 d after treatment. Partial tapeworm simplicity, reliability, availability of mate&s, possi- strobila or a few gravid segmentswere found in 24 h bility of sample transportation, and cost. Individuals faecal collections from 21 (37.5%) of the 56 treated individuals within l-3 d after initiation of treatment. *Addressfor correspondence:Apartado no. 1587,Tegucigal- Eleven (52%) of those 21 individuals were not aware pa, Honduras. of being infected. Of the tapeworms recovered, 4 649

Table. Results of treatment and verification of treatment at 60 and 90 days iu 21 individuals with confirmed Taenia infection Downloaded from https://academic.oup.com/trstmh/article/85/5/648/1878155 by Centers for Disease Control and Prevention user on 25 August 2020 Awareness Subsequent Case Age of Examinationb Worm expelled examinationsb no. Sex” (years) infection at survey Stagec Speciesd 60 d 90 d 22 Yes oi+ sag. 010 :. F Yes o/+ ; sag. 010 ki: ii Yes +I+ sol. 010 ND i F Yes +/ND E sag. 010 5 f i +/ND G sol. 010 ir: F 28 ii: +I+ sol. 010 o/o 76 No O/ND CG sol. 010 o/o E 2 Yes +/ND sag. 010 o/o i F 28 No +/ND E NI 010 010 10 30 +/ND G sol. o/o 010 El 12 tt +/o sol. o/o 010 ;: 68 No +I0 E NI o/o 010 : Yes +t+ sol. o/o 010 :: F :; Yes +I+ E sol. 010 010 15 Yes +I+ sol. 010 010 16 F i Yes +/+ E sol. 010 010 33 No 01-k sol. 010 010 :i ii Yes +/o E sol. 010 010 19 F :27 No +I+ sol. 010 010 +10 E sol. 010 o/o ;!Y E :: ii: +/+ G sol. 010 o/o “F=female, M=male. bExpressed as result of examination of Kato smear/result of ‘Scotch’ tape perianal swab (O=no parasite eggs detected; + =positive; ND=not done). ‘G=gravid segment(s), P=partial strobila. dsag. = Tuenia saginata, sol. = T. sol&n, NI = not identified.

(19%) were identified as T. saginata and 15 (71.4%) as partial strobila and 19 passed a few gravid segments; T. sol&n; 2 (9.5%) could not be identified to species. in 35 nothing was recovered. The second difficulty All 4 persons infected with T. saginatu reported was the unreliability of diagnostic methods to detect passing proglottids that crawled through the anus; tapeworm infections. In our study more than half of only 6 of 15 infected with T. solium became aware of all patients treated were unaware of being infected. infection, after seeing proglottids in their faeces. The Unless they are actively forcing their way and 2 patients who passed unidentifiable proglottids were crawling out of the anal sphincter, tapeworm proglot- not aware of infection. Two pregnant women brought tids excreted with the faeces may go unnoticed by in proglottids without treatment; one was infected infected persons defaecating in latrines, flush toilets with T. saginata and the other with T. so&m. None of orinthe open (H~~~etuZ.,1981; FARAHMANDIAN et the 21 individuals was found to be positive at 60 d or al., 1973). Finding Tuenia eggs m stools may not be 90 d after treatment by Kato or STPS techniques or easy, since they are not deposited by the worm, as is by questioning. the case in other hehninthic infections, but are Of the 35 individuals (62.5%) who did not pass released from the gravid proglottids either by the proglottids but who were positive for Tuenia sp. eggs active crawling movements of the latter or, more by microscopical examination, 24 (68%) were not rarely, by the maceration of dead proglottids (GON- aware of being infected. Ten (28%) said to be aware of NERT et al., 1968). In the study by HALL et al. (198 l), infection were positive for eggs by microscopical the efficiency of diagnosing T. suginata infections by examination but did not pass any tapeworms after faecal examination after formalin-ether concentration treatment. None of those who underwent examination was 68%. In our study, the Kato method had a after 60 d and 90 d were found to be infected. The reliability of 80% and the combination of Kato and results of treatment of the 21 individuals with STPS was 88% efficient; the usefulness of the SPTS in confirmed Taenia infection are shown in the Table. surveys still has to be evaluated. We could not make conclusive observations on the daily pattern of Discussion occurrence of Tuenia eggs in stools of infected In this investigation, the results of albendazole individuals, since not all collaborated by providing treatment could be internreted as excellent, using as stools 5 d before treatment. Among those who did, a criteria the absence of eggs and proglottids’ from-the few patients with infection confirmed by the finding treated individuals at 60 and at 90 d thereafter. Two of proglottids were negative by microscopical ex- major difficulties in assessing drug efficacy, however, amination. were encountered. One was the poor worm recovery Within the constraints discussed and given the after treatment. Only 2 of 56 individuals expelled a doubts about certainty and sensitivity of diagnosis, it 650 would be worthwhile to confirm our results under thiasis, Firth, M. (editor). London: Royal Society of more controlled conditions with co-operative, trust- Medicine, International CongressSymposium Series, no. worthy infected individuals. 61, pp. 79-84. Downloaded from https://academic.oup.com/trstmh/article/85/5/648/1878155 by Centers for Disease Control and Prevention user on 25 August 2020 Escobedo. F.. Penaaos. I’.. Rodriguez, T. & Sotelo, H. (1988). Tratamiento’ de neuroci&cercosis humana’ con Acknowledgements Albendazole. Evaluation controlada con tomografia com- We thank the People-to-People Health Foundation, Pro- putarizada y con resonancia magnetica. Rev&a de la ject HOPE/Honduras, for assistancewith transportation and AsociacSn Guatemalteca de Parasitologia y Medicina significant donations for the towns’ medical dispensaries. Tropical, 3, 24-26. Smith, Kline and French (SKF) provided a grant to carry Farahmandian. I.. Sahba. G. H.. Arfaa. F. & Movafaaph.K. out the surveys, as well as the ZenteP tablets for treatment. (1973). A comparison of stool examinations and mass Special thanks are given to Dr Guido Jimenez, former SKF treatment for indication of the prevalence of T. saginata. Regional Medical Director in Costa Rica. Tropical and Geographical Medicine, 25, 171-173. Gonnert, F., Meister, G. & Thomas, H. (1968). Das References freiwerden der Eier aus Taenia-Proglottiden. Zeitschriji Botey, M. A. (1984). Clinical development of albendazole in fiir Parasitenkunde, 31, 282-288. Latin America. In: Albendazole in Helminthiasis, Firth, Hall, A., Latham, M. C., Crompton, D. W. T. & M. (editor). London: Royal Society of Medicine, Inter- Stephenson, L. (1981). Taenia saginata (Cestoda) in national Congress and Symposium Series, no. 61, pp. western Kenya: reliability of faecal examination in 115-119. diagnosis. Parasitology, 83, 91-101. Cline, B. L., Little, M. D., Bartholomew, R. K. & Halsey, Kaminsky, R. G. (1991). Taeniasis-cysticercosis in Hon- N. A. (1984). Larvicidal activity of albendazole against duras. Transactions of the Royal Society of Tropical Necator americanusin human volunteers. AmericanJour- Medicine and Hygiene, 85, 531-534. nal of Tropical Medicine and Hygiene, 33, 387-394. Misra, R. C., Dewan, R. & Jagota, S. C. (1984). Treatment Coulaud, J. I’., Duchatelle, C., Rouvillois, A. & Deluol, A. of human taeniasis with albendazole. Current Therapeutic M. (1982). Le Zentel dans le traitment des helminthiases Research, 36, 1195-1197. intestinales au Niger, en Guinee et a Paris. MLdicine d’Aftique Noire, 29, numero special, 41-42. Dickson, B. (1984). Summary of albendazole clinical trials in Received 2 October 1990; revised 13 March 1991; the Middle East and Africa. In: Albendazole in Helmin- accepted for publication 14 March 1991

X CONGRESO LATINOAMERICANO DE PARASITOLOGIA and I CONGRESO URUGUAY0 DE PARASITOLOGIA Montevideo, Uruguay; 17-22 November 1991 This meeting is organized by the Federation Latinoamericana de Parasitologos; its theme will be ‘New strategies for parasitic diseases control”, with special emphasis on hydatidosis, Chagas disease and enteroparasites. Further information can be obtained from: Meetings, Av. 18 de Julio 126811105, 11100 Montevideo, Uruguay; telephone +(598) 2 91 52 31 and 92 20 83; fax +(598) 2 90 71 61.