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[伊维菌素作为对传统药物治疗耐药的神经囊尾蚴病的一种治疗选择]

[Ivermectin as a therapeutic alternative in neurocysticercosis that is resistant to conventional pharmacological treatment].

作者信息

Diazgranados-Sánchez J A, Barrios-Arrázola G, Costa J L, Burbano-Pabon J, Pinzón-Bedoya J

机构信息

Centro Médico Imbanaco, Cali, Colombia.

出版信息

Rev Neurol. 2008;46(11):671-4.

Abstract

INTRODUCTION

Neurocysticercosis is a public health problem that can be found in many parts of the world, especially in developing countries, and today's high rates of immigration are making it increasingly more common in developed countries. Cysticidal treatment of neurocysticercosis is a controversial issue because it is only partially effective against vesicular and colloidal-shaped cysts when the parasite persists after a course of albendazole or praziquantel, the only two therapeutic options that are currently available. Ivermectin is a very effective, safe veterinary and human antiparasitic drug, with occasional very mild side effects. It has been used for over 25 years in cases of endoparasitosis that do not respond well to treatment, such as filariasis, oncocerciasis, strongyloidiasis, etc. and also in ectoparasitoses, such as pediculolsis capitis and myasis. It acts in the myoneural junction on the receptors in the chloride channel by increasing their permeability and causing paralysis in adult worms or by a mediated immune mechanism when it acts on immature forms.

CASE REPORTS

We report the cases of four patients who were previously treated with albendazole reiteratively with radiological evidence, which shows the persistence of viable vesicular or colloidal-shaped cysts. These patients were given 10 mg/day of ivermectin for 15 consecutive days or 10 mg/day as an average for 30 days, with excellent clinical and radiological progress.

CONCLUSIONS

Ivermectin was effective and did not give rise to any side effects when used to treat these four patients, who were resistant to conventional treatment with albendazole and/or praziquantel.

摘要

引言

神经囊尾蚴病是一个公共卫生问题,在世界许多地区都有发现,尤其是在发展中国家,而如今的高移民率使得它在发达国家也越来越常见。神经囊尾蚴病的杀囊治疗是一个有争议的问题,因为当寄生虫在阿苯达唑或吡喹酮(目前仅有的两种治疗选择)疗程后仍持续存在时,这两种药物对囊泡状和胶状囊肿仅部分有效。伊维菌素是一种非常有效且安全的兽用和人用抗寄生虫药物,副作用偶尔非常轻微。它已在治疗反应不佳的体内寄生虫病(如丝虫病、盘尾丝虫病、类圆线虫病等)以及体外寄生虫病(如头虱病和蝇蛆病)中使用了25年以上。它通过增加氯化物通道受体的通透性并导致成虫麻痹,或在作用于未成熟形式时通过介导的免疫机制在肌神经接头处发挥作用。

病例报告

我们报告了4例患者的病例,这些患者先前经阿苯达唑反复治疗并有影像学证据表明存活的囊泡状或胶状囊肿持续存在。这些患者连续15天每天给予10毫克伊维菌素,或平均每天10毫克共30天,临床和影像学进展良好。

结论

伊维菌素用于治疗这4例对阿苯达唑和/或吡喹酮常规治疗耐药的患者时有效且未产生任何副作用。

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