Infectious Diseases Unit, University of Verona, Verona, Italy.
Centre for Cystic Fibrosis, AOUI Verona, Italy.
J Travel Med. 2019 Oct 14;26(7). doi: 10.1093/jtm/taz050.
Schistosomiasis affects more than 260 million people worldwide, mostly in sub-Saharan Africa, where more than 280 000 deaths per year are estimated. In the past few years, the increasing flow of migrants from endemic areas and the upward number of international travels have caused the emergence of the disease also in non-endemic areas. A single course of praziquantel (PZQ) 40 mg/kg is the first-line treatment recommended by the World Health Organization, mainly based on clinical trials conducted in endemic countries. No trials have been performed in non-endemic areas.
We carried out a systematic review of case reports and case series published between 1956 and August 2017 on cases of chronic schistosomiasis (infection acquired >3 months before) diagnosed in non-endemic areas and treated with PZQ. Primary outcome was to assess the number of different therapeutic regimens deployed and their frequency of use, calculated as the number of reports for each regimen over the total number of included cases.
The final database included 99 case reports and 51 case series, for a total of 1433 patients. In 57 of the 150 records (38%) the administered treatment was different from the one recommended by the World Health Organization. The proportion of 'alternative' regimens included increased doses of PZQ (up to 80 mg/kg) and/or prolonged duration of treatment and/or doses repeated some days/weeks apart. About 50% of the records regarding Western short-term travellers reported a non-standard treatment.
This is the first complete catalogue of the published experience with PZQ outside of endemic areas in the situation where reinfection is not an issue. We found a wide heterogeneity of the therapeutic regimens reported. Multicenter clinical trials conducted in non-endemic areas and guidelines specifically addressing the treatment of imported cases of chronic schistosomiasis are needed.
血吸虫病影响全球超过 2.6 亿人，主要集中在撒哈拉以南非洲地区，每年估计有 28 万多人因此死亡。在过去几年中，来自流行地区的移民人数不断增加，以及国际旅行人数的增加，导致该疾病也在非流行地区出现。世界卫生组织推荐的一线治疗方法是单次服用 40mg/kg 的吡喹酮（PZQ），主要基于在流行国家进行的临床试验。在非流行地区尚未开展临床试验。
我们对 1956 年至 2017 年 8 月期间发表的在非流行地区诊断为慢性血吸虫病（感染发生在 3 个月之前）并使用 PZQ 治疗的病例报告和病例系列进行了系统回顾。主要结局是评估使用的不同治疗方案的数量及其使用频率，计算方法为每种方案的报告数除以纳入的病例总数。
最终数据库包括 99 份病例报告和 51 份病例系列，共计 1433 例患者。在 150 份记录中的 57 份（38%），所使用的治疗方法与世界卫生组织推荐的方法不同。包括增加 PZQ 剂量（高达 80mg/kg）和/或延长治疗时间和/或间隔数天/数周重复剂量等“替代”方案的比例有所增加。大约 50%的关于西方短期旅行者的记录报告了非标准治疗。
这是首次完整地列出了在不存在再感染问题的情况下，在非流行地区使用 PZQ 的已发表经验目录。我们发现报告的治疗方案存在很大的异质性。需要在非流行地区进行多中心临床试验，并制定专门针对慢性输入性血吸虫病治疗的指南。
