Skuhala Tomislava, Trkulja Vladimir, Runje Mislav, Balen-Topić Mirjana, Vukelić Dalibor, Desnica Boško
University Hospital for Infectious Diseases "Fran Mihaljeviæ", Zagreb, Croatia.
Department of Pharmacology, School of Medicine, Zagreb University, Zagreb, Croatia.
Iran J Parasitol. 2019 Jul-Sep;14(3):492-496.
We present a 40-year-old woman with a history of relapsing echinococcosis who had undergone a number of surgical procedures for cyst removal (right pulmectomy, cardiac surgery and 6 subsequent brain surgeries and two gamma knife procedures) and was admitted to University Hospital for Infectious Diseases "Fran Mihaljeviæ", Zagreb, Croatia in 2014 for pre-operative medical treatment of brain hydatidosis in the right parietal region. We aimed to attain a high cyst albendazole sulphoxide (ASO) concentration in order to achieve a more pronounced protoscolex inactivation and a high serum ASO concentration (reflecting the tissue concentrations) to reduce the risk of disease recurrence. The patient was treated with a higher dose of albendazole (15 mg/kg/day for 4 wk) that we had found effective in patients with liver hydatidosis, and combined with praziquantel over the last 14 d at a dose that is typically used to treat neurocysticercosis with an intention to improve ASO bioavailability. Neither serum nor cerebrospinal fluid concentrations on day 10 apparently differed from those on day 24 indicating a lack of an effect of praziquantel on ASO bioavailability. Intra-cystic ASO concentration was below the lower limit of quantification, but above the limit of detection. After the 7 episode of the disease and combined albendazole-praziquantel and surgery treatment, the patient achieved a 3-year remission. With the apparent lack of a meaningful pharmacokinetic praziquantel-albendazole interaction, this is most likely ascribable to the use of a higher albendazole dose than previously.
我们报告一名40岁复发性棘球蚴病女性患者，她此前已接受多次囊肿切除手术（右肺切除术、心脏手术以及随后的6次脑部手术和2次伽马刀手术），并于2014年入住克罗地亚萨格勒布“弗兰·米哈列维奇”传染病大学医院，接受右顶叶脑包虫病的术前药物治疗。我们旨在获得较高的囊内阿苯达唑亚砜（ASO）浓度，以实现更显著的原头节灭活，并获得较高的血清ASO浓度（反映组织浓度），以降低疾病复发风险。该患者接受了较高剂量的阿苯达唑（15 mg/kg/天，共4周）治疗，我们发现该剂量对肝包虫病患者有效，并在最后14天联合使用吡喹酮，剂量通常用于治疗神经囊尾蚴病，目的是提高ASO的生物利用度。第10天的血清和脑脊液浓度与第24天相比均无明显差异，表明吡喹酮对ASO生物利用度没有影响。囊内ASO浓度低于定量下限，但高于检测限。经过7次发病以及阿苯达唑 - 吡喹酮联合治疗和手术治疗后，患者实现了3年缓解。由于吡喹酮 - 阿苯达唑之间明显缺乏有意义的药代动力学相互作用，这很可能归因于使用了比以前更高剂量的阿苯达唑。
