- Email: [email protected]
Praziquantel for the treatment of Diphyllobothrium nihonkaiense infections in humans
580 Mberu, E. K., Ward, S. A., Winstanley, P. A. & Watkins, W. M. 11991). Measurement of ouinine in filter-oaoer absorbed bloo> by high performance Ii&d chromatography. Journul of Chromatography, 570,18&184.
Molyneux, M. E., Taylor, T. E., Wirima, J. J. & Borgstein, J. (1989). Clinical features and pro nosric indicators in paediatric cerebral malaria: a studv of 14 1 comatoseMalawian children. QuarterIyJournal ofMe&ine, 71,441X59. Pasvol, G., Newton, C. R. J. C., Winstanley, P. A,, Watkins, W. M., Peshu, N. M., Were, J. B. O., Marsh, K. & Warrell, D. A. (1993). Quinine treatment of severefalciparum malaria in African children; a randomized comparison of three regimens. Ammican~ourml of Tropical Medicine and Hygiene, 45,702-713. Shann, F., &ace, J. & Edstein, M. (1985). Pharmacokinedcs of quinine in children. Journal ofl’ediutric~, 106,SC&510.
Silamut, K.? Fte,
N. J.?Looareesuwan,S. + Warrell, D. A.
(1985). l3mdm.g of qmnme roflasma procelns in falc$apm mdaria. Amencan Joumul of ropxal Me&me and ygtene, 34,681-686.
Silamut, K., Molunto, P., Ho, M., Davis, T. M. E. & White, N. J. (l991), Alpha1 acid glycoprotein (orosomucoid) and plasma protein binding of quinine in falciparum malaria. BrilishJournalofClinical
Pharmacology 32,311-317.
Warrell. D. A.. Molvneux, M. & Beales, I’. F., editors 11990). Severe and cbmpl&ed malaria, 2nd edition: TransaciiaF if the Royal Socie& of Tropical Medicine and Hygiene, 84, supptement 2I Warranagoon, Y., Phillips, R. E., Warrell, D. A., Silamut, K., Looareesuwan, S., Nagachinta, B. & Back, D. J. (1986). Intramuscular loading dose of quinine for falciparum malaria: pharmacokinetics and toxicity. British Medical 3oum1, 293, il-13.
White, N. J., Looareesuwan, S., Warrell, D. A., Warrell, M. J,, Bunnag, D. & Harinasuta, T. (1982). Quinine pharmacokinetics and toxicity in cerebral and uncomplicated falciparum malaria. AmricanJournalofMedicine, 73, 564-571. White, N. J., Looareesuwan, S., Warrell, D. A., Warrell, M. J,, Chanthavanich, P., Bunnag, D. & Harinasuta, T. (1983a). Quinine loading dose in cerebra1malaria. AmericanJaumal of Tropical Medicine and Hygiene, 32, I-5.
White, N. J., Chanthavanich, I’:, Krishna, S., Bunch, C. & Silamut, K. (1983b). Quinine disposition kinetics. BritirhJournal of Clinical Phartnacoloev. 16.399-403. WHO “( 1993). Tropical Disyaie kesearch, Progress 39914992: Eleventh Propramme Report of the UNDPIWorld BanklWHO Special Prog&mne fm i?esea& and Training in Tropical Diseases{TDR). Geneva: World I-Ieahh Organization.
Winstanley,P. A., Newton, C. R., Watkins, W. M., Mberu,
E., Ward, S. A., Warn, P. A., Mwangi, I., Waruiru, C., Pasvol, G., Warrell, D. A. & Marsh, K. (1994). Towards optimal
parenteral quinine regimens for young children with cerebral malaria: importance of unbound quinine concentration. Transactions of the Royal Sociey of Tropical Medicine and Hygim,87,201-206.
Wongsrichanalai, C., Webster, H. K., Wimonwartrawatee, T., Sookto, P., Chuanak, N., Timasam, K. & Wernsdorfer, W. H. (1992). In vifm sensitivity of Plasmodium f&iparwn isolaces in Thailand to quinine and chloroquine, 19841990. Southeast Asian Journal Health, 23,533-536.
of Tropical
Medicine
and Public
Received 3 November 1993; revised 4 Januq accepted for publication 4 January I994
1994;
TRANSACTIONS OF THEROYALSOCIETYOF TROPICALMEDICINEANDHYGIENE(1994) 88, $80
1Short Report1 Praziquantel for the treatment Diphyllobothrium nihonkaiense infections in humans
of
Kenji Ohnishi and Misako Murata L)epartment of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, 4-23-15 Kohtohbashi, Sumida-Ku, Tokyo 130, Japan The intermediate hosts of Diflhyllobothrium nihonkaiense are thought to be the fish Oncorhynchus masou and 0. gorbuscha. This tapeworm is a common parasite in Japan, because most Japanese like to eat raw or insufficiently cooked fish such as those mentioned above. Generally, the clinical manifestations of D. nihonkaiew infections are mild, but infection with this parasite is an important problem for patients and their families from the emotional and socioeconomic points of view, because of its long length and the long period of passing strobil?. Thus it 1s important to give suitable treatment. Prazlquantel is effective against human infections with D. latum (see BYLUND et al., 1977: GROLL. 1980). D. Pacificum (S&TGROLL, 1980; ~UMB~ERAS et (Il., 16x2) zhd b. nihorrkaiense (see OHNISHI & MURATA, 1993). We have
reported thatpraziquantel was effective.against D. nihunkaiense infection at a sinale dose of 7, 23 or 25 mgikg OHNISHI & MURATA, 1%3), and we have now success-
Iofullypraziquantel. treated D. nihonkaiense infection with a lower dose
Two male adults, aged 27 and 40 years, were treated as follows: on the day before therapy, they were given low fibre, low fat diets, and then magnesium citrate and bisoxatin acetate were given at night. The patients then received 6 mgikg and 5 mg/kg of praziquantel, respectively, in the morning on an empty stomach; magnesium sulphate dissolved in water was given 2 h later. The first patient expelled a tapeworm, 2.1 m long, with scolex 3 h 15 min after taking praziquantel, and the
other expelled 2 tapeworms, measuring 2.8 and 3.0 m, with scolices after 4 h 40 min. in waterv diarrhoea. All the expelled tapeworms were identified as D. nihonkaiense by light and electron microscopy at the Department of Environmental Medicine II, Shimane Medical University, Izumo-city, Shirnane Prefecture, Japan. No side effect was observed, the praziquantel being well tolerated by the patients. Although determination of the optimum dose of praziquantel in human D. nihonkaiense infection requires further work, our study indicates that a single dose of 5-6 mg/kg of praziquantel may be effective against D. nihonkaiense infection, and the doses reported before, especially 23 and 25 mgikg, may be unnecessarily high for this infection. Headache, dizziness, abdominal discomfort and nauseahave been reported as side effects of praziquantel in patients with cestode infections (GROLL, 1980). Some side effects of oraziouantel mav be associ. . ated with absorption of the drug from the intestine, so it may be desirable to reduce the dose. We thank Drs Yoneyama, Isobe, Shiwaku and Professor Yamane, Department of Environmental Medicine II, Shimane Medical University, for identification of rhe parasites. Refwences Bylund, G., BQng, B. & Wikgren, K. (1977). Tests with a new compound (sraziquantel) against Diphyllobothrium lawn. Jo&al of H&ninthologV, 51, il5-119. Groll, E. 11980). Praziauantel for cestode infections in man. AEta Tropica; 37,29<296.
Lumbreras, H., Terashima, A., Alvarez, H., Tello, R. & Guerra, H. (1982). Single dose treatment with praziquantel (Cesol R. EmBav 84401of human cestodiasis caused bv Di~hyllobotkum &if&n. Tropenmedizin und Parasitdlogie, 33,5-7.
Ohnishi, K. & Murara, M. (1993). Single dose treatment with praziquantel for human Dipkyllobothrium nihonkoiense infections. Transacziorts of the RqyaE Society of Tropical Medicine and Hygiene, 87,482-483.
Received 15 December 1993; revised I8 January accepted for publication 19Januay 1994
1994;
Molyneux, M. E., Taylor, T. E., Wirima, J. J. & Borgstein, J. (1989). Clinical features and pro nosric indicators in paediatric cerebral malaria: a studv of 14 1 comatoseMalawian children. QuarterIyJournal ofMe&ine, 71,441X59. Pasvol, G., Newton, C. R. J. C., Winstanley, P. A,, Watkins, W. M., Peshu, N. M., Were, J. B. O., Marsh, K. & Warrell, D. A. (1993). Quinine treatment of severefalciparum malaria in African children; a randomized comparison of three regimens. Ammican~ourml of Tropical Medicine and Hygiene, 45,702-713. Shann, F., &ace, J. & Edstein, M. (1985). Pharmacokinedcs of quinine in children. Journal ofl’ediutric~, 106,SC&510.
Silamut, K.? Fte,
N. J.?Looareesuwan,S. + Warrell, D. A.
(1985). l3mdm.g of qmnme roflasma procelns in falc$apm mdaria. Amencan Joumul of ropxal Me&me and ygtene, 34,681-686.
Silamut, K., Molunto, P., Ho, M., Davis, T. M. E. & White, N. J. (l991), Alpha1 acid glycoprotein (orosomucoid) and plasma protein binding of quinine in falciparum malaria. BrilishJournalofClinical
Pharmacology 32,311-317.
Warrell. D. A.. Molvneux, M. & Beales, I’. F., editors 11990). Severe and cbmpl&ed malaria, 2nd edition: TransaciiaF if the Royal Socie& of Tropical Medicine and Hygiene, 84, supptement 2I Warranagoon, Y., Phillips, R. E., Warrell, D. A., Silamut, K., Looareesuwan, S., Nagachinta, B. & Back, D. J. (1986). Intramuscular loading dose of quinine for falciparum malaria: pharmacokinetics and toxicity. British Medical 3oum1, 293, il-13.
White, N. J., Looareesuwan, S., Warrell, D. A., Warrell, M. J,, Bunnag, D. & Harinasuta, T. (1982). Quinine pharmacokinetics and toxicity in cerebral and uncomplicated falciparum malaria. AmricanJournalofMedicine, 73, 564-571. White, N. J., Looareesuwan, S., Warrell, D. A., Warrell, M. J,, Chanthavanich, P., Bunnag, D. & Harinasuta, T. (1983a). Quinine loading dose in cerebra1malaria. AmericanJaumal of Tropical Medicine and Hygiene, 32, I-5.
White, N. J., Chanthavanich, I’:, Krishna, S., Bunch, C. & Silamut, K. (1983b). Quinine disposition kinetics. BritirhJournal of Clinical Phartnacoloev. 16.399-403. WHO “( 1993). Tropical Disyaie kesearch, Progress 39914992: Eleventh Propramme Report of the UNDPIWorld BanklWHO Special Prog&mne fm i?esea& and Training in Tropical Diseases{TDR). Geneva: World I-Ieahh Organization.
Winstanley,P. A., Newton, C. R., Watkins, W. M., Mberu,
E., Ward, S. A., Warn, P. A., Mwangi, I., Waruiru, C., Pasvol, G., Warrell, D. A. & Marsh, K. (1994). Towards optimal
parenteral quinine regimens for young children with cerebral malaria: importance of unbound quinine concentration. Transactions of the Royal Sociey of Tropical Medicine and Hygim,87,201-206.
Wongsrichanalai, C., Webster, H. K., Wimonwartrawatee, T., Sookto, P., Chuanak, N., Timasam, K. & Wernsdorfer, W. H. (1992). In vifm sensitivity of Plasmodium f&iparwn isolaces in Thailand to quinine and chloroquine, 19841990. Southeast Asian Journal Health, 23,533-536.
of Tropical
Medicine
and Public
Received 3 November 1993; revised 4 Januq accepted for publication 4 January I994
1994;
TRANSACTIONS OF THEROYALSOCIETYOF TROPICALMEDICINEANDHYGIENE(1994) 88, $80
1Short Report1 Praziquantel for the treatment Diphyllobothrium nihonkaiense infections in humans
of
Kenji Ohnishi and Misako Murata L)epartment of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, 4-23-15 Kohtohbashi, Sumida-Ku, Tokyo 130, Japan The intermediate hosts of Diflhyllobothrium nihonkaiense are thought to be the fish Oncorhynchus masou and 0. gorbuscha. This tapeworm is a common parasite in Japan, because most Japanese like to eat raw or insufficiently cooked fish such as those mentioned above. Generally, the clinical manifestations of D. nihonkaiew infections are mild, but infection with this parasite is an important problem for patients and their families from the emotional and socioeconomic points of view, because of its long length and the long period of passing strobil?. Thus it 1s important to give suitable treatment. Prazlquantel is effective against human infections with D. latum (see BYLUND et al., 1977: GROLL. 1980). D. Pacificum (S&TGROLL, 1980; ~UMB~ERAS et (Il., 16x2) zhd b. nihorrkaiense (see OHNISHI & MURATA, 1993). We have
reported thatpraziquantel was effective.against D. nihunkaiense infection at a sinale dose of 7, 23 or 25 mgikg OHNISHI & MURATA, 1%3), and we have now success-
Iofullypraziquantel. treated D. nihonkaiense infection with a lower dose
Two male adults, aged 27 and 40 years, were treated as follows: on the day before therapy, they were given low fibre, low fat diets, and then magnesium citrate and bisoxatin acetate were given at night. The patients then received 6 mgikg and 5 mg/kg of praziquantel, respectively, in the morning on an empty stomach; magnesium sulphate dissolved in water was given 2 h later. The first patient expelled a tapeworm, 2.1 m long, with scolex 3 h 15 min after taking praziquantel, and the
other expelled 2 tapeworms, measuring 2.8 and 3.0 m, with scolices after 4 h 40 min. in waterv diarrhoea. All the expelled tapeworms were identified as D. nihonkaiense by light and electron microscopy at the Department of Environmental Medicine II, Shimane Medical University, Izumo-city, Shirnane Prefecture, Japan. No side effect was observed, the praziquantel being well tolerated by the patients. Although determination of the optimum dose of praziquantel in human D. nihonkaiense infection requires further work, our study indicates that a single dose of 5-6 mg/kg of praziquantel may be effective against D. nihonkaiense infection, and the doses reported before, especially 23 and 25 mgikg, may be unnecessarily high for this infection. Headache, dizziness, abdominal discomfort and nauseahave been reported as side effects of praziquantel in patients with cestode infections (GROLL, 1980). Some side effects of oraziouantel mav be associ. . ated with absorption of the drug from the intestine, so it may be desirable to reduce the dose. We thank Drs Yoneyama, Isobe, Shiwaku and Professor Yamane, Department of Environmental Medicine II, Shimane Medical University, for identification of rhe parasites. Refwences Bylund, G., BQng, B. & Wikgren, K. (1977). Tests with a new compound (sraziquantel) against Diphyllobothrium lawn. Jo&al of H&ninthologV, 51, il5-119. Groll, E. 11980). Praziauantel for cestode infections in man. AEta Tropica; 37,29<296.
Lumbreras, H., Terashima, A., Alvarez, H., Tello, R. & Guerra, H. (1982). Single dose treatment with praziquantel (Cesol R. EmBav 84401of human cestodiasis caused bv Di~hyllobotkum &if&n. Tropenmedizin und Parasitdlogie, 33,5-7.
Ohnishi, K. & Murara, M. (1993). Single dose treatment with praziquantel for human Dipkyllobothrium nihonkoiense infections. Transacziorts of the RqyaE Society of Tropical Medicine and Hygiene, 87,482-483.
Received 15 December 1993; revised I8 January accepted for publication 19Januay 1994
1994;