Therapeutic trial of praziquantal (Embay 8440; Biltricide®) on the dermal and cerebral human cysticercosis

, Rim, Han Jong; , Lee, Joon Sang; , Joo, Kyoung Hwan; , Kim, Soo Jin; , Won, Chang Ryong; , Park, Chang Yun

doi:1982.20.2.169

Korean J Parasito > Volume 20(2):1982 > Article

Original Article


Korean J Parasitol. 1982 Dec;20(2):169-190. English. Published online Mar 20, 1994. http://dx.doi.org/10.3347/kjp.1982.20.2.169
Copyright © 1982 by The Korean Society for Parasitology


Therapeutic trial of praziquantal (Embay 8440; Biltricide®) on the dermal and cerebral human cysticercosis
Han-Jong Rim,Joon-Sang Lee,Kyoung-Hwan Joo,Soo-Jin Kim,Chang-Ryong Won and Chang-Yun Park
Department of Parasitology and Institute for Tropical Endemic Diseases, College of Medicine, Korea University, Korea.


Abstract
A total of 28 adult cases who were confirmed cysticercosis with or without cerebral involvements were treated with praziquantel at the daily dose of 3 × 25mg/kg for 3 to 7 consecutive days and was evaluated for tolerance and therapeutic effects in the trials clinically performed.The assessment of drug efficacy of praziquantel in the dermal cysticercosis was made by comparing the numbers of cysticercus nodules and histopathological findings of the biopsied parasites by means of light, scanning and transmission electron microscope. In the cerebral cysticercosis, the assessment was considered by the frequency of the episodes of convulsive seizure before and after treatment with praziquantel and by the findings of the disapearance or decreased densities of the lesions in C.T. scan in comparison with those of before and after treatment. The results were as follows: 1. The cysticerci in the subcutaneous tissues began to disappear within one month of drug administration of 3 × 25mg/kg praziquantel over 3 to 7 days. Within 3 to 6 months most of the cysticerci had disappeared, although in some case a small number of cysticercus nodules remained even one year after treatment. 2. Histological observation of the cysticerci biopsied at different times during the course of treatment revealed that morphological changes were already taking place within two weeks after the treatment. At the early stage of the treatment, small vacuoles were scattered along the basement layer in the tegumental syncytium of the scolex and neck regions. In the scanning electron microscopic observation, marked surface changes were present in the neck region with many bleb-like structures formed by the bursting of the large vacuoles in the tegumental syncytium. In the specimens biopsied at 2 or 5 weeks after treatment, the degenerations and necrosis of the tegumental syncytium were seen in all parts of cysticercus. 3. In 12 cases of cerebral cysticercosis treated with praziquantel at the daily dose of 3 × 35 mg/kg for 3 or 4 consecutive days, there were no ceasing of the convulsive seizures during the 6 months follow-up. Among them 9 cases were given again the same doses of the drug for 4 or 7 days. In 7 of 9 cases, no more convulsive seizure was experienced over one or two years after the second time. At the same treatment the lesions of the brain C.T. scan disappeared, decreasd in size or calcified after treatment. In other 3 cerebral cysticercosis cases, complete cure was also obtained after the oral medication of praziquantel at the daily dose of 3 × 25 mg/kg for 7 consecutive days. 4. In the treatment of cerebral cysticercosis with praziquantel, it was found that the concomitant oral medication of dexamethasone during the course of treatment was effective for preventing and minimizing the side-effects.

Figures

Figs. 1-4
Fig. 1. Scanning electron micrograph (SEM) of untreated Cysticercus cellulosae: scolex (Sc), suckers and neck region. (&36)

Fig. 2. SEM of treated C. cellulosae (1 week after treatment): scolex, suckers, neck region and bladder wall (cw). (&36)

Fig. 3. SEM of untreated C. cellulosae: microtriches (M) of neck region. (&4,400)

Fig. 4. SEM of treated C. cellulosae (1 week after treatment): the neck region is covered with many bleb like structure (B). (&4,400)

Figs. 5-10
Fig. 5. Untreated normal scolex of C. cellulosae. (&25)

Fig. 6. Scolex of C. cellulosae at 5 weeks after treatment: the dead cysticercus shows narrowing of neck region. (&25)

Fig. 7. Untreated C. cellulosae the section of neck region showing organization of syncytial tegument (&480)

Fig. 8. Treated C. cellulosae (5 weeks after treatment): the section of neck region showing vacuolization in syncytial tegument. (&480)

Fig. 9. Untreated C. cellulosae: thin section of bladder wall showing organization of syncytial tegument covered with microtriches (M), tegumental cell body (TGC) and longitudinal musculature (LM). (&10,000).

Fig. 10. Treated C. cellulosae (5 weeks after treatment): the thing section of bladder wall showing degeneration with pronounced vacuolization (V) of different size. (&10,000)

Figs. 11-14
Fig. 11. Treated cysticercus (5 weeks after treatment): many vacuoles (V) of different size are scattered in the tegument (TG). (&10,000)

Fig. 12. Untreated cysticercus: thin section of neck region showing organization of syncytial tegument (TG) covered with microtriches (M), tegumental cell body (TGC), circular musculature (CM) and longitudinal musculature (LM). (&10,000)

Fig. 13. Untreated cysticercus: the neck region showing cilia of flame cells (CF). (&10,000)

Fig. 14. Treated cysticercus (5 weeks after treatment): degenerated flame cell like structure are seen in the neck region. (&10,000)


	Fig. 15-16 Fig. 15. Disintegrated and necrotized cysticercus biopsied on 6 months after treatment: sucker(S), hooklets(h). (&240) Fig. 16. Disintegrated and necrotized cysticercus biopsied on one months after treatment: capsule (C), worm(W). (&17)

Tables


	Table 1 Results of treatment of dermal cysticercosis with praziquantel


	Table 2 Results of treatment of cerebral cysticercosis with praziquantel

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