Efficacy and safety of antiparasitic therapy for neurocysticercosis in rural Tanzania: a prospective cohort study.

Abstract

PURPOSE:

Neurocysticercosis is common in regions endemic for Taenia solium. Active-stage neurocysticercosis can be treated with antiparasitic medication, but so far no study on efficacy and safety has been conducted in Africa.

METHODS:

We conducted a prospective cohort study on treatment of neurocysticercosis in Tanzania between August 2018 and January 2022. Patients were initially treated with albendazole (15 mg/kg/d) for 10 days and followed up for 6 months. Additionally in July 2021, all participants who then still had cysts were offered a combination therapy consisting of albendazole (15 mg/kg/d) and praziquantel (50 mg/kg/d). Antiparasitic treatment was accompanied by corticosteroid medication and anti-seizure medication if the patient had experienced epileptic seizures before treatment.

RESULTS:

Sixty-three patients were recruited for this study, of whom 17 had a complete follow-up after albendazole monotherapy. These patients had a total of 138 cysts at baseline, of which 58 (42%) had disappeared or calcified by the end of follow-up. The median cyst reduction was 40% (interquartile range 11-63%). Frequency of epileptic seizures reduced considerably (p < 0.001). Three patients had all active cysts resolved or calcified and of the remaining 14, eight received the combination therapy which resolved 63 of 66 cysts (95%). Adverse events were infrequent and mild to moderate during both treatment cycles.

CONCLUSION:

Cyst resolution was unsatisfactory with albendazole monotherapy but was very high when it was followed by a combination of albendazole and praziquantel.

• Authors: D Stelzle, C Makasi, V Schmidt, C Trevisan, I Van Damme, C Ruether, P Dorny, P Magnussen, G Zulu, K E Mwape, E Bottieau, C Prazeres da Costa, U F Prodjinotho, H Carabin, E Jackson, A Fleury, S Gabriël, B J Ngowi, A S Winkler
• Journal: Infection (Infection) Vol. 51 Issue 4 Pg. 1127-1139 (Aug 2023) ISSN: 1439-0973 [Electronic] Germany
• PMID: 36961623 (Publication Type: Journal Article)
• Copyright: © 2023. The Author(s).

Chemical References

• Albendazole
• Antiparasitic Agents
• Praziquantel
• Anthelmintics

Topics

• Humans
• Neurocysticercosis (drug therapy, complications, parasitology)
• Albendazole (adverse effects)
• Antiparasitic Agents (adverse effects)
• Praziquantel (adverse effects)
• Tanzania
• Prospective Studies
• Cysts (chemically induced, complications, drug therapy)
• Seizures (drug therapy, chemically induced, complications)
• Anthelmintics (adverse effects)