The efficacy of artesunate in the treatment of urinary schistosomiasis in ogoja,Cross river state, nigeria

摘要

The efficacy of artesunate in the treatment of urinary schistosomiasis was investigated among 250 randomly selected subject aged 6 – 50 years in Ogoja, Nigeria. In the parasitological examination, infection was confirmed in 25 (10%) of the 250 subjects screened. Artesunate were administered orally at 4mg/kg body weight. Adverse effects due to drug reactions were assessed 3 days after medication and all perceived symptoms of illness were treated. The cure rate was evaluated after 2 weeks of treatment. There cure rate was 16 (64.0%) after treatment. There was a significant reduction in prevalence from a pre-treatment value of 10% to a post-treatment value of 3.6%. The intensity of infection also reduced significantly (p<.001) from 17.2% -3.1% for pre-treatment and post-treatment respectively giving a reduction rate of 82.1%. This study has shown that artesunate is effective in the treatment of schistosomiasis. It is recommended that a combination of artesunate and praziquantel, might produce a more effective treatment than the separate use of either drug. Introduction Human schistomiasis remains one of the most important parasitic diseases in the tropics for which there are no vaccines1. Chemotherapy with praziquantel currently offers the most feasible means of controlling human schistosomiasis, at least in the short term2,3. There are concerns however that schistosoma haematobium the aetiologic agent of urinary schistosomiasis is developing resistance to praziquantel or at least have the tendency to do so4,5. Studies conducted elsewhere have associated praziquental with low cure and egg production rates after the administration of a single dose of the drug6,7,8. Subsequently, communities in a very intense focus of S. mansoni infection in Senegal showed unexpectedly low rate following treatment with praziquantel9,10. Perhaps the best evidence so far of resistance to praziquantel is the failure of Ismail et al.11 to cure some natural S. mansoni infection in some Egyptian patients with three doses of the drug.The potential problem of praziquantel resistance led to a search for alternative drug for the treatment and control of schistosomiasis12,13. Although artemisinin and it derivatives such as artesunate, arteether, artemether and dihydroartemisinin were originally developed for the treatment of malaria, they have antischistosomal activity13,14. In vitro treatment of adult schistosomes with artemether, for example led to a significant reduction in the glycogen content of the worms and extensive tegumental damage15.For more than a decade, evidence has been accumulating of the effect of treating S. japoniucum and S. mansoni infections with one of the artemisinins16. Artemether appears to exhibit maximum activity against the liver stages and adult worms being less susceptible15. In human trials, administration of artemisinin derivatives (artesunate, artemeter) at a dose of 6mg/kg every 15 days during the S. japonicum transmission season resulted in the effective control of schistosomiasis in highly endemic areas in China17. Recently, treatment of schistosomiasis with the combination of artesunate and praziquantel show that more than 80% curative18,19. Artesunate not only exhibits antimalaria properties, but also possesses strong activities against schistosomes. The objective of our present research is to determine the efficacy of artesunate in the treatment of urinary schistosomiasis in patients attending the General Hospital, Ogoja in the Cross River State of Nigeria. Materials And Methods Sample CollectionThe General Hospital, Ogoja in Cross River State of Nigeria was chosen for this study because a cross section of members of this community often visit the Hospital to sort out their health needs. Ogoja is in Cross River State, Nigeria, which lies between latitude 5°32' and 4°27' North and longitude 7°50' and 2°20' East. There are two different climatic seasons in the area, the rainy season from March to October and the dry season