Twenty patients with primary hepatic alveolar echinococcosis were treated with continuous long-term albendazole at a dose of 20 mg/kg/d for an average of 5.7 years (1.5-13.5 years) and were followed up for an average of 12.7 years (4.1-13.5 years). The therapeutic effects were evaluated by clinical, laboratory (haemogram, liver function tests), ultrasonography and computed tomography (CT) examinations. The CT pattern of hepatic lesions was classified into three types: solid form (5 cases), pseudocystic form (6 cases) and 'geographic map' (mixed) form (9 cases). Short-term results were encouraging. Jaundice and haemoptysis disappeared within 1 month of starting treatment, and hemiparesis in a patient with cerebral metastases also gradually improved. Treatment was less effective in two patients with advanced disease. On long-term follow-up, three patients were apparently cured, and the remaining 17 patients showed a good initial response, but recurrence occurred in 13 patients (65%). Therapeutic outcome was favourable with the solid form, but poor with the pseudocystic form. The mixed form was a transitional phase and slowly progressive. Involvement of the porta hepatis was the cause of various complications with high morbidity and mortality. Five patients (25%) died during the period of observation, the 10-year survival rate being, therefore, 75%.

Objective To observe triclabendazole effect on Paragonimus skrjabini in experimentally infected rats,and to develop a new drug for treating paragonimiasis.Methods Metacercariae of Paragonimus skrjabini were isolated from crabs (Sinopotamon) collected from endemic area. Wistar rats were infected intraperitoneally. One and two months after infection, they were treated with triclabendazole at the dosage of 300 mg*kg-1*2d-1, 450 mg*kg-1*3d-1 and 600 mg*kg-1*3d-1 respectively. Five patients with Paragonimus skrjabini were treated, with Triclabendazole dosage of 10 mg/kg bid×3 days.Results The worm reduction rates were 50.3%, 80.8% and 86.7% respectively one month after completion of treatment. Dead worms of sesame size recovered from muscles, liver, abdominal cavity, chest cavity and lung were greatly diminished in size and weight in comparison with that of the control group. Many large (about 1 cm) black-colored distended worm cysts were found in the lungs of the control rats. Usually there were two adult worms pairs with numerous eggs in each worm cyst. Most worm cysts in the treated groups of rats were changed into hemorrhagic-necrotic patches. All five patients were cured. Conclusion Triclabendazole was highly active against Paragonimus skrjabini in rats experimentally infected and patients.

采用免疫印渍技术分析了斯氏并殖吸虫30、60和90d虫体抗原组份与斯氏、卫氏并殖吸虫病人、华支睾吸虫、血吸虫、囊虫、包虫病人和健康人血清反应情况.结果发现斯氏和卫氏并殖吸虫病人血清均可识别9条抗原多肽,分子量分别为17、27、29、35.5、37.5、60、72和90kDa,其中35.5、37.5和39kDa三条抗原带可100%同2种并殖吸虫病人血清起反应,特异性达100%.72和90kDa抗原多肽可与其他寄生虫病人和正常人血清发生交叉反应.不同虫龄期的抗原在反应条带上无明显区别,但以30d龄虫体抗原的显色更清晰.结果提示35.5、37.5、和39kDa抗原多肽具免疫学诊断价值.

OBJECTIVE:To assess the therapeutic effects of long-term albendazole therapy in intraabdominal cystic echinococcosis.METHODS:Fifteen patients with a total of 45 cysts were treated with albendazole with dosage regimen of 20 mg.kg-1.d-1 for an average of 2.5 years. Repeated CT and ultrasound scannings (US) were performed after the end of therapy. The duration of follow-up was 3.6 years on average. The number, size and morphology of cysts were compared before and after treatment.RESULTS:The hydatid cysts were classified according to location and CT patterns into hepatic simple cysts, hepatic cysts with daughter cysts, hepatic/abdominal cysts and splenic cysts. The hepatic simple cysts responded most favorably to albendazole therapy, with an overall cure rate of 88.7%. The disappearance of cysts was observed in 43.0% of cases (15/35). Sixteen cysts (45.7%) became solidified or calcified, among which 8 cysts were completely calcified, 6 showed egg shell-like calcification of the cystic walls, and 2 showed solidification and calcification of cyst contents. Four patients had large hepatic cysts containing daughter cysts; the daughter cysts all disappeared after treatment, but one patient relapsed with the reappearance of daughter cysts at 4-year follow-up. Two splenic cysts also calcified. Two patients had peritoneal cysts; one calcified and the other one reduced in size. Among 15 patients treated, 9 were cured and 6 were improved. There was no serious toxic reactions with continuous long-term therapy in a small series of patients.CONCLUSIONS:Continuous long-term albendazole treatment of intraabdominal cystic echinococcosis is safe and effective in the treatment of hepatic simple cysts, and some daughter cysts, peritoneal secondary cysts and splenic cysts. No serious toxic reactions were found.

OBJECTIVETo observe the therapeutic effects of triclabendazole in the treatment of dogs with Paragonimiasis westermani.METHODSSix dogs were experimentally infected, each with 100 metacercariae of Paragonimus westermani intraperitoneally and divided into untreated and treated groups, 3 dogs were treated orally with triclabendazole 100 mg/kg.d-1 for 2 consecutive days on day 170 after infection. Stool egg count was done by Stoll method. All dogs were killed on day 38 after treatment and the number of worm cysts and worms in the lungs were examined by naked eye and microscopically.RESULTSStool eggs became negative from day 7 to day 14 after starting chemotherapy in treated dogs. The numbers of worm cysts in the lungs of untreated dogs were 18, 24 and 24 on necropsy, while those in the treated dogs were 10, 7 and 4, respectively. The numbers of adult worms in the untreated dogs were 38, 51 and 42, while in the treated dogs only 2 small adult worms were found in one dog and no worm was found in the other two dogs. The mean worm reduction rate was 98.5%.CONCLUSIONTriclabendazole is highly effective against Paragonimus westermani in experimentally infected dogs.

AIM:To observe the therapeutic effect of triclabendazole in rats infected with Pagumogonimus skrjabini.METHODS:Metacercariae of P. skrjabini were isolated from crabs (Sinopotamon) collected from two endemic areas (Weiyuan County of Sichuan Province and Wansheng District of Chongqing Municipality). Wistar rats were each infected intraperitoneally with metacercariae. One month and two months after infection, the infected rats were treated with triclabendazole at the total dosage of 300 mg/kg over 2 days, 450 mg/kg over 3 days and 600 mg/kg over 3 days, respectively.RESULTS:The worm reduction rates were 50%, 80% and 87% respectively one month after completion of tretment. Dead worms (about 1 mm size) recovered from the muscles, liver, abdominal cavity, chest cavity and lungs were signicantly diminished in size and weight in comparison with those of the control group. Many large (about 1 cm) black-colored distended worm cysts usually with two adult worms and many eggs were found in the lungs of the control rats. Most worm cysts in the treated groups of rats were found to be atrophied, changing into hemorrhagic-necrotic patches.CONCLUSION:Triclabendazole is highly active against P. skrjabini in rats.

Echinococcus granulosus cyst fluid and E. multilocularis protoscolex extract were fractionated by a single step of preparative isoelectric focusing, resulting in an antigen B-rich fraction (8-kD) and an Em18-rich fraction, respectively. The usefulness of both fractions for differential serodiagnosis of cystic (CE) and alveolar (AE) echinococcosis was evaluated by a large-scale immunoblot analysis on a battery of 354 serum samples. These included 66 from AE patients originating from four different endemic areas, 173 from CE patients originating from seven different endemic areas, 71 from patients with other parasitic diseases, 15 from patients with hepatomas, and 29 from healthy individuals. In an immunoblot with the antigen B-rich fraction, 92% (158 of 173) of the CE sera as well as 79% (52 of 66) of the AE sera reacted with the 8-kD subunit. No cross-reactivity occurred with any sera from patients with cysticercosis, other parasitic diseases, or with hepatomas, or from healthy controls. In an immunoblot with the Em18-rich fraction, all but two sera from AE patients (64 of 66, 97%) recognized Em18, and only nine of 34 CE sera from China reacted with it. All other (139) CE sera from six other countries were negative as were all (115) other non-echinococcosis sera. These findings indicate that antigen B (8-kD) is not species-specific for E. granulosus but is genus-specific for Echinococcus, and that the Em18 antigen is a reliable serologic marker for species-specific differentiation of AE from CE.

OBJECTIVE:To study the effect for albendazole therapy for alveolar echinococcus infection in gerbils and mice.METHODS:Mice and gerbils were infected of metacestode tissues by intraperitoneal (i.p.) transplantation and treated with albendazole-medicated feeds. The effects were evaluated by comparison of the treated and control groups in terms of host mortality, larval metastases to lungs and liver, final larval weight, histopathological, and ultrastructural examination of metacestode tissues. Viability of metacestode tissues at necropsy of treated animals was tested by intraperitoneal transplantation into uninfected animals.RESULTS:Albendazole-medicated feeds significantly inhibited larval growth of Echinococcus multilocularis (E. multilocularis) both in mice and gerbils with markedly reduced host mortality and pulmonary and liver metastases. Viability test showed that albendazole therapy was parasiticidal in early stage of experimental infection. Light microscopic and ultrastructural examination of metacestode tissues of the treated animals revealed severe destruction and massive necrosis with marked calcification of protoscoleces and residual tissues.CONCLUSION:Continuous long term albendazole therapy in animal models is parasiticidal against larval E. multilocularis especially in early stage of infection.

目的分析２１例肝泡型包虫病的ＣＴ征象，评价阿苯达唑治疗效果。方法全部病例包虫抗原皮试、血清酶联免疫吸附试验（ＥＬＩＳＡ）与包虫免疫印迹试验（Ｗｅｓｔｅｒｎｂｌｏｔｉｎｇ，ＷＢ）检测均为阳性，全部做ＣＴ扫描检查。阿苯达唑治疗后ＣＴ随访２０例。结果ＣＴ表现最常见特征为轮廓不规则，边界不清，密度不均的以低密度区为主的混合密度灶（ＣＴ值：－２５～＋４０ＨＵ），病灶区出现多少不一的钙化（ＣＴ值：＋９０～＋５５６ＨＵ）是本病突出的表现。ＣＴ影像分三型：实质型７例；假囊型６例；混合型８例。３例增强ＣＴ中２例病灶无强化，１例病灶周边呈轻度环形强化。ＣＴ随访２０例（时间１～９年，平均３．９年）中４例治愈，５例好转，５例稳定，６例恶化。结论ＣＴ扫描不但可用作肝泡型包虫病的诊断，而且可用于阿苯达唑等药物的疗效观察。

In 40 cases of human paragonimiases caused by Paragonimus westermani (20 cases), P. miyazakii (10 cases), and P. skrjabini (10 cases), responses of serum immunoglobulin G (IgG), IgG subclasses, and IgE were analyzed by immunoblotting with crude antigens prepared from egg, 4-week-old juvenile, and adult forms of P. westermani. The 32- and 35-kDa proteins in the adult extracts showed specific reactions regardless of the causative species (39 of 40 cases; 98%). Sera of patients infected with P. westermani and P. miyazakii reacted strongly with the 28-, 46-, and 94-kDa proteins of egg extracts, while those from patients infected with P. skrjabini reacted faintly. No sera from patients with other trematodiases (0 of 15 cases), cestodiases (0 of 20 cases), or lung cancer (0 of 5 cases) or from healthy controls (0 of 10 individuals) showed positive reactions. Analysis by IgG subclass revealed that IgG4 (33 of 40 cases; 83%) and IgG1 (29 of 40 cases; 73%) antibodies in the patient sera recognized the 32- and 35-kDa proteins predominantly. IgG3 reaction was found in 50% (10 of 20 cases) and 30% (3 of 10 cases) of the sera of patients infected with P. westermani and P. miyazakii, respectively. In an IgE immunoblot, 83% (33 of 40 cases) of the sera from paragonimiasis patients reacted with the 32- and 35-kDa proteins while no sera from patients with heterologous diseases and healthy controls showed a positive reaction. Both 32- and 35-kDa proteins in adult extracts of P. westermani were highly reliable for serodiagnosis of human paragonimiases.

Neurocysticercosis (NCC), which is caused by infection with the larval stage of the pork tapeworm (Taenia solium), is now recognized as a major cause of neurologic diseases in countries where the infection is endemic. Migration of persons from these countries is resulting in diagnosis and local transmission in nonendemic countries at increasing rates. In the present study, immunoblotting and an ELISA were carried out using antigens of T. solium cysticerci fractionated by isoelectric focusing and serum samples from patients with NCC, alveolar (AE) or cystic echinococcosis (CE), and other diseases. Immunoblot analysis revealed antigens fractionated by isoelectric focusing (pH 9.2-9.6) either from cyst fluid of T. solium cysticerci or from intact cysts had unique components (glycoproteins) highly specific and sensitive for detection of NCC exclusively. All confirmed NCC serum samples (53 of 53) recognized at least three major bands of 10-26-kD of fractions with pH 9.2-9.6 from either intact cysts or cyst fluid. These bands were not recognized by sera from patients with other parasitic diseases including AE (0 of 34), CE (0 of 36), or other heterologous parasitoses (0 of 77), patients with hepatoma (0 of 19) or sarcoidosis (0 of 11), or sera from healthy controls (0 of 29). The ELISA using the antigens showed the same sensitivity and specificity for differentiation of NCC (53 of 53) from other diseases (0 of 107) or healthy individuals (0 of 29). Both immunoblotting and the ELISA using the fractionated antigens readily differentiated all NCC from AE or CE in a blind test of 29 serum samples of persons with NCC, CE, and AE. Antigens fractionated from cyst fluid of T. solium cysticerci by a simple, single-step isoelectric focusing (pH 9.2-9.6) are highly specific and sensitive for differential serodiagnosis of NCC in immunoblotting and/or an ELISA.

The diagnostic value of a 10 kDa subunit of 150 kDa protein in cyst fluid (CF) ofTaenia soliummetacestodes was evaluated. Immunoblot analysis revealed that most sera from patients with neurocysticercosis recognized the 10 kDa subunit strongly (209/217 cases, 84.6%), while a few sera from individuals with other parasitic diseases including alveolar echinococcosis (AE, 2/20, 10%) and cystic echinococcosis (CE, 2/25, 8%) showed faint reactions. Sera of cases with other parasitic diseases, especially AE and CE, exhibited cross reactions against other bands in CF. Both differential immunoblot and immunoprecipitation analyses showed that the 10 kDa subunit was the most specific to cysticercosis and highly antigenic, whereas other components at 20–40, 64, 95 and 106 kDa in CF were cross‐reactive. IgG subclass ELISA and immunoblot demonstrated that both IgG4 and IgG1 reactions were predominant in neurocysticercosis and recognized the 10 kDa.

Eleven cases of alveolar echinococcosis (Echinococcus multilocularis infection) with non-resectable lesions but treated with albendazole for 17 to 69 months were followed-up clinically and serologically for 4.5-11.5 years. Based on the clinical outcome and computerized tomography (CT) scanning, they were divided into 4 groups of 2 cured cases, 5 stabilized cases, 3 cases with recurrences, and one treatment failure. Forty-seven sequentially collected sera from the 11 cases were analysed by sequential enzyme-linked immunosorbent assay (ELISA) using Em2plus antigen (Em2plus-ELISA) and Western blotting to detect antibody response against Em18 (Em18-Western blots). The antibody levels in one of the cured and 2 of the stabilized cases fell below the cut-off level in the Em2plus-ELISA 4.5-6 years after effective treatment, whereas all other cases, including 2 of those with recurrences, showed large reductions initially but increased again during the follow-up period. Em18-Western blots of the 2 cured cases and 2 of the stabilized cases became negative. IgG subclasses with responses against Em18 which fell to zero included IgG1 (2), IgG3 (one) and IgG4 (one). All other cases showed no decrease in antibody response against Em18. There were, in general, reasonably reliable correlations between the success or failure of chemotherapy and antibody responses by Em2plus-ELISA and Em18-Western blots. These results suggest that both Em2plus-ELISA and Em18-Western blot are potentially useful in evaluating and predicting the efficacy of chemotherapy.

Fourteen cases of alveolar echinococcosis were examined by computed tomographic (CT) scanning of the liver, including 3 cases before treatment and 11 cases 2.0-7.5 years after long-term continuous albendazole therapy. In 7 cases the hepatic lesions were almost completely calcified and cured, while in 3 cases incomplete calcification of the peripheral margin of the hepatic lesions was observed. CT scanning of the one uncured case and the 3 cases before treatment showed active lesions with heterogeneous hypodense areas in the liver without calcification on the peripheral margin. Long-term continuous albendazole therapy can result in parasitological cure with death of the parasite.

Journal Article Cerebral alveolar echinococcosis treated with albendazole Get access Yue-Han Liu, Yue-Han Liu Chongqing University of Medical Sciences, Chongqing, Sichuan, People's Republic of China Search for other works by this author on: Oxford Academic PubMed Google Scholar Xiao-Gen Wang, Xiao-Gen Wang Chongqing University of Medical Sciences, Chongqing, Sichuan, People's Republic of China Search for other works by this author on: Oxford Academic PubMed Google Scholar Deng-Gao Yu Deng-Gao Yu Chongqing University of Medical Sciences, Chongqing, Sichuan, People's Republic of China Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 87, Issue 4, July-August 1993, Page 481, https://doi.org/10.1016/0035-9203(93)90048-U Published: 01 July 1993 Article history Received: 17 August 1991 Revision received: 19 October 1991 Accepted: 21 October 1991 Published: 01 July 1993

Fifteen cases of alveolar echinococcosis were treated with albendazole in a dosage of 20 mg/kg/d x 30 days for 12-60 courses (25.8 courses in average) and were followed up 1-7 years (48 months in average) with computerized tomography and ultrasonography. Abdominal pain in all the cases, jaundice in 4 and hemoptysis in disappeared 2. In 13 of the 15 cases, the hepatic lesions reduced in size. Among 9 cases examined with computerized tomography, the hepatic lesions were completely calcified in 5 and enclosed with calcified walls in 3. Only one patient with huge and extensive hepatic lesions showed no apparent improvement. No severe adverse reaction was observed. Evidently albendazole was effective in the treatment of alveolar echinococcosis.