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Hydatidosis is an endemic disease caused by the larval form of Echinococcus Granulosus. Renal involvement represents less than 5% of confirmed cases. It remains clinically silent for a long time, and only presents at the stage of complications. Diagnosis is suspected on the basis of epidemiological, clinical, radiological and biological data. There are various clinical presentations. Hydaturia, which is observed in 10 to 30% of the cases, is the only pathognomonic feature. Diagnostic accuracy has been improved since the wide use of ultrasonography. Computed tomography and magnetic resonance imaging are helpful tools to confirm the diagnosis. The treatment is mainly based on surgery. The resection of the prominent dome remains the standard option as it allows preservation of the kidney. Total nephrectomy should be proposed only in case of renal destruction. The percutaneous management, which includes puncture, aspiration, injection, and reaspiration, can be performed in very selected cases. However, the results of this technique are still under debate.
Few drugs are available for soil-transmitted helminthiasis (STH); the benzimidazoles albendazole and mebendazole are the only drugs being used for preventive chemotherapy as they can be given in one single dose with no weight adjustment. While generally safe and effective in reducing intensity of infection, they are contra-indicated in first-trimester pregnancy and have suboptimal efficacy against Trichuris trichiura. In addition, drug resistance is a threat. It is therefore important to find alternatives.
In this report, we describe an unusual case of verminous appendicitis due to Enterobius vermicularis and Taenia saginata in a 29-year-old woman from Iran. The histopathological examinations and parasitological descriptions of both worms found in the appendix lumen are discussed. The removed appendix exhibited the macroscopic and microscopic features of acute appendicitis. Antihelminthic therapy was initiated with single doses of praziquantel for the taeniasis and mebendazole for the enterobiasis, and the patient was discharged.
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The aim of the present study was to investigate the effectiveness of several imidazole drugs to inhibit human placental aromatase compared with the known inhibitors of aromatase, 4-hydroxyandrostenedione (4-OHA) and aminoglutethimide (AG). Inhibition was similar with both androstenedione and testosterone as substrates. The order of decreasing inhibitory effect (determined from ID50 values) was: 4-OHA greater than tioconazole greater than econazole greater than bifonazole greater than clotrimazole greater than micomazole greater than isoconazole greater than ketoconazole greater than AG greater than nimorazole. The imidazole drugs and AG were reversible inhibitors of aromatase activity, in contrast 4-OHA was an irreversible inhibitor. Astemizole inhibited less than 40% whereas metronidazole, carbimazole, mebendazole, tinidazole and thiabendazole inhibited less than 20% of aromatase activity at 100 mumol/l. The imidazole drugs and AG were without effect on 3 beta-hydroxysteroid dehydrogenase-isomerase (3 beta-HSD-I) and 17 beta-hydroxysteroid oxidoreductase activity. In contrast 4-OHA was found to be a potent, reversible inhibitor of 3 beta-HSD-I with an ID50 value of 2.15 mumol/l. A common structural feature of the imidazole drugs having an inhibitory effect was the presence of one or more aromatic rings on the N-1 substituent. In contrast, the imidazole drugs having the imidazole ring fused to a benzene ring, i.e. benzimidazoles (astemizole, mebendazole, thiabendazole) and those having an aliphatic side chain on the N-1 of the imidazole ring (carbimazole, metronidazole, nimorazole, tinidazole) were only weak inhibitors of aromatase.
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Thirteen studies were included in the review. Albendazole is superior to placebo for inoperable, symptomatic patients (1 study). In addition, in 4 trials that tested albendazole as a preoperative adjuvant therapy, the drug resulted in degeneration of hydatid cysts at the time of surgery in a considerable proportion of patients. Furthermore, combined therapy with albendazole and PAIR (Puncture, Aspiration, Injection of scolicidal agent, and Re-aspiration) technique was found more effective than albendazole or PAIR treatment alone, in a randomized controlled trial examining this issue. Finally, although existing evidence shows some superiority for albendazole compared to mebendazole, there is no definite proof about this.
Surgical excision using cardiopulmonary bypass combined with medical therapy provides the most optimal treatment for cardiac echinococcosis.
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Parasitological data were available from 5246 children aged 5-16 years. Helminth infections with hookworm were predominant (17.2 %). Ascaris lumbricoides and Trichuris trichiura were rarely found; overall prevalences were 1.9 % and 1.2 %, respectively. Bayesian geostatistical variable selection identified rural setting for hookworm, soil acidity and soil moisture for A. lumbricoides, and rainfall coefficient of variation for T. trichiura as main predictors of infection. The estimated school-aged children population-adjusted risk of soil-transmitted helminth infection in Côte d'Ivoire is 15.5 % (95 % confidence interval: 14.2-17.0 %). We estimate that approximately 1.3 million doses of albendazole or mebendazole are required for school-based preventive chemotherapy, and we provide school-aged children-adjusted risk aggregated at health district level.
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Trichuriasis may be asymptomatic or, in heavy infection, lead to profuse, bloody diarrhea and rectal prolapse. Diagnosis is made by finding the distinctive barrel shaped eggs in the stool or in the heavily infested patient, by anoscopy and identification of worms attached to reddened and ulcerated rectal mucosa. Mebendazole is the drug of choice in treatment. Capillariasis, a parasitic infection encountered mainly in the Philippine Islands, is of interest in that the eggs may be confused with the eggs of trichuris. Hookworm disease is generally asymptomatic, but in heavy infection, leads to iron deficiency and hypochromic, microcytic anemia. Diagnosis is made by finding the characteristic hookworm eggs on a examination of a direct fecal film. Accidental invasion of humans by dog and cat hookworm leads to cutaneous larva migrans, also known as "creeping eruption." Human hookworm is treated most effectively with mebendazole, while the rash produced by creeping eruption responds to topical thiabendazole. Strongyloides is fairly common in rural areas of the southeastern United States and may be seen in the urban setting among inmates of mental institutions, prisons, and in immigrants who formerly resided in endemic tropical regions. Because of its remarkable capacity for dissemination of larvae throughout the body, this parasite is now recognized as a serious problem for the patient who is immunocompromised. Diagnosis is made by finding larvae in the stool or by the Enterotest. All infected patients should be treated with thiabendazole. I consider the issue on Drugs For Parasitic Infections, published annually or biannually by The Medical Letter on Drugs and Therapeutics, to be the single best source of information on the treatment of parasitic diseases for primary care physicians.
Our study indicates a potential for nitazoxanide as an alternative treatment option against CE.
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The anthelmintic benzimidazoles, mebendazole, albendazole and flubendazole have been screened for any propensity to alter the disposition of antipyrine and tolbutamide in the rat isolated perfused liver preparation. The benzimidazoles were added as a 2.5 mg bolus dose into the perfusate reservoir 5 min before the administration of either antipyrine or tolbutamide. Neither mebendazole or albendazole produced any significant effect on the pharmacokinetics of either of the substrate drugs. In contrast, flubendazole significantly decreased the clearance of antipyrine (by 40%) indicating inhibition of mixed function oxidase activity. However, flubendazole did not alter the disposition of tolbutamide. The results suggest that not all benzimidazoles inhibit hepatic drug metabolizing enzymes and that different forms of cytochrome P-450 are involved in the metabolism of antipyrine and tolbutamide.
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Ancylostoma caninum is responsible for cases with eosinophilic enteritis (EE) and unexplained abdominal pain with peripheral eosinophilia in man. Ninety-five patients with obscure acute or recurrent abdominal pain and ten asymptomatic healthy parasite free were subjected to thorough history taking, clinical examination, sonography, routine laboratory investigations and serotesting by IgG ELISA to detect antibodies to excretory/secretory (ES) antigens of adult A. caninum and by IgG and IgG4 Western blot (W.B.) to detect antibodies to Ac68 antigen. Eleven male patients (11.6%) (5 with acute abdomen, 3 diagnosed as appendicitis and 3 had recurrent mild to moderate abdominal pain) fulfilled the criteria of case definition of human enteric infection with A. caninum (G.I). The study also detected human hookworm infection in 14 patients (G.IIb) other parasites in 34 patients (GIIc) and 36 patients had no parasites (G.IIa). Although 3 patients from group I were diagnosed as appendicitis and were dealt with surgically, the pain recurred and mebendazole only put an end to the patient's complaints. The obtained appendices of these operated cases showed marked eosinophilic infiltration but no adult canine hookworms were detected. IgG ELISA was positive in 72.7%, 8.3%, 100%, 23.5% and 0% in groups and control respectively. IgG and IgG4 W.B. did not increase the sensitivity but IgG4 W.B. elevated specificity to 100% excluding those with HH infection (Group Iib) who showed 100% cross-reactions. Stool analysis was the only differentiation between these two types of hookworms. These findings confirmed the presence of human enteric infection with A. caninum as clinical entity in the study community and referred to its value in differential diagnosis of the obscure abdominal pain.
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An infected echinococcal cyst of the liver was diagnosed in a 48-year-old male immigrant from Spain. After preoperative treatment with mebendazole, microscopic examination of the operative cyst contents showed no viable scoleces or brood capsules of Echinococcus. We recommend the preoperative use of mebendazole in the management of hepatic hydatid cysts.