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Open Access Research

Dynamics of Schistosoma haematobium egg output and associated infection parameters following treatment with praziquantel in school-aged children

Katarina Stete1234, Stefanie J Krauth134, Jean T Coulibaly1345, Stefanie Knopp14, Jan Hattendorf14, Ivan Müller134, Laurent K Lohourignon5, Winfried V Kern2, Eliézer K N’Goran35 and Jürg Utzinger14*

Author Affiliations

1 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH–4002 Basel, Switzerland

2 Center for Infectious Diseases and Travel Medicine, Department of Medicine, Albert-Ludwigs-University, Hugstetter Strasse 55, D-79106, Freiburg, Germany

3 Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan 01, Côte d'Ivoire

4 University of Basel, P.O. Box, CH–4003 Basel, Switzerland

5 Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 770, Abidjan 22, Côte d'Ivoire

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Parasites & Vectors 2012, 5:298  doi:10.1186/1756-3305-5-298

Published: 21 December 2012

Abstract

Background

Praziquantel is the drug of choice in preventive chemotherapy targeting schistosomiasis. Increasing large-scale administration of praziquantel requires monitoring of drug efficacy to detect early signs of development of resistance. Standard protocols for drug efficacy monitoring are necessary. Here, we determined the optimal time point for praziquantel efficacy assessment against Schistosoma haematobium and studied the dynamics of infection parameters following treatment.

Methods

Ninety school-aged children from south Côte d’Ivoire with a parasitologically confirmed S. haematobium infection were treated with a single oral dose of praziquantel (40 mg/kg) and followed up for 62 days post-treatment. Urine samples were collected on 23 schooldays during this period and were subjected to visual examination (macrohaematuria), urine filtration and microscopy (S. haematobium eggs) and reagent strip testing (microhaematuria, proteinuria and leukocyturia).

Results

Observed cure and egg reduction rates were highly dependent on the time point post-treatment. Egg reduction rates were high (>97%) in weeks 3–9 post-treatment. Cure rates were highest in weeks 6 (92.9%) and 9 (95.0%) post-treatment. The prevalence of infection-associated parameters decreased after treatment, reaching a minimum of 2.4% in weeks 5 (proteinuria) and 7 (leukocyturia) post-treatment, and 16.3% at the end of week 8 (microhaematuria). Macrohaematuria disappeared between weeks 3 and 6 post-treatment.

Conclusions

For monitoring praziquantel efficacy against S. haematobium, we recommend that the cure rate is assessed at week 6 post-treatment. The egg reduction rate can be evaluated earlier, from day 14 post-treatment onwards. Reagent strips are a useful additional tool for evaluating treatment outcomes in areas with high endemicity, preferably at weeks 5 and 6 post-treatment. The delayed decrease of microhaematuria confirms that lesions in the urinary tract persist longer than egg excretion post-treatment.

Keywords:
Schistosomiasis; Schistosoma haematobium; Praziquantel; Drug efficacy; Macrohaematuria; Microhaematuria; Proteinuria; Leukocyturia; School-aged children; Côte d’Ivoire