Corticosteroids in Schistosomiasis

Q: 52 year old male, who returned from Zambia 8 weeks ago, is admitted to ICU with fever, malaise, hypotension, generalized urticaria and pruritic rash. Blood workup showed marked eosinophilia. Infectious Disease service is consulted and they strongly suspect Schistosomiasis. While urine and fecal microbiology, as well as PCR, is awaiting, infectious disease services recommend a single dose treatment of Schistosomiasis with Praziquantel. Also, corticosteroids are prescribed to reduce inflammation. What should watch out? 


Answer: A cure rate of 60-90% is described after a single dose treatment with praziquantel. But two things should be watched out. 

1. Maturing schistosomes are less susceptible to therapy than adult worms, the second course of treatment may be required after few weeks. 

2. Corticosteroids may affect the plasma levels of Praziquantel. So patient should be watched for the possible requirement of the second dose. 

#infectiousdiseases 
#pharmacology


References: 

1. Grandière-Pérez L, Ansart S, Paris L, et al. Efficacy of praziquantel during the incubation and invasive phase of Schistosoma haematobium schistosomiasis in 18 travelers. Am J Trop Med Hyg 2006; 74:814. 2. 

Vazquez ML, Jung H, Sotelo J. Plasma levels of praziquantel decrease when dexamethasone is given simultaneously. Neurology 1987; 37:1561. 

3. Ross AG, Bartley PB, Sleigh AC, et al. Schistosomiasis. N Engl J Med 2002; 346:1212.