Efficacy and safety of antiparasitic therapy for neurocysticercosis in rural Tanzania: a prospective cohort study

D Stelzle, C Makasi, V Schmidt, C Trevisan, I Van Damme, C Ruether, P Dorny, P Magnussen, G Zulu, K E Mwape, E Bottieau, C Prazeres da Costa, U F Prodjinotho, H Carabin, E Jackson, A Fleury, S Gabriël, B J Ngowi, A S Winkler

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Abstract

PURPOSE: Neurocysticercosis is common in regions endemic for Taenia solium. Active-stage neurocysticercosis can be treated with antiparasitic medication, but so far no study on efficacy and safety has been conducted in Africa.

METHODS: We conducted a prospective cohort study on treatment of neurocysticercosis in Tanzania between August 2018 and January 2022. Patients were initially treated with albendazole (15 mg/kg/d) for 10 days and followed up for 6 months. Additionally in July 2021, all participants who then still had cysts were offered a combination therapy consisting of albendazole (15 mg/kg/d) and praziquantel (50 mg/kg/d). Antiparasitic treatment was accompanied by corticosteroid medication and anti-seizure medication if the patient had experienced epileptic seizures before treatment.

RESULTS: Sixty-three patients were recruited for this study, of whom 17 had a complete follow-up after albendazole monotherapy. These patients had a total of 138 cysts at baseline, of which 58 (42%) had disappeared or calcified by the end of follow-up. The median cyst reduction was 40% (interquartile range 11-63%). Frequency of epileptic seizures reduced considerably (p < 0.001). Three patients had all active cysts resolved or calcified and of the remaining 14, eight received the combination therapy which resolved 63 of 66 cysts (95%). Adverse events were infrequent and mild to moderate during both treatment cycles.

CONCLUSION: Cyst resolution was unsatisfactory with albendazole monotherapy but was very high when it was followed by a combination of albendazole and praziquantel.

Original languageEnglish
JournalInfection
Volume51
Issue number4
Pages (from-to)1127-1139
Number of pages13
ISSN0300-8126
DOIs
Publication statusPublished - 2023

Keywords

  • Humans
  • Neurocysticercosis/drug therapy
  • Albendazole/adverse effects
  • Antiparasitic Agents/adverse effects
  • Praziquantel/adverse effects
  • Tanzania
  • Prospective Studies
  • Cysts/chemically induced
  • Seizures/drug therapy
  • Anthelmintics/adverse effects

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