Acute schistosomiasis, a diagnostic and therapeutic challenge
Acute schistosomiasis, a diagnostic and therapeutic challenge
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DOI：
10.1111/j.1469-0691.2009.03131.x
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发表时间：
2010-03-01
影响因子：
14.2
通讯作者：
Caumes, E.
中科院分区：
文献类型：
--
作者：
Jaureguiberry, S.;Paris, L.;Caumes, E.
在非流行国家，急性（侵袭性）血吸虫病（AS）通常见于无免疫力的旅行者，而慢性血吸虫病更常见于移民。患有AS的旅行者最初表现为非特异性体征，如发热、咳嗽、头痛和荨麻疹。可能发生危及生命的心脏和神经系统并发症。AS的阳性诊断依赖于血清转换，其在症状发作后约3周与嗜酸性粒细胞增多症一起出现。当在AS期间处方时，吡喹酮通常不能预防疾病的慢性期，并且在大约50%的病例中与体征和症状的加重相关。根据已发表的文献，可建议皮质类固醇单独使用或与吡喹酮联合使用。当与皮质类固醇联合使用时，药代动力学相互作用可能会损害吡喹酮的疗效。我们建议，皮质类固醇激素应限制使用在AS的全身并发症的患者，而吡喹酮应启动时，只有在粪便或尿液中检测到卵子，这取决于罪犯的物种。
P>In non-endemic countries, acute (invasive) schistosomiasis (AS) is typically seen in non-immune travellers, whereas chronic schistosomiasis is more frequently diagnosed in immigrants. Travellers with AS initially present with non-specific signs such as fever, cough, headache, and urticaria. Life-threatening cardiac and neurological complications may occur. The positive diagnosis of AS relies on seroconversion, which appears together with hypereosinophilia approximately 3 weeks after the onset of symptoms. When prescribed during AS, praziquantel usually does not prevent the chronic phase of the disease and is associated with exacerbation of signs and symptoms in approximately 50% of cases. According to the published literature, corticosteroids may be recommended alone or in association with praziquantel. When associated with corticosteroids, pharmacokinetic interactions may impair the efficacy of praziquantel. We suggest that corticosteroids should be restricted to use in patients with systemic complications of AS, whereas praziquantel should be initiated only when ova are detected in either stools or urine, depending on the culprit species.