PDF(Pubmed)
Abstract：
Acute schistosomiasis (AS) manifests with a broad spectrum of clinical features in pediatric populations. Diagnosis may be difficult in the absence of detectable numbers of eggs. As a result, new approaches may be required to achieve an accurate diagnosis. Optimal praziquantel (PZQ) treatment regimen for young children is debatable. Also, the post-treatment response is still poorly evaluated due to the lack of reliable markers. A group of 6 children (a toddler and 5 pre-school children) and one pre-adolescent were investigated for AS clinical manifestations and followed-up for two years after treatment. Ova detection was performed by Kato-Katz (KK) and presence of Schistosoma mansoni DNA was assessed by real-time PCR (rt-PCR) in stool samples. IgG and IgE anti-Schistosoma levels and urinary antigen were detected by ELISA and point-of-care circulating cathodic antigen (POC-CCA) testing in serum and urine, respectively. AS clinical symptoms were present in 5/7 (71.4%) of the infected children, and hypereosinophilia was detected in all of them. Ova detection and serology were positive in only 3/7 (44.9%) and 4/7 (57.1%), respectively. However, real-time PCR (rt-PCR) showed the presence of Schistosoma DNA in 6/7 (85.7%) of the cases, and urinary antigen was detected in all infected children. The long-term follow-up after treatment with three doses of PZQ (80mg/kg/dose), showed high cure rates (CR) as demonstrated by the DNA-based assay as well as reduced levels of side effects. CR based on urinary antigen detection ranged from 28.6 to 100%, being the highest CR due to double testing the 2-year post-treatment samples. The results suggest that high dose and repeated treatment with PZQ might be effective for AS in young children. Also, new laboratory markers should be considered to diagnosis and monitor the drug response.
摘要：
急性血吸虫病（AS）在儿科人群中表现出广泛的临床特征。在没有可检测数量的卵的情况下，诊断可能很困难。因此,可能需要新的方法来实现准确的诊断。针对幼儿的最佳吡喹酮（PZQ）治疗方案尚有争议。此外，由于缺乏可靠的标志物,治疗后的反应评估仍然很差.一组6名儿童（1名幼儿和5名学龄前儿童）和1名青春期前儿童进行了AS临床表现的调查，并在治疗后进行了两年的随访。通过Kato-Katz（KK）进行Ova检测，并通过实时PCR（rt-PCR）评估粪便样品中曼氏血吸虫DNA的存在。通过ELISA和即时循环阴极抗原（POC-CCA）检测血清和尿液中的IgG和IgE抗血吸虫水平和尿液抗原，分别。5/7(71.4%)的感染患儿出现AS临床症状,所有患者都检测到嗜酸性粒细胞增多。Ova检测和血清学阳性仅3/7(44.9%)和4/7(57.1%),分别。然而,实时PCR(rt-PCR)显示6/7(85.7%)病例中存在血吸虫DNA,所有感染儿童均检测到尿抗原。经三剂PZQ（80mg/kg/剂）医治后的历久随访，显示出高治愈率（CR），如基于DNA的测定所证明的，以及降低的副作用水平。基于尿抗原检测的CR范围为28.6至100%，由于对治疗后2年样本进行双重测试，因此CR最高。结果表明，高剂量和反复使用PZQ治疗可能对幼儿AS有效。此外，应考虑新的实验室标志物来诊断和监测药物反应。
