Drug trials for treatment of human angiostrongyliasis

Abstract

Abdominal and cerebral angiostrongyliasis are two important infections produced by metastrongylid worms, the former occurring in Central and South America and the later in Asia and Pacific Islands. Drug treatment is a challenge since the worms and its evolving larvae live or migrate inside vessels and efficient killing of the parasites may produce more severe lesions. Larvicidal effect of certain drugs appears to be more easily accomplished but this outcome is not useful in abdominal angiostrongyliasis since clinical manifestations appear to result from sexual maturation of the worms. We review the drug trials in murine experimental models and conclude that most of them could not be considered good candidates for treatment of human infection, except for PF1022A, pyrantel and flubendazole.

Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

“…Evidently, the key issue in treat- There is an urgent need for extensive studies of new approaches to chemotherapy and evaluation of neurological relapses (187,249).…”

Proteolytic activity in the adult and larval stages of the human roundworm parasite Angiostrongylus costaricensis

“…A published method based on a polymerase chain reaction may eventually improve our ability to diagnose the disease, although the results are still preliminary . Moreover, many studies have assessed different types of therapies with limited success, such as treatment with anthelmintic drugs (Morera & Bontempo 1985, Mentz & Graeff-Teixeira 2003, Bohrer Mentz et al 2007), anti-inflammatory drugs (Fante et al 2008) and antithrombotic agents (Rodriguez et al 2011). The present consensus is that anthelmintic drug administration is not recommended given that it usually induces the erratic migration of worms instead of killing them (Morera & Bontempo 1985).…”

Human infection by Angiostrongylus costaricensis in Venezuela: first report of a confirmed case

“…Clinical attempts lack good controls, and clinical as well as parasitological criteria for cure are not easy to establish 10 , especially knowing that the infection may probably be self limited in most human cases. Experimental chemotherapy trials have been made with thiabendazole and albendazole 17 , and a wide array of traditional known antihelminthics including avermectin, ivermectin, santonin, milbemycin D, mebendazole, albendazole, thiabendazole, flubendazole, pyrantel, diethylcarbamazine, piperazine, biothionol, niclosamide, levamisole, as well as new yet undisclosed compounds like PF1022A, on both A. cantonensis and A. costaricensis, with variable effects, either on larval or adult stages 11 . It is suggested from this review, that flubendazole, pyrantel and PF1022A, could be considered candidates for human trials.…”