Efficacy comparison between long-term high-dose praziquantel and surgical therapy for cerebral sparganosis: A multicenter retrospective cohort study

Abstract

BackgroundSparganosis is a parasitic infection caused by the plerocercoid larvae of Spirometra mansoni in East and Southeast Asia. The plerocercoid larvae sometimes invade the encephalon, resulting in severe cerebral sparganosis. Surgical removal of the larvae is considered a standard therapy for cerebral sparganosis. In contrast, the efficacy and safety of long-term, high-dose praziquantel treatment for cerebral sparganosis have not been explored.Methodology/Principal findingsIn this multicenter retrospective study, we assessed the records of 96 patients with cerebral sparganosis who consulted at three medical centers from 2013 to 2017. Forty-two patients underwent surgical lesion removal, and the other 54 patients received long-term, high-dose praziquantel (50 mg/kg/day for 10 days, repeated at monthly intervals). The primary outcome was the complete disappearance of active lesions on cerebral magnetic resonance imaging. The secondary outcomes included the modified Rankin scale score at 90 days, incidence of seizure, eosinophil count, and serological Spirometra. mansoni antibody titer. The efficacy of praziquantel treatment was similar to that of surgical lesion removal for cerebral sparganosis with respect to both the primary outcome and secondary outcomes. Although binary logistic regression models also supported the primary outcome after adjustment for age, sex, lesion location, and loss to follow-up, some unavoidable confounders might have biased the statistical power. No significant clinical complications or laboratory side effects occurred in the praziquantel group with the exception of a relatively benign allergic reaction.Conclusions/SignificanceIn this small-sample, nonrandomized, retrospective exploratory study, some patients with cerebral sparganosis were responsive to long-term, high-dose praziquantel with an efficacy similar to that of surgical lesion removal. These findings increase the treatment flexibility for this serious infection.

A Case of Acquired Immunodeficiency Syndrome With Cerebral Sparganosis and Review of the Literature.

“…Some authors have declared it as effective as surgical treatment while others have declared it ineffective. A study involving 96 patients showed no signi cant difference between long term high dose praziquantel therapy and surgical treatment (9) . Some patients often require multiple cycles of treatment, and there are still some patients, who cannot be cured with medical treatment (8) .…”

Cerebral sparganosis presenting with atypical postcontrast magnetic resonance imaging findings: a case report and literature review

“…Oral medication, including praziquantel, is deemed unable to kill a live worm or achieve beneficial clinical effects [7, 9, 30]. However, recent studies indicated that high-dose praziquantel therapy can be effective in patients with cerebral sparganosis [32, 37, 38]. Of the 15 cases we summarized above, only two patients received oral medication, abendazole and praziquantel, respectively (Table 1).…”

Case Report: Human Subcutaneous Sparganosis in a Thai Migrant

“…However, high-dose praziquantel (repeated cycles of 50–75 mg/kg body weight/day for 10 days) has been reported to be effective in inoperable cases of cerebral sparganosis. 13,18…”