Mebendazole, its fluorine analogue flubendazole, and other benzimidazole derivatives are active against many gastrointestinal and tissue-stage helminths. This article reviews the published literature and proceedings of a workshop on the use of benzimidazoles against larval echinococcosis (hydatid disease). Orally administered high doses (30–50 mg/kg body weight) of mebendazole given daily for 20–90 days to rodents or sheep infected with larvalEchinococcus granulosus cause damage or destruction of the cyst wall, loss of cyst fluid, and death of protoscolices. Similar treatment of rodents infected withE. multilocularis with mebendazole, flubendazole, fenbendazole, and albendazole for 60–300 days leads to reduction of weight, inhibition of growth and of metastases formation ofE. multilocularis tissue, and to prolonged host survival time although the metacestodes are not killed. Mebendazole or flubendazole treatment of human patients infected withE. granulosus is followed by subjective improvement in most, and evidence of regression of cysts in some; in other patients, cysts continue to grow or have been proven viable even after several months of high-dose mebendazole therapy. In patients infected withE. multilocularis, the progressive course of the disease appeared to be arrested, but treatment apparently did not kill the parasite. Side effects in some patients have included allergic reactions, alopecia, and reversible neutropenia. Some possible reasons for differnet responses to treatment include inadequate plasma drug absorption from the gut and age, condition, and location of cysts. Many remaining questions concerning the risk versus benefits of mebendazole therapy can be answered only through controlled clinical trials.

Chemotherapy for larval echinococcosis in animals and humans: report of a workshop

A new method called PAIR (Puncture-Aspiration of cyst contents—Injection of hypertonic saline solution—Reaspiration) was used as a percutaneous treatment of hydatid cysts. In 37 patients, 120 cysts were punctured. All patients had not been considered surgical candidates. The cysts were localized in the liver, peritoneum, spleen, kidneys, muscles, and bones. In 70% of patients, good results were obtained. Recurrence occurred in 5 of 120 cysts, all at the beginning of our experience when a low concentration of sodium chloride solution was injected. Moderate allergic reactions occurred during seven cyst aspirations. No anaphylactic shock, sudden deaths or dissemination of cyst contents were observed.

Percutaneous treatment of hydatid cysts (Echinococcus granulosus)

Surgical management of hydatid cyst is associated with recurrence in 10 per cent of patients. The role of perioperative chemotherapy in prevention of recurrence has not been extensively explored. Sixteen patients with Echinoccus granulosus were treated with albendazole 10 mg kg−1 before operation; of fourteen patients who received albendazole for 1 month or more before operation only one (with doubtful therapeutic compliance) had viable protoscoleces, in contrast both of the two remaining patients who received only 1 and 3 weeks therapy had live disease at the time of operation. A 1 month pre-operative course of albendazole kills most if not all protoscoleces within hydatid cysts in man. This may allow pre-operative ‘sterilization’ of cysts and a reduction in the risk of recurrence.

Pre‐operative albendazole therapy for hydatid cyst

Leishmania is the causative agent of various forms of leishmaniasis, a significant cause of morbidity and mortality. The clinical manifestations of the disease range from self-healing cutaneous and mucocutaneous skin ulcers to a fatal visceral form named visceral leishmaniasis or kala-azar. In the absence of any effective vaccine, the only means to treat and control leishmaniasis is affordable medication. The treatment choice is essentially directed by economic considerations; therefore, for a large majority of countries, chemotherapy relies only on the use of cheaper antimonial compounds. The emergence of antimonial therapy failure in India linked to proven parasite resistance has stressed questions about selective factors as well as transmission risk of drug resistance. Unfortunately, in most parts of the world, the frequency of parasite antimony resistance linked to treatment failure is unknown because of a lack of information on Leishmania antimony susceptibility. This information is crucial for addressing the risk of selection and transmission of drug-resistant parasites, particularly in areas where antimony is the only chemotherapeutic alternative. However, the poor knowledge about factors that favor selection of resistant parasites, the multiplicity of the agents that can play a role in the in vivo antileishmanial activity of antimony, and the lack of a standard protocol to diagnose and survey parasite resistance all contribute to insufficient monitoring of antimony resistance. In this review, we discuss on the factors potentially involved in the selection of antimony resistance in the field and discuss on the methods available for its diagnosis.

Leishmania antimony resistance: what we know what we can learn from the field

The authors report their personal experience of the treatment of 50 patients with hydatid cysts of different localization with 10–12 mg Albendazole per kg per day for three months without intervals...

Treatment of Echinococcus granulosus hydatid disease with albendazole.

Resume L'hydatidose est une affection parasitaire relativement frequente dans notre region mediterraneenne Sur 564 cas de kystes hydatiques operes dans le Sud-Est de la France nous avons pu retrouver 42 fois (soit 7,5 %) la notion d'intervention anterieure pour la meme etiologie Etudiant sur le plan parasitologique les modalites de constitution de ces « recidivespost-operatoires, les auteurs pensent que le malade est souvent deja porteur de sa recidive lors de la premiere intervention, sous forme de kystes latents non deceles ou par vesiculation exogene Ils insistent donc sur la necessite d'explorer avec une grande minutie ces malades avant et pendant l'intervention ainsi que sur l'interet du controle serologique post-operatoire

Les modalités de constitution des «récidives postopératoires de l'échinococcose à Echinococcus granulosus

Persistance de la leishmaniose viscérale dans le sud-est de la France et fréquence marquée de l'affection a l'age adulte. A propos d'observations récentes.

The authors report on 9 cases of mediterranean visceral leishmaniasis (Kala-Azar) collected in the south-eastern part of France in 1978. They emphasize the more frequent occurrence of this disease in adults than children. Out of the 40 cases detected in this region between January 1975 and December 1978, 22 affected adults (55 percent) moreover, Kala-Azar appears to occur particularly in adults with decreased general resistance and diagnosis may be difficult because classical clinical features are no complete.

Persistence of visceral leishmaniasis in the southeast of France and recorded frequency of the disease in adults. Apropos of recent cases

Resume Cinq solutions scolecicides utilisees en chirurgie ont ete testees in vitro et par une technique in vivo sur un modele animal, dans des conditions proches d'une intervention chirurgicale. Les solutions hypertoniques de glucose et de chlorure de sodium sont inefficaces dans ce modele experimental. Les meilleures substances sont le formol a 2 % et l'eau oxygenee a 10 volumes.

Étude expérimentale de l'efficacité des différentes solutions scolecicides utilisées en chirurgie hydatique

Resume De nombreuses techniques sont employees pour le diagnostic de la leishmaniose viscerale chez les patients VIH+ sans qu'aucune ne soit entierement satisfaisante. L'examen direct d'un prelevement pathologique est tres fiable lorsqu'il est positif. Malheureuseument, la sensibilite de l'examen direct depend du type de prelevement (la ponction de rate s'averant la plus performante mais aussi la plus dangereuse) et de sa qualite. La mise en culture du prelevement peut accroitre la sensibilite de l'examen mais elle necessite de nombreux repiquages et peut parfois donner lieu a des faux negatifs. Afin d'ameliorer la sensibilite de l'examen parasitologique direct, plusieurs equipes ont propose des tests diagnostiques utilisant l'amplification par PCR de cibles diverses : DNA kinetoplastique, ADN codant pour la sous-unite ribosomique 18S, sequences genomiques repetees (specifiques des agents de la leishmaniose viscerale). La fiabilite du diagnostic par PCR est encore en cours d'evaluation ; les premiers resultats sont tres encourageants. La serologie permet un diagnostic tres fiable chez les sujets immunocompetents. En revanche, nous avons observe des faux negatifs chez certains sujets immunodeprimes. Cette absence de reponse humorale a persiste durant toute l'evolution de la maladie. L'utilisation des techniques serologiques peut aussi etre mise en defaut lors du diagnostic des rechutes car les patients conservent souvent une serologie positive qui rend delicate l'interpretation des resultats obtenus.

H. Dumon

Papers

Les modalités de constitution des «récidives postopératoires de l'échinococcose à Echinococcus granulosus

Persistance de la leishmaniose viscérale dans le sud-est de la France et fréquence marquée de l'affection a l'age adulte. A propos d'observations récentes.

Persistence of visceral leishmaniasis in the southeast of France and recorded frequency of the disease in adults. Apropos of recent cases

Étude expérimentale de l'efficacité des différentes solutions scolecicides utilisées en chirurgie hydatique

La leishmaniose viscérale à l'ère du SIDA