RESUMEN
Loiasis, a filarial pathogen exclusively endemic in central and western Africa, causes a wide spectrum of symptoms. Understanding the breadth of its clinical manifestations is of importance for adequate patient care and to understand its disease burden. Recurring transient pain in the oral cavity was reported as a self-perceived symptom of loiasis in in-depth interviews of patients in a high transmission region in Gabon. Pain was described as stabbing in character and transient for a few days in its temporal course. A quantitative epidemiological survey indicated that transient tooth pain was experienced by 22% of patients infected with Loa loa. Among those individuals, it was exclusively reported by patients suffering from migratory loiasis (24%). Similar findings have been previously described for other filarial pathogens, indicating that transient swellings of the periodontium and the soft tissue of the oral cavity may explain this symptom reported by patients with migratory loiasis.
RESUMEN
BACKGROUND: Urogenital schistosomiasis is prevalent in many malaria endemic regions of sub-Saharan Africa and can lead to long-term health consequences if untreated. Antimalarial drugs used to treat uncomplicated malaria have shown to exert some activity against Schistosoma haematobium. Here, we explore the efficacy on concomitant urogenital schistosomiasis of first-line recommended artemisinin-based combination therapies (ACTs) and investigational second-generation ACTs when administered for the treatment of uncomplicated malaria in Gabon. METHODS: Microscopic determination of urogenital schistosomiasis was performed from urine samples collected from patients with confirmed uncomplicated malaria. Egg excretion reduction rate and cure rate were determined at 4-weeks and 6-weeks post-treatment with either artesunate-pyronaridine, artemether-lumefantrine, artesunate-amodiaquine or artefenomel-ferroquine. RESULTS: Fifty-two (16%) out of 322 malaria patients were co-infected with urogenital schistosomiasis and were treated with antimalarial drug combinations. Schistosoma haematobium egg excretion rates showed a median reduction of 100% (interquartile range (IQR), 17% to 100%) and 65% (IQR, -133% to 100%) at 4-weeks and 6-weeks post-treatment, respectively, in the artesunate-pyronaridine group (n = 20) compared to 35% (IQR, -250% to 70%) and 65% (IQR, -65% to 79%) in the artemether-lumefantrine group (n = 18). Artesunate-amodiaquine (n = 2) and artefenomel-ferroquine combination (n = 3) were not able to reduce the rate of eggs excreted in this limited number of patients. In addition, cure rates were 56% and 37% at 4- and 6-weeks post-treatment, respectively, with artesunate-pyronaridine and no cases of cure were observed for the other antimalarial combinations. CONCLUSIONS: Antimalarial treatments with artesunate-pyronaridine and artemether-lumefantrine reduced the excretion of S. haematobium eggs, comforting the hypothesis that antimalarial drugs could play a role in the control of schistosomiasis. TRIAL REGISTRATION: This trial is registered with clinicaltrials.gov, under the Identifier NCT04264130.