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Exudative Polyserositis and Acute Respiratory Failure Following Praziquantel Therapy: Discussion (2)

Exudative Polyserositis and Acute Respiratory Failure Following Praziquantel Therapy: Discussion (2)Acute respiratory failure following oxainniquine therapy was described by Davidson et al‘ in 1986 and w as associated with a miliary pattern on the chest roentgenogram that resolved spontaneously. This was attributed to the shifting of worms and ova to the lung vasculature or allergy to schistosomal antigens released after worm death. Transient abnormalities of pulmonary function were documented in 11 Egyptian patients with schistosomiasis following the administration of antimony sodium dimercaptosuccinate (stibocaptate). These abnormalities manifested with decreased lung volumes, increased hypoxemia, and venous admixture, but most of the patients remained asymptomatic. However, praziquantel itself was not previously reported to cause respiratory failure.
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Exudative Polyserositis and Acute Respiratory Failure Following Praziquantel Therapy: Discussion (1)

In our opinion, this patient’s stormy illness was the result of administration of praziquantel for the following reasons: (1) the reaction started w ithin four hours of administration of praziquantel; (2) marked eosinophilia which improved spontaneously; (3) other conditions w ere excluded that might have caused his illness, for example, disseminated pyogenic or tuberculous infection, metastatic disease, or collagen vascular disorders; (4) rapid and complete resolution occurred without the help of any specific medication; (5) all the manifestations of his illness with the exception of polyserositis were described previously as side effects of therapy w ith praziquantel or other antisehistosomal drugs.
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Exudative Polyserositis and Acute Respiratory Failure Following Praziquantel Therapy (3)

Exudative Polyserositis and Acute Respiratory Failure Following Praziquantel Therapy (3)On the second day after hospital admission his general condition deteriorated and he became tachypneic (respirations, 40/min) at rest. A repeated chest rot*ntgenogram showed large right-sided and small left-sided pleural effusions (Fig 2). An echocardiogram revealed a moderate-sized pericardial effusion but there was no clinical or echocardiographic evidence of cardiac tamponade. By this time, he had also developed clinically detectable ascites. As the patient was very symptomatic 1 L of fluid was aspirated from his right pleural cavity. The peritoneal and pleural fluid were both exudates containing six to eight eosinophils per high-power field of 40 to 50 cells. Fluid examination and cultures for all microorganisms, including mycobacteria, were negative. Blood cultures were sterile on several occasions; stool microscopy and cultures showed no pathogens.
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Exudative Polyserositis and Acute Respiratory Failure Following Praziquantel Therapy (2)

On examination he was pvrexial (oral temperature, 38°C), pulse rate was 100 beats per minute, and blood pressure was 100/80 mm Ilg. There were no clinical signs of cardiac failure. His chest was normal but he was unable to take* a deep breath due to pleuritic pain. Abdominal examination revealed hepatospleiiomegaly and generalized tenderness. Bowel sounds were present and findings from rectal examination were normal.
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Exudative Polyserositis and Acute Respiratory Failure Following Praziquantel Therapy (1)

Exudative Polyserositis and Acute Respiratory Failure Following Praziquantel Therapy (1)Praziquantel, a mixture of stereoisomers of pyrazinoiso-quinoline ring structures, is a broad-spectrum antihelminthic that is effective against all forms of human schistosomiasis. It is generally well tolerated with only minor side effects, such as abdominal pain, headache, dizziness, epigastric discomfort, bloody diarrhea, or mild fever. ’ We report an unusual complication of praziquantel therapy in schistosomiasis. Although some of the manifestations of our patients illness, such as fever, skin rash, and diarrhea, have been described in acute schistosomiasis, this patient had hepatosplenomegalv and periportal fibrosis that persisted after recovery from acute illness making the possibility of chronic schistosomiasis more likely. buy asthma inhaler
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