Fernando Llanos-Zavalaga

Strategies for the elimination of taeniasis/cysticercosis

Advances in the field of neurocysticercosis continue to shape our understanding of the disease and our efforts to control it. Several attempts have been made to eradicate the disease with active interventions such as changing domestic pig-raising practices, mass chemotherapy of porcine cysticercosis and taeniasis, selective detection and treatment of taeniasis, and community health education. Moreover, ongoing progress in the diagnosis of taeniasis and the development of a porcine vaccine against cysticercosis in Australia, Mexico and Peru has yielded at least one effective vaccine that is currently available. Thus far, however, attempted interventions have only been successful in temporarily disrupting transmission of the disease. Controlled data on the efficacy and acceptability of the different interventions is urgently needed to provide a base-line schematic for intervention which could later be tailored to each particular endemic scenario.

Prevention and control of Taenia solium taeniasis/cysticercosis in Peru.

Abstract Taenia solium is endemic in most of the world, causing seizures and other neurological symptoms. Transmission is mainly maintained in rural areas by a human to pig cycle. Despite claims on its eradicability, sustainable interruption of transmission has not yet been reported. This manuscript reviews the conceptual basis for control, available diagnostic and control tools, and recent experiences on control in the field performed in Peru along the past decade

Epidemiología y control de la cisticercosis en el Perú

Neurocysticercosis, the infection of the human central nervous system by the larval stage of the cestode Taenia solium, is an important cause of epilepsy and other neurological manifestations in Peru and most developing countries. Since 1987, the Cysticercosis Working Group in Peru has performed a series of epidemiological studies which led to estimate the impact and to better understand the transmission of Taenia solium. This information was later applied to the design and execution of a control program in Tumbes, in the Northern Coast of Peru. This paper reviews the main epidemiological findings, as well as the conceptual framework of the elimination program and the tools used. Advances in the control of taeniasis/cysticercosis in our country open the road towards its elimination and potential eradication.

Efficacy of a 3-day course of albendazole treatment in patients with a single neurocysticercosis cyst.

0 d Neurocysticercosis (NCC) is the most important parasitic isease of the central nervous system (CNS), and a major ause of acquired epilepsy worldwide [1]. NCC is a pleomorhic disease in which a single therapeutic approach can hardly e of value in every patient. Besides symptomatic medicaion, the treatment of NCC includes the use of anti-parasitic gents, albendazole (ABZ) or praziquantel (PZQ). It has been onsistently shown that anti-parasitic agents are effective in illing the parasitic cysts and also provide clinical benefits n the evolution of seizures secondary to NCC [2]. However, he optimal length of cysticidal drug therapy remains undened. We report a study carried out to evaluate the efficacy f the shorter reported regimen of ABZ in patients with few ntracranial lesions. After written informed consent was obtained, patients beween 15 and 65 years old attending the Instituto de Ciencias eurologicas in Lima, Peru, with a definitive diagnosis of CC based on neuroimaging and serology [3], and who had ess than five viable parenchymal brain cysticerci were aditted to the hospital and were given ABZ at 15 mg/kg/day in two divided doses, for 3 days. Seventeen patients completed the study between August 1999 and April 2002 (10 men and 7 women, mean age 30.9 years, S.D. 10.17). Eight of them had a single brain cyst, and the other nine had from two to four cysts, for a total of 31 cysts. Control CTs were obtained after a mean of 105.8 days after treatment (range 69–180 days). Overall, 19 out of 31 cysts (55%) disappeared and 12 out of 17 patients (70%) were completely free of viable cysts on control CTs (Table 1). Response to therapy differed between patients with one cyst and those with more than one cyst. There were no persisting viable cysts in any of the eight patients who had a single cyst at baseline (six of these cysts disappeared and the other two were seen as residual inflammatory nodules). In the nine patients with 2–4 lesions, 11 out of 23 cysts (48%) became non-viable (10 cysts disappeared and one became an inflammatory nodule), and four patients (44%) were free of viable cysts. When comparing the efficacy of ABZ between these subgroups of patients, the drug was significantly more effective in patients with a single cyst in terms of both cyst death (8/8, 100% versus 11/23, 48%, p= 0.003, Fisher’s exact test) and number of patients free of viable ∗ Corresponding author. Tel.: +51 13287360. E-mail address: hgarcia@jhsph.edu (H.H. Garcia). 1 Other members of the CWGP who collaborated in this work include S. odriguez (Instituto de Ciencias Neurologicas, Lima, Peru), A.E. Gonzaez (Universidad de San Marcos, Lima, Peru), M. Verastegui (Universidad cysts (8/8, 100% versus 4/9, 44%, p= 0.049, Fisher’s exact test). Spontaneous degeneration of a single viable brain cysticercus is unlikely, occurring in 20% of cases or less [4–6]. A ayetano Heredia, Lima, Peru), and V.C.W. Tsang (Centers for Disease ontrol, Atlanta, GA).

Características de la prescripción antibiótica en los consultorios de medicina del Hospital Cayetano Heredia de Lima, Perú

Fundamento: La prescripcion adecuada de medicamentos incluye, entre otros aspectos, la eleccion de determinado medicamento en dosis y tiempo requeridos, considerando ademas su eficacia y conveniencia. El presente estudio transversal descriptivo, tiene como objetivo evaluar la prescripcion antibiotica: proporcion de prescripcion y calidad de la misma, en la consulta ambulatoria del servicio de medicina del Hospital Cayetano Heredia. Metodos: La poblacion estuvo formada por las 1.449 personas que acudieron a la consulta del 8 de enero al 2 de febrero del 2001. Para determinar la calidad se calculo una muestra de 120 personas a partir de las que formaban la poblacion de estudio. La informacion fue revisada y calificada por tres medicos especialistas, teniendo como patron referencial la United States Pharmacopeial Drug Information. Resultados: La proporcion de prescripcion fue del 13,53% (IC 95%: 11,77%-15,29%), sin diferencias estadisticamente significativas segun edad, sexo, y consultorios. Los diagnosticos mas frecuentes con prescripcion antibiotica fueron: infeccion urinaria y faringoamigdalitis; los antibioticos mas prescritos fueron: ciprofloxacina y cotrimoxazol. 70,00% de antibioticos indicados fueron prescritos con nombre generico y 70,83% se encuentran en el Petitorio Nacional de Medicamentos Esenciales. En relacion a la calidad, encontramos 81,67% (IC 95%: 79,68%-83,66%) de prescripciones inadecuadas, en cuanto a duracion (59,20%) y dosis (20,00%) del antibiotico. Conclusiones: La proporcion de prescripcion de antibioticos encontrada fue baja e inferior a la reportada en la literatura, mientras que la calidad inadecuada fue elevada, con valores semejantes a otros estudios. Las investigaciones en este campo son todavia escasas, siendo importante realizar mas estudios que permitan documentar las caracteristicas de la prescripcion. Es necesario contar con una politica de antibioticos que establezca estrategias dirigidas a mejorar su acceso y uso racional.