Bone Hydatid Disease Refractory to Nitazoxanide Treatment

Hans G. Schipper Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands

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Suat Simsek Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands

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Michiel A. van Agtmael Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands

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Krijn P. van Lienden Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands

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We report a patient with bone hydatid disease that was refractory to both long-term daily treatment with albendazole, combined with cimetidine or administered as monotherapy (~15 years) and a relatively short course of nitazoxanide combined with albendazole (3 months). Despite continuous daily medical treatment, bone invasion and destruction proceeded. His pain and disability progressively increased.

Author Notes

  • 1

    Winning A, Braslins P, McCarthy JS, 2009. Case report: nitazoxanide for treatment of refractory bony hydatid disease. Am J Trop Med Hyg 80 :176–178.

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    Wen H, Zhang HW, Muhmut M, Zou PF, New RR, Craig PS, 1994. Initial observation on albendazole in combination with cimetidine for the treatment of human cystic echinococcosis. Ann Trop Med Parasitol 88 :49–52.

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    Stettler M, Fink R, Walker M, Gottstein B, Geary TG, Rossignol JF, Hemphill A, 2003. In vitro parasiticidal effect of nitazoxanide against Echinococcus multilocularis metacestodes. Antimicrob Agents Chemother 47 :467–474.

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    Stettler M, Rossignol JF, Fink R, Walker M, Gottstein B, Merli M, Theurillat R, Thormann W, Dricot E, Segers R, Hemphill A, 2004. Secondary and primary murine alveolar echinococcosis: combined albendazole/nitazoxanide chemotherapy exhibits profound anti-parasitic activity. Int J Parasitol 34 :615–624.

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    Walker M, Rossignol JF, Torgerson P, Hemphill A, 2004. In vitro effects of nitazoxanide on Echinococcus granulosus protoscoleces and metacestodes. J Antimicrob Chemother 54 :609–616.

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    Schipper HG, Koopmans RP, Nagy J, Butter JJ, Kager PA, Van Boxtel CJ, 2000. Effect of dose increase or cimetidine coadministration on albendazole bioavailability. Am J Trop Med Hyg 63 :270–273.

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    Nagy J, Schipper HG, Koopmans RP, Butter JJ, Van Boxtel CJ, Kager PA, 2002. Effect of grapefruit juice or cimetidine coadministration on albendazole bioavailability. Am J Trop Med Hyg 66 :260–263.

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    WHO Informal Working Group, 2003. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 85 :253–261.

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    Filice C, Brunetti E, Bruno R, Crippa FG, WHO-Informal Working Group on Echinococcosis-PAIR Network, 2000. Percutaneous drainage of echinococcal cysts (PAIR-puncture, aspiration, injection, reaspiration): results of a worldwide survey for assessment of its safety and efficacy. Gut 47 :156–157.

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