5 U/L selleck products (<40), alanine transaminase (ALT) 58.4 U/L (<41), gamma-glutamyltransferase (γGT) 81.9 U/L (11–50), and alkaline phosphatase (AP) 237 U/L (<270)]. Under the tentative diagnosis of an acute systemic allergic reaction, we initiated symptomatic treatment with oral prednisolone (1.5 mg/kg body weight OD) and inhaled budesonide/formoterol (200/6 µg BID). Under this treatment the respiratory symptoms improved, the laboratory parameters normalized, and it was possible

to taper down and finally discontinue oral prednisolone on August 29. Inhaled budesonide/formoterol was stopped on September 12 when the patient indicated complete resolution of all symptoms. A follow-up spirometry on October 11 was normal. of PZQ Since the advent of PZQ in the late 1970s, the drug has become the treatment of

choice against Sotrastaurin all species of Schistosoma.[2] As the drug is largely ineffective on young (7- to 28-d-old) stages of the parasite (schistosomula), delivery of treatment will only be effective upon maturation of the parasite and once the chronic stage of the infection has been reached.[3] In addition, the administration of PZQ during the acute phase may be associated (in 40–50% of cases) with paradoxical reactions (Jarish Herxheimer-like reactions) due to the drug’s partial effect on juvenile parasite stages.[3, 4] Hence it is generally advised to wait at least 3 months after exposure (marked by presence of eggs in stool or urine) before initiating PZQ treatment.[4, 5] On the other hand, delaying BCKDHA treatment increases the risk of severe ectopic manifestations (eg, neuroschistosomiasis). To reduce the immunological reactions, and to avoid or attenuate paradoxical reactions in patients with acute schistosomiasis (AS), co-administration of corticosteroids with PZQ is occasionally

considered. This approach, however, has the drawback that co-administration with corticosteroids decreases the plasma level of PZQ by approximately 50%.[6] Symptomatic AS (as a treatment-independent phenomenon during the early natural course of infection) and treatment-induced paradoxical reactions can manifest with identical symptoms: namely, fever, fatigue, and pulmonary symptoms (dry cough, shortness of breath, wheezing) as well as neurological signs.[3, 7, 8] Both are considered to constitute allergic reactions after exposure of a naive host to a high level of parasite antigens. These are evoked either by larval maturation and early oviposition in symptomatic AS or by parasite destruction in treatment-induced paradoxical reactions. In both cases eosinophil-mediated toxicity leading to vasculitis is considered to be the most likely pathophysiological correlate of the clinical manifestations (eg, pulmonary, cardiac, cerebral).[8, 9] The pulmonary symptoms in AS (S haematobium and S mansoni) have frequently been reported to persist for weeks (or even months) and may present without radiological findings.