Reduced susceptibility to praziquantel in Schistosoma mansoni: implications for schistosomiasis control
DOI:
https://doi.org/10.55892/jrg.v9i20.2990Keywords:
Schistosomiasis, praziquantel, pharmacological resistance, neglected tropical diseasesAbstract
Schistosomiasis mansoni remains an important neglected tropical disease, with praziquantel serving as the main therapeutic tool for more than four decades. The reliance on this drug in preventive chemotherapy programs has raised concerns regarding the emergence of reduced susceptibility or resistance in Schistosoma mansoni. This study consisted of an integrative review conducted using the PubMed/MEDLINE, Scopus, Web of Science and LILACS databases, aiming to critically synthesize evidence on praziquantel efficacy, therapeutic failures, mechanisms associated with reduced susceptibility, and implications for schistosomiasis control. A total of 42 articles were identified, of which 14 met the inclusion criteria and comprised the final analysis. The findings indicate that, although praziquantel remains effective in reducing parasite burden, experimental and field studies have reported decreased cure rates, survival of adult worms, maintenance of population genetic diversity, and selective pressure associated with repeated drug use. Proposed biochemical and molecular mechanisms include alterations in calcium signaling, tegumental integrity, and detoxification pathways, in the absence of validated molecular resistance markers. Overall, the evidence supports a gradual and multifactorial process of reduced susceptibility, with important implications for the sustainability of schistosomiasis control programs, highlighting the need for efficacy surveillance, therapeutic diversification, and integration with non-pharmacological control strategies.
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