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Treatment of Clonorchiasis

Further Observations¹

The results of treating 6 cases of clonorchiasis are discussed and compared. The first 3 cases were more fully reported in an earlier paper. Details of the others are appended.

Four of the 6 cases appear to have been cured. In favor of this view are the following facts:

1. Rapid disappearance of the ova from the feces during a course of medication when previously the ova had been found with considerable regularity.

2. Repeated negative results of the examination of concentrated specimens of feces during a period of a month or more before discharge from the hospital. Case 6 was an exception to the extent that a single ovum, which showed well-marked signs of degeneration, was seen ten days before discharge.

3. Repeated negative examinations during a period of another month at the United States Immigration Station in East Boston where this work was skilfully handled under the direction of Dr. Albert J. Nute of the United States Public Health Service.

In 2 cases disappearance of the ova took place during a course of intravenous injections of tartar emetic alone.

In 1 case the ova disappeared suddenly after the intravenous use of a few doses of arsphenamin which had been preceded by an intensive course of tartar emetic. In another case a like result occurred after a few doses of tartar emetic which had been preceded by an intensive course of sulph-arsphenamin intramuscularly.

The facts seem to indicate, first, that both tartar emetic and arsphenamins are somewhat poisonous to Clonorchis; and, second, that it may be advantageous to give them in successive courses.

For the treatment of clonorchiasis in the future it may prove desirable to administer an antimonial and an arsenical alternately, or in alternating intensive courses. Some of the newer antimonials, which seem to be less toxic than tartar emetic but equally potent medicinally, can probably be substituted advantageously for tartar emetic. Similarly, it might prove advantageous to use atoxyl or some other arsenical instead of arsphenamin. By some such modifications of method it seems likely that permanent cures can be more quickly and more surely attained.

It seems not improbable that good results might have been obtained in the two cases in which treatment failed had there been opportunity to follow up with arsphenamin the intensive treatment with antimony which these patients received.

¹ Read at the twentieth annual meeting of the American Society of Tropical Medicine, June 9 and 10, Chicago, Illinois.