Comportamiento clínico, epidemiológico y microbiológico de las filariosis en la población de Mouila en Gabón / Clinical, epidemiological and microbiological behavior of filariases in the population of Mouila, Gabon

Introducción: las filarias son nematodos pertenecientes a la familia Filariidae, aunque existen alrededor de 200 filarias parasitas, solo unas pocas parasitan al hombre. Objetivos: realizar una breve descripción de estas parasitosis, que sirviera como guía al gran número de médicos cubanos colaboradores en países africanos, donde es particularmente frecuente este padecimiento, así como describir el comportamiento de las infecciones por filarias en pacientes atendidos en el Hospital Regional de Mouila, Gabón. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal. Se incluyeron 87 pacientes de los 2 sexos, de 15 años de edad y más, en los que se logró confirmar algún tipo de filariosis. Resultados: se observó que 3,7 por ciento de los pacientes presentó una filariosis, 93,1 por ciento por Loa loa, 5,7 por ciento por Mansonella perstans y 1,1 por ciento por coinfección de ambas. El grupo de más de 65 años y el sexo femenino resultaron los más afectados. El síntoma más frecuente fue el prurito (59,8 por ciento), seguido por la poliartralgia, el dolor lumbar y la astenia. La eosinofilia se apreció en 100 por ciento y la anemia fue más frecuente en pacientes parasitados con Mansonella perstans. La intensidad de la infección para ambos tipos de filarias fue baja. En 86,1 por ciento de los pacientes tratados con dietilcarbamazina y 82,4 por ciento de los tratados con ivermectina, la respuesta fue satisfactoria. Conclusiones: Loa loa predominó, sobre todo en mujeres; el prurito, la anemia y la eosinofilia fueron las manifestaciones principales, la respuesta tratamiento con ivermectina mostró ventajas

Introduction: filariae are nematodes from the family Filariidae. There are about 200 parasitic filariae, but only a few infect humans. Objectives: make a brief description of these parasitic diseases which may serve as guidance to the large number of Cuban cooperation doctors in African countries, where this condition is particularly common, and describe the behavior of filarial infections in patients cared for at Mouila Regional Hospital in Gabon. Methods: a cross-sectional observational descriptive study was conducted of 87 patients of both sexes aged 15 and over with confirmed filariasis. Results: it was found that 3.7 percent of patients had some kind of filariasis: 93.1 percent due to Loa loa, 5.7 percent due to Mansonella perstans and 1.1 percent due to coinfection by both. Females and persons over 65 were the most affected groups. The most common symptom was pruritus (59.8 percent), followed by polyarthralgia, lumbar pain and asthenia. Eosinophilia was present in 100 percent of subjects, and anemia was more frequent in patients infected with Mansonella perstans. Infection intensity was low in both filariases. The response was satisfactory in 86.1 percent of the patients treated with diethylcarbamazine and 82.4 percent of those treated with ivermectin. Conclusions: Loa loa was predominant mainly among women. Pruritus, anemia and eosinophilia were the main manifestations. Treatment with ivermectin was found to be effective

Effect of a single dose of diethylcarbamazine, albendazole or both on the clearance of Wuchereria bancrofti microfilariae and antigenaemia among microfilaria carriers: A randomized trial.

Background. Lymphatic filariasis is a major vector-borne parasitic disease. The global programme to eliminate lymphatic filariasis was launched in 1997 and currently over 570 million people are covered under it in 48 countries. Mass annual single-dose drug administration of diethylcarbamazine (DEC), co-administrated with albendazole for 5–6 years and mass distribution of diethylcarbamazine-fortified salt are the two strategies for elimination of filariasis. Methods. Asymptomatic volunteers residing in Puducherry, India were screened for microfilaria (mf) by examining nocturnal thick blood smears. Those testing positive were randomly assigned to receive a single dose of DEC (6 mg/kg body weight) or albendazole 400 mg or both. Participants were hospitalized for 5 days. Membrane filtration count was used to assess microfilaraemia and ELISA (Og4C3) assay to measure circulating filarial antigens (CFA). Measurements were done before treatment and at 1, 2 and 3 years post-treatment. Viability of the adult worms was assessed by looking for the filarial dance sign (FDS) using ultrasound examination of the scrotum in men with hydrocele. Results. Fifty-four microfilaraemic individuals were studied. The mf prevalence started decreasing only by day 180 posttreatment in the DEC group but much earlier in the other two groups (day 30 in the albendazole and day 90 in the DEC with albendazole group). The decrease in mf was marginal (17.6%, 26.3% and 27.8%, respectively) by the end of year 1 posttreatment, but significant (96.7%, 78.6% and 93.3%, respectively) by the end of year 2 post-treatment (p<0.05). By the end of year 3, the level decreased to 80% in the DEC, 90% in the albendazole and to 100% in the DEC and albendazole groups. However, the mf intensity decreased © The National Medical Journal of India 2010 Vector Control Research Centre, Department of Health Research (ICMR), Indira Nagar, Puducherry 605006, India S. L. HOTI, S. P. PANI, P. VANAMAIL, K. ATHISAYA MARY, L. K. DAS, P. K. DAS Correspondence to S. L. HOTI; slhoti@yahoo.com significantly (by 39%; p<0.05) by day 7 post-treatment in both the DEC and DEC with albendazole groups, but only by day 30 in the albendazole group. In all the drug groups, the prevalence as well as intensity of CFA returned to pretreatment levels by the end of year 3 post-treatment. Conclusion. Annual single-dose administration of all the 3 drug regimens significantly reduced antigenaemia levels. There were no significant differences in the efficacy and overall pattern of CFA clearance between the 3 drug regimens.

Ivermectina: sus múltiple usos, seguridad y toxicidad / Ivermectin: its multiple uses, safety and toxicity

La Ivermectina, con más de 30 años de uso en humanos, es una droga que aún sigue siendo estudiada en otras indicaciones. Su seguridad es alta; se han dado casi 2.000 millones de dosis en humanos con efectos colaterales mínimos. Se excreta por las heces, no es nefrotóxica ni hepatotóxica. Es el tratamiento de elección en pacientes con SIDA, recibiendo terapia HAART para estrongiloidiasis sistémica y sarna noruega. Es empleada en niños mayores de dos años de edad o con más de 15 kilos de peso. La dosis es de 200 microgramos/kg en forma oral, al 0,6 por ciento en gotas (1 gota/kg de peso) y de 400 microgramos/kg en forma tópica al 0,1 por ciento (0,4 cc/kg de peso). Logró erradicar la oncocercosis que produce la “ceguera del río” y fue considerada como el triunfo de la humanidad sobre la adversidad por la OMS en 2009.

Ivermectin has been used during more than 30 years and yet it is an old drug in search for additional indications. Ivermectin has high safety profile, and more than 2 billion doses have been administered with mild side effects. Ivermectin is metabolized in the liver, and the drug or its metabolites are excreted almost exclusively in the feces over an estimated 12 days, with less than 1percent of the oral dose excreted in the urine. The plasma half-life of ivermectin in humans is approximately 18 hours following oral administration. Ivermectin is primarily metabolized by CYP3A4, and does not provoke hepato /nephrotoxicicty. This molecule is the gold standard treatment for strongyloidiasis and crusted scabies in patients with AIDS during treatment with HAART therapy. Ivermectin is used in children older than 2 years or more than 15 kg weight. Oral ivermectin 0.6 percent dose is 200 micrograms/kg (1 drop per kg) and topical ivermectin 0.1 percent dose is 400 micrograms/kg (0.4 cc per kg). Ivermectin was able to eliminate human river blindness (onchocerciasis) and “represent one of the most triumphant public health campaigns ever waged in the developing world” by WHO in 2009.

In vitro effect of four herbal plants on the motility of Brugia malayi microfilariae.

BACKGROUND & OBJECTIVE: Disease burden due to lymphatic filariasis is disproportionately high despite mass drug administration with conventional drugs. Usage of herbal drugs in traditional medicine is quite well known but largely empirical. Hence the present study was designed to screen the in vitro antifilarial effect of four herbal plants on Brugia malayi. METHODS: Motility of microfilariae of B. malayi after incubation for 48 h with aqueous/methanol extracts of Vitex negundo L. (roots), Butea monosperma L. (roots and leaves), Ricinus communis L. (leaves), and Aegle marmelos Corr. (leaves) was explored in the concentration range of 20 to 100 ng/ml for possible antifilarial effect by comparing with suitable solvent control. RESULTS: Butea monosperma leaves and roots, Vitex negundo root and Aegle marmelo leaves showed significant inhibition of motility of microfilariae as compared to controls whereas inhibitory activity demonstrated by Ricinus communis L. leaves was not significant. Antifilarial effects imparted by all these extracts were found to be a function of their relative concentrations. Inhibitory concentrations (IC(50)) for the plant extracts with significant antifilarial activity against Brugia malayi microfilariae in in vitro system have been derived to be 82, 83 and 70 ng/ml for Vitex negundo L., Butea monosperma L. and Aegle marmelos Corr. respectively. INTERPRETATION & CONCLUSION: The present study recorded significant antifilarial effect of all plant extracts studied except for Ricinus communis L. leaves and contributes to the development of database for novel drug candidates for human lymphatic filariasis.

Efficacy of a single-dose treatment with 300 mg diethylcarbamazine and a combination of 400 mg albendazole in reduction of Wuchereria bancrofti antigenemia and concomitant geohelminths in Myanmar migrants in Southern Thailand.

BACKGROUND: There seems to be a large magnitude of parasitic worm loads caused by nocturnally periodic Wuchereria bancrofti and geohelminths, in cross-border Myanmar migrant workers in Thailand. We are therefore considering an effective Mass Drug Administration (MDA) with Diethylcarbamazine (DEC) and Albendazole (ABZ). Due to short periods of their residency and current situation of W. bancrofti antigenemics and concomitant geohelminths, treatment effects on the containment of the infections need to be analyzed. OBJECTIVES: Analyze short-term effects on reduction of W. bancrofti antigen (WbAg) and geohelminths' egg (GhE) loads. The efficacy of a single-dose combined treatment with 300 mg DEC (for filariasis) and 400 mg ABZ (for helminthiasis) was evaluated and compared with a single-dose treatment arm with 300 mg DEC alone. MATERIAL AND METHOD: A randomized clinical trial of two treatment choices in 28 Myanmar male workers (DEC/ABZ or group I = 15, DEC or group II = 13) was conducted in Phang Nga province, Southern Thailand. Because of the withdrawal of three subjects of the DEC group, all the 10 DEC subjects were follow-up monitored at post treatment 2, 4, 8 and 12 weeks. Their mean age was 26.4 years; worm loads (mean +/- SD x 10(3)) of W. bancrofti, Ascaris and Trichuris was 103.9 +/- 44.1 antigen units (AU)/ml, 47.3 +/- 38.7 eggs per gram (EPG) and 16.6 +/- 22.2 EPG respectively. The data on the 15 DEC/ABZ subjects showed a mean age of 25.7 years; corresponding worm loads = 96.1 +/- 54.6 AU/ml, 397.0 +/- 117.3 EPG and 54.5 +/- 42.8 EPG respectively. The Antigen Reduction Rates (ARR) and Egg Reduction Rates (ERR) were presented. RESULTS: At the 12-week post treatment, WbAg loads (mean +/- SD x 10(3) AU/ml) were 61.5 +/- 58.4 for group I and 76.8 +/- 40.7 for group II. A significant WbAg reduction was noted for both groups at weeks 8 and 12 (p < 0.05). Also, the significant reduction of GhE loads was more pronounced for both groups after week 2 (p < 0.05). When comparing efficacy of the treatment choices by the treatment retention time, it was more likely to show both groups had similar adulticidal effects on either WbAg, denoted as the ARR (F = 0. 064, p = 0.806) or GhE, denoted as the ERR (F = 0.196, p = 0.669). CONCLUSION: The single-dose 300 mg DEC plus 400 mg ABZ, or 300 mg DEC alone, can be effectively used for treating infections with W. bancrofti and concomitant geohelminths commonly observed in the area. But treatment rounds are required to clear the infections. The reduction of the parasitic worm loads in the legal Myanmar migrants provide values in monitoring and evaluating an effective MDA program with the DEC/ABZ at the provincial level.

Eye lesion caused by adult Brugia malayi: a first case reported in a child from Malaysia.

We are reporting a case of an eye lesion caused by an adult Brugia malayi. The patient was a 3-year-old Chinese boy from Kemaman District, Terengganu, Peninsular Malaysia. He presented with a one week history of redness and palpebral swelling of his right eye. He claimed that he could see a worm in his right eye beneath the conjunctiva. He had no history of traveling overseas and the family kept dogs at home. He was referred from Kemaman Hospital to the eye clinic of Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia. On examination by the ophthalmologist, he was found to have a subconjunctival worm in his right eye. Full blood count revealed eosinophilia (10%). Four worm fragments, each about 1 cm long were removed from his right eye under general anesthesia. A thick blood smear stained with Giemsa was positive for microfilariae of Brugia malayi. A Brugia Rapid test done was positive. He was treated with diethylcarbamazine.

Independent assessment of Mass Drug Administration in filariasis affected Surat city.

The Mass Drug Administration (MDA) done in Surat city (Gujarat) during 2005, revealed good impact on infection and infectivity in mosquitoes and also on microfilaria rate & mean infection density. The overall impact seen was 23% on mf rate, 28% on mean mf density, 65% on infection rate and 50% on infectivity rate in vectors. Indigenous population contribution to microfilaria cases was 9.7%, whereas migratory population contributed 72.2%; predominant 51.9% from Orissa and 20.3% from U.P. Of the total 3640 persons interviewed for MDA compliance in seven zones of the Surat city revealed that actual drug consumption was 76.7% (2792/3640). Another 11.9% although took the drug but did not consume and 11.4% refused. Important reasons for consuming was fear to get the disease (40.7%) and for not consuming; 'will consume after meal' (6.9%), too many tablets (1.7%), seek consent from doctor (1.5%), lack of awareness (1.4%) etc. Refusal was mainly due to the reason as respondents felt apparently healthy. Assessment of IEC activities suggested that main awareness was created by media (local or national TV, banners or handbills, local news papers or mike announcement) alongwith some impact made through NGO's. These observations clearly indicated the utility of effective health education for optimum community participation and shown that it was crucial for successful community based elimination campaign. However some gray areas also suggest the scope for further improvements.

The efficacy of a single-oral-dose administration of ivermectin and diethylcarbamazine on the treatment of feline Brugia malayi.

The combination of ivermectin and diethylcarbamazine (DEC) have been shown to be superior to either drug alone for the suppression of Brugia malayi in humans, but their efficacy against infection with B. malayi in cats has never been investigated. Fourteen asymptomatic microfilaremic (1-200 microfilariae/20 microl blood) cats received oral doses of ivermectin (400 microg/kg body weight) and DEC (6 mg/kg body weight) as a single treatment. A two-month post-treatment examination revealed that 87-100% of the microfilariae in each subject had been cleared, with two of the subjects being amicrofilaremic. A further reduction in microfilarial levels was observed until the final follow-up, at 8 months post-treatment, when the mean clearance rate was 99% and 12 out of the 14 subjects (86%) were amicrofilaremic. The combination of ivermectin and DEC demonstrated a microfilaricidal effect superior to that of either drug used alone, both in the initial rapid clearance of microfilariae, and in sustaining the effect for 8 months. This finding has important implications for the control of brugian lymphatic filariasis in the cat reservoir.

Endosymbiotic Wolbachia of parasitic filarial nematodes as drug targets.

The parasitic nematodes Wuchereria bancrofti, Brugia malayi and B. timori cause a dreadful disease in humans known as lymphatic filariasis, which afflicts more than 120 million people worldwide. As per recent epidemiologic estimates on prevalence of W. bancrofti and B. malayi, about 428 million people are at risk, with 28 million microfilaria carriers and 21 million clinical cases spread out in 13 States and 5 Union Territories of India. The Indian subcontinent that comprises Bangladesh, India, Maldives, Nepal and Sri Lanka harbours 50 per cent of the world's lymphatic filarial disease burden. Recently, an endobacterium of Wolbachia species that belongs to the family Rickettsiaceae was found in all life cycle stages of these nematodes and the transmission is exclusively vertical through the embryonic stages of the female worms. People with filariasis have been exposed to these Wolbachia bacteria or their proteins by the natural killing of parasites. Wolbachia have also been identified occasionally in body fluids of infected patients. Evidence suggests that these Wolbachia are mutualistic symbionts and can be cured from the nematodes by several antibiotics having antirickettsial properties. Treatment of nematodes with tetracyclines affect Wolbachia and they get cleared from worm tissues; and this elimination causes reproductive abnormalities in worms and affect worm's embryogenesis, resulting in sterility. Although it is impractical, prolonged treatment with doxycycline significantly reduces the numbers of microfilaria in circulation, which is an important strategy to control transmission of filariasis by mosquito vectors. In this review, the current knowledge of Wolbachia as a drug target and potential ways to reduce the infection through anti-Wolbachia treatments is discussed.

Surveillance of imported bancroftian filariasis after two-year multiple-dose diethylcarbamazine treatment.

Myanmar migrants are at increased risk for nocturnally periodic Wuchereria bancrofti causing imported bancroftian filariasis. They have a significant influence on the effectiveness of diethylcarbamazine (DEC) mass treatment at the provincial level in the National Program to Eliminate Lymphatic Filariasis (PELF) during the fiscal years (FY) 2002-2006, in Thailand. Two oral doses of DEC 6 mg/kg are given twice a year to the eligible Myanmar migrants (> or = 2 years old). A 300 mg DEC provocation test is given once a year to all Myanmar migrants with work permits. Effectiveness evaluation parameters, such as cumulative index (CI) and the effectiveness ratio (ER), were obtained after 2 years of the multiple-dose DEC treatment program in Ranong Province, Southern Thailand. By cross-sectional night blood surveys at the end of FY 2003 in two districts of Ranong Province, the microfilarial positive rates (MPR) were 0.8% and 1.2% for Mueang Ranong and Kra Buri, respectively. The MPR in the agricultural (1.5%) and industrial (0.4%) occupations were not significantly different from each other. Our findings suggest that most untreated microfilaremics working in agriculture, with short-term residency in Thailand, may have delayed multiple-dose DEC treatment.

Wuchereria bancrofti antigenemia clearance among Myanmar migrants after biannual mass treatments with diethylcarbamazine, 300 mg oral-dose FILADEC tablet, in Southern Thailand.

Using qualitative ICT Filariasis and quantitative Og4C3 ELISA, we assessed a long-term macrofilaricidal effect of two-year biannual mass treatments with a 300 mg oral-dose FILADEC tablet, a reformulation of 6 mg/kg diethylcarbamazine (DEC), on clearance of the Wuchereria bancrofti adult worm circulating filarial antigens (CFA) in Myanmar migrants, at risk of emergence of imported bancroftian filariasis in Southern Thailand. Of the 34 antigenemic Myanmar index cases of varying initial CFA levels, who were initially screened out with the ICT Filariasis, 13 index cases were follow-up treated and monitored at the DEC post treatments, 6, 12, and 18 months. At the 18-month post treatment, residual antigenemias (%) in 4 of 5 index cases (group 1) with high antigen titers (99.7-181.6 x 10(3) AU/ml) were 54.44%, 33.58%, 27.43%, and 9.97%. Significant decreases of the CFA levels in only 3 out of 5 index cases were affected by the response to DEC treatments (p < 0.007). The treatment effects on clearance of the CFA in 8 index cases (group II) with low antigen titers (15.4-37.2 x 10(3) AU/ml) were shown for at least 6 months post DEC treatment and hence had 100% efficacy in the first 6 months of the first year of year round treatment. Group I, was more likely to show an increase of the DEC efficacy after the first 6 months of the second year round treatment, but there was no statistically significant difference (p = 0.063). We reemphasized that, for use in the national program to eliminate lymphatic filariasis (PELF) in Thailand, such a DEC regimen had a macrofilaricidal effect on antigenemia clearance, and confirmed its value in evaluating response to the treatment and monitoring the long-term efficacy of the DEC regimen in W. bancrofti adult worm burden reductions in Myanmar migrants on a wide scale.

Treatment of microfilaraemics with DEC and its effect on vector infection and infectivity in tribal and non-tribal areas of Bankura district, West Bengal, India.

Single course DEC treatment (6 mg/kg body weight/day for 12 days) was administered to 66 tribal and 442 non-tribal microfilaria (mf) carriers detected through a Filariasis survey in Bankura district, West Bengal, India. All the mf carriers remained amicrofilaraemic on 22nd, 180th and 365th post-treatment day. As a result of DEC treatment to the mf carriers, vector (Culex quinquefasciatus) infection rate in tribal study areas reduced from 2.06% to 1.07%. Infectivity rate was "nil" both before and after treatment. In non-tribal study areas, vector infection rate reduced from 4.33% to 2.22% and infectivity rate from 0.51% to 0.29%.

Bancroftian filariasis: Clinical parasitologic and serologic evaluation after 4 years appling two antifilarial regimens

In August 1997, 124 individuals out of 1110 were selected as being seropositive for circulating filarial antigen OG4C3 [CFA]. Ten healthy children proven negative for CFA were used as controls. The patients were classified into: G1 [28 patients, 20 asymptomatic microfilaremic [MF] and eight symptomatic amicrofilaremic [AMF]], G2 [80 patients, 22 asymptomatic MF, 48 asymptomatic AMF and 10 symptomatic AMF] and G3 [16 asymptomatic AMF]. G1 was treated by a single annual dose of diethyl carbamazine [DEC] [6 mg/kg], G2 by a single annual dose of albendazole 400 mg and DEC [6 mg/kg] and G3 remained untreated. Four years later [2001], patients were reevaluated. Microfilaremia prevalence in MF patients was lowered to 20% [G1] and 9.1% [G2]. Antigenemia prevalence was lowered to 46.4%, 17.5% and 87.5% in the three groups, respectively. The disease became manifested among the asymptomatic in 5% [G1], 10% [G2] and 25% [G3]. The four years lowered the prevalence of microfilaremia, but it was not sufficient for its elimination from the blood

Community perception of Malayan filariasis in the rural areas of Cherthala Taluk of Kerala State, south India.

Lymphatic filariasis, one of the major public health problems can be controlled with the active participation of the community. The human factors involved in the disease transmission are important. The knowledge on the community perception and practice is essential to develop community oriented control programmes. A descriptive study was conducted in the filariasis endemic area of Cherthala, Kerala State, India, to identify the level of people's perception on Malayan filariasis. Two methods namely, interviews and uncontrolled observation were used in the study. A total of 450 respondents (150 microfilaria carriers, 150 chronic patients and 150 normals) were interviewed. The study results showed that majority of the respondents (86.7%) were aware that the disease was caused by a parasite and 93.6% had awareness on transmission of the disease through mosquito bite. The knowledge on the preventive measures against filariasis was also high (78.2%) among the sampled respondents. The strategy for community mobilization in filariasis control programme is discussed in view of high awareness.

Mass DEC campaign for filariasis in a hyper endemic district of West Bengal.

As a part of the on-going National Filaria Control Programme, National Filaria Day was observed in Purulia district of West Bengal on 26th Nov 2000 with an extensively organized mass DEC consumption campaign preceded by IEC activities and followed by mopping up operations. In all 81.07% of the targeted population was covered, females (84.3%) being more available than males (78.3%). Percentage of coverage declines with increase in age. Municipalities and notified areas had less coverage as well as supervised consumption than in other areas. Consumption was highest in Balarampur block (88.6%). Supervised consumption among surveyed population was highest in Bandwan (56.0%). Overall patient compliance was very good, with side effects of vomiting, dizziness, headache and fever being 2.12% only among surveyed population. Disease prevalence among population covered showed 0.1% hand swelling, 0.6 to 0.8% leg swelling, while 1.1% of males had hydrocele.

Anti-fasciola IgG isotypes among patients with fascioliasis before and after treatment

Stool examination using modified Kato thick smear method was performed to detect Fasciola eggs and other parasites. Abdominal pain was the major presenting symptom [83.3%] followed by pallor [71.6%] and fever [16.7%]. Anemia and hepatomegaly were recorded in 70% of patients compared to 25% with splenomegaly. Abdominal ultrasonography revealed hepatomegaly and common bile duct dilatation in 70% of patients. Moreover, six cases showed Olympic game rings which are diagnostic. All of patients had positive IgG4 levels, 58 cases were found positive for specific total IgG and IgG1, whereas, only 36 cases had positive IgG2 levels [60%]. All negative control groups showed no cross- reactions. On the other hand, ELISA detecting IgG4 showed the highest specificity [95%], followed by IgG2 [85%] and the least specific test was obtained with detection of IgG [70%] and IgG2 [65%]. One week after treatment, 90% of patients were completely cured. One and three months after treatment, the cure rate was 83.3%. In completely cured patients, none of anti-Fasciola isotypes was significantly changed

Dietilcarbamazina no tratamento da filariose bancroftiana / Diethylcarbamazine in the treatment of Bancroft's filariasis

Os autores realizaram uma ampla revisão sobre o tratamento da filariose bancroftiana com a droga dietilcarbamazina. Os aspectos interessantes sobre o histórico de sua descoberta e os conceitos básicos de sua farmacologia foram relatados de forma resumida. Ênfase especial, por outro lado, foi dada às especulações feitas pelos diversos autores sobre os achados intrigantes descritos na literatura. Foram trazidos os novos avanços sobre o conhecimento da doença, como por exemplo, a visualização pela ultra-sonografia do verme vivo de Wuchereria bancrofti, no seu hospedeiro natural, o homem. Isso possibilitou a compreensão de muitos dos achados aparentemente paradoxais encontrados na literatura sobre o tratamento da infeção com a DEC. Assim, devido à inexistência de uma droga sucessora que reunisse efeitos micro e macrofilaricidas ideais e aos novos conhecimentos sobre a bancroftose e sobre a própria dietilcarbamazina, foi-lhe conferido um novo realce. Esses aspectos a colocaram numa posição de destaque no cenário da infecção, à época do seu quase cinqüentenário de existência.

The authors presented a detailed review about the treatment of bancroftian filariasis with diethylcarbamazine. The interesting aspects about the drug discovery and the basic concepts about its pharmacology were reported in a summarised form. On the other hand, emphasis was made about the speculation done by several authors about the intriguing findings regarding its efficacy reported in the literature. Latter, it was brought the new advances about the disease, as for example, the visualization by ultrasound of living Wuchereria bancrofti adult worm on its natural host--the human being. This made possible the comprehension of several paradoxical issues reported, focusing the treatment of infection using diethylcarbamazine. So far, because of the lack of ideal drug with micro and macrofilaricidal properties, together with the new understand about the disease and the new parameters for monitoring the efficacy of the drug, diethylcarbamazine has back its importance conquered at the begin of its discovery, almost fifth years ago.

Effect of two single doses of ivermectin in treatment of asymptomatic bancroftian filariasis in two villages in the Nile delta, Egypt

To evaluate the efficacy and longitudinal effect of two single [100 mug/kg] doses of ivermectin, 3 months apart, 240 asymptomatic male subjects from 2 endemic Egyptian villages were enrolled in a one- year double-blind study. Subjects aged 15 - 55 years were randomly assigned to placebo [40] or ivermectin [200]. Microfilaria [MF] density in 1 ml blood was measured by membrane filtration before and every 3 months after treatment. Initial mean MF density was 462 [range 14 - 2869/ml]. Clinical examination performed daily for 3 days after each treatment revealed brief, mild side effects [fever, headache, weakness, nausea, and epigastric pain] with no adverse physical or laboratory findings. Three months after initial dose, 31% of MF counts had completely cleared, in the remaining, mean MF density was 11.0 [2.4% of pretreatment level]. At 3, 6 and 9 months after the second Dose, there was complete MF clearance in 60%, 45% and 47%. In those who still infected, MF densities were 1.7, 4.6 and 6.1% of the pretreatment level. Therefore, treatment with 2 doses of ivermectin reduced microfilaremia, without inducing severe side effects. Prolonged suppression of microfilaremia may indicate an effect of ivermectin on the adult worms and may reduce the potential for MF acquisition by mosquitos, reducing transmission of lymphatic filariasis. It was concluded that ivermectin is a useful drug for public health measure, including asymptomatic filariasis patients

"Larva currens": relato de dois casos / \"Larva currens\": two case report

O autor relata dois casos de erupçäo cutânea, extremamente pruriginosa, com eosinofilia importante e concomitante com infestaçäo por S.stercoralis (Larva currens).