title: Long-term follow-up of treatment with diethylcarbamazine on anti-filarial IgG4: dosage, compliance, and differential patterns in adults and children.
abstract: We have followed a population in an area endemic for Brugia malayi for three years after intensive treatment with diethylcarbamazine (DEC). Microfilariae were cleared from the circulation within four months in all eligible study participants (n = 60). There appeared to be a strong correlation between the maximum reduction in specific IgG4 and the number of days drug was taken under supervision (p = 0.41, P < 0.001), indicating that high total dosage of DEC is necessary for optimal reduction of active infection. In individuals with good compliance (at least 180 mg/kg of body weight, n = 34), we observed variable IgG4 patterns. All pre-treatment IgG4+ children (9-14 years old) and 40% of the IgG4+ adult population (> or = 15 years old) showed a gradual decrease in anti-filarial IgG4; 53% of these showed complete clearance of worm burden by the end of the study. In contrast, another group of male IgG4+ adults showed IgG4 patterns that started to increase between nine months and two years after treatment, indicating either a partial efficacy of DEC that allowed recovery of resident adult worms or reinfection.
authors.affiliation: Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Terhell
authors.forename: M
authors.initials: M
authors.lastname: Haarbrink
authors.forename: A
authors.initials: A
authors.lastname: van den Biggelaar
authors.forename: A
authors.initials: A
authors.lastname: Mangali
authors.forename: E
authors.initials: E
authors.lastname: Sartono
authors.forename: M
authors.initials: M
authors.lastname: Yazdanbakhsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D017178:Brugia malayi / Q000187:drug effects / Q000276:immunology*; D002648:Child; D004049:Diethylcarbamazine / Q000008:administration & dosage / Q000627:therapeutic use*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005368:Filariasis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D005369:Filaricides / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D010349:Patient Compliance; D015995:Prevalence
chemical_list: D005369:Filaricides; D007074:Immunoglobulin G; D004049:Diethylcarbamazine