Posttreatment Reactions After Single-Dose Diethylcarbamazine or Ivermectin in Subjects With Loa loa Infection.
Severe adverse reactions have been observed in individuals with Loa loa infection treated with either diethylcarbamazine (DEC), the drug of choice for loiasis, or ivermectin (IVM), which is used in mass drug administration programs for control of onchocerciasis and lymphatic filariasis in Africa. In this study, posttreatment clinical and immunologic reactions were compared following single-dose therapy with DEC or IVM to assess whether these reactions have the same underlying pathophysiology.



Twelve patients with loiasis and microfilarial counts <2000 mf/mL were randomized to receive single-dose DEC (8 mg/kg) or IVM (200 µg/kg). Clinical and laboratory assessments were performed at 4, 8, 24, 48, and 72 hours and 5, 7, 9, and 14 days posttreatment.



Posttreatment adverse events were similar following DEC or IVM, but peaked earlier in subjects who received DEC, consistent with a trend toward more rapid and complete microfilarial clearance in the DEC group. After a transient rise (post-IVM) or fall (post-DEC) in the first 24 hours posttreatment, the eosinophil count rose significantly in both groups, peaking at day 5 in the DEC group and day 9 in the IVM group. Serum interleukin 5 levels and eosinophil activation, as assessed by surface expression of CD69 and serum levels of eosinophil granule proteins, were increased posttreatment in both groups.



Despite differences in eosinophil and lymphocyte counts during the first 24 hours posttreatment, the overall pattern of hematologic and immunologic changes suggest that posttreatment reactions following DEC and IVM share a common pathophysiology.



NCT01593722.
Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Jesica A
JA
Herrick
Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Fanny
F
Legrand
Faculty of Sciences, University of Yaoundé I,  Yaoundé, Cameroon.
Raceline
R
Gounoue
Laboratory of Immunology, Chantal Biya International Reference Centre for Research on Prevention and Management of HIV/AIDS, Yaoundé, Cameroon.
Godwin
G
Nchinda
Institut de recherche pour le développement, Montpellier, France.
Céline
C
Montavon
Center for Research on Filariasis and Other Tropical Diseases, Yaoundé, Cameroon.
Jean
J
Bopda
Center for Research on Filariasis and Other Tropical Diseases, Yaoundé, Cameroon.
Steve Mbickmen
SM
Tchana
Central Hospital of Yaoundé,  Yaoundé, Cameroon.
Bienvenu Etogo
BE
Ondigui
District Hospital of Akonolinga, Cameroon.
Konrad
K
Nguluwe
Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Michael P
MP
Fay
Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Michelle
M
Makiya
Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Simon
S
Metenou
Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Thomas B
TB
Nutman
Center for Research on Filariasis and Other Tropical Diseases, Yaoundé, Cameroon.|Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
Joseph
J
Kamgno
Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Amy D
AD
Klion
D000328:Adult; D000368:Aged; D004049:Diethylcarbamazine / Q000008:administration & dosage / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000473:pathology*; D005260:Female; D005369:Filaricides / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007559:Ivermectin / Q000008:administration & dosage / Q000009:adverse effects*; D008118:Loiasis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D055815:Young Adult
D005369:Filaricides; D007559:Ivermectin; D004049:Diethylcarbamazine
Loa loa; diethylcarbamazine; eosinophil; filariasis; ivermectin