0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10
574 Filariasis■Loa loa: diethylcarbamazine
■Onchocerciasis: ivermectin single dose, repeat every 6–12 months
for lifetime of adult worms (3–4 years in children, 10–12 years in
adults)
Side Effects & Complications
■Diethycarbamazine: at onset of therapy can get allergic reactions
due to parasite death: urticaria, intense itching, edema, hypoten-
sion. Using graduated dose generally avoids this. Steroids reduce
the reaction. Drug otherwise well tolerated.
■Ivermectin: allergic reactions (due to parasite death) are frequent
early in treatment, but generally not severe, and respond to steroids.
Otherwise drug well tolerated.
■Contraindications to treatment: absolute: diethlycarbamazine
should never be used in onchocerciasis where there is eye involve-
ment. First trimester treatment should be avoided.
■Contraindications to treatment: relative. Pregnancy, if no urgency
about treatment.
follow-up
During Treatment
■Watch for allergic reactions (all filariases), treat with steroids if severe.
Patients with heavy loa loa should receive even more cautious gra-
dations of dosage.
Routine
■Lymphatic filariasis and loa loa: clinical follow-up, as well as follow-
ing eosinophil count and blood examinations. Retreatment may be
needed, sometimes several times, to achieve cure.
■Onchocerciasis: needs ivermectin every 6–12 months for 1–2 years,
then once yearly. Ophthalmologic follow-up if eyes involved.
complications and prognosis
■Lymphatic disease: lymph nodes can suppurate during treat-
ment. Lymph channel damage prior to treatment will have limited
improvement and edema may persist. Streptococcal infections may
recur, and sometimes chronic penicillin coverage is needed.
■Loa loa: heavily infected patients can get an encephalitis during
treatment; they need to be treated slowly and watched.
■Onchocerciasis: Eye disease may improve some, but corneal scarring
will not reverse.