Analysis of severe adverse effects following community-based ivermectin treatment in the Democratic Republic of Congo

Abstract

Background The progress of mass, community-directed, treatment with ivermectin (CDTI) for onchocerciasis control was disrupted by severe adverse effects (SAE) in the Democratic Republic of Congo (DRC). The study aimed at determining the frequency of post-CDTI SAE as well as factors associated with the occurrence of SAE. Methods Our retrospective study relied on SAE collection cards, as archived by the DRC Ministry of Health, and compiled for people who benefited from ivermectin treatment then further developed SAE. The study included 945 post-CDTI SAE recorded in DRC between 2003 and 2017. These cases occurred in 15 projects out of 22 projects implemented in the country. All cards were reviewed and analysed. Results Between the years 2003 and 2017, the total average population treated was around 15,552,588 among which 945 cases of SAE were registered in DR Congo, i.e. 6 cases of SAE for 100,000 persons treated per year. 55 deaths related to post-CDTI SAE were recorded, which represents 5.8% of all cases of SAE. Non-neurological SAE were dominated by severe headaches (74.8%), myalgia (64.0%) and arthralgia (62.7%). Neurological SAE were mainly coma (94.1%), motor deficit (75.4%) and palpebral subconjunctival haemorrhages (38.8%). Factors associated with the occurrence of SAE were: male, age over 18 years old, alcohol consumption, hemp intake and the presence of loiasis. The study also highlighted weaknesses of the National Program for Onchocerciasis Control (NPOC) in terms of awareness campaigns among the population. Conclusion Co-endemicity of loiasis and onchocerciasis is one of the key factors responsible for the occurrence of SAE following ivermectin treatment. Mobilization of resources necessary to the appropriate management of SAE and awareness of populations are essential to achieve onchocerciasis control in DRC.

Loa loa in the Vitreous Cavity of the Eye: A Case Report and State of Art

“…ALB is a benzimidazole derivative with a great absorption after oral administration and a wide spectrum of activity. 37 There are currently no studies that suggest the use of albendazole as an alternative regimen for loiasis, and a short regimen with ALB has been demonstrated to have little effect on microfilaraemia. 38 Its role is accepted by the CDC if a blood tests shows > 8,000 microfilaria/mL, at a dosage of 200 mg twice daily for 21 days to reduce the Loa loa microfilariemia (LLM) and to avoid the neurological adverse effects of DEC.…”

Potential of Anthelmintic Herbal Drugs against Gastrointestinal Nematodes in Farm Animals: A Review

“…At very high doses, Ivermectin results in CNS toxicity in farm animals that manifests as lethargy, ataxia, mydriasis, tremors, and eventually death 19 . Most of the time, mazzotti-like reactions to dying microfilariae develop in infected humans injected with Ivermectin due to hypertensives reaction to dead microfilariae.…”

Ivermectin: A Promising Therapeutic for Fighting Malaria. Current Status and Perspective

“…For example, a retrospective study depicted the occurrence of severe neurological and non-neurological adverse effects, including coma, arthralgia, severe headaches, and palpebral subconjunctival hemorrhages, after MDA of 2 in onchocerciasis- and L. loa-coendemic areas in Congo . To check whether 2 may express CNS toxicity because of its affinity toward GABA-Cls, a study was conducted in Cameroon in which four individuals coinfected with Onchocerca volvulus and L.…”

“…For example, a retrospective study depicted the occurrence of severe neurological and nonneurological adverse effects, including coma, arthralgia, severe headaches, and palpebral subconjunctival hemorrhages, after MDA of 2 in onchocerciasis-and L. loa-coendemic areas in Congo. 120 To check whether 2 may express CNS toxicity because of its affinity toward GABA-Cls, 121 a study was conducted in Cameroon 122 in which four individuals coinfected with Onchocerca volvulus and L. loa who displayed adverse events after MDA of 2 were assessed for plausible mutations of the MDR1 gene. 123,124 However, the absence of any loss-of-function mutations in P-glycoproteins (P-gps) suggested that the occurrence of adverse effects post-treatment of 2 may be linked to the accumulation of L. loa microfilaria in cerebrospinal fluid.…”