Clinical Characteristics of Post-Treatment Reactions to Ivermectin/Albendazole for Wuchereria Bancrofti in a Region Co-Endemic for Mansonella Perstans

Abstract

Post-treatment reactions to single-dose ivermectin (200 g/kg) and albendazole (400 mg) were studied in a filarial endemic region of Mali. The prevalence of Wuchereria bancrofti in this region was 48.3% (69 of 143), and coinfection with Mansonella perstans was common (30 of 40, 75%). Microfilarial levels of M. perstans correlated positively with age (P ‫ס‬ 0.006) and with W. bancrofti microfilarial levels (P ‫ס‬ 0.006). Forty individuals (28 infected and 12 uninfected) were treated, with mild post-treatment reactions occurring in 35.7% (7 of 28) of the W. bancrofti-infected subjects. Reaction severity correlated with pretreatment W. bancrofti microfilarial levels (P ‫ס‬ 0.001). There were no significant differences in the prevalence or severity of post-treatment reactions in those who were co-infected with M. perstans. It is concluded that co-infection with M. perstans does not significantly alter the post-treatment reaction profile to single-dose ivermectin/albendazole in W. bancrofti infection in this community, and that acute post-treatment reactions should not limit patient compliance in community-based programs to eliminate lymphatic filariasis.

Filaria-Induced Monocyte Dysfunction and Its Reversal following Treatment

“…All filaria-infected individuals were treated with single-dose ivermectin plus albendazole; at 8 months posttreatment, the monocytes from the W. bancrofti-infected patients were isolated and compared with those pretreatment. With a larger sample size, we have previously (12) reported that circulating filarial antigen levels at 8 months following treatment were significantly lower than those pretreatment (n ϭ 26; P ϭ 0.010). In addition, a significant decrease in W. bancrofti MF counts was reported (n ϭ 15; P ϭ 0.002); however, in the same study, it was shown that M. perstans counts did not change significantly (n ϭ 29; P ϭ 0.58) following treatment (12) ( Table 1).…”

“…Individuals were administered ivermectin (100 g/kg) and albendazole (400 mg) as described previously (12). Posttreatment ex vivo assessments were performed 8 months after the first drug administration (Table 1).…”

“…For the purpose of analysis, W. bancrofti infection was based on positivity with a semiquantitative antigen detection kit (TropBio, Townsville, Queensland, Australia). MF counts were done using calibrated thick smears for both W. bancrofti and M. perstans between 9 p.m. and midnight as previously described (12). Seven circulating-antigen-positive and four circulating-antigen-negative individuals were selected for this study (Table 1).…”

“…For example, the distribution of Mansonella perstans infection, generally nonpathogenic, often overlaps with that of W. bancrofti infection (1,12,30). We have previously shown with this same group of patients (12) that ivermectin-albendazole treatment alters only the levels of W. bancrofti MF and circulating filarial antigen and does nothing to the levels of M. perstans MF.…”

Description of the parasite Wucheria Bancrofti Microfilariae identified in follicular fluid following transvaginal oocyte retrieval

“…Co-infection, as in the patient described in this report, with the pathogen Onchoceriasis volvulus is commonly described with W. Bancrofti infection. This fact changes the treatment profile dramatically as DEC treatment can Onchoceriasis has resulted in severe allergic-type reactions [10]. As illustrated by this case, the complexities involved in treating parasitic infections demand a multidisciplinary approach with involvement of an infectious disease specialist as well as other specialties, such as opthamology, as necessary.…”