Tolerance of diethylcarbamazine by microfilaraemic and amicrofilaraemic individuals in an endemic area of Bancroftian filariasis, Recife, Brazil

Abstract

To determine the tolerance to diethylcarbamazine (DEC) treatment of patients with Bancroftian filariasis, 193 individuals (138 asymptomatic microfilaraemic, 30 amicrofilaraemic diseased patients and 25 asymptomatic amicrofilaraemic endemic residents) were enrolled in a prospective trial with different dose schedules, in a hospital and outpatient clinic setting in Brazil. Systemic adverse reactions, localized adverse reactions, and side effects, related to microfilariae, adult worms and the drug itself, were evaluated. Systemic reactions occurred irrespective of the DEC dose and schedule in about 40% of the microfilariae carriers, but not in amicrofilaraemic diseased patients or residents; they usually consisted of microscopic haematuria, followed by fever and malaise. Localized reactions were manifested by the appearance of inflammatory reactions, mainly in the scrotal area. Nodules containing degenerating adult worms developed mainly in the scrotal lymphatics of microfilaraemic patients, diseased amicrofilaraemic patients, and residents. Drowsiness, which increased with higher doses of DEC, was the most common side effect in both microfilaraemic and amicrofilaraemic individuals, followed by nausea and gastric upset. The results indicate that the occurrence of systemic and local adverse reactions was unrelated to either the dose of DEC or the pretreatment microfilarial density. The severity of systemic reactions was proportional to the microfilarial density. Side effects were dependent on the drug dosage irrespective of infection status.

Frequency, Severity, and Costs of Adverse Reactions Following Mass Treatment for Lymphatic Filariasis Using Diethylcarbamazine and Albendazole in Leogane, Haiti, 2000

“…[27][28][29][30] Potential risks and known benefits of mass treatment using albendazole should be considered carefully. 31 The median time to onset of moderate systemic adverse reactions was 24 hours or less, which was consistent with previous reports and typically reflecting the rapid microfilaricidal effects of DEC. 8,10 In contrast, the median time to onset of localized scrotal reactions was longer, 24-48 hours, presumably reflecting adult filarial death and the subsequent inflammatory response within the lymphatic vessel. Overall, 85% of those reporting moderate adverse reactions did so within 48 hours of receiving antifilarial drugs.…”

“…This problem manifests most commonly in men because of inflammatory scrotal nodules that contain dead and degenerating adult worms. 10 Much less frequently, nodules are reported elsewhere in the body; however, we restricted the analysis of local adverse reactions to men who reported scrotal reactions. Adverse reactions characterized as other were those that fit neither the systemic nor local definitions.…”

“…[7][8][9] Treated microfilaremic persons may experience headache, fever, chills, and body aches and the severity of adverse reactions increases with microfilarial density. [9][10][11][12] Some adult worms may die as a result of treatment with diethylcarbamazine (DEC), which causes painful inflammatory granulomas, especially in the intrascrotal lymphatic vessels in men. [13][14][15] A few clinical studies have assessed adverse reactions following treatment with DEC and albendazole, 9,16 but the burden of adverse reactions in large community-based interventions using DEC and albendazole has not been adequately documented.…”

Recomendações para o tratamento da filariose bancroftiana, na infecção e na doença

“…Eles inexistem com a ivermectina mas são leves e transitórios quando se usa a DEC. Esses efeitos se caracterizam por sonolência, náusea e malestar gástrico e geralmente desaparecem após o terceiro dia da administração da droga, mesmo sem redução da dose 30 , quando o tratamento de 12 dias é recomendado.…”

“…As reações adversas sistêmicas são microfilária-dependentes, assemelham-se para as duas drogas e se caracterizam, principalmente, por hematúria transitória, que geralmente é microscópica, e febre, podendo ainda existir cefaléia e mialgia 30 . Tais reações podem aparecer precocemente quanto em cinco horas, e geralmente desaparecem em torno de 48 horas após * A DEC é derivada da piperazina, distribuída no Brasil pela Fundação Nacional de Saúde e fabricada por Farmanguinhos/FIOCRUZ.…”