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Loa loa encephalopathy temporally related to ivermectin administration reported from onchocerciasis mass treatment programs from 1989 to 2001: implications for the future.

Twum-Danso NA - Filaria J (2003)

Bottom Line: The mean time to onset of symptoms was 1.7 days (95% CI: 1.3, 2.2) but the mean time to receiving medical attention after the onset of symptoms was 2.0 days (95% CI: 1.5, 2.6).Hospitalization was reported in 53 cases with a mean duration of 27.5 days (95% CI: 13.3, 41.6, n = 35).Clinical outcome was reported in 34 cases: 64.7% recovered fully, 11.8% had partial neurologic deficit and 23.5% died.

View Article: PubMed Central - HTML - PubMed

Affiliation: Mectizan(R) Donation Program, 750 Commerce Drive, Suite 400, Decatur, GA 30030, U,S,A. ntwumdanso@taskforce.org

ABSTRACT
Of the 207 Serious Adverse Events (SAEs) following treatment with Mectizan(R) (ivermectin, Merck, Sharpe & Dohme) that were reported from 1989 to 2001 through the passive SAE surveillance system required of all onchocerciasis mass treatment programs, 65 were cases of 'Probable' or 'Possible' Loa loa Encephalopathy temporally Related to treatment with Mectizan(R) (PLERM).A retrospective analysis of these 65 PLERM cases revealed that 97% were from southern Cameroon, 85% were male and 93% were being treated with ivermectin for the first time. The mean time to onset of symptoms was 1.7 days (95% CI: 1.3, 2.2) but the mean time to receiving medical attention after the onset of symptoms was 2.0 days (95% CI: 1.5, 2.6). Hospitalization was reported in 53 cases with a mean duration of 27.5 days (95% CI: 13.3, 41.6, n = 35). Clinical outcome was reported in 34 cases: 64.7% recovered fully, 11.8% had partial neurologic deficit and 23.5% died. For the 32 cases where quantitative L. loa data were reported, the arithmetic means with 95% confidence intervals were for 1) peripheral blood: pre-treatment - 164,250 mf/ml (79,537, 248,963; n = 4); post-treatment within 1 month - 3926 mf/ml (2,128, 5,725; n = 21) and within 5 to 6 months - 7800 mf/ml (3417, 12,183; n = 7); and for 2) cerebrospinal fluid: 32 mf/ml (7, 37; n = 10) within 1 month post-treatment.Pending further research on practical methods to exclude individuals with high intensity L. loa infection from onchocerciasis mass treatment programs, more emphasis should be placed on surveillance and monitoring to ensure early recognition, referral and management of SAEs, during the first 2 years when majority of the population is presumably naïve to ivermectin.

No MeSH data available.


Related in: MedlinePlus

Geographical distribution of reported encephalopathic cases following mass treatment with ivermectin from 1989 to 2001 (as of August 31, 2002)
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Figure 1: Geographical distribution of reported encephalopathic cases following mass treatment with ivermectin from 1989 to 2001 (as of August 31, 2002)

Mentions: All encephalopathic cases temporally related to ivermectin treatment occurring in onchocerciasis mass treatment programs that have ever been reported to the MDP have been systematically screened for documentation of infection with L. loa, and categorized according to the case definitions in Table 1. The categorization of the 103 encephalopathic cases reported to the MDP from January 1, 1989 to December 31, 2001 and their geographical distribution are shown in Table 2 and Figure 1 respectively. Included in these illustrations are the 65 encephalopathic cases which had documented infection with L. loa such that they met the presumptive diagnosis of 'probable' or 'possible' case of L. loa encephalopathy temporally related to ivermectin treatment as defined in Table 1. The demographic and clinical description of these 65 cases of L. loa encephalopathy following ivermectin treatment forms the subject of this paper. To date, the published literature on this clinical entity has been limited to case reports and case series of a few patients, because it occurs so rarely. To our knowledge, this is the first paper that systematically reviews a large number of such patients. The implications for mass treatment strategies using ivermectin are discussed.


Loa loa encephalopathy temporally related to ivermectin administration reported from onchocerciasis mass treatment programs from 1989 to 2001: implications for the future.

Twum-Danso NA - Filaria J (2003)

Geographical distribution of reported encephalopathic cases following mass treatment with ivermectin from 1989 to 2001 (as of August 31, 2002)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2147656&req=5

Figure 1: Geographical distribution of reported encephalopathic cases following mass treatment with ivermectin from 1989 to 2001 (as of August 31, 2002)
Mentions: All encephalopathic cases temporally related to ivermectin treatment occurring in onchocerciasis mass treatment programs that have ever been reported to the MDP have been systematically screened for documentation of infection with L. loa, and categorized according to the case definitions in Table 1. The categorization of the 103 encephalopathic cases reported to the MDP from January 1, 1989 to December 31, 2001 and their geographical distribution are shown in Table 2 and Figure 1 respectively. Included in these illustrations are the 65 encephalopathic cases which had documented infection with L. loa such that they met the presumptive diagnosis of 'probable' or 'possible' case of L. loa encephalopathy temporally related to ivermectin treatment as defined in Table 1. The demographic and clinical description of these 65 cases of L. loa encephalopathy following ivermectin treatment forms the subject of this paper. To date, the published literature on this clinical entity has been limited to case reports and case series of a few patients, because it occurs so rarely. To our knowledge, this is the first paper that systematically reviews a large number of such patients. The implications for mass treatment strategies using ivermectin are discussed.

Bottom Line: The mean time to onset of symptoms was 1.7 days (95% CI: 1.3, 2.2) but the mean time to receiving medical attention after the onset of symptoms was 2.0 days (95% CI: 1.5, 2.6).Hospitalization was reported in 53 cases with a mean duration of 27.5 days (95% CI: 13.3, 41.6, n = 35).Clinical outcome was reported in 34 cases: 64.7% recovered fully, 11.8% had partial neurologic deficit and 23.5% died.

View Article: PubMed Central - HTML - PubMed

Affiliation: Mectizan(R) Donation Program, 750 Commerce Drive, Suite 400, Decatur, GA 30030, U,S,A. ntwumdanso@taskforce.org

ABSTRACT
Of the 207 Serious Adverse Events (SAEs) following treatment with Mectizan(R) (ivermectin, Merck, Sharpe & Dohme) that were reported from 1989 to 2001 through the passive SAE surveillance system required of all onchocerciasis mass treatment programs, 65 were cases of 'Probable' or 'Possible' Loa loa Encephalopathy temporally Related to treatment with Mectizan(R) (PLERM).A retrospective analysis of these 65 PLERM cases revealed that 97% were from southern Cameroon, 85% were male and 93% were being treated with ivermectin for the first time. The mean time to onset of symptoms was 1.7 days (95% CI: 1.3, 2.2) but the mean time to receiving medical attention after the onset of symptoms was 2.0 days (95% CI: 1.5, 2.6). Hospitalization was reported in 53 cases with a mean duration of 27.5 days (95% CI: 13.3, 41.6, n = 35). Clinical outcome was reported in 34 cases: 64.7% recovered fully, 11.8% had partial neurologic deficit and 23.5% died. For the 32 cases where quantitative L. loa data were reported, the arithmetic means with 95% confidence intervals were for 1) peripheral blood: pre-treatment - 164,250 mf/ml (79,537, 248,963; n = 4); post-treatment within 1 month - 3926 mf/ml (2,128, 5,725; n = 21) and within 5 to 6 months - 7800 mf/ml (3417, 12,183; n = 7); and for 2) cerebrospinal fluid: 32 mf/ml (7, 37; n = 10) within 1 month post-treatment.Pending further research on practical methods to exclude individuals with high intensity L. loa infection from onchocerciasis mass treatment programs, more emphasis should be placed on surveillance and monitoring to ensure early recognition, referral and management of SAEs, during the first 2 years when majority of the population is presumably naïve to ivermectin.

No MeSH data available.


Related in: MedlinePlus