Boussinesq Michel, Gardon Jacques, Gardon-Wendel N., Kamgno J., Ngoumou P., Chippaux Jean-Philippe. (1998). Three probable cases of Loa loa encephalopathy following ivermectin treatment for onchocerciasis. American Journal of Tropical Medicine and Hygiene, 58 (4), p. 461-469. ISSN 0002-9637.
Titre du document
Three probable cases of Loa loa encephalopathy following ivermectin treatment for onchocerciasis
American Journal of Tropical Medicine and Hygiene, 1998,
58 (4), p. 461-469 ISSN 0002-9637
Over the past nine years, more than 12 million people exposed to Onchocerca volvulus infection have received at least one dose of ivermectin, almost all without serious adverse reactions. Since 1991, however, several cases with neurologic manifestations, including coma, have been reported after ivermectin treatment of persons infected with O. volvulus who also had concomitant Loa loa infection with very high microfilaremia (>50,000 microfilariae/ml of blood). In 1995, four criteria were established to define probable cases of Loa encephalopathy temporally related to treatment with ivermectin (PLERI). The present paper describes three PLERI cases recorded in Cameroon and compares them with two others reported previously. Disorders of consciousness began 3-4 days after treatment. The objective neurologic signs were variable. The conditions improved favorably in three patients who benefited from early hospitalization and good nursing ; their disorders of consciousness lasted only 2-3 days ; the results of clinical examination became normal after one month and electroencephalographic abnormalities disappeared after 5-7 months. Conversely, late diagnosis and delay in proper management in two others probably led to worsening of the condition and to fatal outcome related to the usual complications of coma. In addition to these cases, patients with high Loa microfilaremia also developped milder neurologic manifestations causing functional impairment lasting for at least one week after treatment. Before launching mass ivermectin distribution programs to control onchocerciasis in central Africa, communities in which the intensity of concomittant L. loa microfilaremia is high need to be identified, and specific educational measures and monitoring strategies should be developed and applied before they are treated. (Résumé d'auteur)
Plan de classement
Epidémiologie de l'onchocercose [052SIMONC03]
Descripteurs
ONCHOCERCOSE ; LOASE ; ETUDE DE CAS ; FACIES EPIDEMIOLOGIQUE ; CHIMIOTHERAPIE DE MASSE ; ENCEPHALOPATHIE ; IVERMECTINE ; MECTIZAN ; DIETHYLCARBAMAZINE ; DEC ; EFFET SECONDAIRE
