Loa loa encephalopathy temporally related to ivermectin administration reported from onchocerciasis mass treatment programs from 1989 to 2001: implications for the future.
Loa loa encephalopathy temporally related to ivermectin administration reported from onchocerciasis mass treatment programs from 1989 to 2001: implications for the future.
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DOI：
10.1186/1475-2883-2-s1-s7
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发表时间：
2003-10-24
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通讯作者：
Twum-Danso NA
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作者：
Twum-Danso NA
在1989年至2001年通过所有盘尾丝虫病大规模治疗计划所需的被动SAE监测系统报告的Mectizan®（伊维菌素，Merck，Sharpe & Dohme）治疗后的207起严重不良事件（SAE）中，65例为与Mectizan®（PLERM）治疗暂时相关的“可能”或“可能”Loa loa脑病病例。对这65例PLERM病例的回顾性分析显示，97%来自喀麦隆南部，85%为男性，93%首次接受伊维菌素治疗。至症状发作的平均时间为1.7天（95% CI：1.3，2.2），但至症状发作后接受医疗护理的平均时间为2.0天（95% CI：1.5，2.6）。53例病例报告住院，平均持续时间为27.5天（95% CI：13.3，41.6，n = 35）。34例病例报告了临床结局：64.7%完全恢复，11.8%有部分神经功能缺损，23.5%死亡。32例定量L.报告LOA数据，算术平均值和95%置信区间为1）外周血：治疗前-164，250 mf/ml（79，537，248，963; n = 4）;治疗后1个月内- 3926 mf/ml（2，128，5，725; n = 21）和5至6个月内- 7800 mf/ml（3417，12，183; n = 7）;和2）脑脊液：治疗后1个月内32 mf/ml（7，37; n = 10）。有待进一步研究的实用方法，以排除个人的高强度L。由于盘尾丝虫病大规模治疗计划导致的loa感染，应更加重视监测和监测，以确保在大多数人群可能未接受伊维菌素治疗的前2年内早期识别、转诊和管理SAE。
Of the 207 Serious Adverse Events (SAEs) following treatment with Mectizan® (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® (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.