Thirty-month follow-up of sub-optimal responders to multiple treatments with ivermectin, in two onchocerciasis-endemic foci in Ghana
Thirty-month follow-up of sub-optimal responders to multiple treatments with ivermectin, in two onchocerciasis-endemic foci in Ghana
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DOI：
10.1179/000349804225003442
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发表时间：
2004-06-01
影响因子：
--
通讯作者：
Edwards, G
中科院分区：
文献类型：
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作者：
Awadzi, K;Attah, SK;Edwards, G
通过对 28 名个体进行为期 30 个月的随访，研究了盘尾丝虫对伊维菌素反应欠佳的发病机制，在之前的研究中发现这些人对该药物的多次治疗表现出次优反应 (N = 15) 或充分反应 (N = 13)。在对每个受试者进行一般临床和眼科检查之前，获得口头知情同意。从两个髂嵴和两个小腿上剪下皮肤。十七名结节携带者住院接受结节切除术。收获成虫，构建胚胎图并对所有发育阶段进行计数；退化的、拉伸的微丝蚴被单独记录。所有受试者的总体健康状况良好，自早期研究以来，除了一名受试者外，所有受试者都至少接受过一次伊维菌素额外治疗。 11 名次优反应者中，有 10 名是结节携带者，其中 10 名成年雌性蠕虫的很大一部分处于完全胚胎生产状态，但它们携带的大多数伸展微丝蚴是退化的。该图片与暴露于第一剂伊维菌素的成虫中发现的图片相似。在一名结节中没有活的蠕虫的受试者中，治疗后不到 12 个月观察到的高水平微丝蚴病推断出存在隐匿但活跃繁殖的蠕虫。这些观察结果证实了成年雌性盘旋丝虫种群的存在，它们对重复剂量的伊维菌素反应不佳。讨论了苏拉明在治疗次优反应者中的应用。
The pathogenesis of the sub-optimal response of Onchocerca volvulus to ivermectin was investigated in a 30-month follow-up of 28 individuals who, in a previous study, had been found to show a sub-optimal (N = 15) or adequate response (N = 13) to multiple treatments with the drug. Verbal informed consent was obtained before each subject was given a general clinical and ocular examination. Skin snips were taken from both iliac crests and both calves. Seventeen nodule carriers were hospitalized for nodulectomy. Adult worms were harvested, embryogrammes were constructed and all developmental stages were counted; degenerate, stretched microfilariae were noted separately. All the subjects were in good general health and all except one had received at least one additional treatment with ivermectin since the earlier study. A large proportion of the adult female worms in 10 out of the 11 sub-optimal responders who were nodule carriers were in full embryonic production but most of the stretched microfilariae they carried were degenerate. This picture is similar to that found in adult worms exposed to the first dose of ivermectin. In one subject who had no viable worms in his nodules, the existence of occult but actively reproductive worms was inferred from the high level of microfilaridermia observed less than 12 months after treatment. These observations confirm the existence of populations of adult female O. volvulus that respond poorly to repeated doses of ivermectin. The use of suramin in the treatment of the sub-optimal responders is discussed.