Clinical picture, epidemiology and outcome of Loa-associated serious adverse events related to mass ivermectin treatment of onchocerciasis in Cameroon.
Clinical picture, epidemiology and outcome of Loa-associated serious adverse events related to mass ivermectin treatment of onchocerciasis in Cameroon.
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与LOA相关的严重不良事件的临床图像，流行病学和与喀麦隆质量伊维菌素治疗有关的严重不良事件的结果。
DOI：
10.1186/1475-2883-2-s1-s4
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发表时间：
2003-10-24
期刊：
影响因子：
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通讯作者：
Chippaux, Jean-Philippe
中科院分区：
文献类型：
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作者：
Boussinesq, Michel;Gardon, Jacques;Gardon-Wendel, Nathalie;Chippaux, Jean-Philippe
2002年8月，报告了65例伊维菌素治疗后发生与Loa相关的神经系统严重不良事件的病例。最初的症状出现在治疗后 12-24 小时内，包括疲劳、全身关节痛，有时还有烦躁、沉默和失禁。包括昏迷在内的意识障碍通常出现在 24 至 72 小时之间，并且随着时间的推移呈现快速变化。最常见的客观神经系统体征是锥体外系体征。患者出现结膜和视网膜出血。生物学检查显示大量罗阿微丝蚴、罗阿微丝蚴进入脑脊液、血尿和 C 反应蛋白增加，所有这些都与最初的罗阿微丝蚴血症的高强度相关。嗜酸性粒细胞计数在最初 24 小时内急剧下降，然后又迅速上升。脑电图表明在最初几周内存在弥漫性病理过程； 3-6个月后异常消失。如果患者没有得到适当的管理，即缺乏良好的护理，则可能会发生死亡。然而，一些康复的患者出现了失语、阵发性遗忘或锥体外系体征等后遗症。这些脑病的主要危险因素是最初的罗阿微丝蚴血症的强度。当每毫升 Loa 微丝蚴超过 50,000 条时，可能会出现意识障碍。辅助因素（例如 Loa 菌株、个体遗传倾向、与其他寄生虫共同感染或饮酒）的可能作用似乎很小，但应予以考虑。应研究伊维菌素后 Loa 相关脑病的机制，以改善对该病患者的治疗。
In August 2002, 65 cases of Loa-associated neurological Serious Adverse Events were reported after ivermectin treatment. The first signs, occurring within the 12–24 hours following treatment, included fatigue, generalized arthralgia, and sometimes agitation, mutism, and incontinence. Disorders of consciousness, including coma, generally appeared between 24 and 72 hours, and showed a rapid variation with time. The most frequent objective neurological signs were extrapyramidal. The patients presented with haemorrhages of the conjunctiva and of the retina. Biological examinations showed a massive Loa microfilaruria, the passage of Loa microfilariae into the cerebrospinal fluid, haematuria, and an increase in the C-reactive protein, all of which have been correlated with the high intensity of the initial Loa microfilaraemia. Eosinophil counts decreased dramatically within the first 24 hours, and then rose again rapidly. Electroencephalograms suggested the existence of a diffuse pathological process within the first weeks; the abnormalities disappearing after 3–6 months. Death may occur when patients are not properly managed, i.e. in the absence of good nursing. However, some patients who recovered showed sequelae such as aphasia, episodic amnesia, or extrapyramidal signs. The main risk factor for these encephalopathies is the intensity of the initial Loa microfilaraemia. The disorders of consciousness may occur when there are >50,000 Loa microfilariae per ml. The possible roles of co-factors, such as Loa strains, genetic predisposition of individuals, co-infestations with other parasites, or alcohol consumption, seem to be minor but they should be considered. The mechanisms of the post-ivermectin Loa-related encephalopathies should be investigated to improve the management of patients developing the condition.