RESUMO
INTRODUCTION: The Global Programme to Eliminate Lymphatic Filariasis was launched with the goal of eliminating this disease via the annual mass drug administration (MDA) of a single dose of antifilarial drugs. Adverse drug reactions following MDA are a major factor of poor treatment adherence in several countries. This study assessed the occurrence of adverse drug reactions (ADRs) following the first round of mass treatment in two communities treated with different dosages of diethylcarbamazine (DEC) in the City of Recife, Brazil. METHODS: Population-based cross-sectional surveys were conducted in a random sample of the population living in both communities (Areas I and II). The dose of DEC recommended by the WHO (6mg/kg) was calculated based on the individual's weight-for-age. In Area II, weight differences between the genders were also considered when determining dosage. Data were obtained through interviews conducted in the first 12 to 48h and on the 5th day after MDA during household visits. RESULTS: A total of 487 and 365 individuals were interviewed in Areas I and II, respectively. The prevalence of ADRs in Area I (23.6; 95%CI: 19.1-29.5) was higher than in Area II (16.2; 95%CI:11.9-21.5)(p=0.0078). The prevalence of ADRs among females was higher than in males in Area I (p=0.0021). In Area II, no significant difference between the genders was observed (p=0.1840). Age was not associated with ADRs in either area. CONCLUSIONS: Adjusting MDA dosage schedules according to weight-for-age and sex may be may contribute to reduce the occurrence of adverse drug reactions in the population.
INTRODUÇÃO: O Programa Global de Eliminação da Filariose Linfática foi lançado visando à eliminação da doença pela administração de medicamentos em massa (MDA). As reações adversas seguidas ao MDA são um importante fator de baixa adesão ao tratamento em vários países. Este estudo avaliou a ocorrência de reações adversas medicamentosas (ADRs) após a primeira dose de tratamento em massa em duas comunidades tratadas com diferentes doses de dietilcarbamazina (DEC), na Cidade de Recife, Brasil. MÉTODOS: Estudos transversais foram realizados em uma amostra aleatória da população de duas áreas (Áreas I e II). A dose de DEC recomendada pela OMS (6mg/kg) foi calculada com base em parâmetros populacionais de peso para a idade. Na Área II, diferenças de peso entre os sexos também foram consideradas no cálculo. Dados foram obtidos através de entrevistas nas primeiras 12 às 48h e 5º dia após o tratamento durante visitas domiciliares. RESULTADOS: Um total de 487 e 365 pessoas foi entrevistado nas Áreas I e II, respectivamente. A prevalência de ADRs na Área I (23,6; IC95%: 19,1-29,5) foi maior do que na Área II (16,2; IC 95%:11,9-21,5)(p=0,0078). Na Área I, a prevalência de ADRs foi maior nas mulheres do que nos homens (p=0,0021), não se observando diferença na Área II (p=0,1840). Idade não esteve associada à ADRs. CONCLUSÕES: Doses de tratamento em massa (MDA) ajustadas por peso para a idade e sexo parecem contribuir para redução da ocorrência de ADRs na população.
Assuntos
Adolescente , Adulto , Animais , Feminino , Humanos , Masculino , Adulto Jovem , Dietilcarbamazina/efeitos adversos , Filariose Linfática/tratamento farmacológico , Filaricidas/efeitos adversos , Brasil/epidemiologia , Estudos Transversais , Dietilcarbamazina/administração & dosagem , Doenças Endêmicas , Filariose Linfática/epidemiologia , Filaricidas/administração & dosagem , PrevalênciaRESUMO
INTRODUCTION: The Global Programme to Eliminate Lymphatic Filariasis was launched with the goal of eliminating this disease via the annual mass drug administration (MDA) of a single dose of antifilarial drugs. Adverse drug reactions following MDA are a major factor of poor treatment adherence in several countries. This study assessed the occurrence of adverse drug reactions (ADRs) following the first round of mass treatment in two communities treated with different dosages of diethylcarbamazine (DEC) in the City of Recife, Brazil. METHODS: Population-based cross-sectional surveys were conducted in a random sample of the population living in both communities (Areas I and II). The dose of DEC recommended by the WHO (6mg/kg) was calculated based on the individual's weight-for-age. In Area II, weight differences between the genders were also considered when determining dosage. Data were obtained through interviews conducted in the first 12 to 48h and on the 5th day after MDA during household visits. RESULTS: A total of 487 and 365 individuals were interviewed in Areas I and II, respectively. The prevalence of ADRs in Area I (23.6; 95%CI: 19.1-29.5) was higher than in Area II (16.2; 95%CI:11.9-21.5)(p=0.0078). The prevalence of ADRs among females was higher than in males in Area I (p=0.0021). In Area II, no significant difference between the genders was observed (p=0.1840). Age was not associated with ADRs in either area. CONCLUSIONS: Adjusting MDA dosage schedules according to weight-for-age and sex may be may contribute to reduce the occurrence of adverse drug reactions in the population.
Assuntos
Dietilcarbamazina/efeitos adversos , Filariose Linfática/tratamento farmacológico , Filaricidas/efeitos adversos , Adolescente , Adulto , Animais , Brasil/epidemiologia , Estudos Transversais , Dietilcarbamazina/administração & dosagem , Filariose Linfática/epidemiologia , Doenças Endêmicas , Feminino , Filaricidas/administração & dosagem , Humanos , Masculino , Prevalência , Adulto JovemRESUMO
We report the occurrence of serious reactions after treatment with oral ivermectin in two patients with Mansonella ozzardi infections. Both had systemic and respiratory symptoms and recovered without sequelae. Follow-up revealed clearance of microfilaremia in both cases, with relapse in one of them. These reactions are well described in the treatment of other filarial infections, but have not yet been reported in the treatment of M. ozzardi. We are now reporting the first such known reactions with this helminthiasis.
Assuntos
Calafrios/induzido quimicamente , Dispneia/induzido quimicamente , Febre/induzido quimicamente , Filaricidas/efeitos adversos , Ivermectina/efeitos adversos , Mansonella , Mansonelose/tratamento farmacológico , Parasitemia/tratamento farmacológico , Idoso , Animais , Argentina , Terapia Combinada , Feminino , Filaricidas/uso terapêutico , Humanos , Ivermectina/uso terapêutico , Masculino , Mansonella/efeitos dos fármacos , Mansonelose/parasitologia , Microfilárias/efeitos dos fármacos , Parasitemia/parasitologia , Fitoterapia , RecidivaRESUMO
In filariasis-endemic areas beyond sub-Saharan Africa, the World Health Organization's recommended strategy for interrupting transmission of the causative parasites is annual, single-dose, mass treatment with a combination of diethylcarbamazine (DEC; given at 6 mg/kg) and albendazole (ALB; given at 400 mg) for 4-6 years (the minimum estimated life-span of the adult parasites). In an open, hospital-based, randomized and controlled trial, with a blinded evaluation of outcome, 82 children and adolescents from Recife, all with Wuchereria bancrofti microfilaraemias, were given either DEC alone (6 mg/kg) or the same dose of DEC combined with ALB (at 400 mg/patient). Every 90 days for 1 year after the single treatment, each patient was checked for microfilaraemia by the filtration of up to 5 ml of venous blood collected at night. One year post-treatment, 16 (39%) of the 41 patients given DEC alone and 20 (49%) of the 41 given DEC-ALB were found microfilaraemic (relative risk=0.8, with a 95% confidence interval of 0.49-1.31) and the corresponding geometric mean levels of microfilaraemia were 2.0% and 1.8% of the levels recorded immediately pre-treatment, respectively (P>0.05). In terms of the prevalences and intensities of microfilaraemia, therefore, the addition of ALB to the DEC appeared to offer no significant benefit.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Dietilcarbamazina/uso terapêutico , Filariose Linfática/tratamento farmacológico , Wuchereria bancrofti , Adolescente , Adulto , Albendazol/efeitos adversos , Animais , Anti-Helmínticos/efeitos adversos , Brasil/epidemiologia , Criança , Dietilcarbamazina/efeitos adversos , Quimioterapia Combinada , Filariose Linfática/epidemiologia , Filariose Linfática/parasitologia , Feminino , Filaricidas/efeitos adversos , Filaricidas/uso terapêutico , Humanos , Masculino , Prevalência , Resultado do TratamentoRESUMO
In 2000, annual mass administration of diethlycarbamazine and albendazole began in Leogane Commune, Haiti, to interrupt transmission of lymphatic filariasis (LF). After 5 years of treatment, microfilaremia, antigenemia, and mosquito infection rates were significantly reduced, but LF transmission was not interrupted. These finding have implications for other LF elimination programs.
Assuntos
Albendazol/administração & dosagem , Dietilcarbamazina/administração & dosagem , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Filaricidas/administração & dosagem , Programas Governamentais/normas , Albendazol/efeitos adversos , Albendazol/uso terapêutico , Animais , Dietilcarbamazina/efeitos adversos , Dietilcarbamazina/uso terapêutico , Quimioterapia Combinada , Filariose Linfática/tratamento farmacológico , Filariose Linfática/parasitologia , Filaricidas/efeitos adversos , Filaricidas/uso terapêutico , Haiti/epidemiologia , Humanos , Microfilárias/efeitos dos fármacos , Prevalência , Avaliação de Programas e Projetos de Saúde , Wuchereria bancrofti/efeitos dos fármacosRESUMO
In October 2000, 71,187 persons were treated for lymphatic filariasis using albendazole and diethylcarbamazine (DEC) or DEC alone in Leogane, Haiti. We documented the frequency of adverse reactions, severity and cost of treatment. Adverse reactions were classified as minor, moderate, or severe. Overall, 24% (17,421) of the treated persons reported one or more adverse reactions. There were 15,916 (91%) minor and 1502 (9%) moderate adverse reaction reports. Men outnumbered women 2:1 in reporting moderate problems. Three patients, representing roughly one in 25,000 persons treated, were hospitalized with severe adverse reactions judged to be treatment-associated by physician review. The cost per person treated for adverse reactions was more than twice the cost per person treated for lymphatic filariasis (dollar 1.60 versus dollar 0.71). Severe adverse reactions to lymphatic filariasis treatment using DEC with or without albendazole are uncommon. Minor and moderate reactions are more commonly reported and their management represents a challenge to lymphatic filariasis elimination programs.
Assuntos
Albendazol/efeitos adversos , Anti-Helmínticos/efeitos adversos , Dietilcarbamazina/efeitos adversos , Filariose Linfática/tratamento farmacológico , Filaricidas/efeitos adversos , Adolescente , Adulto , Fatores Etários , Albendazol/economia , Albendazol/uso terapêutico , Anti-Helmínticos/economia , Anti-Helmínticos/uso terapêutico , Dietilcarbamazina/economia , Dietilcarbamazina/uso terapêutico , Filariose Linfática/economia , Feminino , Filaricidas/economia , Filaricidas/uso terapêutico , Haiti , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
Although testicular hydrocele is the most common clinical manifestation of bancroftian filariasis, its pathogenesis is poorly understood, as is its relationship to inflammatory scrotal nodules following death of adult Wuchereria bancrofti. Between 1994 and 1998, we prospectively determined the incidence and clinical evolution of nodule-associated acute hydrocele in men attending 2 outpatient clinics in Recife, Brazil who were infected with W. bancrofti, had living adult worms detectable by ultrasound in the intrascrotal lymphatic vessels, and were scheduled for treatment with 6 mg/kg diethylcarbamazine (DEC). A total of 132 men developed 173 scrotal nodules 1-7 (mean 4.2) d after DEC treatment and another 47 developed 58 spontaneous nodules before they received DEC treatment. These 179 men with a single 'nodule event' (simultaneous development of > or =1 scrotal nodules) were followed-up by serial physical and ultrasound examinations for 18 months. Overall, 40 (22.3%) men developed acute hydrocele, 3 of whom underwent biopsy and hydrocele repair. Of the remaining 37 men, 9 (24.3%) developed chronic hydrocele and 28 had acute hydrocele resolution within 14-210 (mean 60.9) d. Rate of chronic hydrocele was similar for men who received DEC and those with spontaneous nodules. Seventeen (42.5%) men with hydrocele had multiple scrotal nodules, compared with 28 (20.1%) men who did not develop hydrocele (P= 0.007). Of 134 men with single nodules, superior paratesticular nodules were found in 56.5% and 29.7% of those with and without hydrocele, respectively (P = 0.02). Acute hydrocele occurs frequently following death of adult W. bancrofti and single episodes of scrotal nodule formation. Chronic hydrocele may develop following 5.1% of these episodes.
Assuntos
Filariose Linfática/complicações , Hidrocele Testicular/parasitologia , Doença Aguda , Adolescente , Adulto , Animais , Biópsia , Doença Crônica , Dietilcarbamazina/efeitos adversos , Filariose Linfática/tratamento farmacológico , Filariose Linfática/patologia , Filaricidas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Escroto/patologia , Hidrocele Testicular/induzido quimicamente , Hidrocele Testicular/patologia , Wuchereria bancrofti/efeitos dos fármacosAssuntos
Filaricidas/efeitos adversos , Inseticidas/efeitos adversos , Ivermectina/efeitos adversos , Escabiose/tratamento farmacológico , Idoso , Colômbia/epidemiologia , Filaricidas/administração & dosagem , Humanos , Inseticidas/administração & dosagem , Ivermectina/administração & dosagem , Mortalidade , Resultado do TratamentoRESUMO
Os autores realizaram uma ampla revisão sobre o tratamento da filariose bancroftiana com a droga dietilcarbamazina. Os aspectos interessantes sobre o histórico de sua descoberta e os conceitos básicos de sua farmacologia foram relatados de forma resumida. Ênfase especial, por outro lado, foi dada às especulações feitas pelos diversos autores sobre os achados intrigantes descritos na literatura. Foram trazidos os novos avanços sobre o conhecimento da doença, como por exemplo, a visualização pela ultra-sonografia do verme vivo de Wuchereria bancrofti, no seu hospedeiro natural, o homem. Isso possibilitou a compreensão de muitos dos achados aparentemente paradoxais encontrados na literatura sobre o tratamento da infeção com a DEC. Assim, devido à inexistência de uma droga sucessora que reunisse efeitos micro e macrofilaricidas ideais e aos novos conhecimentos sobre a bancroftose e sobre a própria dietilcarbamazina, foi-lhe conferido um novo realce. Esses aspectos a colocaram numa posição de destaque no cenário da infecção, à época do seu quase cinqüentenário de existência.
The authors presented a detailed review about the treatment of bancroftian filariasis with diethylcarbamazine. The interesting aspects about the drug discovery and the basic concepts about its pharmacology were reported in a summarised form. On the other hand, emphasis was made about the speculation done by several authors about the intriguing findings regarding its efficacy reported in the literature. Latter, it was brought the new advances about the disease, as for example, the visualization by ultrasound of living Wuchereria bancrofti adult worm on its natural host--the human being. This made possible the comprehension of several paradoxical issues reported, focusing the treatment of infection using diethylcarbamazine. So far, because of the lack of ideal drug with micro and macrofilaricidal properties, together with the new understand about the disease and the new parameters for monitoring the efficacy of the drug, diethylcarbamazine has back its importance conquered at the begin of its discovery, almost fifth years ago.
Assuntos
Dietilcarbamazina/uso terapêutico , Filaricidas/uso terapêutico , Filariose/tratamento farmacológico , Wuchereria bancrofti , Animais , Dietilcarbamazina/efeitos adversos , Dietilcarbamazina/farmacocinética , Dietilcarbamazina/farmacologia , Filaricidas/efeitos adversos , Filaricidas/farmacocinética , Filaricidas/farmacologia , Filariose/parasitologia , Humanos , Microfilárias/efeitos dos fármacos , Recidiva , Wuchereria bancrofti/efeitos dos fármacosRESUMO
The authors presented a detailed review about the treatment of bancroftian filariasis with diethylcarbamazine. The interesting aspects about the drug discovery and the basic concepts about its pharmacology were reported in a summarised form. On the other hand, emphasis was made about the speculation done by several authors about the intriguing findings regarding its efficacy reported in the literature. Latter, it was brought the new advances about the disease, as for example, the visualization by ultrasound of living Wuchereria bancrofti adult worm on its natural host--the human being. This made possible the comprehension of several paradoxical issues reported, focusing the treatment of infection using diethylcarbamazine. So far, because of the lack of ideal drug with micro and macrofilaricidal properties, together with the new understand about the disease and the new parameters for monitoring the efficacy of the drug, diethylcarbamazine has back its importance conquered at the begin of its discovery, almost fifth years ago.
Assuntos
Dietilcarbamazina/uso terapêutico , Filariose/tratamento farmacológico , Filaricidas/uso terapêutico , Wuchereria bancrofti , Animais , Dietilcarbamazina/efeitos adversos , Dietilcarbamazina/farmacocinética , Dietilcarbamazina/farmacologia , Filariose/parasitologia , Filaricidas/efeitos adversos , Filaricidas/farmacocinética , Filaricidas/farmacologia , Humanos , Microfilárias/efeitos dos fármacos , Recidiva , Wuchereria bancrofti/efeitos dos fármacosRESUMO
La oncocercosis es una enfermedad parasitaria que tradicionalmente se ha considerado como un padecimiento que afecta exclusivamente a los tejifos oculares y cutáneos. Sin embargo, ya se ha demostrado que existen también otras alteraciones sistématicas, renales y neurológicas especialmente inducidas durante el tratamiento con microfilaricidas. En este artículo se hace una revisión de los aspectos renales de la oncocercosis que incluyen la presencia de microfilarias de onchocerca volvulus en orina (microfilaruria), así como de hematuria y proteinuria en pacientes infectados con esta filaria. Estas manifestaciones renales pueden observarse en oncocercosos que no se encuentran bajo tratamiento, pero su aparición es especialmente notable durante la quimioterapia tanto con microfilaricidas como con macrofilaricidas. No obstante que estas alteraciones pueden desaparecer o no después de finalizado el tratamiento, aparentemente tienen muy poca influencia en el cuadro clínico general de la oncocercosis. Se hace hincapié en los posibles mecanismos por los cuales las microfilarias de 0. volvulus pasan de los tejidos cutáneos hacia el torrente sanguíneo y, desde allí, hacia la orina. Asimismo, se comentan los mecanismos propuestos para explicar el lesión renal, mecanismos que al parecer tienen un origen inmunológico basado en el depósito de complejos inmunitarios en la membrana basal de glomérulo.
Assuntos
Humanos , Filaricidas/efeitos adversos , Oncocercose/fisiopatologia , Rim/parasitologia , Urina/parasitologia , Ativação do Complemento/imunologia , Oncocercose/tratamento farmacológico , Oncocercose/epidemiologia , Rim/imunologiaRESUMO
An open clinical trial of amocarzine was carried out in onchocerciasis patients in Ecuador and Guatemala. Administration after food was more effective than that during fasting. The most effective and best tolerated regimen, 3 mg/kg twice daily after food for 3 days (in 312 patients), killed 73% of 1477 female worms at nodulectomy 4 months after treatment. The mean microfilarial skin count was greatly reduced within a week (6-11% Of day 0 value on day 8) and it remained low at least 6 months (14-18% on day 180). Follow-up of a higher dose 3 day regimen taken while fasting showed microfilaridermia of 7-9% of the day 0 value 2 years after treatment.