1/2. loiasis in an expatriate American child: diagnostic and treatment difficulties.On the basis of this experience, we recommend the following when faced with possible filariasis in an expatriate from Western Central africa: (1) Attempt a clinical differentiation between L loa and other filarial infections present in West africa. It is important to suspect loiasis because this is the only filarial infection that is readily curable; (2) ophthalmologic assessment to diagnose onchocerciasis; (3) if L loa is suspected, thick blood smears should be obtained from midmorning to midafternoon and stained with Giemsa or hematoxylin stains, after a concentration technique is used. Nighttime blood specimens should be obtained if the patient has been in an area where W. bancrofti is prevalent; (4) skin snip biopsies prepared as follows: Bilateral symmetrical skin snips should be taken. In the case of suspected West African filariasis, the pelvic girdle, iliac crest, and back of scapula are thought to have the highest yield. One snip from each of six different sites should be obtained. Each skin snip should be approximately 2 to 3 mm (a cornealoscleral biopsy forceps can be used). Each skin snip is placed in 100 microL (approximately one drop) of normal saline in a flat-bottomed microtiter plate. The plate is incubated at room temperature and checked periodically for 24 hours under a dissecting microscope (X20 to X40). If present, the small worms will be seen wiggling and squirming in the drop of saline; (5) serologic diagnostic methods are most efficient if human filarial antigens are used; (6) if treatment is with diethylcarbamazine, the initial dose should be small.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = onchocerciasis (Clic here for more details about this article) |
2/2. Three probable cases of loa loa encephalopathy following ivermectin treatment for onchocerciasis.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 w with high loa microfilaremia also developed 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 concomitant 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.- - - - - - - - - - ranking = 5keywords = onchocerciasis (Clic here for more details about this article) |