Filariasis medical therapy: Difference between revisions

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{{Filariasis}}
{{Filariasis}}
{{CMG}}
{{CMG}}; {{AE}} {{MAD}}


==Overview==
==Overview==
Different drugs are recommended for the treatment of filariasis depending on the specific causal pathogen.
The mainstay treatment for patients with filariasis is [[albendazole]] (a [[broad spectrum]] [[anthelmintic]]) combined with [[ivermectin]].<ref name="CDC">{{Citation|author=U.S. Centers for Disease Control|title= Lymphatic Filariasis Treatment|url=http://www.cdc.gov/ncidod/dpd/parasites/lymphaticfilariasis/treatment_lymphatic_filar.htm|accessdate=2008-07-17}}</ref> A combination of [[diethylcarbamazine]] (DEC) and [[albendazole]] is also effective. All of these treatments are microfilaricides; they have no effect on the adult worms.


==Medical Therapy==
==Medical Therapy==
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* '''Filariasis'''<ref>{{cite web | title = Drugs for Parasitic Infections (Treatment Guidelines from The Medical Letter) | url = http://secure.medicalletter.org/para }}</ref><ref name="pmid20739055">{{cite journal| author=Taylor MJ, Hoerauf A, Bockarie M| title=Lymphatic filariasis and onchocerciasis. | journal=Lancet | year= 2010 | volume= 376 | issue= 9747 | pages= 1175-85 | pmid=20739055 | doi=10.1016/S0140-6736(10)60586-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20739055  }} </ref><ref name="pmid22632644">{{cite journal| author=Knopp S, Steinmann P, Hatz C, Keiser J, Utzinger J| title=Nematode infections: filariases. | journal=Infect Dis Clin North Am | year= 2012 | volume= 26 | issue= 2 | pages= 359-81 | pmid=22632644 | doi=10.1016/j.idc.2012.02.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22632644  }}</ref>
* '''Filariasis'''<ref>{{cite web | title = Drugs for Parasitic Infections (Treatment Guidelines from The Medical Letter) | url = http://secure.medicalletter.org/para }}</ref><ref name="pmid20739055">{{cite journal| author=Taylor MJ, Hoerauf A, Bockarie M| title=Lymphatic filariasis and onchocerciasis. | journal=Lancet | year= 2010 | volume= 376 | issue= 9747 | pages= 1175-85 | pmid=20739055 | doi=10.1016/S0140-6736(10)60586-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20739055  }} </ref><ref name="pmid22632644">{{cite journal| author=Knopp S, Steinmann P, Hatz C, Keiser J, Utzinger J| title=Nematode infections: filariases. | journal=Infect Dis Clin North Am | year= 2012 | volume= 26 | issue= 2 | pages= 359-81 | pmid=22632644 | doi=10.1016/j.idc.2012.02.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22632644  }}</ref>
:* 1. '''Lymphatic filariasis caused by Wuchereria bancrofti, Brugia malayi, Brugia timori'''
:* 1. '''Lymphatic filariasis caused by Wuchereria bancrofti, Brugia malayi, Brugia timori'''
::* Preferred regimen: [[Diethylcarbamazine]] 6 mg/kd/day PO tid for 12 days (single dose if patient will continue to live in endemic area or is younger than 9 years old)
::* Preferred regimen: [[Diethylcarbamazine]] 6 mg/kd/day PO tid for 12 days. Single dose of (DEC) has the same long-term effect in decreasing levels of microfilaria in blood as 12-day regimen. If  patient is co-infected with onchocerciasis or loiasis  DEC is contraindicated. DEC induces reversal of early lymphatic dysfunction in a patient with W.bancrofiti filariasis.<ref name="pmid8922794">{{cite journal| author=Moore TA, Reynolds JC, Kenney RT, Johnston W, Nutman TB| title=Diethylcarbamazine-induced reversal of early lymphatic dysfunction in a patient with bancroftian filariasis: assessment with use of lymphoscintigraphy. | journal=Clin Infect Dis | year= 1996 | volume= 23 | issue= 5 | pages= 1007-11 | pmid=8922794 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8922794  }}</ref>
::* '''Chronic cases''':
::** Regular exercise and leg elevation during night increase lymph flow. 
::** Physiotherapy may be effective in some cases. 
::** Reconstructive surgery involving lymphatic-venous anastomoses have been attempted to improve lymphatic drainage, but the long-term benefit is still unclear. 
:* 2. '''Loa loa filariasis'''<ref>{{cite web | title = Parasites - Loiasis (CDC) | url = http://www.cdc.gov/parasites/loiasis/health_professionals/index.html }}</ref>
:* 2. '''Loa loa filariasis'''<ref>{{cite web | title = Parasites - Loiasis (CDC) | url = http://www.cdc.gov/parasites/loiasis/health_professionals/index.html }}</ref>
::* 2.1 '''Symptomatic loiasis with < 8,000 microfilariae/mL'''
::* 2.1 '''Symptomatic loiasis with < 8,000 microfilariae/mL'''
:::* Preferred regimen: [[Diethylcarbamazine]] 8–10 mg/kd/day PO tid for 21 days
:::* Preferred regimen: [[Diethylcarbamazine]] 8–10 mg/kd/day PO tid for 21 days.
::* 2.2 '''Symptomatic loiasis, with < 8,000 microfilariae/mL and failed 2 rounds DEC'''
::* 2.2 '''Symptomatic loiasis, with < 8,000 microfilariae/mL and failed 2 rounds DEC'''
:::* Preferred regimen: [[Albendazole]] 200 mg PO bid for 21 days
:::* Preferred regimen: [[Albendazole]] 200 mg PO bid for 21 days.
::* 2.3 '''Symptomatic loiasis, with ≥ 8,000 microfilariae/ml to suppress microfilaremia prior to treatment with DEC'''
::* 2.3 '''Symptomatic loiasis, with ≥ 8,000 microfilariae/ml to suppress microfilaremia prior to treatment with DEC'''
:::* Preferred regimen: [[Albendazole]] 200 mg PO bid for 21 days
:::* Preferred regimen: [[Albendazole]] 200 mg PO bid for 21 days.
::* 2.4 '''Symptomatic loiasis, with ≥ 8,000 microfilariae/mL'''
::* 2.4 '''Symptomatic loiasis, with ≥ 8,000 microfilariae/mL'''
:::* Preferred regimen: Apheresis followed by [[Diethylcarbamazine]]
:::* Preferred regimen: Apheresis followed by [[Diethylcarbamazine]].
:::* Note: Apheresis should be performed at an institution with experience in using this therapeutic modality for loiasis.
:::* Note: Apheresis should be performed at an institution with experience in using this therapeutic modality for loiasis.
:* 3. '''River blindness caused by Onchocerca volvulus'''
:* 3. '''River blindness (onchocerciasis) caused by Onchocerca volvulus'''
::* Preferred regimen: [[Ivermectin]] 150 μg/kg PO single dose, repeated every 6-12 mos until asymptomatic
::* Preferred regimen: [[Ivermectin]] 150 μg/kg PO single dose, repeated every 6-12 mos until asymptomatic.
::* Alternative regimen: [[Doxycycline]] 100 mg/day PO for 6 weeks, alone or followed by [[Ivermectin]] 150 μg/kg PO single dose
::* Alternative regimen: [[Doxycycline]] 100 mg PO qd for 6 weeks, alone or followed by [[Ivermectin]] 150 μg/kg PO single dose.
::* Note: Do <u>NOT</u> administer Diethylcarbamazine where onchocerciasis is endemic due to increased risk for severe local inflammation in patients with ocular microfilariae.
::* Note: Do <u>NOT</u> administer Diethylcarbamazine where onchocerciasis is endemic due to increased risk for severe local inflammation in patients with ocular microfilariae.
:* 4. '''Mansonella ozzardi'''
:* 4. '''Mansonella ozzardi'''
::* Preferred regimen: [[Ivermectin]] 200 μg/kg PO single dose
::* Preferred regimen: [[Ivermectin]] 200 μg/kg PO single dose.
::* Note: Endosymbiotic Wolbachia are essential to filarial growth, development, embryogenesis and survival and represent an additional target for therapy.  [[Doxycycline]] 100–200 mg PO qd for 6–8 weeks results in loss of Wolbachia and decrease in both micro- and macrofilariae.
::* Note: Endosymbiotic Wolbachia are essential to filarial growth, development, embryogenesis and survival and represent an additional target for therapy.  [[Doxycycline]] 100–200 mg PO qd for 6–8 weeks results in loss of Wolbachia and decrease in both micro- and macrofilariae.
:* 5. '''Mansonella perstans'''
:* 5. '''Mansonella perstans'''
::* Preferred regimen: [[Doxycycline]] 100–200 mg PO qd for 6–8 weeks
::* Preferred regimen: [[Doxycycline]] 100–200 mg PO qd for 6–8 weeks.
:* 6. '''Mansonella streptocerca'''
:* 6. '''Mansonella streptocerca'''
::* Preferred regimen (1): [[Diethylcarbamazine]] 6 mg/kd/day PO tid for 12 days
::* Preferred regimen (1): [[Diethylcarbamazine]] 6 mg/kd/day PO tid for 12 days.
::* Preferred regimen (2): [[Ivermectin]] 150 μg/kg PO single dose
::* Preferred regimen (2): [[Ivermectin]] 150 μg/kg PO single dose.
:* 7. '''Tropical pulmonary eosinophilia'''
:* 7. '''Tropical pulmonary eosinophilia caused by Wuchereria bancrofti'''
::* Preferred regimen: [[Diethylcarbamazine]] 6 mg/kd/day PO tid for 12–21 days
::* Preferred regimen: [[Diethylcarbamazine]] 6 mg/kd/day PO tid for 12–21 days.


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category: Infectious Disease Project]]
[[Category:Infectious Disease Project]]
[[Category: Disease]]
[[Category:Disease]]
[[Category: Infectious disease]]
[[Category:Infectious disease]]
[[Category: Neglected diseases]]
[[Category:Neglected diseases]]
[[Category: Parasitic diseases]]
[[Category:Parasitic diseases]]
[[Category:Emergency mdicine]]
[[Category:Up-To-Date]]
[[Category:Vascular medicine]]
[[Category:Urology]]
[[Category:Gastroenterology]]

Latest revision as of 21:45, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Overview

The mainstay treatment for patients with filariasis is albendazole (a broad spectrum anthelmintic) combined with ivermectin.[1] A combination of diethylcarbamazine (DEC) and albendazole is also effective. All of these treatments are microfilaricides; they have no effect on the adult worms.

Medical Therapy

Antimicrobial Regimen

  • 1. Lymphatic filariasis caused by Wuchereria bancrofti, Brugia malayi, Brugia timori
  • Preferred regimen: Diethylcarbamazine 6 mg/kd/day PO tid for 12 days. Single dose of (DEC) has the same long-term effect in decreasing levels of microfilaria in blood as 12-day regimen. If patient is co-infected with onchocerciasis or loiasis DEC is contraindicated. DEC induces reversal of early lymphatic dysfunction in a patient with W.bancrofiti filariasis.[5]
  • Chronic cases:
    • Regular exercise and leg elevation during night increase lymph flow.
    • Physiotherapy may be effective in some cases.
    • Reconstructive surgery involving lymphatic-venous anastomoses have been attempted to improve lymphatic drainage, but the long-term benefit is still unclear.
  • 2. Loa loa filariasis[6]
  • 2.1 Symptomatic loiasis with < 8,000 microfilariae/mL
  • 2.2 Symptomatic loiasis, with < 8,000 microfilariae/mL and failed 2 rounds DEC
  • Preferred regimen: Albendazole 200 mg PO bid for 21 days.
  • 2.3 Symptomatic loiasis, with ≥ 8,000 microfilariae/ml to suppress microfilaremia prior to treatment with DEC
  • Preferred regimen: Albendazole 200 mg PO bid for 21 days.
  • 2.4 Symptomatic loiasis, with ≥ 8,000 microfilariae/mL
  • Preferred regimen: Apheresis followed by Diethylcarbamazine.
  • Note: Apheresis should be performed at an institution with experience in using this therapeutic modality for loiasis.
  • 3. River blindness (onchocerciasis) caused by Onchocerca volvulus
  • Preferred regimen: Ivermectin 150 μg/kg PO single dose, repeated every 6-12 mos until asymptomatic.
  • Alternative regimen: Doxycycline 100 mg PO qd for 6 weeks, alone or followed by Ivermectin 150 μg/kg PO single dose.
  • Note: Do NOT administer Diethylcarbamazine where onchocerciasis is endemic due to increased risk for severe local inflammation in patients with ocular microfilariae.
  • 4. Mansonella ozzardi
  • Preferred regimen: Ivermectin 200 μg/kg PO single dose.
  • Note: Endosymbiotic Wolbachia are essential to filarial growth, development, embryogenesis and survival and represent an additional target for therapy. Doxycycline 100–200 mg PO qd for 6–8 weeks results in loss of Wolbachia and decrease in both micro- and macrofilariae.
  • 5. Mansonella perstans
  • Preferred regimen: Doxycycline 100–200 mg PO qd for 6–8 weeks.
  • 6. Mansonella streptocerca
  • 7. Tropical pulmonary eosinophilia caused by Wuchereria bancrofti

References

  1. ↑ U.S. Centers for Disease Control, Lymphatic Filariasis Treatment, retrieved 2008-07-17
  2. ↑ "Drugs for Parasitic Infections (Treatment Guidelines from The Medical Letter)".
  3. ↑ Taylor MJ, Hoerauf A, Bockarie M (2010). "Lymphatic filariasis and onchocerciasis". Lancet. 376 (9747): 1175–85. doi:10.1016/S0140-6736(10)60586-7. PMID 20739055.
  4. ↑ Knopp S, Steinmann P, Hatz C, Keiser J, Utzinger J (2012). "Nematode infections: filariases". Infect Dis Clin North Am. 26 (2): 359–81. doi:10.1016/j.idc.2012.02.005. PMID 22632644.
  5. ↑ Moore TA, Reynolds JC, Kenney RT, Johnston W, Nutman TB (1996). "Diethylcarbamazine-induced reversal of early lymphatic dysfunction in a patient with bancroftian filariasis: assessment with use of lymphoscintigraphy". Clin Infect Dis. 23 (5): 1007–11. PMID 8922794.
  6. ↑ "Parasites - Loiasis (CDC)".
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