Loa loa filariasis medical therapy: Difference between revisions
| Line 23: | Line 23: | ||
| Loa loa | | Loa loa | ||
| '''Diethylcarbamazine (DEC) | | '''Diethylcarbamazine (DEC)''' | ||
8–10 mg/kg orally in 3 divided doses daily | 8–10 mg/kg orally in 3 divided doses daily | ||
| Line 33: | Line 33: | ||
Symptomatic loiasis, with MF/ml ≥8,000 to reduce level to <8,000 prior to treatment with DEC | Symptomatic loiasis, with MF/ml ≥8,000 to reduce level to <8,000 prior to treatment with DEC | ||
| Loa loa | | Loa loa | ||
| ''' | | '''Albendazole''' | ||
200 mg orally twice daily | 200 mg orally twice daily | ||
Revision as of 16:38, 26 December 2012
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Loa Loa Filariasis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Loa loa filariasis medical therapy On the Web |
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American Roentgen Ray Society Images of Loa loa filariasis medical therapy |
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Risk calculators and risk factors for Loa loa filariasis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Overview
Medical Therapy
The treatment of loiasis is complex and is best undertaken after consultation with experts who have experience in the treatment of the disease and prevention of complications of treatment. Additionally, there may be times when it is best not to treat the infection. Surgical excision of migrating adult worms is an effective treatment for symptoms localized to the migrating worm and provides an opportunity for diagnosis. Systemic therapy would be required to cure the infection unless the patient is infected with only a single adult worm. The drug of choice for the treatment of loiasis in patients without detectable microfilariae is diethylcarbamazine (DEC). Most patients will achieve cure, defined as resolution of symptoms, resolution of eosinophilia, and decreasing antifilarial antibody titers, with one or two courses of DEC. Some will require additional courses of DEC or a trial of albendazole. DEC is the treatment of choice because there is solid evidence that it kills both the microfilariae and the adult worms, resulting in quicker resolution of the infection. DEC can also be used to prevent infection in long-term travelers to endemic areas. The prophylactic dose is 300mg orally once a week. There is some evidence that albendazole given 200mg twice daily for 21 days may be an effective treatment for loiasis that is refractory to DEC treatment. It may also be used to reduce microfilarial load prior to initiation of DEC treatment. As albendazole's mechanism of action is believed to be an embryotoxic effect and possibly a directly toxic effect on the adult worms, both of which reduce microfilaraemia levels more slowly than DEC, it does not appear to be prone to causing encephalopathy, though published data are limited. Treatment of loiasis with antiparasitic agents may result in a brief increase of symptoms, such as Calabar swelling or pruritus. Some authors suggest that these symptoms might be attenuated with the concomitant use of antihistamines or corticosteroids during the first seven days of treatment. There is also the risk of fatal encephalopathy with DEC treatment; this risk has not been shown to be eliminated by corticosteroid treatment. More details on this are given below the treatment table. Loa loa, unlike many other filarial parasites, do not contain Wolbachia so doxycycline is not an effective treatment.
- Shown below is a table summarizing the preferred treatment for Loa loa filariasis [1]
| Characteristics of the Patient | Possible Pathogens | Preferred Treatment | Duration of Treatment |
| Symptomatic loiasis with MF/mL <8,000 | Loa loa | Diethylcarbamazine (DEC)
8–10 mg/kg orally in 3 divided doses daily |
For 21 days |
| Symptomatic loiasis, with MF/mL <8,000 and failed 2 rounds DEC
OR Symptomatic loiasis, with MF/ml ≥8,000 to reduce level to <8,000 prior to treatment with DEC |
Loa loa | Albendazole
200 mg orally twice daily |
For 21 days |
| Symptomatic loiasis, with MF/mL ≥8,000 | Apheresis* followed by DEC | N/A | N/A |