Barb--thots? ANybody else? Tony? ?

[Guest guest]

" Treatment and prevention of lymphatic filariasis

Diethylcarbamazine (DEC, at 6 mg/kg) is the drug registered for use in

lymphatic filariasis. Ivermectin (400 mcg/kg/d) is an equally potent

microfilaricide, and the combination of these 2 drugs provides

significant synergism.

For control, the World Health Organization (WHO) recommends a single,

yearly oral dose of ivermectin (400 mcg/kg) with DEC (6 mg/kg), or

under specific conditions either of these drugs alone, OR A DAILY USE

OF DEC-FORTIFIED SALT (!).

DEC is also effective in killing some, but not all, adult worms.

Ivermectin has the same ability as DEC to decrease the level of

circulating W bancrofti antigen Og4C3 (Eberhard, 1997); ivermectin

also suppresses microfilaremia for prolonged periods, but it does so

without killing the adult worm (Dreyer, 1995; Dreyer, 1996).

Curiously, a single dose of DEC has essentially the same long-term

effectiveness in decreasing microfilaremia and in the apparent killing

of adult worms as the 1- to 3-week courses previously recommended.

This has enormous implications for control programs, but studies

should be performed to decide if the standard 6- to 12-day regimen for

most infections and the 34-week regimen for tropical eosinophilic

syndrome should be altered for individual patients.

Using DEC alone can cause problems. DEC sometimes can precipitate

acute inflammatory reactions, especially in Malayan filariasis, which

merely accelerates the natural history of the disease (Ottesen, 1985).

The efficacy of albendazole is now under investigation. Kline

Beecham is donating albendazole free of charge to organizations and

governments wishing to assess the drug's ability to control filariasis

(Cicatelli, 1998).

Aplysinopsin, an extract from marine sponges that can be produced

synthetically, has significant adulticidal activity against filariae.

CDRI compound 92/138, a synthetic analogue of aplysinopsin, also

destroys developing larval forms (L3 and L4 stages) of filarial

nematodes (Singh, 1997).

The aggressive treatment of chronic lymphoedema and elephantiasis can

lead to a surprising reversal of symptoms. The treatment consists of

providing long-term, low-dose DEC (to eradicate persistent or new

filarial infections) with diligent attention to the local area of the

lymphedematous extremity.... "

These 2 paragraphs were also interesting:

" Patients with tropical eosinophilia respond dramatically to DEC.

Symptoms of untreated patients may resolve spontaneously, but the

eosinophilia usually persists, and these patients frequently have

recurrences or relapses. Bronchoalveolar lavage reveals that even

patients treated with DEC often have persistent mild chronic

alveolitis that can cause a mild, chronic, interstitial lung disease

(Rom, 1990). Steroid therapy can be used with anthelminthic therapy to

lessen minor allergic reactions. Mebendazole with levamisole is a

promising alternative therapy for TPE patients who are allergic to DEC

(Karnad, 1992).

Importantly, in places where onchocerciasis and/or loiasis are likely

to be co-endemic (eg, sub-Saharan Africa, Latin American countries,

Yemen), DEC should not be used for treatment of lymphatic filariasis

because of the risk of reactions caused by the presence of one or both

of the 2 parasites. "