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PubMed1981

Chemotherapy with spaced doses of diethylcarbamazine preceded by levamisole on Bancroftian filariasis.

The administration of levamisole (2.5 mg/kg) in a single oral dose, the day before beginning weekly spaced dose of diethylcarbamazine (DEC), resulted in low blood levels of microfilariae of Wuchereria bancrofti six weeks after commencing treatment. This rapid decrease in microfilaraemia associated with the addition of levamisole overcomes a major disadvantage of using DEC alone-namely the necessity to commence spaced dose treatment several months before the transmission season. A further advantage of combined levamisole-DEC therapy is that levamisole is effective in ascariasis and hookworm-conditions which often co-exist in areas endemic for Bancroftian filariasis.

Adolescent↗

PubMed1982

Litomosoides carinii infection in cotton-rats before and after treatment with diethylcarbamazine and suramin: evolution of free serum antigens.

Immunoelectrodiffusion was used to detect free serum antigens after treatment with diethylcarbamazine (DEC) and Suramin (S) in 30 cotton-rats infected with Litomosoides carinii. Precipitin lines between an antiserum produced by an adult worm extract and the test serum indicated the presence of free antigens in the serum. The number of precipitin lines was between one and 3. Before treatment only 13.3% of infected rats were positive compared with 83.7% after treatment. There was a difference in the delay before the appearance, the persistence and, possibly, the nature of antigens liberated by DEC and S treatment. With DEC release occurred earlier than with S and the antigens persisted for a shorter time. With combined DEC + S therapy the results were similar to those obtained with DEC and S used alone.

Animals↗

PubMed1982

Evaluation of the diethylcarbamazine provocative test in the diagnosis of Wuchereria bancrofti infections in the Nigerian savanna and the effects on Dipetalonema perstans.

Large scale filariasis surveys in rural areas for microfilaraemia, especially of periodic types such as Wuchereria bancrofti are known to cause considerable administrative, technical and social problems. The present investigation was carried out in the population of two villages in the Malumfashi district of the Northern Nigerian savanna. From the survey results, the sensitivity and specificity of two techniques-day-time diethylcarbamazine (DEC) provocative test by blood smear and concentration, and night-blood examination by smear and concentration especially for W. bancrofti-were assessed. Day-time DEC provocative test proved to be efficient in terms of sensitivity and specificity, compared with the night-blood method, for W. bancrofti detection but less so for Dipetalonema perstans, the other blood microfilaria found in this population during these studies. A regression line between night-blood survey results for W. bancrofti and the results from day-time DEC provocative test was calculated. With the help of this regression line it is possible to estimate W. bancrofti microfilarial prevalence for night surveys, using the DEC provocative test results of day-time surveys. This can be done with minimal, but known, loss of accuracy and incurs fewer administrative, technical and social difficulties.

Adult↗

PubMed1984

Low dosage diethylcarbamazine administered by villagers for the control of timorian filariasis.

The results of mass treatment using low dosage diethylcarbamazine (DEC) in three small villages in West Flores, Indonesia, endemic for Brugia timori are described. DEC was distributed on a weekly basis by motivated persons in the community to nearly all villagers for 18 months. An educational programme was developed which focused on describing the relationship between microfilaraemia, vector and disease manifestations, the danger of repeated attacks of adenolymphangitis, and the efficiency of DEC in eliminating the parasites and attacks. During the consolidation phase motivated persons were assigned to treat promptly all cases with acute filariasis and to distribute DEC to all new residents. With this programme the microfilaria rates decreased to very low levels, even as detected by the use of membrane filtration techniques. The adenolymphangitis rates also decreased. An unexpected bonus was the cure of "elephantiasis" in many people. Mild side effects attributed to DEC were encountered only during the first few weeks of treatment.

Brugia↗

PubMed1984

A diagnostic "patch test" for onchocerciasis using topical diethylcarbamazine.

There is great need for a simple, inexpensive, and sensitive diagnostic test for onchocerciasis, especially in endemic areas where trained personnel and laboratory facilities are limited. Diethylcarbamazine (DEC) was applied as a "patch test" to the skin of 45 patients with onchocerciasis in the Southern Sudan. 75 tests were done on these 45 patients, and 69 (92%) were positive. A positive reaction was a papular eruption beneath the patch. Histopathological studies of the skin beneath the patch revealed the microscopic features of a severe Mazzotti reaction, including degenerating microfilariae in the upper dermis and within epidermal eosinophilic abscesses.

Administration, Topical↗

PubMed1985

Wuchereria bancrofti in Tanzania: immune reactions to the microfilarial surface, and the effect of diethylcarbamazine upon these reactions.

Immune reactions to the surface of microfilariae (mff) of Wuchereria bancrofti were investigated among persons living in an endemic filariasis area of Tanzania. The sera from a proportion of mff-negative persons contained antibodies to the microfilarial sheath, and a clear correlation was seen between presence of anti-sheath antibodies and the ability of the sera to mediate leucocyte attack on the mff in vitro. The anti-sheath antibodies were mainly of the IgG class and to a lesser degree of the IgM class. Only in some sera did the binding of antibody to the microfilarial sheath lead to deposition of C3 on the sheath. The cuticle of some of the sheathless mff activated complement without presence of anti-cuticle antibody. Further, the effect of diethylcarbamazine (DEC) administration in vivo (i.e., as full course treatment or as Day Provocative Test) and in vitro (i.e., applied directly to the immune tests) on the reactions to the microfilarial surface was examined. No interference of this anti-filarial drug was, however, observed, neither on the ability of sera to mediate leucocyte attack on mff in vitro, nor on complement activation and C3 deposition on the microfilarial sheath.

Antibodies↗

PubMed1986

A double-blind comparison of the efficacy and safety of ivermectin and diethylcarbamazine in a placebo controlled study of Senegalese patients with onchocerciasis.

Ivermectin (MK-933) has been compared with diethylcarbamazine (DEC) and placebo in a double-blind study in 30 adult male Senegalese patients with Onchocerca volvulus infection. 10 patients were randomly assigned to each treatment group. Ivermectin was administered as a single oral dose of 12 mg and DEC as 50 mg daily for two days and 100 mg twice daily for the following six days, total 1.3 g in eight days. Skin O. volvulus microfilaria densities remained near pre-study values in the placebo patients, but decreased rapidly with both active drugs to mean values about 2% of pretreatment (Day 8) and then increased slowly, reaching in 12 months about 4% of pre-treatment (ivermectin) and 18% (DEC). This difference is statistically significant. Clinical adverse reactions were recorded in four ivermectin, ten DEC and three placebo patients. One ivermectin and six DEC patients received steroid treatment for relief of these reactions. Serious adverse ocular changes were not seen in any patients, possibly because of the steroid therapy in the DEC patients. Adult O. volvulus from onchocercal nodules one and six months after treatment showed no effect of either drug on viability. Intra-uterine developing forms of the microfilariae appeared normal in all three treatment groups at the one month examination but deformed and degenerated forms were evident at six months in the ivermectin group but not in the DEC and placebo patients. Ivermectin as a single oral dose appears to be a safer and more effective microfilaricidal drug in human onchocerciasis than DEC in the standard multi-dose regimen.

Adolescent↗

PubMed1987

Bancroftian filariasis in coastal north Trinidad: the effects of mass chemotherapy using spaced doses of diethylcarbamazine citrate on human microfilaraemias and vector infection rates.

The effects of a mass chemotherapy programme using spaced doses of diethylcarbamazine citrate on Wuchereria bancrofti microfilaraemias and vector infection rates were studied in an isolated rural community of 650 people in north Trinidad where a microfilaria rate of 15% had previously been recorded. A single oral dose of 6 mg/kg body weight was given at monthly intervals for one year. After 6 months, 79% (52/66) of persons previously microfilaraemic had become negative. After 12 months the negative proportion had increased to 90% (63/70). The geometric mean microfilaria density of those still microfilaraemic was reduced from 19.7 to 4.6 per 100 mm3 of blood. Of 147 initially negative persons, none had become positive following treatment. Filarial infection rates in Culex quinquefasciatus from randomly sampled houses fell from 6.4% to zero; in houses where occupants with microfilaraemia had been identified before treatment, the rate was reduced from 15.8% to zero. In a supplementary study, however, weekly collections from one initially positive house showed a rapid decline in the vector infection rate from 43% to 2% after three months but an additional 3 months elapsed before the index reached zero. There was negligible microfilarial uptake by the vectors from residual low-density microfilaraemias (less than 10 microfilariae per 100 mm3 of blood) after chemotherapy.

Animals↗

PubMed1988

The effect of diethylcarbamazine treatment of Bancroftian filariasis on the immunological reactivity of microfilaraemic individuals.

Patent filarial infection has been correlated with a profound suppression of humoral and cellular responses to filarial antigens. In the present study, the filarial antigen-specific humoral and cellular reactivity of 30 Haitian subjects with patent Wuchereria bancrofti infection was monitored before and after treatment with diethylcarbamazine. Microfilarial density was reduced from a pre-treatment mean of 1778/ml to 9/ml, with residual microfilaraemias detectable in 10 subjects. Peripheral blood mononuclear cells from 18 of the 30 patients responded to an extract of Brugia pahangi before treatment, and this number increased to 25 after treatment. There was no significant change in the mean level of response to B. pahangi in patients who were responsive to filarial antigen before treatment; however, the mean responsiveness to B. pahangi of individuals who were classified as nonresponders before treatment was significantly increased following treatment. Cellular reactivity to purified protein derivative and geometric mean titres to soluble B. pahangi, measured by enzyme-linked immunosorbent assay, were unaffected by treatment. Similarly, most post-treatment sera did not recognize new B. pahangi bands on Western blots, compared to pre-treatment controls. These observations imply that the relationship between microfilariae and immunosuppression is complex.

Adolescent↗

PubMedDate not supplied

A placebo-controlled double-blind trial for the treatment of bancroftian filariasis with ivermectin or diethylcarbamazine.

Therapeutic efficacy and clinical side-effects of ivermectin (single dose of 100 micrograms/kg) and diethylcarbamazine (DEC) (3 mg/kg for one day, then 6 mg/kg daily for 12 d) were evaluated for microfilaricidal effect in Bancroftian filariasis. Seventy-one microfilaraemic consenting adult male patients (greater than or equal to 100 microfilariae (mf)/ml) were randomly assigned to receive ivermectin, DEC or placebo and kept in hospital for 15 d. Those receiving placebo were treated with ivermectin on day 9. Ivermectin (19 'double-blinded' and 22 'unblinded' patients) caused an abrupt reduction in mf count to 1.5% of the pre-treatment level 12 h after drug administration and to 0.06% on day 14, with recrudescence to 1.8% after one month and to 9.2% after 3 months. DEC (30 patients) caused a gradual drop in mf count to 1.1% of the pre-treatment level on day 14, which increased to 2.4% after one and 3 months. The total scores of side-effects were 77 (1%), 305 (2.1%) and 311.5 (3.0%) for placebo, ivermectin and DEC respectively; the differences between DEC or ivermectin and placebo were statistically significant. Ivermectin produced lower side-reaction scores than DEC and the differences were highly significant at the 95% confidence level. Side-effects were mainly headache and body aches in the ivermectin patients, which appeared as early as 4 h after drug administration, resolved within 36 to 48 hours, and were significantly related to mf densities. Side-effects in DEC patients were mainly testicular and epididymal pain and swelling, unrelated to mf densities, which began at day 2 and continued to day 7.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Diethylcarbamazine in the control of splenomegaly associated with Bancroftian filariasis in the Ok Tedi area of Papua New Guinea.

Bancroftian filariasis is highly endemic in the Ok Tedi region of Papua New Guinea, with a reported mean rate of 39% before the implementation of a single-dose diethylcarbamazine (DEC) treatment programme in 1986. This was followed by a 72% decline in the rate of detectable microfilaraemia and a 40% reduction in pre- and post-treatment splenomegaly. No significant difference was observed when spleen enlargement was compared to the presence of patent malaria. A significant difference in splenomegaly was observed between DEC-treated villagers and their untreated counterparts. Significant differences were reported in the rate of detectable microfilariae of Wuchereria bancrofti, but not of malaria, between the two groups. The number of DEC administrations and the period of time since the first treatment played a significant role immunologically. Significant differences were observed in immunoglobulin (Ig) M and IgG levels and in the extent of splenomegaly between DEC-treated and untreated areas. Filarial infection associated with malaria resulted in higher spleen rates and size. W. bancrofti is a major contributor to splenomegaly in the Ok Tedi region, and splenomegaly associated with bancroftian filariasis can be reduced or controlled by low, well-spaced doses of DEC.

Animals↗

PubMedDate not supplied

Wuchereria bancrofti infection in human and mosquito populations of a Polynesian village ten years after interruption of mass chemoprophylaxis with diethylcarbamazine.

In 1991, a study on Wuchereria bancrofti microfilariae (mf) and infection rates was carried out in the human and mosquito populations of a Polynesian village where, 10 years before, the mf prevalence rate was 6.4% and twice-yearly mass treatment with 3 mg/kg of diethylcarbamazine (DEC) was interrupted. Venous blood samples were collected from 575 (97%) individuals aged 15 years or more, of whom 122 (21.4%) were mf positive. The mf carrier prevalence rate was 27.4% in males, significantly higher than that of 14% in females; it increased from 7-12% in the youngest age group (15-19 years) to 40-50% in the oldest (> or = 60 years) for both males and females. 387 mosquito collections were performed and 1748 female Aedes polynesiensis were dissected, of which 1176 were parous. Among the latter, 114 (9.7%) were infected with Wuchereria bancrofti larvae at L1, L2 or L3 stages. The mean number of larvae per mosquito was 2.46 (range 1-15). Of the 114 infected mosquitoes, 30 harboured L3 larvae, giving a 2.55% infective rate; the mean number of L3 larvae per mosquito was 1.15 (range 1-2). Such findings indicate that the interruption of systematic twice-yearly mass treatment with DEC (3 mg/kg) has resulted, after 10 years, in a substantial increase of microfilarial prevalence in humans, and in high infection rates in mosquitoes.

Adolescent↗

PubMedDate not supplied

Double-blind controlled trial of a single dose of the combination ivermectin 400 micrograms/kg plus diethylcarbamazine 6 mg/kg for the treatment of bancroftian filariasis: results at six months.

In 1993, a three-arm double-blind controlled trial was implemented in French Polynesia to compare the tolerance and efficacy of a single dose of the combination ivermectin (IVR) 400 micrograms/kg plus diethylcarbamazine (DEC) 6 mg/kg vs. IVR 400 micrograms/kg alone vs. DEC 6 mg/kg alone, for treatment of Wuchereria bancrofti carriers. Of the 57 treated male patients in whom microfilaria (mf) densities ranged from 22 to 4709 mg/mL, 3 groups of 19 were randomly selected and allocated to one of the 3 treatments. Side effects were experienced by 34 patients (60%), but none suffered a severe reaction. Grade of reaction did not differ between treatment group, but was significantly correlated with the pretreatment mf density. Six months after treatment, 26%, 32% and 53% of patients were amicrofilaraemic in the DEC, IVR and IVR+DEC groups, respectively. Mf levels were 6.3%, and 3.1% and 1.0% of the pretreatment level, respectively, significantly lower in the IVR+DEC group than in both the IVR and DEC comparison groups. The combination IVR+DEC showed promise in term of sustained mf decrease, and could be an effective alternative for lymphatic filariasis control programmes.

Adult↗

PubMedDate not supplied

Tolerance of diethylcarbamazine by microfilaraemic and amicrofilaraemic individuals in an endemic area of Bancroftian filariasis, Recife, Brazil.

To determine the tolerance to diethylcarbamazine (DEC) treatment of patients with Bancroftian filariasis, 193 individuals (138 asymptomatic microfilaraemic, 30 amicrofilaraemic diseased patients and 25 asymptomatic amicrofilaraemic endemic residents) were enrolled in a prospective trial with different dose schedules, in a hospital and outpatient clinic setting in Brazil. Systemic adverse reactions, localized adverse reactions, and side effects, related to microfilariae, adult worms and the drug itself, were evaluated. Systemic reactions occurred irrespective of the DEC dose and schedule in about 40% of the microfilariae carriers, but not in amicrofilaraemic diseased patients or residents; they usually consisted of microscopic haematuria, followed by fever and malaise. Localized reactions were manifested by the appearance of inflammatory reactions, mainly in the scrotal area. Nodules containing degenerating adult worms developed mainly in the scrotal lymphatics of microfilaraemic patients, diseased amicrofilaraemic patients, and residents. Drowsiness, which increased with higher doses of DEC, was the most common side effect in both microfilaraemic and amicrofilaraemic individuals, followed by nausea and gastric upset. The results indicate that the occurrence of systemic and local adverse reactions was unrelated to either the dose of DEC or the pretreatment microfilarial density. The severity of systemic reactions was proportional to the microfilarial density. Side effects were dependent on the drug dosage irrespective of infection status.

Adolescent↗

PubMedDate not supplied

Advantages of an annual single dose of ivermectin 400 micrograms/kg plus diethylcarbamazine for community treatment of bancroftian filariasis.

In 1994 and 1995, 2 supervised single dose treatments for bancroftian filariasis were given to all inhabitants ( > 3500) aged > or = 3 years on a Polynesian island. This island is divided into 4 political zones. Each zone was treated with a different dosage of the combination ivermectin (IVR) and diethylcarbamazine (DEC) as follows: (1) IVR 400 micrograms/kg plus DEC 6mg/kg, (2) IVR 400 micrograms/kg alone, (3) DEC 6 mg/kg alone (4) IVR 400 micrograms/kg plus DEC 3 mg/kg. 1717 inhabitants (aged > or = 20 years) had venous blood sampled when treated. The reductions in microfilaraemia prevalence rates one year after treatment were, respectively, 32%, 11%, 14% and 32%. The reductions in microfilaraemia levels one year after treatment were, respectively, 96%, 80%, 82% and 95%. Stool specimens from 82 children aged 6 years were examined for intestinal nematodes just before and just after treatment. IVR 400 micrograms/kg significantly reduced the prevalence and intensity of trichiuriasis. The combination IVR + DEC is a powerful tool for the control of lymphatic filariasis. Further studies are required to determine the appropriate presentation of DEC (salt and/or tablets), the frequency of treatment, and the duration of the control programme necessary to eradicate this disease.

Adolescent↗

PubMedDate not supplied

Single-dose diethylcarbamazine in the control of periodic brugian filariasis in Peninsular Malaysia.

The study compared the effectiveness of a single dose of diethylcarbamazine (DEC) (6mg/kg) with the standard regimen of 6 doses (total 36 mg/kg) in mass chemotherapy for the control of brugian filariasis. Mass chemotherapy with single-dose DEC was instituted in one area and standard dose in the other and treatment was repeated after one year. Parasitological surveys were conducted before, and 3, 7 and 12 months after treatment. Pretreatment characteristics were not significantly different between the 2 treatment areas. There was a significant reduction in microfilaraemia prevalence rate from 24.7% to 14.7% at 12 months and to 6.8% at 19 months in the single dose area and from 22.8% to 9.6% at 12 months and to 2.7% at 19 months with the standard dose. Maximum reduction was at 7 months after treatment with both regimens. There was also significant progressive reduction in mean microfilarial density from 4.39 +/- 20.37 to 0.89 +/- 4.16 per 60 microL in the single-dose area and from 4.43 +/- 17.31 to 0.75 +/- per 60 microL in the standard dose area. There was a greater reduction of both microfilarial prevalence and density using the standard regimen but it was not statistically significant. Thus, a single dose of DEC is as effective as the standard dose in controlling periodic brugian filariasis.

Adolescent↗

PubMedDate not supplied

Comparative efficacy of three different diethylcarbamazine regimens in lymphatic filariasis.

To assess the efficacy of diethylcarbamazine (DEC) in clearing Wuchereria bancrofti microfilariae (mf) from the circulation, we conducted a single blind hospital-based therapeutic trial of 3 DEC regimens. All patients were assessed by filtration of 1 mL of venous blood taken before and 1, 3, 6 and 12 months after DEC administration. The efficacy of a 12 d course of 6 mg/kg DEC once daily was identical to that of a similar course with 2 mg/kg given 3 times daily, indicating that split-dose treatment does not improve mf clearance over single daily drug administration. Microfilarial densities in patients treated only once with 6 mg/kg DEC remained significantly higher at 1, 3, and 6 months after treatment. However, all 3 treatment regimens proved equally effective in controlling microfilaraemia after 12 months, when 41, 42 and 40% of patients in the 3 treatment groups were amicrofilaraemic. These results suggest that a single DEC dose of 6 mg/kg administered annually or biannually may be a suitable regimen to control bancroftian filariasis in Recife, Brazil.

Adolescent↗

PubMedDate not supplied

Treatment of bancroftian filariasis in Recife, Brazil: a two-year comparative study of the efficacy of single treatments with ivermectin or diethylcarbamazine.

The effectiveness of single oral doses of ivermectin (200 or 400 micrograms/kg) and diethylcarbamazine (DEC, 6 mg/kg), preceded 4 d earlier by either placebo or very small doses of these drugs, was compared, over a 2-year period, in a double-blind trial in 67 microfilaraemic Brazilian men with bancroftian filariasis. Regimens containing ivermectin alone decreased the number of microfilariae significantly faster and more effectively for the first month after treatment than regimens containing DEC alone, but the latter were significantly more effective throughout the second year after treatment (1.7-8.2% of pretreatment levels with DEC vs. 12.6-30.8% with ivermectin during that period); the higher ivermectin dose showed a tendency towards more effectiveness than the lower dose. Most effective was the combination of ivermectin (20 micrograms/kg) followed 4 d later by DEC (6 mg/kg), with reduction of microfilaraemia to 2.4% of pretreatment levels at 2 years. Adverse reactions were well tolerated with all regimens, the reactions being significantly more generalized (i.e., fever) following ivermectin and localized (i.e., scrotal inflammatory nodules around dying adult worms) following DEC. Further trials of single-dose combination therapy vs. single high doses of ivermectin or DEC should determine the ideal regimen for treatment and control of bancroftian filariasis.

Administration, Oral↗