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CLINICAL CHARACTERISTICS OF POST-TREATMENT REACTIONS TO IVERMECTIN/ALBENDAZOLE FOR WUCHERERIA BANCROFTI IN A REGION CO-ENDEMIC FOR MANSONELLA PERSTANS

Post-treatment reactions to single-dose ivermectin (200 µg/kg) and albendazole (400 mg) were studied in a filarial endemic region of Mali. The prevalence of Wuchereria bancrofti in this region was 48.3% (69 of 143), and coinfection with Mansonella perstans was common (30 of 40, 75%). Microfilarial levels of M. perstans correlated positively with age (P = 0.006) and with W. bancrofti microfilarial levels (P = 0.006). Forty individuals (28 infected and 12 uninfected) were treated, with mild post-treatment reactions occurring in 35.7% (7 of 28) of the W. bancrofti-infected subjects. Reaction severity correlated with pretreatment W. bancrofti microfilarial levels (P = 0.001). There were no significant differences in the prevalence or severity of post-treatment reactions in those who were co-infected with M. perstans. It is concluded that co-infection with M. perstans does not significantly alter the post-treatment reaction profile to single-dose ivermectin/albendazole in W. bancrofti infection in this community, and that acute post-treatment reactions should not limit patient compliance in community-based programs to eliminate lymphatic filariasis.

Received April 3, 2003. Accepted for publication July 1, 2003.

Acknowledgments: We are grateful to the faculty and staff of the Malaria Research and Training Center of the National Institute of Allergy and Infectious Diseases and the University of Mali School of Medicine, Pharmacy, and Dentistry who made available to us laboratory facilities and logistical support. We are also grateful to Dr. Sidibé, Chief Medical Officer in Kolokani, and the health care teams of Kolokani and Massantola for their participation in the study. Most importantly, we thank of the residents and leaders of Sabougou, especially the study participants, for their cooperation.

Financial support: This study was supported by the Malaria Research and Training Center of the National Institutes of Allergy and Infectious Disease (Bamako, Mali).

Authors’ addresses: Paul B. Keiser, Roshanak T. Semnani, Amy D. Klion, and Thomas B. Nutman, Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Building 4, Room B1-03, Bethesda, MD, 20892-0425. Yaya I. Coulibaly, Falaye Keita, Djakiridia Traore, Abdallah Diallo, Dapa A. Diallo, Ogobara K. Doumbo, and Sekou F. Traore, Faculty of Medicine, Pharmacy, and Dentistry, BP 1805 Bamako, Mali, Fax: 223-224-987.

Reprint requests: Thomas B. Nutman, Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Building 4, Room B1-03, Bethesda, MD, 20892-0425, Telephone: 301-496-5398, Fax: 301-496-5398, E-mail: tnutman{at}niaid.nih.gov.

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