Encephalopathy after Ivermectin Treatment in a Patient Infected with Loa Loa and Plasmodium spp.

Joseph Kamgno National Onchocerciasis Task Force, Yaounde, Cameroon; Unité de Recherche 24, Institut de Recherche pour le Développement, Paris, France; Service d’Anatomie Pathologique, Hôpital Universitaire Dupuytren, Limoges, France; Centre Hospitalier Universitaire, Yaounde, Cameroon; Mectizan Donation Program, Atlanta, Georgia; Filarial Diseases Unit, Michigan State University, East Lansing, Michigan

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Michel Boussinesq National Onchocerciasis Task Force, Yaounde, Cameroon; Unité de Recherche 24, Institut de Recherche pour le Développement, Paris, France; Service d’Anatomie Pathologique, Hôpital Universitaire Dupuytren, Limoges, France; Centre Hospitalier Universitaire, Yaounde, Cameroon; Mectizan Donation Program, Atlanta, Georgia; Filarial Diseases Unit, Michigan State University, East Lansing, Michigan

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François Labrousse National Onchocerciasis Task Force, Yaounde, Cameroon; Unité de Recherche 24, Institut de Recherche pour le Développement, Paris, France; Service d’Anatomie Pathologique, Hôpital Universitaire Dupuytren, Limoges, France; Centre Hospitalier Universitaire, Yaounde, Cameroon; Mectizan Donation Program, Atlanta, Georgia; Filarial Diseases Unit, Michigan State University, East Lansing, Michigan

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Blaise Nkegoum National Onchocerciasis Task Force, Yaounde, Cameroon; Unité de Recherche 24, Institut de Recherche pour le Développement, Paris, France; Service d’Anatomie Pathologique, Hôpital Universitaire Dupuytren, Limoges, France; Centre Hospitalier Universitaire, Yaounde, Cameroon; Mectizan Donation Program, Atlanta, Georgia; Filarial Diseases Unit, Michigan State University, East Lansing, Michigan

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Björn I. Thylefors National Onchocerciasis Task Force, Yaounde, Cameroon; Unité de Recherche 24, Institut de Recherche pour le Développement, Paris, France; Service d’Anatomie Pathologique, Hôpital Universitaire Dupuytren, Limoges, France; Centre Hospitalier Universitaire, Yaounde, Cameroon; Mectizan Donation Program, Atlanta, Georgia; Filarial Diseases Unit, Michigan State University, East Lansing, Michigan

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Charles D. Mackenzie National Onchocerciasis Task Force, Yaounde, Cameroon; Unité de Recherche 24, Institut de Recherche pour le Développement, Paris, France; Service d’Anatomie Pathologique, Hôpital Universitaire Dupuytren, Limoges, France; Centre Hospitalier Universitaire, Yaounde, Cameroon; Mectizan Donation Program, Atlanta, Georgia; Filarial Diseases Unit, Michigan State University, East Lansing, Michigan

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Despite over 350 million people being safely treated with ivermectin, there have been rare cases of death post-treatment; these events are most often associated with high Loa loa microfilaremia. This first autopsy description of an encephalopathy case following the administration of ivermectin involves a 45-year-old male who became comatose 3 days after treatment. He slowly deteriorated over 5 weeks and died at 54 days after the anthelminthic treatment, probably as a result of a secondary skin or pulmonary infection exacerbated by malnutrition. The major pre- and post-autopsy findings included the presence of high loads of Loa loa, positivity for Plasmodium, the presence of a longstanding respiratory condition, and vascular pathology in the brain. The central nervous system lesions have similarities with those described in previously reported cases of Loa loa-associated death following diethylcarbamazine treatment.

Author Notes

  • 1

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    Gardon J, Gardon-Wendel N, Demanga-Ngangue, Kamgno J, Chippaux JP, Boussinesq M, 1997. Serious reactions after mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet 350 :18–22.

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    Boussinesq M, Gardon J, Gardon-Wendel N, Chippaux JP, 2003. Clinical picture, epidemiology and outcome of Loa-associated serious adverse events related to mass ivermectin treatment of onchocerciasis in Cameroon. Filaria J 2 (Suppl 1):S4.

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    Haselow NJ, Akame J, Evini C, Akongo S, 2003. Programmatic and communication issues in relation to serious adverse events following ivermectin treatment in areas co-endemic for onchocerciasis and loiasis. Filaria J 2 (Suppl 1):S10.

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    Mackenzie CD, Geary TG, Gerlach JA, 2003. Possible pathogenic pathways in the adverse clinical events seen following ivermectin administration to onchocerciasis patients. Filaria J 2 (Suppl 1):S5.

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    Fobi G, Gardon J, Santiago M, Ngangue D, Gardon-Wendel N, Boussinesq M, 2000. Ocular findings after ivermectin treatment of patients with high Loa loa microfilaremia. Ophthalmic Epidemiol 7 :27–39.

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