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

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  • 1 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.

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