Adverse reactions following diethylcarbamazine (DEC) intake in ‘endemic normals’, microfilaraemics and elephantiasis patients

Abstract

This paper reports on adverse reactions following a 12-day course of 6 mg/kg diethylcarbamazine (DEC) therapy in brugian filariasis patients in Indonesia. Microfilaria-positive individuals ( n = 26), ‘endemic normals’ ( n = 12) and elephantiasis patients ( n = 17) were included in the study. Fever, headache and body aches started between 2 and 24 h after DEC intake. Adverse reactions were categorized into ‘no or mild’, ‘moderate’ or ‘severe’ depending on the total reaction score. Four microfilaraemic individuals (15·4%) suffered from severe adverse reactions and their pre-treatment microfilarial levels (geometric mean, GM = 3060 mf/10 mL) were significantly higher than in the 5 microfilaraemic individuals (19·2%) suffering from moderate reactions (GM = 1268 mf/10 mL) and in the 17 microfilaraemic patients (65·4%) who experienced no or mild reactions (GM = 6 mf/10 mL)( P < 0·001 and P < 0·001, respectively). Endemic normals showed no or mild adverse reactions. No or mild adverse reactions were also recorded in all but 2 elephantiasis patients after DEC intake. Two elephantiasis patients with moderate reactions had high levels of circulating microfilariae at pre-treatment (2097 and 7375 mf/10 mL). Concentrations of DEC were measured in plasma, but could not explain the differences in the severity of adverse reactions.