China
Africa
Explore chapters and articles related to this topic
The Host Immune Response Against Parasitic Helminth Infection
Published in Peter D. Walzer, Robert M. Genta, Parasitic Infections in the Compromised Host, 2020
While most of the evidence for eosinophil cytotoxicity is based on in vitro experimentation, evidence that this occurs in vivo has been accumulating. First, eosinophils from immune animals have been shown to confer a high degree of resistance to Schistosoma mansoni when adoptively transferred to naive animals (105). Second, in studies involving humans undergoing the Mazzotti reaction (onchocerciasis), there was clear-cut evidence of eosinophil attachment to and eosinophil-mediated degradation of the dying filarial parasite in biopsy material (106).
Eosinophil-Active Cytokines in Human Disease: Development and Use of Monoclonal Antibodies to IL-3, IL-5, and GM-CSF
Published in Gerald J. Gleich, A. Barry Kay, Eosinophils in Allergy and Inflammation, 2019
John S. Abrams, Jon E. Silver, Robert E. Van Dyke, Gerald J. Gleich
Eosinophilia has been commonly reported following treatment of infections with Schistosoma mansoni and most of the filariae, including Wuchereria bancrofti, Onchocerca volvulus, Loa loa, and Mansonella ozzardi. We examined both the posttreatment eosinophilic response (known as the Mazzotti reaction) in a group of microfilaria-positive patients with onchocerciasis (n = 10) before and after treatment with diethylcarbamazine and the serum levels of eosinophil-active cytokines measured in serial samples obtained at various times following treatment (43). Serum levels of IL-5 rose sharply from pretreatment levels to a peak (70.5 ± 11 pg/ml) by 24 h after treatment. They remained elevated over the next 2–3 days, and declined toward baseline approximately 6 days after treatment, at which time the eosinophil levels were steadily increasing. The rise in serum IL-5 prior to the posttreatment eosinophilia seen in this group of patients indicates a temporal relationship between IL-5 and the subsequent development of eosinophilia. The other cytokines examined, IL-3 and GM-CSF, were not detectable in the serum at any time before or after treatment. The mechanism by which IL-5 is selectively induced to levels high enough to be detected in the serum by immunoassay is not clear. It may be a function of antigenic presentation to T cells of dead and dying parasite antigens, which are somehow seen by the immune system de novo and skew the cytokine response toward high IL-5.
Diethylcarbamazine
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Sarah Coghill, Steve McGloughlin, James McCarthy
DEC is rapidly effective against microfilariae of Onchocerca volvulus, but has very limited activity against adult worms (Awadzi and Gilles, 1980). However, the drug is contraindicated because of the risk of significant adverse reactions, termed the Mazzotti reaction (see below under 7, Clinical uses of the drug).
Moxidectin: an oral treatment for human onchocerciasis
Published in Expert Review of Anti-infective Therapy, 2020
Philip Milton, Jonathan I. D. Hamley, Martin Walker, María-Gloria Basáñez
In the treatment of onchocerciasis patients, moxidectin results in the same risk management profile as ivermectin. The incidence and severity of AEs were similar between moxidectin and ivermectin. Rapid microfilarial death in infected patients can result in AEs, including pruritus, rash, tachycardia, and orthostatic hypotension as part of the so-called Mazzotti reactions (complex, acute inflammatory responses mounted by the immune system after administration of microfilaricides). Both phase II and phase III clinical trials monitored basic vital signs as well as monitoring of AEs and SAEs including Mazzotti reactions. Nearly all patients in either treatment arm in both phase II and III trials had some form of Mazzotti reaction but events were transient and self-limiting. Nearly all non-Mazzotti AEs and all SAEs were unrelated to the drug administration. Treatment groups with higher microfilarial loads were more likely to suffer reactions [16,17], unsurprising given that Mazzotti reactions are correlated with skin microfilarial density [71]. In the phase II trial, the 8 mg moxidectin group showed a statistically significant (p < 0.05) increase in the occurrence of rash and pruritus, as well as increased pulse rate and hypotension compared to ivermectin. There was no significant difference between ivermectin and moxidectin 2 mg, although 4 mg showed a significant increase in hypotension compared to ivermectin. In the much larger phase III trial, the frequency, nature, and severity of Mazzotti reactions were very similar between ivermectin and 8 mg moxidectin. Moxidectin significantly increased (Onchocerciasis Chemotherapy Research Centre grade 4) Mazzotti reactions (p < 0.01), primarily attributed to increased rates of hypotension. No patient in either trial required major clinical intervention for a Mazzotti reaction. In the phase II trial, all rashes resolved without intervention with only one severely infected participant treated with 2 mg moxidectin requiring chlorpheniramine to relieve pruritus symptoms. Hypotension, in both phase II and III trials, required no treatment beyond lying down for a few minutes.