Ivermectin treatment of hyperreactive onchodermatitis (sowda) in Liberia
Darge, K.; Büttner, D.W.
Tropical Medicine and Parasitology Official Organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft für Technische Zusammenarbeit 46(4): 206-212
1995
ISSN/ISBN: 0177-2392 PMID: 8826099 Document Number: 448932
Seventeen male and 39 female Liberian patients, one third of them children, who were diagnosed as having hyperreactive onchodermatitis (sowda) presented with itching (98%), asymmetric (98%), chronic onchodermatitis (median 5 years) and swelling of femoral lymph nodes (89%). The geometric means of microfilaria (mff) densities were 1.0 mff/mg in children and 0.7 mff/mg in adults. The patients suffered from severe itching resulting in disturbance of sleep and they were socially ostracized. Ivermectin was administered as a single oral dose of 150 micro g/kg. The following adverse effects were observed in 30 patients within the first 72 h after ivermectin treatment: increase of pruritus (93%), aggravation of dermatitis (73%), fever (25%), headache (20%), myalgia (20%), painful swelling of lymph nodes (13%) and severe swelling of an arm or leg (10%). Symptomatic therapy was sufficient and no dangerous or life-threatening side effects were observed. At follow-up 1-2 months after ivermectin treatment, the prevalence of mff carriers had decreased from 100 to 19%. Seventeen of 18 patients felt their dermatitis had improved. Evaluation of the dermatitis by a physician using a score from 0 (no dermatitis) to 9 (severe dermatitis) revealed a reduction of the score from 4.3 before treatment to 0.7 after ivermectin treatment. In contrary, at the follow-up examination of 16 patients 6-12 months after ivermectin treatment, some recrudescences were observed. In this group the prevalence of mff carriers was 47%, 13 of the 16 patients felt that their skin lesions had improved and the score had decreased from 2.2 to 0.5. Consequently, ivermectin treatment every 3-4 months is recommended for patients with hyperreactive onchodermatitis.