Saito Makoto, Armstrong Margaret, Boadi Samuel, Lowe Patricia, Chiodini Peter L, Doherty Tom
Hospital for Tropical Diseases, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom
Hospital for Tropical Diseases, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom.
Am J Trop Med Hyg. 2015 Sep;93(3):607-11. doi: 10.4269/ajtmh.15-0214. Epub 2015 Jun 22.
We retrospectively analyzed the background, clinical features, and treatment response of 50 cases of imported loiasis who presented between 2000 and 2014 to the Hospital for Tropical Diseases (HTD), London, United Kingdom. Of them, 29 were migrants from, and 21 were visitors to, countries where the disease is endemic. Clinical features differed between these groups. Migrants experienced fewer Calabar swellings (odds ratio [OR] = 0.12), more eye worm (OR = 3.4), more microfilaremia (OR = 3.5), lower filarial antibody levels, and lower eosinophil counts (P < 0.05 for all tests). Among 46 patients who were started on treatment at HTD, 33 (72%) received diethylcarbamazine (DEC) monotherapy as first-line treatment, and among 26 patients who were followed up after treatment, seven (27%) needed a second course of treatment. There were 46 courses of treatment with DEC, and 20 (43%) of them had reactions. All patients with microfilaremia > 3,000 microfilariae/mL and all those with an elevated C-reactive protein (CRP) (≥ 5 mg/L) before treatment had reactions (P = 0.10 and P = 0.01, respectively). These data suggest that monotherapy with DEC may not be the optimal treatment for patients with loiasis, particularly for those with a high microfilarial load.
我们回顾性分析了2000年至2014年间就诊于英国伦敦热带病医院（HTD）的50例输入性罗阿丝虫病患者的背景、临床特征及治疗反应。其中，29例为来自该病流行国家的移民，21例为来自该病流行国家的访客。这些群体的临床特征有所不同。移民经历的卡拉巴肿较少（优势比[OR]=0.12），眼虫感染较多（OR=3.4），微丝蚴血症较多（OR=3.5），丝虫抗体水平较低，嗜酸性粒细胞计数较低（所有检测P<0.05）。在HTD开始治疗的46例患者中，33例（72%）接受乙胺嗪（DEC）单药治疗作为一线治疗，在治疗后接受随访的26例患者中，7例（27%）需要第二个疗程的治疗。共有46个DEC疗程，其中20个（43%）出现反应。所有微丝蚴血症>3000条/毫升的患者以及所有治疗前C反应蛋白（CRP）升高（≥5毫克/升）的患者均出现反应（分别为P=0.10和P=0.01）。这些数据表明，DEC单药治疗可能不是罗阿丝虫病患者的最佳治疗方法，特别是对于微丝蚴负荷高的患者。
