Stingl P, Pierce P F, Connor D H, Gibson D W, Straessle T, Ross M A, Ribas J L
National Leprosy Training Centre, Wau, Southern Sudan.
Acta Trop. 1988 Mar;45(1):77-85.
The Mazzotti reaction is a frequent complication in patients with onchocerciasis being treated with diethylcarbamazine (DEC); and more severe manifestations of this reaction may be unacceptable in many patients. It has recently been demonstrated that prednisone modifies the severity of this reaction and reduces the microfilaricidal activity of DEC. A clinical trial was performed at the National Leprosy Training Center in Wau, Sudan, to evaluate the clinical and histologic effect of the use of corticosteroids in patients receiving DEC. Administration of a low dose of dexamethasone (3 mg/day), begun after onset of the Mazzotti reaction, modifies the progression of the Mazzotti reaction without interfering with the microfilaricidal efficacy of DEC. Pretreatment with low-dose dexamethasone--prior to beginning DEC therapy--prevents the development of the Mazzotti reaction and greatly reduces the microfilaricidal activity. Administration of diphenhydramine, after onset of the Mazzotti reaction, has no effect on the course and intensity of the Mazzotti reaction nor on microfilaricidal activity. We recommend that low-dose corticosteroids be administered in conjunction with DEC--after onset of the Mazzotti reaction--and that they be tapered rapidly.
马佐蒂反应是接受乙胺嗪（DEC）治疗的盘尾丝虫病患者常见的并发症；这种反应的更严重表现对许多患者来说可能是不可接受的。最近有研究表明，泼尼松可减轻该反应的严重程度，并降低DEC的杀微丝蚴活性。在苏丹瓦乌的国家麻风病培训中心进行了一项临床试验，以评估在接受DEC治疗的患者中使用皮质类固醇的临床和组织学效果。在马佐蒂反应开始后开始给予低剂量地塞米松（3毫克/天），可改变马佐蒂反应的进程，而不影响DEC的杀微丝蚴疗效。在开始DEC治疗前用低剂量地塞米松预处理可预防马佐蒂反应的发生，并大大降低杀微丝蚴活性。在马佐蒂反应开始后给予苯海拉明，对马佐蒂反应的进程和强度以及杀微丝蚴活性均无影响。我们建议在马佐蒂反应开始后，将低剂量皮质类固醇与DEC联合使用，并迅速减量。
