Bryceson A D, Warrell D A, Pope H M
Br Med J. 1977 Mar 19;1(6063):742-4. doi: 10.1136/bmj.1.6063.742.
Nine Nigerians with severe onchocerciasis who were treated with diethylcarbamazine developed clinical changes, ranging in severity from mild itching to distress, cough, and syncope. Physiological changes (fever, tachypnoea, tachycardia, or hypotension) were seen in eight. In five patients the systolic blood pressure fell by more than 25 mm Hg, and one patient collapsed on attempting to sit up. Circulating eosinophils decreased profoundly in all cases, reaching their lowest levels just before or during the clinical and physiological changes. A fall in serum complement (c3) accompanied the reaction but there was no fall in antibody titre. Diethylcarbamazine probably acts on the parasite's cuticle, thus exposing it to the body's defence mechansims. The reaction coincides with the death of microfilariae, and the accompanying physiological changes may be so severe, even in generally healthy patients, the treatment should perferably be started in hospital.
9名患有严重盘尾丝虫病的尼日利亚人接受了乙胺嗪治疗后出现了临床变化，严重程度从轻度瘙痒到不适、咳嗽和晕厥不等。8人出现了生理变化（发热、呼吸急促、心动过速或低血压）。5名患者的收缩压下降超过25毫米汞柱，1名患者试图坐起时晕倒。所有病例中循环嗜酸性粒细胞均显著减少，在临床和生理变化之前或期间降至最低水平。反应伴有血清补体（c3）下降，但抗体滴度没有下降。乙胺嗪可能作用于寄生虫的角质层，从而使其暴露于人体的防御机制。该反应与微丝蚴死亡同时发生，即使在一般健康的患者中，伴随的生理变化也可能很严重，治疗最好在医院开始。
