Loa loa Encephalopathy Following Treatment With Benzimidazole Derivatives: A Systematic Review

Loiasis, a filarial vector-borne disease, is common in rural West and Central Africa. Benzimidazole derivatives albendazole and mebendazole are recommended as alternative treatments due to their perceived safety in hypermicrofilaremic patients. There is growing evidence that benzimidazoles might also lead to Loa loa-associated encephalopathy. In this systematic review we analyzed all available evidence of benzimidazole-associated encephalopathy. Literature was systematically searched in PubMed, Google Scholar, and WHO-VigiBase®, including conference abstracts and consultation of experts. Six potential cases of benzimidazole-associated encephalopathy, including 2 fatalities, were identified among microfilaremic loiasis patients. Due to the limited global use of prolonged benzimidazole regimens for loiasis, the number of encephalopathy cases identified raises significant safety concerns, challenging the rationale of their use. Further research on mechanisms and safer alternative regimens is urgently needed.