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Ocular and systemic complications of diethylcarbamazine therapy for onchocerciasis: association with circulating
Abstract:
Diethylcarbamazine (DEC) therapy for Onchocerca volvulus infection results in frequent ocular and systemic complications, but the pathogenesis of these complications is unclear. Twenty men with O. volvulus infection were treated over a period of six months with DEC given daily for one week and weekly thereafter. Major systemic and ocular complications included proteinuria, severe pruritus, visual field constriction, optic nerve pallor, chorioretinitis, anterior uveitis, and punctate keratitis. Levels of circulating immune complexes (CICs) were increased (greater than 11% [125I]C1q binding) in 14 of the 20 men prior to treatment. Persons with pretreatment C1q binding activity of greater than 30% were at increased risk to develop constriction of visual fields (P less than 0.05) and proteinuria (P less than 0.015). Linear regression analysis revealed a striking correlation between pretreatment levels of CICs and the total number of both systemic and ocular complications (P less than 0.001) and ocular complications alone (P less than 0.005). These results suggest that CICs may be important in the pathogenesis of the delayed systemic and ocular complications following DEC therapy for O. volvulus infection.
Insights
Diethylcarbamazine (DEC) treatment for Onchocerca volvulus infection can cause complications. Elevated circulating immune complexes (CICs) before treatment correlate with increased risk of severe systemic and ocular side effects.
Area of Science:
- Immunology
- Tropical Medicine
- Ophthalmology
Background:
- Diethylcarbamazine (DEC) is a primary treatment for Onchocerca volvulus infection.
- DEC therapy is associated with significant ocular and systemic complications.
- The underlying mechanisms driving these adverse reactions remain poorly understood.
Purpose of the Study:
- To investigate the role of circulating immune complexes (CICs) in the pathogenesis of DEC-induced complications.
- To identify potential biomarkers for predicting adverse reactions to DEC therapy.
Main Methods:
- A cohort of 20 men with Onchocerca volvulus infection was treated with DEC over six months.
- Pre-treatment levels of CICs were measured using [125I]C1q binding assay.
- Systemic and ocular complications were meticulously documented throughout the study period.
Main Results:
- Elevated CICs (greater than 11% [125I]C1q binding) were detected in 14 out of 20 participants prior to treatment.
- Higher pre-treatment CIC levels (greater than 30%) were significantly associated with an increased risk of visual field constriction and proteinuria.
- A strong positive correlation was observed between pre-treatment CIC levels and the number of both systemic and ocular complications.
Conclusions:
- Circulating immune complexes (CICs) appear to play a crucial role in the development of delayed systemic and ocular complications following DEC therapy.
- Measuring pre-treatment CIC levels may help identify patients at higher risk for adverse events, enabling personalized treatment strategies.