Encephalopathy after Ivermectin Treatment in a Patient Infected with Loa Loa and Plasmodium spp

• Published in: The American journal of tropical medicine and hygiene Vol. 78; no. 4; pp. 546 - 551
• Main Authors: Kamgno, Joseph, Boussinesq, Michel, Labrousse, Francois, Nkegoum, Blaise, Thylefors, Bjorn I, Mackenzie, Charles D
• Format: Journal Article
• Language: English
• Published: United States ASTMH 01-04-2008
• Subjects: Animals; Antiparasitic Agents - adverse effects; Antiparasitic Agents - therapeutic use; Brain Diseases - chemically induced; Brain Diseases - pathology; Cameroon; Fatal Outcome; Humans; Ivermectin - adverse effects; Ivermectin - therapeutic use; Loa - growth & development; Loa - isolation & purification; Loiasis - complications; Loiasis - drug therapy; Malaria - complications; Malaria - drug therapy; Male; Middle Aged; Plasmodium; Plasmodium - growth & development; Plasmodium - isolation & purification; Cameroon
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.2008.78.546

Despite over 350 million people being safely treated with ivermectin, there have been rare cases of death post-treatment; these events are most often associated with high Loa loa microfilaremia. This first autopsy description of an encephalopathy case following the administration of ivermectin involves a 45-year-old male who became comatose 3 days after treatment. He slowly deteriorated over 5 weeks and died at 54 days after the anthelminthic treatment, probably as a result of a secondary skin or pulmonary infection exacerbated by malnutrition. The major pre- and post-autopsy findings included the presence of high loads of Loa loa, positivity for Plasmodium, the presence of a longstanding respiratory condition, and vascular pathology in the brain. The central nervous system lesions have similarities with those described in previously reported cases of Loa loa-associated death following diethylcarbamazine treatment.