Mazzotti reaction

During the last four decades, microfilaricidal diethylcarbamazine [46] and macrofilaricidal suramin [47,48] have been used for the treatment of filariasis however, iboth of these drugs possess unwanted side-effects such as mazzotti reaction, toxicity, etc. Suramin is highly active against the adult worm of 0. volvulus [47] in humans, but it is very toxic to the kidney, liver and bone marrow and has other side-effects similar to DEC. DEC in the treatment of onchocerciasis produces severe mazzotti reaction (an allergic response due to rapid death of microfilariae) along with other side-effects such as pruritus and anaphylactic shock. However, the mass treatment of lymphatic filariasis with DEC was successful due to a lower and milder incidence of these adverse... 

Ivermectin possesses a broad spectrum of antiparasitic activities [51] and is a 22,23-dihydro analogue of the macrocyclic lactone, avermectin B,. Ivermectin is highly effective against microfilariae of O. volvulus at very low doses (50-200/ig/kg) [52] and in comparison with DEC, induces only mild mazzotti reactions and other side-effects. Its effectiveness against D. viteae in M. natalenis [38] and D. immitis [53] is also documented. 

In onchocerciasis, severe reactions can occur in the initial stages of therapy, particularly since diethylcarbamazine only kills the microfilariae of Onchocerca volvulus (resulting in the release of toxins) and does not eradicate the infection. The Mazzotti reaction, a Herxheimer-like response, can be severe and even fatal it comprises a pruritic papular dermatitis, urticaria, fever, malaise, and postural hypotension asthma and respiratory distress can occur and the hypotension can be associated with irreversible collapse. There can be painful lymphadenopathy. 

A role for the release of Wolbachia bacterial endosym-bionts has been suggested in the pathogenesis of the Mazzotti reaction (SEDA-26, 345). There was a good correlation between Wolbachia DNA, serum TNF-alfa, and the antibacterial peptides calprotectin and calgranu-lin after treatment with ivermectin or diethylcarbamazine, supporting a role for Wolbachia products in mediating these inflammatory responses (27). 

Metrifonate (18) is an effective drug for onchocerciasis and schistosomiasis. At an oral dose of 10 mg/kg given for 6 days, the drug exhibits high activity against the microfilariae and some action on the adult worms of O. volvulus in humans [85,86]. A lower dose of 7.5 mg/kg given at 3-week intervals has been found to kill the microfilariae of O. volvulus in patients [87]. The major side effects of metrifonate are vomiting, diarrhea and the Mazzotti reaction [86]. 

Francis, H., Awadzi, K., and Ottesen, E. A. (1985). The Mazzotti reaction following treatment of onchocerciasis with diethylcarbamazine Clinical severity as a function of infection intensity. Am. J. Trop. Med. Hyg. 34, 529-536. 

Contrast diethylcarbamate and ivermectin with respect to the Mazzotti reaction. 

Ivermectin does not cause this phenomenon. This is in direct contrast to diethylcarbamate, which has the potential for a strong Mazzotti reaction. 

Toxicity Adverse effects include headache, malaise, weakness, and anorexia. Reactions to proteins released by dying filariae include fever, rashes, ocular damage, joint and muscle pain, and lymphangitis. In onchocerciasis, the Mazzotti reaction includes most of these symptoms as well as hypotension, pyrexia, respiratory distress, and prostration. 

Toxicity Single-dose oral treatment in onchocerciasis results in Mazzotti reactions that include fever, headache, dizziness, rashes, pruritus, tachycardia, hypotension, and pain in joints, muscles, and lymph glands. These symptoms are usually of short duration, and most can be controlled with antihistamines and nonsteroidal anti-inflammatory drags. 

A nonindigenous individual who develops onchoeereiasis in an endemic region would normally be treated with ivermeetin and is likely to experienee the Mazzotti reaction. Which one of the following statements eoneerning this reaction is LEAST accurate ... 

A) The Mazzotti reaction is more intense in expatriate adults than indigenous adults... 

The Mazzotti reaction is due to the killing action of ivermectin on microfilariae and its intensity correlates with skin microfilaria load. It occurs more frequently and with greater severity in nonindigenous persons than in the indigenous inhabitants of endemic areas. The reaction will occur with any dmg capable of killing microfilariae, and it is not a dmg toxicity. The answer is (C). 

It causes the Mazzotti reaction, which is due to toxic products from dying worms It should be avoided in pregnancy It inhibits microtubule aggregation It has a high therapeutic index... 

In alkaline urine most of the diethylcarbamazine is non-ionised and is therefore easily reabsorbed in the kidney by simple diflusion through the lipid membrane. However, the conclusion was reached that in practice there is no advantage in making the urine alkaline in order to be able to use smaller doses of diethylcarbamazine because the severity of the adverse reactions (the Mazzotti reaction) is not reduced, and the microfilarial counts at the end of a month are not significantly different. ... 

Antihelminthic drugs Mazzotti reaction, 31.507 pharmacovigilance in developing countries, 32.571... 

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