Loa loa - Revision history

Ostermayer: /* Diethylcarbamazine (DEC) */

2022-04-03T12:13:12Z

Diethylcarbamazine (DEC)

← Older revision		Revision as of 12:13, 3 April 2022
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	===Eye worm removal===		===Eye worm removal===
	*Use local anesthesia to make small incision in conjunctiva to extract worm with forceps		*Use local anesthesia to make small incision in conjunctiva to extract worm with forceps
	===Diethylcarbamazine (DEC)===		===[[Diethylcarbamazine]] (DEC)===
	*'''First Line Treament'''		*'''First Line Treament'''
	*Only treatment that is definitively curative killing both larvae and adult worms		*Only treatment that is definitively curative killing both larvae and adult worms
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	**Give antihistamines or corticosteroids at the same time to reduce side effects		**Give antihistamines or corticosteroids at the same time to reduce side effects
	*Associated with severe encephalopathy if Loa Loa burden is high		*Associated with severe encephalopathy if Loa Loa burden is high

	===[[Ivermectin]] and [[Albendazole]]===		===[[Ivermectin]] and [[Albendazole]]===
	*'''Second Line Treament'''		*'''Second Line Treament'''

Ostermayer: /* Management */

2022-04-03T12:12:01Z

Management

← Older revision		Revision as of 12:12, 3 April 2022
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	==Management==		==Management==
	*Eye worm removal		===Eye worm removal===
	**Use local anesthesia to make small incision in conjunctiva to extract worm with forceps		*Use local anesthesia to make small incision in conjunctiva to extract worm with forceps
	*Diethylcarbamazine (DEC)		===Diethylcarbamazine (DEC)===
	**Only treatment that is definitively curative killing both larvae and adult worms		*'''First Line Treament'''
	**May need 2-3 courses of treatment		*Only treatment that is definitively curative killing both larvae and adult worms
	**First course should last 3-4 weeks		*May need 2-3 courses of treatment
	***Starting doses should be divided into BID or TID doses starting at 3-6mg/day and doubling daily until up to 400mg/day is reached		*First course should last 3-4 weeks
	***Side effects occur in >50% of people – pruritus, rashes, edema, headaches, fever, pleural effusion, laryngeal edema		**Starting doses should be divided into BID or TID doses starting at 3-6mg/day and doubling daily until up to 400mg/day is reached
	***Give antihistamines or corticosteroids at the same time to reduce side effects		**Side effects occur in >50% of people – pruritus, rashes, edema, headaches, fever, pleural effusion, laryngeal edema
	**Associated with severe encephalopathy if Loa Loa burden is high		**Give antihistamines or corticosteroids at the same time to reduce side effects
	*2nd line – [[Ivermectin]] or [[Albendazole]]		*Associated with severe encephalopathy if Loa Loa burden is high
	**Ivermectin kills only larvae so is not curative, may be more effective if given monthly		===[[Ivermectin]] and [[Albendazole]]===
	***Given as a single dose 150 ug/kg, then repeated every 1-3 months		*'''Second Line Treament'''
	**Albendazole kills only adult worms so is not curative, treatment is very slow, and may not be effective if high worm burden		*[[Ivermectin]] kills only larvae so is not curative, may be more effective if given monthly
	***Given as 200mg BID for 21 days		**Given as a single dose 150 ug/kg, then repeated every 1-3 months
	**Both treatments may be more effective as a therapy to decrease disease burden so that follow-up treatment with DEC is less likely to cause encephalopathy		*[[Albendazole]] kills only adult worms so is not curative, treatment is very slow, and may not be effective if high worm burden
			**Given as 200mg BID for 21 days
			*Both treatments may be more effective as a therapy to decrease disease burden so that follow-up treatment with DEC is less likely to cause encephalopathy

	==Complications==		==Complications==

Rossdonaldson1: /* Clinical Features */

2020-12-12T12:48:35Z

Clinical Features

← Older revision		Revision as of 12:48, 12 December 2020
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	==Clinical Features==		==Clinical Features==
	[[File:PMC3029165 tropmed-84-183-g001.png\|thumb\|Subconjunctival Loa loa worm.]]		[[File:PMC3029165 tropmed-84-183-g001.png\|thumb\|Subconjunctival Loa loa worm.]]
			[[File:PMC2699795 co-2-965f1.png\|thumb\|Intraocular adult Loa loa worm.]]
	*Usually asymptomatic		*Usually asymptomatic
	**Symptoms can begin within 2 months of exposure		**Symptoms can begin within 2 months of exposure

Rossdonaldson1: /* Clinical Features */

2020-12-12T12:47:01Z

Clinical Features

← Older revision		Revision as of 12:47, 12 December 2020
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	==Clinical Features==		==Clinical Features==
			[[File:PMC3029165 tropmed-84-183-g001.png\|thumb\|Subconjunctival Loa loa worm.]]
	*Usually asymptomatic		*Usually asymptomatic
	**Symptoms can begin within 2 months of exposure		**Symptoms can begin within 2 months of exposure

Rossdonaldson1: /* Background */

2020-12-12T12:42:39Z

Background

← Older revision		Revision as of 12:42, 12 December 2020
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	==Background==		==Background==
			[[File:L loa LifeCycle.gif\|thumb\|''Loa loa'' life cycle.]]
	*Also known as “African Eye Worm”		*Also known as “African Eye Worm”
	*Generally thought to be a harmless infection<ref>Metzer, WG, Mordmuller, B. “Loa Loa – does it deserve to be neglected?” Lancet Infect Dis. 2014 Apr; 14 (4):353-7. Epub 2013 Dec 12.</ref>		*Generally thought to be a harmless infection<ref>Metzer, WG, Mordmuller, B. “Loa Loa – does it deserve to be neglected?” Lancet Infect Dis. 2014 Apr; 14 (4):353-7. Epub 2013 Dec 12.</ref>

Adriack: /* Epidemiology */

2017-09-06T19:05:12Z

Epidemiology

← Older revision		Revision as of 19:05, 6 September 2017
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	*Majority of cases in western and central Africa		*Majority of cases in western and central Africa
	**Countries with the highest disease burden: Angola, Benin, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Nigeria, Republic of Congo, Sudan		**Countries with the highest disease burden: Angola, Benin, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Nigeria, Republic of Congo, Sudan
			*Low risk to short-term travelers, but should be suspected among immigrants, refugees, visiting nationals, expatriates living more than several months in endemic areas

	===Risk Factors===		===Risk Factors===

Mholtz at 02:44, 25 December 2016

2016-12-25T02:44:40Z

← Older revision		Revision as of 02:44, 25 December 2016
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	**Aphasia, incontinence, extrapyramidal signs		**Aphasia, incontinence, extrapyramidal signs
	**Generally fatal or resulting in severe morbidity		**Generally fatal or resulting in severe morbidity

			==Disposition==
			*Discharge

	==See Also==		==See Also==
	*[[Parasitic ~~Diseases~~]]		*[[Parasitic diseases]]
	*[[Travel ~~Medicine~~]]		*[[Travel medicine]]

	==References==		==References==

ClaireLewis: /* Management */

2016-12-24T17:44:13Z

Management

← Older revision		Revision as of 17:44, 24 December 2016
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	***Give antihistamines or corticosteroids at the same time to reduce side effects		***Give antihistamines or corticosteroids at the same time to reduce side effects
	**Associated with severe encephalopathy if Loa Loa burden is high		**Associated with severe encephalopathy if Loa Loa burden is high
	*2nd line – Ivermectin or Albendazole		*2nd line – [[Ivermectin]] or [[Albendazole]]
	**Ivermectin kills only larvae so is not curative, may be more effective if given monthly		**Ivermectin kills only larvae so is not curative, may be more effective if given monthly
	***Given as a single dose 150 ug/kg, then repeated every 1-3 months		***Given as a single dose 150 ug/kg, then repeated every 1-3 months

ClaireLewis: /* Clinical Features */

2016-10-05T05:14:48Z

Clinical Features

← Older revision		Revision as of 05:14, 5 October 2016
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	*Infection is generally noticed when the patient sees a white worm migrating through the subconjuctiva or sclera of their eye		*Infection is generally noticed when the patient sees a white worm migrating through the subconjuctiva or sclera of their eye
	*Calabar swellings – pruritic transient swellings in the subcutaneous tissues as the worm migrates through, usually on the limbs, especially forearms, and near joints		*Calabar swellings – pruritic transient swellings in the subcutaneous tissues as the worm migrates through, usually on the limbs, especially forearms, and near joints
	*[[Pruritus]], [[~~arthralgias~~]] or myalgias, [[headache]]		*[[Pruritus]], [[arthralgia]] or myalgias, [[headache]]
	*Can cause severe disease rarely		*Can cause severe disease rarely
	**Encephalopathy, endomyocardial fibrosis, pulmonary infiltrates, renal failure		**Encephalopathy, endomyocardial fibrosis, pulmonary infiltrates, renal failure

ClaireLewis: /* Clinical Features */

2016-10-05T05:13:57Z

Clinical Features

← Older revision		Revision as of 05:13, 5 October 2016
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	*Infection is generally noticed when the patient sees a white worm migrating through the subconjuctiva or sclera of their eye		*Infection is generally noticed when the patient sees a white worm migrating through the subconjuctiva or sclera of their eye
	*Calabar swellings – pruritic transient swellings in the subcutaneous tissues as the worm migrates through, usually on the limbs, especially forearms, and near joints		*Calabar swellings – pruritic transient swellings in the subcutaneous tissues as the worm migrates through, usually on the limbs, especially forearms, and near joints
	*Pruritus, ~~joint~~ or ~~muscle pain~~, headache		*[[Pruritus]], [[arthralgias]] or myalgias, [[headache]]
	*Can cause severe disease rarely		*Can cause severe disease rarely
	**Encephalopathy, endomyocardial fibrosis, pulmonary infiltrates, renal failure		**Encephalopathy, endomyocardial fibrosis, pulmonary infiltrates, renal failure