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Table 2 The major components associated with microfilarial destruction.

From: Possible pathogenic pathways in the adverse clinical events seen following ivermectin administration to onchocerciasis patients.

NATURAL SITUATIONS

 

DERMAL RESPONSES

  

Clinical

    

Pruritus

    

Self-destruction of the skin (mechanical)

    

Development of dermal microabscesses

  

Histopathological

    

Vascular endothelial activation

    

Mast cell increase

    

Blood and tissue eosinophilia

    

Eosinophil adherence to the surface of the microfilariae

    

Macrophage accumulation

    

Fragmentation of microfilariae

    

Local tissue damage (destruction of collagen, etc.)

 

SYSTEMIC EFFECTS

  

Antigen release

  

Organ dysfunction

  

Cytokine circulation

DRUG INDUCED SITUATIONS (additional activities):

 

GENERAL (in addition to those activities in Natural Situations)

  

Clinical

    

Migration of microfilariae

    

Increased rate of Mf destruction,

    

More rapid and severe development of the events

    

Progressive movement of the papular response over different parts the body (with low dose DEC)

  

Histopathological

    

Macrophage ingestion of excess eosinophil-derived material

    

Evidence of immunostimulation