Table 3 Major clinical characteristics of patients with loa-associated adverse reaction syndrome – "loa encephalopathy" *

PRESENT:

• Comatose condition with 4 days of treatment with ivermectin

• Microfilariae blood levels > 8000 Mf/ml

• Resident in an onchocerciasis meso- or hyper-endemic area

• Early fever

• Developing neurological symptoms and signs

• Gradual worsening (to coma) (basal ganglia)

• Retinal or conjunctival hemorrhages +/-

• Renal damage +/-

• Drop in Mf load

• Movement of Mf into CSF and urine (extra vascular)

OUTCOMES

• Coma – encephalopathy

• Death

• Secondary infections (poor nursing)

• Hypoglycaemia

• Persistent fever, sepsis

• Dehydration

• Abdominal pain

• Urinary complications

OTHER SIGNIFICANT OBSERVATIONS:

• No dermal reactions

• No acute Mazzotti reactions

• No allergic phenomenon (obvious non-parasitic, lung wheezing etc.)

• No cardiac complications

• No hepatic involvement (?)

• No bleeding

• No cerebral edema

• No fundal edema

• No convulsions