Histological evaluation of sodium percarbonate exposure on the gills of rainbow trout

Ichthyophthirius multifiliis is a recurring problem in Australian rainbow trout Oncorhynchus mykiss farms and requires strategically timed, repeat treatments for effective management. Sodium percarbonate (SPC) is permitted for use in Australia, with host safety margins based on the toxicity of acute exposures to hydrogen peroxide (HP), the active product released when SPC is added to water. The effects of exposure to HP released by SPC, of repeated doses and of doses exceeding 100 mg l-1 on rainbow trout are unknown. We exposed juvenile rainbow trout (mean weight: 30.5 ± 9 g) to repeated doses of 50, 150 and 250 mg l-1 SPC for 1 h on Days 1, 2, 7 and 8 of a treatment regime. The effect of SPC was assessed by histological evaluation of structural changes in gill tissue. Survival was 100% in all groups, but some fish exposed to 250 mg l-1 SPC displayed impaired swimming performance, and on Day 9 after the final treatment, oedema was present in 9.8% of lamella, which was significantly higher than the mean occurrence of 1.7, 4.2 and 1.3% in fish treated with 0, 50 and 150 mg l-1 SPC, respectively. These changes resolved within 24 h of the cessation of treatment. We conclude that SPC is safe to use on rainbow trout in doses of ≤150 mg l-1 at 17°C, however caution is advised at doses approaching 250 mg l-1. Water temperature, fish age, fish size and maturity, intensity of parasite infection and stocking density could alter the sensitivity of rainbow trout to SPC treatments.

Interactions between parasitic infections and reproductive efficiency in sheep

This review article summarises the many reports in the literature, confirming that, in sheep, parasitic infections can adversely affect reproductive efficiency; examples, which refer to all parts of the reproductive cycle of sheep, are as follows: trichostrongylosis in ewe-lambs (which can lead to delayed attainment of puberty), myiosis of the prepuce (which can cause impediment of mating), chorioptic mange or trypanosomosis in rams (which can lead to testicular degeneration or azoospermia, respectively), trypanosomosis or sarcoptic mange in pre-conceptual ewes (which can lead to poor conception rates or reduced number of ovulations, respectively), toxoplasmosis or neosporosis in pregnant ewes (which are causes of abortion), trichostrongylosis or trematode infections in lactating ewes (which can cause reduction of milk yield and can be a risk factor for mastitis, respectively), cryptosporidiosis in newborn lambs (which can be a cause of deaths), coccidiosis in growing pre-weaned lambs (which can cause suboptimal growth rate). In other cases, the reproductive status of the animal can influence the parasitic infection; examples are as follows: the increase in faecal parasitic output during the peri-parturient period (as a consequence of the peri-parturient relaxation of immunity), the heavier trichostrongylid infections of twin lambs compared to lambs from single parities (as a consequence of developmental origin issues in twin lambs). All the above examples support the idea of presence of interactions between parasitic infections and reproductive efficiency in sheep.

Review of the treatment of liver hydatid cysts

A review was carried out in Medline, LILACS and the Cochrane Library. Our database search strategy included the following terms: “hydatid cyst”, “liver”, “management”, “meta-analysis” and “randomized controlled trial”. No language limits were used in the literature search. The latest electronic search date was the 7^th of January 2014. Inclusion and exclusion criteria: all relevant studies on the assessment of therapeutic methods for hydatid cysts of the liver were considered for analysis. Information from editorials, letters to publishers, low quality review articles and studies done on animals were excluded from analysis. Additionally, well-structured abstracts from relevant articles were selected and accepted for analysis. Standardized forms were designed for data extraction; two investigators entered the data on patient demographics, methodology, recurrence of HC, mean cyst size and number of cysts per group. Four hundred and fourteen articles were identified using the previously described search strategy. After applying the inclusion and exclusion criteria detailed above, 57 articles were selected for final analysis: one meta-analysis, 9 randomized clinical trials, 5 non-randomized comparative prospective studies, 7 non-comparative prospective studies, and 34 retrospective studies (12 comparative and 22 non-comparative). Our results indicate that antihelminthic treatment alone is not the ideal treatment for liver hydatid cysts. More studies in the literature support the effectiveness of radical treatment compared with conservative treatment. Conservative surgery with omentoplasty is effective in preventing postoperative complications. A laparoscopic approach is safe in some situations. Percutaneous drainage with albendazole therapy is a safe and effective alternative treatment for hydatid cysts of the liver. Radical surgery with pre- and post-operative administration of albendazole is the best treatment option for liver hydatid cysts due to low recurrence and complication rates.

Focus on: human adverse events to companion animal spot-ons and sprays

Recently, the Veterinary Products Committee has taken great interest in the number of human adverse events reported following the use of companion animal products that are applied topically to prevent and treat parasite infestations. One particular question it has is whether the legal category of some of these products means that current point of sale advice is insufficient to influence pet owner behaviour in preventing these incidents. This article by the Veterinary Medicines Directorate (VMD) seeks to respond to these concerns, and to remind veterinary professionals of their responsibility to inform clients how to use the products supplied to them in a manner that is safe, not only for their pets, but also for themselves.

Repurposed automated handheld counter as a point-of-care tool to identify individuals 'at risk' of serious post-ivermectin encephalopathy

Introduction

Administration of ivermectin (IVM) as part of mass drug administration (MDA) campaigns for onchocerciasis and/or lymphatic filariasis (LF) has been suspended in areas co-endemic for Loa loa due to severe post-treatment adverse events (SAEs) associated with high-burden of infection (>30,000 mf/ml). One simple approach for preventing SAEs is to identify and exclude individuals at risk from MDA. Here, we describe a repurposed hand-held automated cell counter (Scepter 2.0; HHAC) as a rapid, point-of-care method for quantifying microfilariae (mf) in the blood of infected individuals.

Methodology/Principal Findings

The quantification of microfilarial levels in blood of naturally infected humans, experimentally infected baboons, or mf-spiked human blood was tested using a microfluidic-based automated counter and compared to traditional calibrated thick-smears. We demonstrate that mf can be quantified in 20 µl of whole blood following lysis with 10% saponin within a minute of obtaining blood. There was a highly significant concordance between the counts obtained by the HHAC and those by microscopy for mf densities of >5,000 (p<0.0001, r_c = 0.97) or >30,000 per ml (p<0.0001, r_c = 0.90). Preliminary proof of concept field studies in Cameroon with 20 µl of blood from L. loa infected humans (n = 22) and baboons (n = 4) also demonstrated a significantly high concordance (p<0.0001, r_c = 0.89) with calibrated thick blood smears counts.

Conclusions/Significance

A repurposed HHAC is a portable, sensitive, rapid, point-of-care and quantitative tool to identify individuals with high levels of L. loa mf that put them at risk for SAEs following MDA. In addition, it provides ease of data storage and accessibility.

Mass drug administration (MDA) efforts with ivermectin-based regimens for onchocerciasis and for lymphatic filariasis in Africa have been suspended in certain areas that are co-endemic for Loa loa infection. This is due to the serious adverse events (encephalopathy and death) that can develop following ivermectin administration in individuals with very high circulating levels of Loa loa microfilariae (mf) (>30,000 mf/ml). Currently thick-blood smears are performed to quantify the mf levels that are neither rapid nor high throughput. To develop a point of care (POC) strategy for rapid and high throughput mf quantification, a repurposed handheld automated counter (HHAC) was assessed and shown to be an efficient POC tool to identify individuals with very high Loa loa microfilaraemia in a manner sufficient to be used as part of a Test and (not) Treat (TNT) program in an effort to restart the suspended MDA programs while preventing severe adverse neurologic events.

Do antiparasitic medicines used in aquaculture pose a risk to the Norwegian aquatic environment?

Aquaculture production is an important industry in many countries and there has been a growth in the use of medicines to ensure the health and cost effectiveness of the industry. This study focused on the inputs of sea lice medication to the marine environment. Diflubenzuron, teflubenzuron, emamectin benzoate, cypermethrin, and deltamethrin were measured in water, sediment, and biota samples in the vicinity of five aquaculture locations along the Norwegian coast. Deltamethrin and cypermethrin were not detected above the limits of detection in any samples. Diflubenzuron, teflubenzuron, and emamectin benzoate were detected, and the data was compared the UK Environmental Quality Standards. The concentrations of emamectin benzoate detected in sediments exceed the environmental quality standard (EQS) on 5 occasions in this study. The EQS for teflubenzuron in sediment was exceeded in 67% of the samples and exceeded for diflubenzuron in 40% of the water samples collected. A crude assessment of the concentrations detected in the shrimp collected from one location and the levels at which chronic effects are seen in shrimp would suggest that there is a potential risk to shrimp. It would also be reasonable to extrapolate this to any species that undergoes moulting during its life cycle.

Efficacy of ivermectin and oxfendazole against Taenia solium cysticercosis and other parasitoses in naturally infected pigs

Smallholder semi-confined pig production is a fast growing practice in sub-Saharan Africa with an unfortunate outcome of high prevalence of Taenia solium cysticercosis and other parasitoses. The widely used anthelmintic for control of endo and ecto-parasites in pigs in the area is ivermectin at a recommended dose of 0.3mg/kg. This study was conducted to evaluate the efficacy and safety in pigs after subcutaneous injection of ivermectin (IVM, 0.3mg/kg) and orally administration of oxfendazole (OFZ, 30mg/kg) in treatment of porcine cysticercosis and other parasitoses in naturally infected pigs. A total of 61 pigs with T. solium cysticercosis (38 males and 23 females) as identified by tongue palpation with age ranging from 3 to 24 months were recruited. The pigs were stratified based on sex, age and number of cysts on the tongue and randomly allocated to IVM, OFZ and control groups. Three days before treatment and two weeks after treatment faecal samples and skin scrapings were taken to establish the burden of endo- and ectoparasites, respectively and the effect of the treatment. No adverse effect was observed in any of the treatment groups throughout the study period. Half of the pigs from each group were slaughtered at week four and the remaining half at week twelve post treatment. The IVM treatment group had no significant effect (p=0.224) on T. solium cysts viability in comparison to the control group. Significant effect on cysts viability was observed in the OFZ treated group (p<0.001) compared to IVM and control groups in all muscle tissues. Regarding to brain cysts, neither of the drugs was efficacious. Ivermectin and OFZ treatments significantly reduced (p<0.001) the faecal egg count of Ascaris suum, strongyles and Trichuris suis two weeks after treatment. At slaughter, Oesophagostomum dentatum, Ascarops strongylina and Physocephalus sexalatus were recovered from pigs in the IVM treated and in the control groups. Ivermectin was 100% effective in control of Sarcoptes scabiei. In conclusion, IVM at a single dose of 0.3mg/kg was efficacious against ectoparasites but did not effectively cure pigs from T. solium cysticercosis or nematodes. Oxfendazole, on the other hand, killed all nematodes and muscle cysts, but did not have any effect on ectoparasites. A combination of the two drugs would be a most useful treatment option for control of pig parasitoses in sub-Saharan Africa.

Antiparasitical chemotherapy in Chagas' disease cardiomyopathy: current evidence

Chronic chagasic cardiomyopathy affects 20% of Chagas' disease patients. At present, Chagas' disease chemotherapy uses nitrofurans, benznidazole (Rochagan®, Rodanil®, Roche) or nifurtimox (Lampit®, Bayer). Treatment during acute and recent chronic phases in childhood effects 71.5% and 57.6%, respectively, of parasitological cure. However, in clinical trials during the late chronic phase, only 5.9% of parasitological cure were achieved. This review focuses on the benefit from aetiological treatment to avoid, stop or revert myocarditis. Divergent data gathered from clinical practice are not convincing to support prescription of aetiological treatment as routine for indeterminate and cardiac chronic patients.

Treatment of Parkinson disease: a 64-year-old man with motor complications of advanced Parkinson disease

In early stages, Parkinson disease typically begins with asymmetric or unilateral motor symptoms due to combinations of mild bradykinesia, rigidity, and tremor. In most cases, with progression, signs of more generalized bradykinesia appear, which include facial masking, reduced voice volume, and slowing of activities of daily living. In more advanced Parkinson disease, other disabling manifestations may follow, such as impaired balance, gait freezing, falls, speech disturbance, and cognitive impairment. Levodopa is the most effective medical treatment for Parkinson disease. However, motor complications uniquely related to levodopa treatment may emerge that may be difficult to manage. These include fluctuating levodopa responses and involuntary movements and postures known as dyskinesia and dystonia. Medication adjustments are usually effective, but in some cases surgical intervention with deep brain stimulation becomes necessary to alleviate motor complications. The case of Mr L, a man with an 11-year history of Parkinson disease, illustrates these emerging motor complications and the manner in which they may be managed both medically and surgically.

Treatment of MDR1 mutant dogs with macrocyclic lactones

P-glycoprotein, encoded by the multidrug resistance gene MDR1, is an ATP-driven drug efflux pump which is highly expressed at the blood-brain barrier of vertebrates. Drug efflux of macrocyclic lactones by P-glycoprotein is highly relevant for the therapeutic safety of macrocyclic lactones, as thereby GABA-gated chloride channels, which are confined to the central nervous system in vertebrates, are protected from high drug concentrations that otherwise would induce neurological toxicity. A 4-bp deletion mutation exists in the MDR1 gene of many dog breeds such as the Collie and the Australian Shepherd, which results in the expression of a non-functional P-glycoprotein and is associated with multiple drug sensitivity. Accordingly, dogs with homozygous MDR1 mutation are in general prone to neurotoxicity by macrocyclic lactones due to their increased brain penetration. Nevertheless, treatment of these dogs with macrocyclic lactones does not inevitably result in neurological symptoms, since, the safety of treatment highly depends on the treatment indication, dosage, route of application, and the individual compound used as outlined in this review. Whereas all available macrocyclic lactones can safely be administered to MDR1 mutant dogs at doses usually used for heartworm prevention, these dogs will experience neurological toxicity following a high dose regimen which is common for mange treatment in dogs. Here, we review and discuss the neurotoxicological potential of different macrocyclic lactones as well as their treatment options in MDR1 mutant dogs.

Area-wide impact of macrocyclic lactone parasiticides in cattle dung

Following the treatment of cattle with veterinary parasiticides and insecticides, residues are excreted into the dung in concentrations that may be toxic to functionally important dung-colonizing insects. In the dung, these residues cause a range of well-studied lethal and sub-lethal effects, the magnitudes of which vary with the compound used, mode of administration and concentration, and the insect species in question. Particular concern has been associated with the use of macrocyclic lactones in this context. Loss of insect colonizers may delay pat decomposition, but field studies report contrasting results that reflect confounding factors such as weather conditions, pat moisture content, pat location, time of year and dung insect species phenologies. The question of fundamental concern is whether the impacts seen in experimental or laboratory studies are likely to have a functional impact on insect populations, community interactions and the economically important process of dung decomposition. Recent studies which have attempted to address these wider, landscape-level impacts in temperate ecosystems are reviewed here. These show that the extent to which chemical residues may have any sustained ecological impact will depend on both a range of farm management factors, such as the temporal and spatial patterns of chemical use, the number of animals treated and the choice of active ingredient, and a range of insect-related factors, such as abundance, population dynamics and dispersal rates. However, they also demonstrate that considerable uncertainty remains about the likely extent of such effects and that current data are insufficient to support firm conclusions regarding sustained pasture-level effects. More large-scale, longterm field experiments are required, particularly in relation to insect dispersal and functional interactions within the dung insect community.

Treatment of scabies using 8% and 10% topical sulfur ointment in different regimens of application

BACKGROUND

Many therapeutic modalities for scabies were available, topical sulfur ointment is a cost-effective and safe therapeutic agent. It is often applied for the whole body for three successive days.

OBJECTIVE

To evaluate their therapeutic regimen of 8% and 10% topical precipitated sulfur in petrolatum ointment for single day, three successive nights or three successive days in management of scabies.

PATIENTS AND METHODS

This single-blinded, comparative study was conducted in the Department of Dermatology-Baghdad Teaching Hospital from April 2008 through October 2009. A total of 97 patients with scabies were enrolled in this study. The diagnosis was established on clinical basis. The patients treated with 8% and 10% topical sulfur in petrolatum ointment were divided randomly into three groups: Group A: 33 patients treated for single day (24 hours); Group B: 32 patients treated for three successive nights (from 6 p.m. to 8 p.m. to 6 a.m. to 8 a.m. and bathing every day); and Group C: 32 patients treated for three successive days (bathing every 24 hours). The patients were seen regularly every two weeks for the duration of four weeks.

RESULTS

Study included 58 (59.8%) males and 39 (40.2%) females, with a male to female ratio 1.4:1. The age range of males at presentation from 3 to 64 (26.74±15.98) years, while the females age ranged at presentation from 3 to 60 (24.05±14.53) years of age. At the end of the study, the response to treatment was: Group A, response in 14 (42.4%) patients and no response in 19 (57.6%); Group B, response in 29 (90.6%) patients and no response in 3 (9.4%); and Group C, response in 31 (96.9%) patients and no response in 1 (3.1%). There is significant statistical difference among the response of 3 groups with (P=0.00000011), but no statistically significant difference between the response of Group C and Group B, (P=0.6055). Mild burning sensation and irritating (sulfur) dermatitis were the only side effects of 8% and 10% sulfur. Pruritic rash occurred in Group C mainly, in 11 (34.4%) patients, 8 (25%) in Group B and 4 (12.1%) in Group A, with no significance (P=0.1058). Recurrence or relapse occurred in Group A mainly, with 4 (12.1%) patients, and in Group B, 1 patient, (3.1%), with no recurrence in group C, with significance (P=0.0060).

CONCLUSION

Three successive days and three successive nights of 8% and 10% sulfur ointment were effective regimens with no statistical difference in favor of three successive days, while single-day application was much less effective but with fewer side effects.

Adverse drug reactions in patients admitted on internal medicine wards in a district and regional hospital in Uganda

INTRODUCTION

The burden of both community and hospital acquired adverse drug reactions (ADRs) are some of the important issues in pharmacotherapy. At the time of this study there was very scanty literature in this area from Africa.

OBJECTIVE

This study was done to determine the frequency and characteristics of ADRs in patients admitted on medical wards in public hospitals.

METHODS

This was a longitudinal observational study on 728 adult patients on medical wards in one regional and one district hospitals. Community and hospital acquired ADRs were assessed.

RESULTS

Thirty three patients (4.5%) were admitted with suspected ADR, and an ADR was the reason for hospitalization in 1.5%. Most ADRs were due to antiparasitic products, mainly quinine (61%). Community acquired ADRs prolonged hospital stay, 5.6 days vs 4.0 days (p-value < 0.001). During hospitalization ADRs occurred in 49.5% of the patients. Antiparasitic products, predominantly quinine, were the commonest drugs class associated with ADRs (85.9%). Hospital acquired ADRs did not affect hospital stay, 4.2 days vs 3.9 (p-value 0.129).

CONCLUSION

ADRs are an important cause of morbidity in patients, both in the community and in hospitals, and the majority are associated with the commonly used drugs.

Permethrin for scabies in children

QUESTION

I frequently see children with scabies in my practice. A variety of medications are available to treat scabies. Permethrin is one of the most common medications used. Is permethrin a safe and effective option for children?

ANSWER

Scabies is a common parasitic skin infection. It is highly prevalent in young children. Topical permethrin (5% cream) is a safe and effective scabicide in children. It is recommended as a first-line therapy for patients older than 2 months of age. Because there are theoretical concerns regarding percutaneous absorption of permethrin in infants younger than 2 months of age, guidelines recommend 7% sulfur preparation instead of permethrin.

Treatment and eradication of murine fur mites: I. Toxicologic evaluation of ivermectin-compounded feed

Fur mite outbreaks remain a persistent problem in laboratory mouse colonies. All currently published treatment methods are labor-intensive, expensive, or unreliable. During a recent outbreak with Myobia musculi and Myocoptes musculinus in a large colony (approximately 30,000 cages), we developed a feed-based treatment regime in which ivermectin was the active ingredient. Rodent feed was compounded with 3 different concentrations of ivermectin (12, 24, and 48 ppm) and γ-irradiated. Postcompounding analysis revealed loss of ivermectin during manufacturing, but the remaining drug was stable for at least 6 mo. In an 8-wk toxicity study in a C57BL/6NTac mouse breeding colony, ad-libitum feeding of the 3 diets yielded estimated doses of 1.3, 2.7, and 5.4 mg/kg. Adult mice lacked adverse clinical effects, except that 1 of the 144 mice in the 48-ppm group developed tremors and ataxia and was euthanized. No significant differences between doses were revealed by CBC, serum chemistry, body weight, or gross necropsy. Plasma drug concentrations plateaued at a dose-dependent level 7 to 10 d after initiation of treatment and decreased to undetectable levels 6 to 9 d after its discontinuation. Fertility of the P0 generation was unaffected. Pup mortality was higher in the 24- and 48-ppm groups, reaching 100% at the higher dose. Animals exposed to ivermectin as neonates had normal weaning weights, but mice receiving 24-ppm feed had lower adult weights. Our results indicate that using feed containing 12 ppm ivermectin (estimated ingested dose, 1.3 mg/kg) was safe in a C57BL/6NTac breeding colony.

Phytochemical and biological investigations of Elaeodendron schlechteranum

AIM OF THE STUDY

Elaeodendron schlechteranum (Loes.) Loes. is a shrub or tree belonging to the family Celastraceae. In Tanzania, in addition to ethnopharmacological claims in treating various non-infectious diseases, the root and stem bark powder is applied on septic wounds, and the leaf paste is used for treatment of boils and carbuncles. The aim of this study was to identify the putative active constituents of the plant.

MATERIALS AND METHODS

Dried and powdered root bark was extracted and subjected to bioassay-guided fractionation, based on antibacterial, antiparasitic and anti-HIV activity. Isolated compounds were identified by spectroscopic methods, and evaluated for biological activity.

RESULTS AND CONCLUSIONS

Bioassay-guided isolation led to the identification of tingenin B (22beta-hydroxytingenone) as the main antibacterial constituent. It was active against Bacillus cereus, Staphylococcus aureus and Escherichia coli (IC(50)<0.25 microg/mL). Furthermore, antiparasitic activity was observed against Trypanosoma cruzi (IC(50)<0.25 microg/mL), Trypanosoma brucei (<0.25 microg/mL), Leishmania infantum (0.51 microg/mL), and Plasmodium falciparum (0.36 microg/mL). Tingenin B was highly cytotoxic to MRC-5 cells (CC(50) 0.45 microg/mL), indicating a poor selectivity. Two inactive triterpenes, 3beta,29-dihydroxyglutin-5-ene and cangoronine methyl ester were also obtained. Phytochemical investigation of the anti-HIV active fractions led to the isolation and identification of three phenolic compounds, namely 4'-O-methylepigallocatechin, 4'-O-methylgallocatechin, and a new procyanidin dimer, i.e. 4',4'''-di-O-methyl-prodelphinidin B(4) or 4'-O-methylgallocatechin-(4alpha-->8)-4'-O-methylepigallocatechin. However, none of these showed anti-HIV activity.

[Antiparasitic drugs. Review of the useful drugs in the treatment of classic and emergent parasitic diseases]

INTRODUCTION

In the 10 last years, the increase of international travels and immigration from low income countries to Spain was related with an increased of prevalence of parasitic diseases.

SOURCE

Critical review of the literature.

STRUCTURE

Firstly, several general considerations were made on the antiparasitic drugs revised in this paper. Chemical structures and mechanisms of action of the main drugs with antiparasitic effect were considered in the second part of the review. Further, antiparasitic spectrum of selected drugs, main pharmacokinetical characteristics, usual posology, possible side effects and contraindications were detailed. Finally, some practical aspects, such as interactions and the methods for practical obtention of these drugs are indicated. This information is relevant because in Spain many anti-parasitic drugs may be obtained using non conventional methods.

CONCLUSION

In Spain, the increase of parasitic diseases necessitates an update on antiparasitics drugs for their treatment.

Efficacy of ivermectin and albendazole alone and in combination for treatment of soil-transmitted helminths in pregnancy and adverse events: a randomized open label controlled intervention trial in Masindi district, western Uganda

A randomized open-label trial, including 834 pregnant women, examined efficacy and recorded adverse events of ivermectin (ivc) and albendazole (alb) alone and combined (comb) on soil-transmitted helminth infections (STHs) in the second trimester of pregnancy. One abortion occurred in the alb group and 10 stillbirths (1, 5, 3, and 1) in the ivc, alb, comb, and the reference group (ref) with no STHs, respectively. Two babies were born with congenital abnormalities (1 [ivc] and 1 [ref]). The prevalence of anemia at first antenatal care (ANC) visit was 20.6% (23.7% [ivc], 21.1% [alb], 22.2% [comb], and 16.1% [ref]). Anemia was reduced to 8.5% at 36 weeks of gestation with 10.9% (ivc), 11.5% (alb), 7.7% (comb), and 6.9% (ref). Hookworm cure rates were 29.4% (ivc), 95.5% (alb), and 92.6% (comb). No severe adverse events were reported by the women after the administration of ivc, alb, or comb during the second trimester of pregnancy, but long-term pharmacovigillance is needed to assess safety of ivc, alb, or comb in pregnancy.

Encephalopathy after ivermectin treatment in a patient infected with Loa loa and Plasmodium spp

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.

The effect of ivermectin on convulsions in rats produced by lidocaine and strychnine

Ivermectin is one of the most commonly used drugs in pharmacotherapy of parasitic diseases in domestic and wild animals caused by parasitic nematodes and arthropods. However, ivermectin and other avermectins very often produce side-effects in hosts. The most dominant clinical symptom of ivermectin toxicity in domestic and wild animals is CNS depression. In nematodes, the target site of ivermectin's action is glutamate-gated chloride-channel receptor and GABA receptor. The depressive effect of ivermectin in mammals might include more than one mechanism; therefore, the anticonvulsive effect of ivermectin against convulsions caused by lidocaine and strychnine was evaluated. Ivermectin antagonized lidocaine- and strychnine-induced convulsions in rats, although these have different mechanisms. In the present study, the anticonvulsive ED50 ofivermectin for lidocaine-induced convulsions was 2.44 mg/kg (95% CL 1.67 to 3.57 mg/kg), whereas for convulsions induced by strychnine it was higher at 4.25 mg/kg (95% CL 2.32 to 3.78 mg/kg). At the same time, both anticonvulsive doses are significantly lower then the observed LD50 of ivermectin (18.20 mg/kg). Furthermore, flumazenil (0.1 and 0.2 mg/kg), an antagonist of benzodiazepine receptors, antagonizes just one part of these anticonvulsive effects of ivermectin. Our results show the significant anticonvulsive properties of ivermectin and support the findings that ivermectin in the CNS of mammals produces multiple inhibitory effects, probably through participation in the function of GABA-sensitive and GABA-insensitive chloride channels.