A 54-year-old woman who had spent most of her adult life as a missionary in Senegal was referred to an ophthalmologist for evaluation of diminished visual acuity. Treating Microfilariae Infection and Ocular Complications- A Case for Diethylcarbamazine Treating Microfilariae Infection and Ocular Complications- A Case for Diethylcarbamazine An eye exam showed sclerosing keratitis and chorioretinal lesions. Physical examination disclosed firm, non-tender subcutaneous nodules on her elbows, iliac bones, and knees. A skin biopsy showed microfilariae. Which of the following drugs would be appropriate for this patient? A. Diethylcarbamazine B. Praziquantel C. Ivermectin D. Fluconazole E. Metronidazole Please provide rationales and references in APA format for your selected answer choice.
Treating Microfilariae Infection and Ocular Complications- A Case for Diethylcarbamazine
The patient’s presentation with sclerosing keratitis, chorioretinal lesions, subcutaneous nodules, and positive microfilariae on skin biopsy suggests a parasitic infection, specifically onchocerciasis, commonly known as river blindness. Onchocerciasis is caused by the filarial nematode Onchocerca volvulus, which is transmitted through the bites of blackflies and Simulium species (Siewe Fodjo et al., 2019). The infection is prevalent in certain regions of Africa, including Senegal, where the patient worked as a missionary.
The drug of choice for the treatment of onchocerciasis is ivermectin. Ivermectin is a broad-spectrum antiparasitic medication that effectively kills microfilariae and prevents the release of microfilarial progeny. It does not kill adult worms but paralyzes them, rendering them noninfective (Siewe Fodjo et al., 2019). The drug is highly effective against Onchocerca volvulus and is widely used in mass drug administration programs to control onchocerciasis in endemic areas.
Diethylcarbamazine is another antiparasitic drug, but it is primarily used for treating lymphatic filariasis, not onchocerciasis. Praziquantel is effective against certain flatworms but has no activity against filarial nematodes like Onchocerca volvulus. On the other hand, fluconazole is an antifungal agent with no efficacy against parasitic infections like onchocerciasis, while metronidazole is an antibiotic that acts against anaerobic bacteria and certain parasites, but it is not the drug of choice for onchocerciasis (Wogu & Okaka, 2021).
Given the patient’s clinical presentation, including the characteristic eye findings, subcutaneous nodules, and positive skin biopsy for microfilariae, ivermectin would be the most appropriate and effective treatment in this case. It is essential to note that treatment with ivermectin may cause an initial inflammatory reaction due to the rapid killing of microfilariae, but this is generally transient and self-limiting (Wogu & Okaka, 2021). In summary, the correct answer is Choice C (Ivermectin), as it is the specific and effective treatment for onchocerciasis, consistent with the patient’s clinical presentation and positive skin biopsy for microfilariae.
References
Siewe Fodjo, J. N., Kugler, M., Hotterbeekx, A., Hendy, A., Van Geertruyden, J. P., & Colebunders, R. (2019). Would ivermectin for malaria control be beneficial in onchocerciasis-endemic regions? Infectious Diseases of Poverty, 8(1), 1-4. https://doi.org/10.1186/s40249-019-0588-7
Wogu, W. D., & Okaka, C. E. (2021). The knowledge, attitude, and perception of onchocerciasis and ivermectin treatment by the people in Okpuje, Edo State, Nigeria. International Journal of Biomedical and Health Sciences, 4(3).