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Ivermectin Treatment Response in Onchocerca Volvulus Infected Persons with Epilepsy: A Three-Country Short Cohort Study

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Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium
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National Institute Medical Research, Tanga Centre, P.O. Box 5004 Tanga, Tanzania
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Amref South Sudan, P.O. 30125 Juba, South Sudan
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Ministry of Health, Bas Uélé province, B.P. 105 Buta, Democratic Republic of Congo
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Provincial Health Division Ituri, Ministry of Health, Bunia, P.O. Box 57 Ituri, Democratic Republic of Congo
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Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
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Robert Colebunders, Global Health Institute, Gouverneur Kinsbergencentrum, University of Antwerp, Doornstraat 331, 2610 Wilrijk, Belgium
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Author to whom correspondence should be addressed.
Pathogens 2020, 9(8), 617; https://doi.org/10.3390/pathogens9080617
Received: 13 May 2020 / Revised: 24 July 2020 / Accepted: 27 July 2020 / Published: 29 July 2020
(This article belongs to the Section Human Pathogens)
Despite a long history of community-directed treatment with ivermectin (CDTI), a high ongoing Onchocerca volvulus transmission is observed in certain onchocerciasis-endemic regions in Africa with a high prevalence of epilepsy. We investigated factors associated with higher microfilarial (mf) density after ivermectin treatment. Skin snips were obtained from O. volvulus-infected persons with epilepsy before, and 3 to 5 months after ivermectin treatment. Participants were enrolled from 4 study sites: Maridi (South Sudan); Logo and Aketi (Democratic Republic of Congo); and Mahenge (Tanzania). Of the 329 participants, 105 (31.9%) had a post-treatment mf density >20% of the pre-treatment value. The percentage reduction in the geometric mean mf density ranged from 69.0% (5 months after treatment) to 89.4% (3 months after treatment). A higher pre-treatment mf density was associated with increased probability of a positive skin snip after ivermectin treatment (p = 0.016). For participants with persistent microfiladermia during follow-up, a higher number of previous CDTI rounds increased the odds of having a post-treatment mf density >20% of the pre-treatment value (p = 0.006). In conclusion, the high onchocerciasis transmission in the study sites may be due to initially high infection intensity in some individuals. Whether the decreasing effect of ivermectin with increasing years of CDTI results from sub-optimal response mechanisms warrants further research. View Full-Text
Keywords: ivermectin; sub-optimal response; onchocerciasis; Onchocerca volvulus; epilepsy ivermectin; sub-optimal response; onchocerciasis; Onchocerca volvulus; epilepsy
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MDPI and ACS Style

Dusabimana, A.; Bhwana, D.; Raimon, S.; Mmbando, B.P.; Hotterbeekx, A.; Tepage, F.; Mandro, M.; Siewe Fodjo, J.N.; Abrams, S.; Colebunders, R. Ivermectin Treatment Response in Onchocerca Volvulus Infected Persons with Epilepsy: A Three-Country Short Cohort Study. Pathogens 2020, 9, 617. https://doi.org/10.3390/pathogens9080617

AMA Style

Dusabimana A, Bhwana D, Raimon S, Mmbando BP, Hotterbeekx A, Tepage F, Mandro M, Siewe Fodjo JN, Abrams S, Colebunders R. Ivermectin Treatment Response in Onchocerca Volvulus Infected Persons with Epilepsy: A Three-Country Short Cohort Study. Pathogens. 2020; 9(8):617. https://doi.org/10.3390/pathogens9080617

Chicago/Turabian Style

Dusabimana, Alfred, Dan Bhwana, Stephen Raimon, Bruno P. Mmbando, An Hotterbeekx, Floribert Tepage, Michel Mandro, Joseph N. Siewe Fodjo, Steven Abrams, and Robert Colebunders. 2020. "Ivermectin Treatment Response in Onchocerca Volvulus Infected Persons with Epilepsy: A Three-Country Short Cohort Study" Pathogens 9, no. 8: 617. https://doi.org/10.3390/pathogens9080617

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