Test-and-not-treat: importance for mass drug administration.,The Lancet Infectious Diseases

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Test-and-not-treat: importance for mass drug administration.
The Lancet Infectious Diseases ( IF 36.4 ) Pub Date : 2019-10-31 , DOI: 10.1016/s1473-3099(19)30533-x
Jesica Herrick ₁

Affiliation

The helminth Loa loa is endemic in much of west and central Africa. Symptoms of loiasis include transient localised angioedema and subconjunctival migration of adult worms; however, most residents of endemic areas have an asymptomatic infection and a high microfilarial count. Despite the high proportion of infected individuals who are asymptomatic, loiasis is clinically important because serious adverse events can occur when some patients with loiasis receive medication for other filarial helminth infections during mass drug administration (MDA) programmes. The principal risk factor for these adverse events is a high microfilarial count (odds ratio >1000 for serious adverse events in those with a microfilarial count >50 000 microfilariae per mL). Although these reactions are believed to be immune-mediated, steroids have not been shown to prevent adverse events after treatment. Because of the risk of these adverse events, MDA programmes have been impeded in the large geographical areas where loiasis is endemic, leaving many patients at risk of blindness or other disabling symptoms of filarial infections.^,

中文翻译：

测试与非治疗：对于大规模药物管理的重要性。

蠕虫Loa loa在非洲西部和中部很多地方流行。丝虫病的症状包括成虫暂时性局限性血管性水肿和结膜下迁移。但是，大多数流行地区的居民无症状感染且微丝数较高。尽管无症状感染个体的比例很高，但在大规模药物管理（MDA）计划中，当某些患有精神病的患者接受治疗其他丝虫感染的药物时，会发生严重的不良事件，因此，精神病在临床上仍然很重要。这些不良事件的主要危险因素是高的微丝计数（微丝计数> 50000微丝/ mL的严重不良事件的比值> 1000）。尽管这些反应被认为是免疫介导的，尚未显示类固醇可预防治疗后的不良事件。由于存在这些不良事件的风险，MDA计划在疯病流行的大地理区域受到了阻碍，使许多患者处于失明或其他丝虫感染致残症状的风险中。^，

更新日期：2019-12-25

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