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LONG-TERM FOLLOW-UP OF TREATMENT WITH DIETHYLCARBAMAZINE ON ANTI-FILARIAL IgG4: DOSAGE, COMPLIANCE, AND DIFFERENTIAL PATTERNS IN ADULTS AND CHILDREN

We have followed a population in an area endemic for Brugia malayi for three years after intensive treatment with diethylcarbamazine (DEC). Microfilariae were cleared from the circulation within four months in all eligible study participants (n = 60). There appeared to be a strong correlation between the maximum reduction in specific IgG4 and the number of days drug was taken under supervision ( = 0.41, P < 0.001), indicating that high total dosage of DEC is necessary for optimal reduction of active infection. In individuals with good compliance (at least 180 mg/kg of body weight, n = 34), we observed variable IgG4 patterns. All pre-treatment IgG4+ children (9–14 years old) and 40% of the IgG4+ adult population ( 15 years old) showed a gradual decrease in anti-filarial IgG4; 53% of these showed complete clearance of worm burden by the end of the study. In contrast, another group of male IgG4+ adults showed IgG4 patterns that started to increase between nine months and two years after treatment, indicating either a partial efficacy of DEC that allowed recovery of resident adult worms or reinfection.

Received July 19, 2001. Accepted for publication May 6, 2002.

Acknowledgments: We express our special thanks to inhabitants of Karondang for their willingness to participate in this survey for many years. The study would not have been feasible without the great efforts and enthusiasm of A. Jalil, village head of Karondang. We thank S. Syukur, Dr. M. Risal, and other staff of the District Health Center (PUSKESMAS) Babana for their technical assistance during the entire study period. Infrastructure for fieldwork was provided by the Communicable Disease Center (Makassar, Sulawesi). Fieldwork assistance by Jan Willem Koot, Jolanda Gelderblomden Hartog, Yvonne Hoeksma-Kruize, Yvonne Ruiterman, Selma Jonkers, and Vincent Dézentjé is greatly appreciated.

Financial support: This study was supported by the Netherlands Foundation for the Advancement of Tropical Research (WOTRO, grant no. W93-242).

Authors’ addresses: A. J. Terhell, M. Haarbrink, A. van den Biggelaar, E. Sartono, and M. Yazdanbakhsh, Department of Parasitology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands, Telephone: 31-71-526-5067, Fax: 31-71-526-6907, E-mail: M.Yazdanbakhsh{at}LUMC.nl. A. Mangali, Department of Parasitology, Hasanuddin University, Kampus Tamalanrea, Jl. Perintis Kemerdekaan, Makassar, Sulawesi, Indonesia.