Improved drug regimens are needed to accelerate elimination of lymphatic filariasis in Africa. This study determined whether a single co-administered dose of ivermectin plus diethylcarbamazine plus ...albendazole IDA is noninferior to standard 3 annual doses of ivermectin plus albendazole (IA) used in many LF-endemic areas of Africa.
Treatment-naive adults with Wuchereria bancrofti microfilaremia in Côte d'Ivoire were randomized to receive a single dose of IDA (n = 43) or 3 annual doses of IA (n = 52) in an open-label, single-blinded trial. The primary endpoint was the proportion of participants who were microfilaria (Mf) negative at 36 months. Secondary endpoints were Mf clearance at 6, 12, and 24 months; inactivation of adult worm nests; and safety.
At 36 months posttreatment with IDA, 18/33 (55%; 95% CI, 38-72%) cleared Mf versus 33/42 (79%; 67-91%) with IA (P = .045). At 6 and 12 months IDA was superior to IA in clearing Mf (89% 77-99% and 71% 56-85%), respectively, versus 34% (20-48%) and 26% (14-42%) (P < .001). IDA was equivalent to IA at 24 months (61% 45-77% vs 54% 38-72%; P = .53). IDA was superior to IA for inactivating adult worms at all time points. Both treatments were well tolerated, and there were no serious adverse events.
A single dose of IDA was superior to 2 doses of IA in reducing the overall Mf burden by 24 months. Reinfection may have contributed to the lack of sustained clearance of Mf with IDA.
NCT02974049.
Abstract
Background
Ivermectin (IVM) plus albendazole (ALB), or IA, is widely used in mass drug administration (MDA) programs that aim to eliminate lymphatic filariasis (LF) in Africa. However, IVM ...can cause severe adverse events in persons with heavy Loa loa infections that are common in Central Africa. ALB is safe in loiasis, but more information is needed on its efficacy for LF. This study compared the efficacy and safety of 3 years of semiannual treatment with ALB to annual IA in persons with bancroftian filariasis.
Methods
Adults with Wuchereria bancrofti microfilaremia (Mf) were randomized to receive either 3 annual doses of IA (N = 52), 6 semiannual doses of ALB 400 mg (N = 45), or 6 semiannual doses of ALB 800 mg (N = 47). The primary outcome is amicrofilaremia at 36 months.
Results
IA was more effective for completely clearing Mf than ALB 400mg or ALB 800mg (79%, 95% confidence interval CI: 67–91; vs 48%, 95% CI: 32–66 and 57%, 95% CI: 41–73, respectively). Mean percentage reductions in Mf counts at 36 months relative to baseline tended to be greater after IA (98%, 95% CI: 88–100) than after ALB 400 mg (88%, 95% CI: 78–98) and ALB 800 mg (89%, 95% CI: 79–99) (P = .07 and P = .06, respectively). Adult worm nest numbers (assessed by ultrasound) were reduced in all treatment groups. Treatments were well tolerated.
Conclusions
Repeated semiannual treatment with ALB is macrofilaricidal for W. bancrofti and leads to sustained reductions in Mf counts. This is a safe and effective regimen that could be used as MDA to eliminate LF in areas where ivermectin cannot be used.
Clinical Trials Registration
NCT02974049
This study showed that semiannual treatment with albendazole alone has macrofilaricidal activity that can lead to sustained reductions in microfilaremia, circulating filarial antigenemia, and in adult worm nests in people infected with lymphatic filariasis.
Ultrasound is the first-line examination in the morphological exploration of the thyroid. It is an excellent diagnostic and prognostic tool in nodular thyropathy.
to determine the profile of thyroid ...nodules on ultrasound according to the EU-TIRADS classification.
descriptive cross-sectional study carried out in the radiology department of the University Hospital of Bouaké during one year. We included all thyroid ultrasound reports of patients with thyroid nodules. Data were analysed using Epi Info 7 software.
A total of 60 patients had nodules out of 97 referred for thyropathy (60.8%). The mean age was 45.6 years 13-82 years. Females predominated with 82.7%. Anterior cervical swelling was the main indication in 72%. Thyroid volume was increased in 63% of patients with a mean volume of 71 cm3. Solitary nodules were present in 46.55%. Spongiform nodules were predominant in 32%. The nodules were solid in 29.8% and mixed in 16.5%. Hypoechogenicity was found in 44.8% of solid nodules. Lesions were classified as EU-TIRADS 2 in 58.8%, EU-TIRADS 3 in 23.5%, EU-TIRADS 4 in 14.7% and EU-TIRADS 5 in 2.9%.
The characterisation and classification of thyroid nodules is an important step in the management of patients. In our study, these nodules are essentially benign (EU-TIRADS 2 and 3) with a female predominance. A decision tree taking into account the clinical and cytopathological elements would be more useful for possible surgery.
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