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The treatment of choice is diethylcarbamazine, which eliminates microfilariae and has some activity against adult worms Treatment with 8 10 mg/kg/d for 21 days is curative in about 50% of amicrofilaremic patients, and repeat courses increase efficacy Mild side effects are common with therapy, including fever, pruritus, arthralgias, nausea, diarrhea, and Calabar swellings These symptoms may be lessened by administration of antihistamines or corticosteroids Patients with large worm burdens are at greater risk for serious complications of therapy, including renal failure, shock, encephalitis, coma, and death Treatment with ivermectin, which is highly active against microfilariae, but not adult worms, also entails a high risk of severe reactions To attempt to avoid these sequelae, pretreatment with corticosteroids and antihistamines, and escalating dosage of diethylcarbamazine have been used, but this strategy does not prevent encephalitis The circulating parasite load that indicates particular risk for severe complications with therapy has been estimated at 2500/mL or greater Strategies to treat patients with high parasite loads include (1) no treatment; (2) apheresis, if available, to remove microfilariae prior to therapy with diethylcarbamazine; or (3) therapy with albendazole, which appears to be well tolerated due to its slow antiparasitic effects, prior to therapy with diethylcarbamazine or ivermectin

Boussinesq M Loiasis Ann Trop Med Parasitol 2006 Dec;100 (8):715 31 [PMID: 17227650] Pion SD et al Loiasis: the individual factors associated with the presence of microfilaraemia Ann Trop Med Parasitol 2005 Jul;99(5):491 500 [PMID: 16004708] Tabi TE et al Human loiasis in a Cameroonian village: a doubleblind, placebo-controlled, crossover clinical trial of a threeday albendazole regimen Am J Trop Med Hyg 2004 Aug;71 (2):211 5 [PMID: 15306713]

Loiasis is a chronic filarial disease caused by infection with Loa loa The infection occurs in humans and monkeys in rainforest areas of West and central Africa An estimated 3 13 million persons are infected The disease is transmitted by chrysops flies, which bite during the day Over 6 12 months after infection, larvae develop into adult worms, which migrate through subcutaneous tissues, including the subconjunctiva (leading to the term eye worm ) Adults can live for up to 17 years

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Many infected persons are asymptomatic, although they may have high levels of microfilaremia and eosinophilia Transient subcutaneous swellings (Calabar swellings) develop in symptomatic persons The swellings are nonerythematous, up to 20 cm in diameter, and may be preceded by local pain or pruritus They usually resolve after 2 4 days but occasionally persist for several weeks Calabar swellings are commonly seen around joints and may recur at the same or different sites Visitors from nonendemic areas are more likely to have allergic-type reactions, including pruritus, urticaria, and angioedema Adult worms may be seen to migrate across the eye, with either no symptoms or conjunctivitis, with pain and edema The most serious complication of loiasis is encephali-

Fungal infections have assumed an increasingly important role as use of broad-spectrum antimicrobial agents has increased and the number of immunodeficient patients has risen Some pathogens (eg, Cryptococcus, Candida, Pneumocystis, Fusarium) rarely cause serious disease in normal hosts Other endemic fungi (eg, Histoplasma, Coccidioides, Paracoccidioides) commonly cause disease in normal hosts but tend to be more aggressive in immunocompromised ones Superficial mycoses are discussed in 6 Successful management of most systemic fungal infections requires knowledge of the natural history of these diseases as well as familiarity with the unique pharmacokinetics, adverse effects, and drug interactions of the various therapeutic agents Furthermore, most affected individuals usually have significant underlying illnesses Consequently, clinicians with extensive experience in the management of these disorders should be consulted

When no other underlying cause is found, persistent oral or vaginal candidiasis should arouse a suspicion of HIV infection

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