日本熱帯医学会雑誌
Online ISSN : 2186-1781
フィラリア症の化学療法
福島 英雄
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ジャーナル フリー

1968 年 8 巻 2 号 p. 80-103

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At the present time, diethylcarbamazine and arsenical-oxophenarsine hydrochloride-are frequently used for the chemotherapy of bancroftian filariasis. The author succeeded in the treatment of microfilaria carriers who were administered with more than 70 mg/kg diethylcarbamazine, showing no microfilaria among them for 5 years, a long period. For this reason, it was estimated by the author that the administration with more than 70 mg/kg of this drug was necessary to eradicate bancroftian filariasis.
Venous injection of oxophenarsine hydrochloride were effected continuously for a long time.
Based on this result, the above mentioned dose was considered satisfactory for eradication of microfilaria.
Microfilariae usually disappear from the peripheral blood quickly on administration with diethylcarbamazine. On the other hand, they disappear slowly on treatment with oxophenarsine hydrochloride.
For this reason the author considered that diethylcarbamazine acted first on microfilariae and thereafter on adult worms, and that oxophenarsine hydrochloride acted first on adult worms and then on microfilariae. Simultaneous administration of these two drugs to patients with bancroftian filariasis was tried with great success.
There are two methods for the treatment of filariasis. The first is the active treatment for filarial worms. The second, the conservative treatment of patients with chronic symptoms.
Diethylcarbamazine shows remarkable effect against filarial fever and hemato-chyluria. Oxophenarsine hydrochloride shows a satisfactory effect on filarial fever. Microfilaria carriers without symptoms are responsive to the administration of diethylcarbamazine and oxophenarsine hydrochloride, and patients with filarial fever are responsive to diethylcarbamazine, oxophenarsine hydrochloride, adrenocorticotropic hormone, anti-histaminics and antibioctics. The administration of diethylcarbamazine, trichomycin and chloroquine diphosphate, intrapelvic infusion with the drugs, and the operative blockage of perirenal lymphatics are tried on the patients with hematochyluria.Radical treatment is given for filarial hydrocele. Plastic surgery is done on elephantiasis cases.
The continuous administration of diethylcarbamazine with gradual increasing doses shows remarkable effect in the mass treatment of filariasis. This method is able to reduce gastro-intestinal and neurological disturbances.
At the present time microfilaria carriers are treated exclusively without paying attention to the eradication of endemic areas. It is necessary to pay attention to the problems of eradication ; Blood survey by the present technicis incomplete. Because the detection rate of microfilariae from 0.03, 0.06, 0.3 and 2.0 ml periperal blood is 45. 1 %, 55.8 %, 67.4 % and 100.0 %, respectively, new microfilaria carriers usually appear year by year (The positive rate increases between 6.5 % and 10.5 % one year later, among the inhabitants which consist of 15 % to 30 % carriers). Further-more, patients with reinfection, patients within the incubation period, untreated or incompletely treated patients, and patients with a small number of microfilariae are playing important roles as reservoir hosts and disrupt the eradication of bancroftian filariasis.
From this aspect, the author tried to administer 2 mg/kg diethylcarbamazine for 5 days to all the inhabitants, both microfilaria carriers and non-microfilaria carriers from a village in Amami Islands of Kagoshima Prefecture, (total dose was 10 mg/kg). Thereafter, an additional 60 mg/kg and 72 mg/kg diethylcarbamazine was administered to microfilaria carriers who were detected among them. Two years and 4 months later, the author obtained successful result in eradication. No microfilaria carriers were then found in this village.
This result suggests that the administration of diethylcarbamazine to all the inhabitants in an endemic area effected treatment of reservoir carriers.

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