Inflammatory cytokines following diethylcarbamazine (DEC) treatment of different clinical groups in lymphatic filariasis

In an earlier study in Indonesia Eve reported on adverse reactions to dieth ylcarbamazine (DEC) in brugian filariasis patients identified as microfilar aemics (n = 26), endemic normals (n = 11) and elephantiasis patients (n = 1 7). To assess the link between adverse reactions and cytokines we have now analysed an array of inflammatory mediators in plasma samples collected dur ing the same study. Pre-treatment levels of interleukin (IL)-6 and soluble tumour necrosis factor receptor 75 (sTNF-R75) were higher in elephantiasis patients compared to microfilaraemics and endemic normals, indicating the p resence of an ongoing inflammation in patients with chronic disease. After initiation of treatment, the levels of IL-6 and LPS-binding protein (LBP) w ere consistently and significantly higher in microfilaraemics who suffered most from adverse reactions compared with endemic normals and elephantiasis patients. In microfilaraemics the levels of sTNF-R75 increased after treat ment to reach levels recorded in elephantiasis patients. IL-6 increased ear ly, concurrent with the development of adverse reactions and peaked by 24 h post treatment. The levels of LBP and sTNF-R75 in microfilaraemics also in creased to peak, later than IL-6, at 32 h post DEC therapy. Although change s were recorded in IL-8 and IL-10 levels in some individuals, no significan t differences were found between the 3 clinical groups. These results demon strate that intake of DEC leads to an increase in a selected number of infl ammatory mediators in the group of filarial patients who suffer most from a dverse systemic reactions.