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Adverse reactions following treatment of onchocerciasis and bancroftian filariasis are common and frequently severe. They are generally caused not by direct drug toxicity but by host inflammatory responses to dying microfilariae. To define the responsible mechanism, serial blood levels of interleukin-6 (IL-6) and tumor necrosis factor (TNF) were studied in 15 microfilaria-positive patients (10 with bancroftian filariasis, 5 with onchocerciasis) and 4 microfilaria-negative persons after diethylcarbamazine treatment. Elevations in IL-6 correlated with the occurrence and severity of clinical symptoms after treatment; for the onchocerciasis patients IL-6 levels directly reflected pretreatment intensity of infection. Serum TNF levels also rose but did not correlate directly with infection intensity or reaction severity. Microfilaria-negative controls remained asymptomatic with no significant rise in either cytokine. These findings suggest an etiologic role for systemically elevated cytokines in the inflammatory reactions developing after treatment of filarial infections in humans.

Original publication




Journal article


The Journal of infectious diseases

Publication Date





1071 - 1075


Anton Breinl Centre for Tropical Health and Medicine, James Cook University of North Queensland, Townsville, Australia.


Animals, Humans, Onchocerca volvulus, Wuchereria bancrofti, Elephantiasis, Filarial, Onchocerciasis, Diethylcarbamazine, Tumor Necrosis Factor-alpha, Interleukin-6, Adult, Male