{"id":35,"date":"2019-08-03T11:39:00","date_gmt":"2019-08-03T11:39:00","guid":{"rendered":"https:\/\/avo6.com\/index.php\/2019\/08\/03\/loase-a-loa-loa-epidemiologiediagnostic-et-traitement\/"},"modified":"2022-09-28T20:31:31","modified_gmt":"2022-09-28T20:31:31","slug":"loase-a-loa-loa-epidemiologiediagnostic-et-traitement","status":"publish","type":"post","link":"https:\/\/avo6.com\/?p=35","title":{"rendered":"Loase \u00e0 loa- loa: \u00e9pid\u00e9miologie,Diagnostic et Traitement"},"content":{"rendered":"
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<\/a><\/div>\n
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>I.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Loase \u00e0 loa- loa<\/span><\/b><\/div>\n
    \n
  1. D\u00e9finition\u00a0:<\/span><\/b><\/li>\n<\/ol>\n
    Helminthose africaine cutan\u00e9o-dermique due \u00e0 une filaire sp\u00e9cifiquement humaine\u00a0: loa loa<\/span><\/div>\n
    Dont l\u2019adulte est un ver rond, blanch\u00e2tre de 2 \u00e0 7 cmde long vivant dans les tissus cellulaires sous-cutan\u00e9 avec une long\u00e9vit\u00e9 qui peut d\u00e9passer 15 ans.<\/span><\/div>\n
    H\u00f4te d\u00e9finitif: Homme et h\u00f4te int\u00e9rm\u00e9diaire et vecteur\u00a0: chrysops (Taon)<\/span><\/div>\n
    Cet affection se caract\u00e9rise par la b\u00e9nignit\u00e9 de ses manifestations cliniques.\u00a0\u00a0<\/span><\/span><\/a><\/div>\n
      \n
    1. \u00a0<\/span><\/span>Epid\u00e9miologie\u00a0:<\/span><\/b><\/li>\n<\/ol>\n
      a.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Classification<\/span><\/b><\/div>\n
      Embranchement\u00a0<\/span><\/b>: Helminthes<\/span><\/div>\n
      Sous embranchement<\/span><\/b>\u00a0: N\u00e9mathelminthes<\/span><\/div>\n
      Classe\u00a0<\/span><\/b>: N\u00e9matodes<\/span><\/div>\n
      Ordre<\/span><\/b>\u00a0: Spiriruna<\/span><\/div>\n
      Famille<\/span><\/b>\u00a0: Filarioidea<\/span><\/div>\n
      b.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>R\u00e9partition g\u00e9ographique<\/span><\/b><\/div>\n
      \u00a0<\/span><\/span>La loase n\u2019existe qu\u2019en Afrique et dans une r\u00e9gion limit\u00e9e\u00a0: Afrique centrale, le Gabon, le Cameron, le Congo, le Nig\u00e9ria, le Za\u00efre et la r\u00e9publique centrale Africaine <\/span><\/div>\n
      c.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Morphologie du parasite<\/span><\/b><\/div>\n\n\n\n
      \n
      Adulte<\/span><\/u><\/b><\/div>\n
      Ver rond de couleur blanch\u00e2tre<\/span><\/div>\n
      Le male\u00a0: mesure 3 cm sur 0,3 avec une extr\u00e9mit\u00e9 post\u00e9rieure enroul\u00e9e.<\/span><\/div>\n
      La femelle\u00a0: est plus grande mesure 5cm sur 0,5mm et elle est vivipare <\/span><\/div>\n<\/td>\n
      		\n
      \n<\/p>\n\n\n\n\n
      <\/p>\n
      \n
      <\/div>\n<\/div>\n

      <\/ins><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      <\/p>\n<\/div>\n<\/td>\n<\/tr>\n

      \n
      Larve\u00a0:<\/span><\/u><\/b> <\/b>La microfilaire<\/span><\/div>\n
      \u00a0<\/span>Cylindrique pourvues d\u2019une gaine. Elle mesure 250-300 <\/span>\u00b5<\/span>m de long sur 7 <\/span>\u00b5<\/span>m de large. L\u2019espace c\u00e9phalique court et pas d\u2019espace caudal<\/span> et les noyaux somatiques ovalaires, le dernier est terminal.<\/span> A l\u2019\u00e9tat frais elle est mobile et pourvue d\u2019un mouvement d\u2019ondulation diurne semblable A celui d\u2019un serpent.<\/span><\/div>\n<\/td>\n
      		\n
      <\/a><\/div>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
      <\/div>\n
      d.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Vecteur\u00a0:<\/span><\/b><\/div>\n
      Le vecteur est un dipt\u00e9re tabanid\u00e9 qui est\u00a0: chrysops.sp<\/span><\/div>\n
      Seule la femelle est h\u00e9matophage et \u00e0 activit\u00e9 diurne <\/span><\/div>\n
      e.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Cycle \u00e9volutif<\/span><\/b><\/div>\n
      le cycle est h\u00e9t\u00e9rox\u00e8ne qui fait intervenir\u00a0: <\/span><\/div>\n
      H\u00f4te interm\u00e9diaire\u00a0 <\/span>et vecteur\u00a0: Chrysops\u00a0; <\/span><\/div>\n
      H\u00f4te d\u00e9finitif qui constitue le seul r\u00e9servoir de parasite\u00a0: Homme<\/b><\/span><\/div>\n
        \n
      1. Symptomatologie clinique\u00a0: <\/span><\/b><\/li>\n<\/ol>\n
        Sympt\u00f4mes classiques de la loase\u00a0sont des manifestations spectaculaires g\u00eanantes mais sans gravit\u00e9, seul risque s\u00e9rieux r\u00e9side dans l\u2019administration inadapt\u00e9e de la th\u00e9rapeutique. <\/span><\/div>\n
        a.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Incubation<\/span><\/u><\/b>\u00a0<\/span><\/b>: <\/span><\/div>\n
        G\u00e9n\u00e9ralement silencieuse et peut durer 6 \u00e0 18 mois.<\/span><\/div>\n
        b.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Phase d\u2019\u00e9tat\u00a0: <\/span><\/u><\/b><\/div>\n
        10 \u00e0 12 semaines apr\u00e8s infestation au moins, peuvent survenir 3 types de manifestions\u00a0:<\/b><\/span><\/div>\n
        L\u2019\u0153d\u00e8me fugace de Calabar<\/span><\/b>\u00a0: <\/b>\u0153d\u00e8me prurigineux, allergique, se localisant volontiers au niveau de la face, le thorax et les\u00a0 <\/span>membres sup\u00e9rieures, dispara\u00eet en 24 \u00e0 72 h et r\u00e9cidive dans un d\u00e9lai variable dans une localisation diff\u00e9rente.<\/b><\/span><\/div>\n
        Migration sous- cutan\u00e9e d\u2019une filaire<\/span><\/b>\u00a0: <\/span>se traduit par un prurit localis\u00e9 avec apparition d\u2019un cordon palpable sous la peau (bras, thorax, face, \u00e9paules). <\/span>Cet incident appara\u00eet soit spontan\u00e9ment soit au d\u00e9but d\u2019un traitement sp\u00e9cifique. <\/span><\/div>\n
        Passage sous conjonctivale du ver adulte<\/span><\/b>\u00a0<\/span>: se traduit par des manifestations spectaculaires mais sans gravit\u00e9, le passage rapide entraine une r\u00e9action conjonctivale +\/- intense.<\/span><\/div>\n
        Ph\u00e9nom\u00e8ne allergiques<\/span><\/b><\/div>\n
        Arthralgie ou prurit <\/span><\/b><\/div>\n
        c.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Complications\u00a0:<\/span><\/u><\/b><\/div>\n
        Complications neurologiques majeurs<\/span><\/b>\u00a0: enc\u00e9phalite en relation avec un traitement mal conduit par la di\u00e9thyl carbamazine chez un sujet \u00e0 Microfilar\u00e9mie intense.<\/span><\/div>\n
        Des complications cardiaques et r\u00e9nales<\/span><\/b> (glom\u00e9rulon\u00e9phrite) sont possible<\/span><\/div>\n
        <\/div>\n
          \n
        1. Diagnostic biologique\u00a0:<\/span><\/b><\/li>\n<\/ol>\n
          a.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Diagnostic de pr\u00e9somption<\/span><\/b><\/div>\n
            \n
          • Origine du patient ou s\u00e9jour dans un pays d\u2019end\u00e9mie<\/span><\/li>\n
          • Signes cliniques \u00e9vocateurs<\/span><\/li>\n
          • Hyper \u00e9osinophilie sanguine\u00a0: \u00e9lev\u00e9\u00a0 <\/span>\u00e0 distance de la phase d\u2019infestation <\/span><\/span><\/li>\n<\/ul>\n
            b.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Diagnostic de certitude<\/span><\/b><\/div>\n
            Il repose essentiellement sur la mise en \u00e9vidence de microfilaires dans le sang pr\u00e9lev\u00e9 \u00e0 midi\u00a0:<\/span><\/div>\n
              \n
            • Frottis ou goutte \u00e9paisse avec num\u00e9ration pour adapter la th\u00e9rapeutique.<\/span><\/li>\n
            • Leuco concentration ou filtration sur membrane (sang veineux recueilli sur anticoagulant \u00e0 la mi-journ\u00e9e)<\/span><\/li>\n<\/ul>\n
              La filaire adulte peut \u00eatre extraite lors de son passage sous conjonctivale \u00e0 l\u2019aide d\u2019une pince fine ou un vaccinostyle mais risque de complications infectieuses<\/span><\/div>\n
              c.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Diagnostic immunologiques\u00a0:<\/span><\/b><\/div>\n
              Techniques\u00a0: Immuno -fluorescence, Immuno \u2013\u00e9l\u00e9ctrophor\u00e8se\u00a0 <\/span>positives dans 80% des cas\u00a0.<\/span><\/div>\n
              Il est indiqu\u00e9 devant des signes cliniques \u00e9vocateurs avec recherche de microfilaires restent n\u00e9gative.<\/span><\/div>\n
                \n
              1. Traitement\u00a0: <\/span><\/b><\/li>\n<\/ol>\n
                a.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Microfilar\u00e9mie faible<\/ins>ou absente\u00a0:<\/span><\/span><\/b><\/div>\n
                Di\u00e9thyl carbamazine (NOTEZINE*)\u00a0: <\/span><\/div>\n
                \u00a7\u00a0 <\/span><\/span><\/span>Conduit avec prudence car il permet une destruction rapide des microfilaires, mais il pr\u00e9sente un grand risque de r\u00e9action allergiques.<\/span><\/div>\n
                \u00a7\u00a0 <\/span><\/span><\/span>Dose de d\u00e9but tr\u00e8s faible (1\/32 \u00e0 1\/16 cp) pour atteindre progressivement la dose de 4 cp \u00e0 100 mg\/j pdt 21j<\/span><\/div>\n
                \u00a7\u00a0 <\/span><\/span><\/span>Cortico\u00efdes et antihistaminiques doivent \u00eatre souvent associ\u00e9s.<\/span><\/div>\n
                b.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span><\/span><\/b>Microfilar\u00e9mie >50\/ ml\u00a0:<\/span><\/b><\/div>\n
                Traitement \u00e0 base d\u2019ivermectine (STROMECTOL* ou MECTIZAN*)<\/span><\/div>\n
                200<\/span>\u00b5<\/span>g\/Kg\/ jour pendant plusieurs mois<\/span><\/div>\n
                  \n
                1. Prophylaxie\u00a0:<\/span><\/b><\/li>\n<\/ol>\n
                  Bas\u00e9e sur\u00a0:<\/span><\/div>\n
                    \n
                  • Lutte contre le vecteur par l\u2019utilisation de r\u00e9pulsifs et d\u2019insecticides<\/span><\/li>\n
                  • Destruction des microfilaires chez les porteurs en zones hyper end\u00e9mique.<\/span><\/li>\n<\/ul>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

                    \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 I.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Loase \u00e0 loa- loa D\u00e9finition\u00a0: Helminthose africaine cutan\u00e9o-dermique due \u00e0 une filaire sp\u00e9cifiquement humaine\u00a0: loa loa Dont l\u2019adulte…<\/p>\n","protected":false},"author":2,"featured_media":386,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0},"categories":[10],"tags":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/posts\/35"}],"collection":[{"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/avo6.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=35"}],"version-history":[{"count":1,"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/posts\/35\/revisions"}],"predecessor-version":[{"id":387,"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/posts\/35\/revisions\/387"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/avo6.com\/index.php?rest_route=\/wp\/v2\/media\/386"}],"wp:attachment":[{"href":"https:\/\/avo6.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=35"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/avo6.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=35"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/avo6.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=35"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}