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Djune-Yemeli L, Domché A, Nana-Djeunga HC, Donfo-Azafack C, Lenou-Nanga CG, Masumbe-Netongo P, Kamgno J. Relationship between skin snip and Ov16 ELISA: Two diagnostic tools for onchocerciasis in a focus in Cameroon after two decades of ivermectin-based preventive chemotherapy. PLoS Negl Trop Dis 2022; 16:e0010380. [PMID: 35499993 PMCID: PMC9098087 DOI: 10.1371/journal.pntd.0010380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/12/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background Onchocerciasis elimination currently relies on repeated ivermectin-based preventive chemotherapy. Current World Health Organization’s guidelines strongly recommend, though with low evidence of certainty, the use of Ov16 serology testing in children younger than 10 years old to assess whether mass drugs administration can be safely stopped. Therefore, more evidences are needed to support the use of this marker as sero-evaluation tool. This study aimed at determining the relationship between microfilaridermia and anti-Ov16 IgG4, and their variation according to age, gender and ivermectin intake history. Methodology A cross-sectional survey was conducted in an area where ivermectin-based MDA has been implemented since more than 20 years. A questionnaire was used to record ivermectin intake history for the last 5 years. All volunteers aged ≥2 years were tested for microfilaridermia. IgG4 antibodies against Ov16 antigen were determined using the Standard Diagnostic Ov16 IgG4 ELISA kits and the recombinant anti-Ov16 AbD19432 antibodies. Prevalences, microfilaridermia counts and IgG4 concentrations were compared with regards to age, gender and history of ivermectin intake. Principal findings The prevalence of skin microfilariae was 23.4% (95% CI: 23.4–30.8), whereas Ov16 seroprevalence was 53.2% (95% CI: 47.9–58.4). A moderate positive percentage agreement (50.4%) and a high negative percentage agreement (69.2%) was found between skin snip and Ov16 serology in the whole population, while in children aged <10 years, the agreements were higher (positive percentage agreement: 62.6%; negative percentage agreement: 83.5%). In addition, no associations were found between ivermectin intake, Mf counts and estimated IgG4 concentration of participants. Anti-Ov16 IgG4 were higher in individuals harboring microfilariae than their negative counterparts (p<0.0001), though a negative correlation was found between skin microfilarial counts and anti-Ov16 IgG4 levels (r = -0.2400; p = 0.03). No variation in microfilarial counts according to age and gender was observed. Though positively correlated with age (r = 0.4020; p<0.0001), IgG4 was significantly different between the different age classes (p<0.0001). Conclusion/Significance Our results revealed moderate positive and negative agreements between parasitological and immunological parameters of onchocerciasis infection after several rounds MDA. Anti-Ov16 IgG4 levels increased with age but decreased with microfilarial counts, suggesting a variation of anti-Ov16 IgG4 as a result of constant exposure and accumulation of infection. This brings evidence sustaining the use of Ov16 serology in children as evaluation tool. However, additional investigations are needed to further reshape the appropriate age range among children aged <10 years old. The elimination of onchocerciasis places high demands on monitoring and evaluation. The current WHO’s guidelines recommend the use of serological test (ELISA) to determine the presence of IgG4 antibodies to the O. volvulus specific antigen Ov16 among children aged <10 years old, thought with low evidence of certainty. In this paper, we explored the relationship between anti-Ov16 IgG4 antibodies and microfilaridermia counts, and assessed their variation according to age, gender and history of ivermectin intake. Our findings revealed no variation of Mf count and IgG4 with ivermectin intake. However, we observed that anti-Ov16 IgG4 decrease with microfilaridermia counts, but an increasing trend was observed with age. This brings evidence sustaining the use of Ov16 serology testing as exposition marker in children younger than 10 years. However, children age 2 to 4 years seem to have a very low anti-Ov16 IgG4 concentration, this finding should be considered when defining the age class for seroprevalence evaluation.
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Affiliation(s)
- Linda Djune-Yemeli
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
- Molecular Diagnosis Research Group, Biotechnology Centre-University of Yaoundé I (BTC-UY-I), Yaoundé, Cameroon
| | - André Domché
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
- Parasitology and Ecology Laboratory, Department of Animal Biology and Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Hugues C. Nana-Djeunga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Cyrille Donfo-Azafack
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Cedric G. Lenou-Nanga
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
| | - Palmer Masumbe-Netongo
- Molecular Diagnosis Research Group, Biotechnology Centre-University of Yaoundé I (BTC-UY-I), Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Joseph Kamgno
- Centre for Research on Filariasis and other Tropical Diseases (CRFilMT), Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- * E-mail:
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Kwarteng EVS, Osei FB, Andam-Akorful SA, Kwarteng A, Asare DCBM, Quaye-Ballard JA, Duker AA. Mapping Spatial Variation and Impact of the National MDA Program on Lymphatic Filariasis Elimination in Ghana: An Initial Study. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.811909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lymphatic filariasis (LF) is a public health menace, especially in developing countries. A periodic review of mass drug administration (MDA) performance is critical to monitoring elimination progress. However, investigating the spatial pattern of LF with respect to MDA intervention is yet to be documented. This is essential to appreciating the transmission dynamics across LF-endemic communities and how it is spatially impacted by MDA programs. The aim of this study was to map and explore the spatial variation and hotspots of LF infection among endemic communities and evaluate the impact of the MDA intervention program on its spatial pattern in Ghana. Relative risks, clustering and clusters, prevalence odds ratios, and their confidence intervals were studied with community-level LF data prior to intervention and post intervention periods. The overall risk of LF infection was 0.12% and 0.02% before and after MDA, respectively, suggesting reduced transmission. Using empirical Bayesian smoothing to map the relative risk, a substantial variation in the spatial distribution of the relative risk of LF among endemic communities was observed. Most of the excess prevalence communities were unexpectedly visible even after years of MDA. The Empirical Bayesian Moran’s Index for global clustering showed a reduction in clustering of LF prevalence after MDA with IM = 0.455 and 0.119 for before and after MDA, respectively. Furthermore, examining risks associated with ecological zones, it was observed that the Guinea Savannah and the Transition Zone were the most vulnerable zones for LF infection with prevalence odds ratios 18.70- and 13.20-fold higher than in the reference Moist evergreen zone, respectively. We observed a drastic reduction in risk in the Wet evergreen zone after MDA, while the Guinea Savannah sustained high levels of risk even after MDA. These findings should prompt public health officials to adopt stratified cluster sampling in LF-endemic regions to monitor the rate and density of microfilaria.
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Phuakrod A, Sripumkhai W, Jeamsaksiri W, Pattamang P, Loymek S, Brindley PJ, Sarasombath PT, Wongkamchai S. A miniPCR-Duplex Lateral Flow Dipstick Platform for Rapid and Visual Diagnosis of Lymphatic Filariae Infection. Diagnostics (Basel) 2021; 11:diagnostics11101855. [PMID: 34679553 PMCID: PMC8534866 DOI: 10.3390/diagnostics11101855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/18/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
Lymphatic filariasis (LF) is a neglected major tropical disease that is a leading cause of permanent and long-term disability worldwide. Significant progress made by the Global Programme to Eliminate Lymphatic Filariasis (GPELF) has led to a substantial decrease in the levels of infection. In this limitation, DNA detection of lymphatic filariae could be useful due to it capable of detecting low level of the parasites. In the present study, we developed a diagnostic assay that combines a miniPCR with a duplex lateral flow dipstick (DLFD). The PCR primers were designed based on the HhaI and SspI repetitive noncoding DNA sequences of Brugia malayi and Wuchereria bancrofti, respectively. The limits of detection and crossreactivity of the assay were evaluated. In addition, blood samples were provided by Thais living in a brugian filariasis endemic area. The miniPCR-DLFD assay exhibited a detection limit of 2 and 4 mf per milliliter (mL) of blood for B. malayi as well as W. bancrofti, respectively, and crossamplification was not observed with 11 other parasites. The result obtained from the present study was in accordance with the thick blood smear staining for the known cases. Thus, a miniPCR-DLFD is an alternative tool for the diagnosis of LF in point-of-collection settings with a modest cost (~USD 5) per sample.
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Affiliation(s)
- Achinya Phuakrod
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Witsaroot Sripumkhai
- Thai Microelectronic Center, National Electronics and Computer Technology Center, Thailand Science Park, Pathum Thani 12110, Thailand; (W.S.); (W.J.); (P.P.)
| | - Wutthinan Jeamsaksiri
- Thai Microelectronic Center, National Electronics and Computer Technology Center, Thailand Science Park, Pathum Thani 12110, Thailand; (W.S.); (W.J.); (P.P.)
| | - Pattaraluck Pattamang
- Thai Microelectronic Center, National Electronics and Computer Technology Center, Thailand Science Park, Pathum Thani 12110, Thailand; (W.S.); (W.J.); (P.P.)
| | - Sumat Loymek
- Office of Disease Prevention and Control, Region 12, Department of Disease Control, The Ministry of Public Health, Songkhla 9000, Thailand;
| | - Paul J. Brindley
- Immunology & Tropical Medicine & Research Center for Neglected Diseases of Poverty, Department of Microbiology, School of Medicine & Health Sciences, George Washington University, Washington, DC 20037, USA;
| | - Patsharaporn T. Sarasombath
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Correspondence: (P.T.S.); (S.W.); Tel.: +66-2-419-6468 (P.T.S. & S.W.); Fax: +66-2-419-6470 (P.T.S. & S.W.)
| | - Sirichit Wongkamchai
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Correspondence: (P.T.S.); (S.W.); Tel.: +66-2-419-6468 (P.T.S. & S.W.); Fax: +66-2-419-6470 (P.T.S. & S.W.)
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Dietrich CF, Chaubal N, Hoerauf A, Kling K, Piontek MS, Steffgen L, Mand S, Dong Y. Review of Dancing Parasites in Lymphatic Filariasis. Ultrasound Int Open 2019; 5:E65-E74. [PMID: 31312785 PMCID: PMC6629997 DOI: 10.1055/a-0918-3678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/04/2019] [Accepted: 05/01/2019] [Indexed: 02/07/2023] Open
Abstract
Lymphatic filariasis is an infection transmitted by blood-sucking mosquitoes with filarial nematodes of the species Wuchereria bancrofti, Brugia malayi und B. timori . It is prevalent in tropical countries throughout the world, with more than 60 million people infected and more than 1 billion living in areas with the risk of transmission. Worm larvae with a length of less than 1 mm are transmitted by mosquitoes, develop in human lymphatic tissue to adult worms with a length of 7-10 cm, live in the human body for up to 10 years and produce millions of microfilariae, which can be transmitted further by mosquitoes. The adult worms can be easily observed by ultrasonography because of their size and fast movements (the so-called "filarial dance sign"), which can be differentiated from other movements (e. g., blood in venous vessels) by their characteristic movement profile in pulsed-wave Doppler mode. Therapeutic options include (combinations of) ivermectin, albendazole, diethylcarbamazine and doxycycline. The latter depletes endosymbiotic Wolbachia bacteria from the worms and thus sterilizes and later kills the adult worms (macrofilaricidal or adulticidal effect).
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Affiliation(s)
| | - Nitin Chaubal
- Thane Ultrasound Centre, Thane Ultrasound Centre, Thane, India
| | - Achim Hoerauf
- Institut für Med. Mikrobiologie, Immunologie und Parasitologie (IMMIP), Universität Bonn, Bonn, Germany
| | - Kerstin Kling
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Markus Schindler Piontek
- Caritas Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Medical Clinic 2, Bad Mergentheim, Germany
| | - Ludwig Steffgen
- Trainings-Zentrum Ultraschall-Diagnostik LS GmbH, Ultrasound, Mainleus, Germany
| | - Sabine Mand
- Institut für Med. Mikrobiologie, Immunologie und Parasitologie (IMMIP), Universität Bonn, Bonn, Germany
| | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
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Budge PJ, Herbert C, Andersen BJ, Weil GJ. Adverse events following single dose treatment of lymphatic filariasis: Observations from a review of the literature. PLoS Negl Trop Dis 2018; 12:e0006454. [PMID: 29768412 PMCID: PMC5973625 DOI: 10.1371/journal.pntd.0006454] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/29/2018] [Accepted: 04/16/2018] [Indexed: 11/18/2022] Open
Abstract
Background WHO’s Global Programme to Eliminate Lymphatic Filariasis (LF) uses mass drug administration (MDA) of anthelmintic medications to interrupt LF transmission in endemic areas. Recently, a single dose combination of ivermectin (IVM), diethylcarbamazine (DEC), and albendazole (ALB) was shown to be markedly more effective than the standard two-drug regimens (DEC or IVM, plus ALB) for achieving long-term clearance of microfilaremia. Objective and methods To provide context for the results of a large-scale, international safety trial of MDA using triple drug therapy, we searched Ovid Medline for studies published from 1985–2017 that reported adverse events (AEs) following treatment of LF with IVM, DEC, ALB, or any combination of these medications. Studies that reported AE rates by treatment group were included. Findings We reviewed 162 published manuscripts, 55 of which met inclusion criteria. Among these, 34 were clinic or hospital-based clinical trials, and 21 were community-based studies. Reported AE rates varied widely. The median AE rate following DEC or IVM treatment was greater than 60% among microfilaremic participants and less than 10% in persons without microfilaremia. The most common AEs reported were fever, headache, myalgia or arthralgia, fatigue, and malaise. Interpretation Mild to moderate systemic AEs related to death of microfilariae are common following LF treatment. Post-treatment AEs are transient and rarely severe or serious. Comparison of AE rates from different community studies is difficult due to inconsistent AE reporting, varied infection rates, and varied intensity of follow-up. A more uniform approach for assessing and reporting AEs in LF community treatment studies would be helpful. WHO’s Global Programme to Eliminate Lymphatic Filariais (LF) supports annual mass drug administration to over 400 million people in LF-endemic areas each year. Two drug combinations (either DEC or ivermectin, given with albendazole) have been recommended in most endemic areas. With the exception of well-described serious adverse events (AEs) occurring in patients with high level loiasis, severe AEs due to these medications are extremely rare. Mild to moderate AEs, however, are common, particularly in patients with active filarial infection. In this manuscript we synthesize published data on AEs following single-dose treatment of LF with ivermectin, DEC, or albendazole. This provides a background against which to compare the safety of triple drug therapy (ivermectin, DEC, and albendazole) recently endorsed by WHO, and provides a useful context for evaluating safety of new treatments for LF. The compiled data illustrate that transient, mild to moderate AEs following single-dose LF treatment are common in microfilaremic patients and are much less common in amicrofilaremic patients. They also show that passive surveillance for post-treatment AEs underestimates AE incidence and suggest that adherence to common reporting standards would improve the usefulness of AE reporting in filariasis studies.
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Affiliation(s)
- Philip J. Budge
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
- * E-mail:
| | - Carly Herbert
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Britt J. Andersen
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Gary J. Weil
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
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de Araújo PSR, de Souza Junior VR, de Souza A, de Barros Correia Fontes L, Brandao E, Rocha A. Chiluria in a lymphatic filariasis endemic area. BMC Res Notes 2018; 11:269. [PMID: 29720217 PMCID: PMC5932810 DOI: 10.1186/s13104-018-3357-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/18/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To establish clinical and laboratory data of individuals presenting chyluria in endemic areas. RESULTS 75 individuals were studied. The majority were females with an average age of 45 years residing in the Metropolitan Region of Recife. The mean time between the beginning of the presentation of chyluria and the first care service in the Serviço de Referencia Nacional em Filarioses was approximately 5 years. The most frequent urinalysis changes were hematuria (27.6%), leukocytes (21.9%) and proteinuria (10.5%). The Addis test showed mean values of 155.43 E/min/mL of cylinders, 52,892 E/min/mL of erythrocytes and 291,660 E/min/mL of leukocytes. Among recorded cases, proteinuria had a mean value of 1372.80 mg/dL in 24 h, and the presence of lymphocytes in the urine was positive in 68.3%. Among lymphatic filariasis tests, immunochromatography was positive in 16.7%, there was circulating filarial antigen determined by detection of OG4C3 antibodies in 7.7% and microfilaremia in only 1/55.
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Affiliation(s)
- Paulo Sérgio Ramos de Araújo
- Federal University of Pernambuco, Av. Prof. Moraes Rego 1235, Recife, Pernambuco 50670-901 Brazil
- Instituto Aggeu Magalhaes, FIOCRUZ, Av. Prof. Moraes Rego 1235, Recife, 50670-901 Brazil
| | | | - Anderson de Souza
- Federal University of Pernambuco, Av. Prof. Moraes Rego 1235, Recife, Pernambuco 50670-901 Brazil
| | | | - Eduardo Brandao
- Instituto Aggeu Magalhaes, FIOCRUZ, Av. Prof. Moraes Rego 1235, Recife, 50670-901 Brazil
| | - Abraham Rocha
- Instituto Aggeu Magalhaes, FIOCRUZ, Av. Prof. Moraes Rego 1235, Recife, 50670-901 Brazil
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Dorkenoo MA, Bronzan R, Yehadji D, Tchalim M, Yakpa K, Etassoli S, Adjeloh P, Maman I, Sodahlon Y. Surveillance for lymphatic filariasis after stopping mass drug administration in endemic districts of Togo, 2010-2015. Parasit Vectors 2018; 11:244. [PMID: 29661231 PMCID: PMC5902853 DOI: 10.1186/s13071-018-2843-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/09/2018] [Indexed: 11/22/2022] Open
Abstract
Background Togo is a country previously endemic for lymphatic filariasis (LF). In 2010, following nine years of mass drug administration (MDA) for LF, the country established a post-treatment surveillance (PTS) system. We present here the results of these PTS activities, carried out from 2010 to 2015, as well as the findings of follow-up investigations in 2016 to confirm the absence of infection in previously infected individuals. Methods The routine surveillance established in 2010 consisted of a network of 47 laboratories, which searched for Wuchereria bancrofti microfilaria on nocturnal blood smears collected for malaria diagnosis and an additional network of 20 peripheral health facilities, which collected dried blood spots and tested them for Og4C3 antigen. Two transmission assessment surveys (TAS) were also undertaken, as recommended by WHO, in 2012 and 2015. Any positive case identified through any surveillance activity was immediately retested by nocturnal smear and confirmed cases were immediately investigated by screening family members and neighboring household members. In 2016, 32 of the 40 positive cases detected during TAS or laboratory and health facility network activities were traced and whether confirmed positive by nocturnal smear or not were tested again simultaneously by filariasis test strip (FTS), Og4C3 and a nocturnal blood smear to rule out any active infection. Results From 2010 to 2015, the laboratory network identified one microfilaria-positive individual (0.0% of 26,584 persons tested) and the peripheral health facility network detected 19 Og4C3-positive individuals (0.28% of 6788 persons tested). All 19 Og4C3 cases were negative for microfilaremia by nocturnal blood smear. In the 2012 and 2015 TAS, thirteen and six ICT/FTS positive cases, respectively, were identified, which were significantly below the critical cut-off (18–20 cases) across all evaluation units. Three of the six ICT/FTS-positive cases from the 2015 TAS were positive by nocturnal smear; immediate investigation identified one additional microfilaria-positive individual. Epidemiological investigation revealed that four of the five cases of microfilaremia were imported from another country in the region. In 2016, 32 of the 40 positive cases detected by at least one test during all surveillance activities were traced: four (12.5%) individuals were still positive by FTS but all 32 individuals were negative for microfilaremia and Og4C3 antigen. Conclusion The results of post-treatment surveillance in Togo have demonstrated that W. bancrofti filariasis is no longer of public health concern in Togo, more than six years after stopping MDA. Every possible effort should be made to maintain surveillance in order to promptly detect any resurgence and preserve this achievement.
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Affiliation(s)
- Monique Ameyo Dorkenoo
- Faculté des Sciences de la santé, Université de Lomé, BP 1515, Lomé, Togo. .,Programme National d'Elimination de la Filariose Lymphatique, Ministère de la Santé et de la Protection Sociale, Angle avenue Sarakawa et Avenue du 24 Janvier, BP 336, Lomé, Togo.
| | - Rachel Bronzan
- Health and Development International (HDI), Newburyport, MA, USA
| | - Degninou Yehadji
- Programme National d'Elimination de la Filariose Lymphatique, Ministère de la Santé et de la Protection Sociale, Angle avenue Sarakawa et Avenue du 24 Janvier, BP 336, Lomé, Togo
| | - Mawèke Tchalim
- Programme National d'Elimination de la Filariose Lymphatique, Ministère de la Santé et de la Protection Sociale, Angle avenue Sarakawa et Avenue du 24 Janvier, BP 336, Lomé, Togo
| | - Kossi Yakpa
- Programme National de Lutte contre le Paludisme, BP 518, Lomé, Togo
| | - Santrao Etassoli
- Programme National d'Elimination de la Filariose Lymphatique, Ministère de la Santé et de la Protection Sociale, Angle avenue Sarakawa et Avenue du 24 Janvier, BP 336, Lomé, Togo
| | | | - Issaka Maman
- Laboratoire de référence, Institut National d'Hygiène, BP 1396, Lomé, Togo
| | - Yao Sodahlon
- Mectizan Donation Program, 325 Swanton Way, Decatur, GA, 30030, USA
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Bal M, Sahu PK, Mandal N, Satapathy AK, Ranjit M, Kar SK. Maternal Infection Is a Risk Factor for Early Childhood Infection in Filariasis. PLoS Negl Trop Dis 2015. [PMID: 26225417 PMCID: PMC4520468 DOI: 10.1371/journal.pntd.0003955] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Global Program to Eliminate Lymphatic Filariasis (GPELF) launched by WHO aims to eliminate the disease by 2020. To achieve the goal annual mass drug administration (MDA) with diethylcarbamazine (DEC) plus albendazole (ABZ) has been introduced in all endemic countries. The current policy however excludes pregnant mothers and children below two years of age from MDA. Since pregnancy and early childhood are critical periods in determining the disease outcome in older age, the present study was undertaken to find out the influence of maternal filarial infection at the time of pregnancy on the susceptibility outcome of children born in a community after implementation of MDA for the first time. Methodology and Principal Findings The participants in this cohort consists of pregnant mothers and their subsequently born children living in eight adjacent villages endemic for filarial infections, in Khurda District, Odisha, India, where MDA has reduced microfilariae (Mf) rate from 12% to 0.34%. Infection status of mother and their children were assessed by detection of Mf as well as circulating filarial antigen (CFA) assay. The present study reveals a high rate of acquiring filarial infection by the children born to infected mother than uninfected mothers even though Mf rate has come down to < 1% after implementation of ten rounds of MDA. Significance To attain the target of eliminating lymphatic filariasis the current MDA programme should give emphasis on covering the women of child bearing age. Our study recommends incorporating supervised MDA to Adolescent Reproductive and Sexual Health Programme (ARSH) to make the adolescent girls free from infection by the time of pregnancy so as to achieve the goal. Lymphatic filariasis, commonly known as elephantiasis, is a painful and profoundly disfiguring disease. A massive global effort has been undertaken to eliminate this disease by 2020 using annual mass drug administration (MDA). However the MDA excludes pregnant women and children below two years of age, which are the two critical periods thought to be playing a major role in determining the disease susceptibility in older age. We have been working on the impact of filarial infection at the time of pregnancy on neonates since 2009 in India. We have assessed the impact of maternal infection among a group of children from the time of their birth till they attain early childhood. We have observed that children born to mothers having filarial infection at the time of pregnancy were more prone to infection at early childhood than born to infection free mother in an area having very low infection rate after MDA. Our finding reveals that infection in mother at the time of pregnancy plays a crucial role in acquiring infection in children. Hence to achieve the goal of elimination of filariasis the women of child bearing age should be treated with antifilarials through MDA under supervision.
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Affiliation(s)
- Madhusmita Bal
- Division of Immunology, Regional Medical Research Center (Indian Council of Medical Research), Chandrasekharpur, Bhubaneswar, Odisha, India
- * E-mail:
| | - Prakash K. Sahu
- Division of Immunology, Regional Medical Research Center (Indian Council of Medical Research), Chandrasekharpur, Bhubaneswar, Odisha, India
| | - Nityananda Mandal
- Division of Immunology, Regional Medical Research Center (Indian Council of Medical Research), Chandrasekharpur, Bhubaneswar, Odisha, India
| | - Ashok K. Satapathy
- Division of Immunology, Regional Medical Research Center (Indian Council of Medical Research), Chandrasekharpur, Bhubaneswar, Odisha, India
| | - Manoranjan Ranjit
- Division of Immunology, Regional Medical Research Center (Indian Council of Medical Research), Chandrasekharpur, Bhubaneswar, Odisha, India
| | - Shatanu K. Kar
- Division of Immunology, Regional Medical Research Center (Indian Council of Medical Research), Chandrasekharpur, Bhubaneswar, Odisha, India
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Oliveira P, Braga C, Alexander N, Brandão E, Silva A, Wanderley L, Aguiar AM, Diniz G, Medeiros Z, Rocha A. Evaluation of diagnostic tests for Wuchereria bancrofti infection in Brazilian schoolchildren. Rev Soc Bras Med Trop 2014; 47:359-66. [PMID: 25075488 DOI: 10.1590/0037-8682-0093-2014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/30/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Since the launch of the Global Programme to Eliminate Lymphatic Filariasis, more than 70% of the endemic countries have implemented mass drug administration (MDA) to interrupt disease transmission. The monitoring of filarial infection in sentinel populations, particularly schoolchildren, is recommended to assess the impact of MDA. A key issue is choosing the appropriate tools for these initial assessments (to define the best intervention) and for monitoring transmission. METHODS This study compared the pre-MDA performance of five diagnostic methods, namely, thick film test, Knott's technique, filtration, Og4C3-ELISA, and the AD12-ICT card test, in schoolchildren from Brazil. Venous and capillary blood samples were collected between 11 pm and 1 am. The microfilarial loads were analyzed with a negative binomial regression, and the prevalence and associated 95% confidence intervals were estimated for all methods. The accuracies of the AD12-ICT card and Og4C3-ELISA tests were assessed against the combination of parasitological test results. RESULTS A total of 805 schoolchildren were examined. The overall and stratified prevalence by age group and gender detected by Og4C3-ELISA and AD12-ICT were markedly higher than the prevalence estimated by the parasitological methods. The sensitivity of the AD12-ICT card and Og4C3-ELISA tests was approximately 100%, and the positive likelihood ratios were above 6. The specificity of the Og4C3-ELISA was higher than that of the AD12-ICT at different prevalence levels. CONCLUSIONS The ICT card test should be the recommended tool for monitoring school-age populations living in areas with ongoing or completed MDA.
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Affiliation(s)
- Paula Oliveira
- Serviço de Referência Nacional em Filarioses, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Cynthia Braga
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Neal Alexander
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Eduardo Brandão
- Serviço de Referência Nacional em Filarioses, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Almerice Silva
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Leandro Wanderley
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Ana Maria Aguiar
- Serviço de Referência Nacional em Filarioses, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - George Diniz
- Departamento de Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Zulma Medeiros
- Serviço de Referência Nacional em Filarioses, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Abraham Rocha
- Serviço de Referência Nacional em Filarioses, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
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10
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Smits HL. Prospects for the control of neglected tropical diseases by mass drug administration. Expert Rev Anti Infect Ther 2014; 7:37-56. [DOI: 10.1586/14787210.7.1.37] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Hagiya H, Terasaka T, Kimura K, Satou A, Asano K, Waseda K, Hanayama Y, Takahashi T, Aoe M, Iio K, Watanabe T, Kondo E, Otsuka F. Filarial chyluria as a rare cause of urinary retention. Intern Med 2014; 53:2001-5. [PMID: 25175138 DOI: 10.2169/internalmedicine.53.2572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein describe a case of Wuchereria bancrofti infection in a previously healthy 37-year-old Nepalese man. The patient presented with a history of milky urine with subsequent acute urinary retention lasting for a few days. The presence of microfilariae was confirmed on both peripheral blood and urine smears obtained at midnight. He was conservatively treated with diethylcarbamazine combined with doxycycline. Filariasis was previously endemic in southern parts of Japan, although it has been eradicated. Clinicians should remember filariasis as a potential etiology of urinary retention, especially in cases that may be associated with imported infectious disease.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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12
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Bennuru S, Maldarelli G, Kumaraswami V, Klion AD, Nutman TB. Elevated levels of plasma angiogenic factors are associated with human lymphatic filarial infections. Am J Trop Med Hyg 2010; 83:884-90. [PMID: 20889885 DOI: 10.4269/ajtmh.2010.10-0039] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lymphatic dilatation, dysfunction, and lymphangiogenesis are hallmarks of patent lymphatic filariasis, observed even in those with subclinical microfilaremia, through processes associated, in part, by vascular endothelial growth factors (VEGFs). A panel of pro-angiogenic factors was measured in the plasma of subjects from filaria-endemic regions using multiplexed immunological assays. Compared with endemic normal control subjects, those with both subclinical microfilaremia, and those with longstanding lymphedema had significantly elevated levels of VEGF-A, VEGF-C, VEGF-D, and angiopoietins (Ang-1/Ang-2), with only levels of basic fibroblast growth factor (bFGF) and placental growth factor (PlGF) being elevated only if lymphedema was evident. Furthermore, levels of these factors 1-year post-treatment with doxycycline were similar to pretreatment levels suggesting a minimal role, if any, for Wolbachia. Our data support the concept that filarial infection per se is associated with elevated levels of most of the known pro-angiogenic factors, with only a few being associated with the serious pathologic consequences associated with Wuchereria bancrofti infection.
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Affiliation(s)
- Sasisekhar Bennuru
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
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13
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Rocha A, Braga C, Belém M, Carrera A, Aguiar-Santos A, Oliveira P, Texeira MJ, Furtado A. Comparison of tests for the detection of circulating filarial antigen (Og4C3-ELISA and AD12-ICT) and ultrasound in diagnosis of lymphatic filariasis in individuals with microfilariae. Mem Inst Oswaldo Cruz 2009; 104:621-5. [DOI: 10.1590/s0074-02762009000400015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 06/22/2009] [Indexed: 11/21/2022] Open
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14
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Alves LC, Cavalcanti MGS, Araújo HRC, Silva GM, Veras DL, Paiva MHS, Brayner FA. Ultrastructural analysis of microfilariae of Wuchereria bancrofti obtained from persistent carriers after repeated courses of diethylcarbamazine. Micron 2009; 40:659-64. [PMID: 19359187 DOI: 10.1016/j.micron.2009.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 01/13/2009] [Accepted: 01/15/2009] [Indexed: 11/18/2022]
Abstract
Single dose of diethylcarbamazine (DEC) used in control programs is effective in breaking the transmission of filariasis. In order to investigate the effect of aggressive therapy on Wuchereria bancrofti (Wb) microfilariae, DEC was given to 29 patients who were positive for the circulating filarial antigen (CFA) assay but did not have clinical manifestations of filariasis, at 6 mg/kg/day for 12 days and again six months later using the same dosing regimen. For each patient, microfilarial density and serum CFA were followed up for two years. Ultrastructural analyses on Wb microfilariae obtained after repeated treatment with DEC were also performed. Microfilaremia and antigenemia decreased significantly after 12 months but returned to the initial levels after 24 months. This could indicate, as shown by other authors, that aggressive repeated therapy with DEC alone is ineffective in eradicating adult W. bancrofti, particularly in infected but asymptomatic individuals. The objective of the present study was to analyze the microfilaremic and antigenemic behavior and ultrastructural changes caused by different DEC concentrations in vitro in Wb microfilariae obtained from individuals who were sensitive and refractory to treatment. After in vitro treatment of the microfilariae using 5 and 10 microg/ml of DEC for 1h, ultrastructural analysis revealed low levels of cell damage compared with embryos obtained from individuals from a different area who had never received DEC treatment before. The results obtained suggest that microfilariae from patients who receive repeated aggressive therapy are less sensitive to DEC in vitro.
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Affiliation(s)
- L C Alves
- Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães (FIOCRUZ), Recife, PE, Brazil.
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15
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HARNETT W, HARNETT MM. Lymphocyte hyporesponsiveness during filarial nematode infection. Parasite Immunol 2008; 30:447-53. [DOI: 10.1111/j.1365-3024.2008.01045.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Efficacy and safety of drug combinations in the treatment of schistosomiasis, soil-transmitted helminthiasis, lymphatic filariasis and onchocerciasis. Trans R Soc Trop Med Hyg 2007; 101:747-58. [PMID: 17481681 DOI: 10.1016/j.trstmh.2007.03.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 03/05/2007] [Accepted: 03/05/2007] [Indexed: 11/28/2022] Open
Abstract
This review concerns the efficacy and safety of combinations of various drugs, including albendazole (ALB), diethylcarbamazine (DEC), ivermectin (IVM), mebendazole and praziquantel (PZQ). There were no significant pharmacokinetic interactions when ALB-PZQ, ALB-DEC, ALB-IVM or ALB-IVM-PZQ were co-administered. ALB did not add to the cure rate of PZQ in the treatment of Schistosoma japonicum, S. mansoni and S. haematobium. ALB and DEC in combination and alone were ineffective against S. haematobium infections. No combinations (ALB-PZQ, ALB-IVM and ALB-DEC) were superior to ALB against Ascaris lumbricoides and hookworm infections, whilst IVM, but not PZQ or DEC, added to the effect of ALB in the treatment of Trichuris trichiura. Results with ALB added to single-drug therapy with IVM or DEC against lymphatic filariasis were inconclusive, but DEC and IVM in combination appeared to be superior to DEC or IVM alone. None of the drug combinations against lymphatic filariasis showed more adverse reactions than single-drug therapy. In onchocerciasis patients, ALB and IVM were safe in those also infected with lymphatic filariasis, but were not superior to IVM alone. Existing policies are based on limited knowledge. Well conducted, comparative, randomised controlled studies would greatly aid in the future use of these drug combinations.
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17
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Ramaiah KD, Vanamail P, Das PK. Changes in Wuchereria bancrofti infection in a highly endemic community following 10 rounds of mass administration of diethylcarbamazine. Trans R Soc Trop Med Hyg 2007; 101:250-5. [PMID: 16890256 DOI: 10.1016/j.trstmh.2006.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 05/09/2006] [Accepted: 05/09/2006] [Indexed: 11/21/2022] Open
Abstract
Mass drug administration (MDA) is the principal strategy of the programme to eliminate lymphatic filariasis (LF). Evaluation of MDA in highly endemic 'sentinel' communities is necessary to understand its impact on LF infection. This study examined the changes in Wuchereria bancrofti infection following 10 rounds of annual mass administration of diethylcarbamazine (DEC) in a highly endemic community. The mean number of DEC treatments received per adult in the community was 7.4+/-2.0. Following 10 rounds of DEC administration, the number of microfilaria (mf) carriers fell from 565 to 55. None of the pre-MDA amicrofilaraemic individuals showed circulating filarial antigen (CFA). However, 54.5% of the pre-MDA microfilaraemic individuals were positive for CFA. All the pre-MDA high intensity mf carriers continued to be positive for CFA, and some of them also showed blood mf. These patients are the most difficult to be cured by MDA and were distributed in 8.2% of the households. All the children born during the last 7 years of the MDA programme were negative for CFA. The study suggests that six to seven DEC treatments per individual suppresses microfilaraemia, except in some people with heavy infection, and repeated MDA has very good potential to prevent infection in children.
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Affiliation(s)
- K D Ramaiah
- Vector Control Research Centre (Indian Council of Medical Research), Medical Complex, Indira Nagar, Pondicherry 605006, India.
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18
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Simonsen PE, Magesa SM, Meyrowitsch DW, Malecela-Lazaro MN, Rwegoshora RT, Jaoko WG, Michael E. The effect of eight half-yearly single-dose treatments with DEC on Wuchereria bancrofti circulating antigenaemia. Trans R Soc Trop Med Hyg 2005; 99:541-7. [PMID: 15869771 DOI: 10.1016/j.trstmh.2004.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Revised: 11/11/2004] [Accepted: 11/12/2004] [Indexed: 11/18/2022] Open
Abstract
The effect of eight half-yearly treatment rounds with diethylcarbamazine (DEC; 6mg/kg bodyweight) on Wuchereria bancrofti-specific circulating filarial antigen (CFA), a marker of adult worm infection, was followed in 79 individuals who were CFA-positive before start of treatment. Half of these were also microfilariae (mf)-positive. Microfilaraemia decreased rapidly after onset of treatment and became undetectable after four treatments. Circulating antigenaemia also decreased progressively, but at a much slower rate. After two, four and eight treatment rounds, the mean CFA intensity was reduced by 81, 94 and 98%, and the prevalence of CFA positivity was 85, 66 and 57%, compared with pre-treatment, respectively. CFA clearance rates were negatively related to pre-treatment CFA intensities, and were higher among pre-treatment mf-negative individuals than among pre-treatment mf-positive individuals. Even among patients who had pre-treatment CFA intensities above the upper measuring level (32000antigen units), and who continued to have intensities above this level after treatment, a decrease in post-treatment CFA intensities was obvious from a continuous decrease in ELISA optical density values. Repeated DEC therapy thus appears to have a slow but profound and persistent macrofilaricidal effect, which in the long run may be beneficial to populations undergoing DEC-based control interventions by reducing the probability of future morbidity development.
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Affiliation(s)
- Paul E Simonsen
- DBL-Institute for Health Research and Development, Jaegersborg Alle 1D, 2920 Charlottenlund, Denmark.
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19
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Tisch DJ, Michael E, Kazura JW. Mass chemotherapy options to control lymphatic filariasis: a systematic review. THE LANCET. INFECTIOUS DISEASES 2005; 5:514-23. [PMID: 16048720 DOI: 10.1016/s1473-3099(05)70192-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Understanding the efficacy of microfilaricidal drugs is important in guiding the global programme for the elimination of lymphatic filariasis as a public-health problem. We did a systematic review of the available literature to determine which currently available drug intervention most effectively decreases circulating Wuchereria bancrofti microfilaria in individuals and populations. 57 randomised studies of drug efficacy were identified. Data were combined and compared using weighted mean effect estimates taking into account the longitudinal nature of the data. Combined treatment with diethylcarbamazine plus ivermectin, diethylcarbamazine plus albendazole, and ivermectin plus albendazole resulted in average microfilarial intensity decreases that were 0.7%, 4.6%, and 12.7% of the pre-treatment values, respectively. Drug combinations containing diethylcarbamazine were the most effective against microfilarial prevalence and intensity relative to single drugs or other combinations. The relative efficacies of drug combinations have not been well documented from existing studies and therefore limit the application of evidenced-based recommendations for chemotherapy-based interventions to control lymphatic filariasis. These results provide valuable estimates of drug effect using existing data, but highlight the need for more comprehensive comparative drug studies.
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Affiliation(s)
- Daniel J Tisch
- Department of Epidemiology and Biostatistics and Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio 44106-7286, USA
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20
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Abstract
Currently, only three drugs are used to control and treat the mosquito-borne parasitic disease lymphatic filariasis: diethylcarbamazine, ivermectin (Mectizan) and albendazole (Zentel). All interrupt transmission by eliminating microfilaria, the parasite stage that is responsible for transmission between hosts, but do not reliably kill the adult worms that are responsible for much of the pathology seen in the disease. There is an urgent need to develop drugs that will reliably kill adult worms and several compounds are under-going in vitro and animal testing. An alternative strategy - that of targeting symbiont bacteria within the parasite - has also shown promising results.
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Affiliation(s)
- Wayne D Melrose
- Lymphatic Filariasis Support Center, School of Public Health and Tropical Medicine, James Cook University, Townsville, Australia
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21
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Rocha A, Lima G, Medeiros Z, Aguiar-Santos A, Alves S, Montarroyos U, Oliveira P, Béliz F, Netto MJ, Furtado A. Circulating filarial antigen in the hydrocele fluid from individuals living in a bancroftian filariasis area - Recife, Brazil: detected by the monoclonal antibody Og4C3-assay. Mem Inst Oswaldo Cruz 2004; 99:101-5. [PMID: 15057356 DOI: 10.1590/s0074-02762004000100018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to examine the circulating filarial antigen (CFA) detected by the monoclonal antibody (mAb) Og4C3-ELISA in paired samples of serum and hydrocele fluid from 104 men with hydrocele, living in an endemic area of Wuchereria bancrofti. Nocturnal blood specimens were filtered and examined for microfilariae (MF) and ultrasound was used in order to identify the presence of adult worms (the filaria dance sign - FDS) in the lymphatic vessels of the scrotal area. Four groups were selected according to their parasitological status: group I - 71 MF- and FDS-; group II - 21 MF+ and FDS+; group III - 10 MF- and FDS+ and group IV- 2 MF+ and FDS-. CFA was identified simultaneously (fluid and serum) in 11 (15.5%), 21 (100%), 3 (30%), and 1 (50%) in groups I, II, III, and IV, respectively. In despite of high CFA+ level (antigen Og4C3) units/ml, the Geometrical Mean (GM) = 2696) in the sera of these 36/104 paired samples, when compared to the hydrocele fluid, (GM = 1079), showed a very good correlation between the CFA level in the serum and CFA level in the fluid (r = 0.731). CFA level in the serum of the 23 microfilaremics (groups II and IV) was extremely high (GM = 4189) and was correlated with MF density (r = 0.442). These findings report for the first time the potential alternative use of the hydrocele fluid to investigate CFA using the mAb Og4C3-ELISA.
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Affiliation(s)
- Abraham Rocha
- Departamento de Parasitologia, Serviço de Referência Nacional em Filariose, Centro de Pesquisas Aggeu Magalhães, Fiocruz, Recife, PE, Brasil.
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22
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Walther M, Muller R. Diagnosis of human filariases (except onchocerciasis). ADVANCES IN PARASITOLOGY 2003; 53:149-93. [PMID: 14587698 DOI: 10.1016/s0065-308x(03)53004-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The traditional method of diagnosing filarial infections is to examine blood or skin samples for microfilariae and for many this is still the standard procedure. However, since the present global campaign to eliminate lymphatic filariasis new diagnostic tools have emerged like PCR, antigen detection using finger-prick blood taken during the day and ultrasound to visualize adult worms. The last two can be applied in endemic countries with limited resources and enable the detection of early infections. As well as their value in control schemes, the latter is particularly important for the individual since recent research has shown that damage is usually caused long before symptoms appear. The usefulness in different situations and the advantages and disadvantages of the various new tools for diagnosis of lymphatic filariasis are discussed. For loiasis, immunodiagnostic methods have not been very successful but repetitive DNA sequences in the Loa genome have been found to be species specific. Techniques based on them are particularly useful for diagnosing cases of occult infection without microfilaraemia. There have been no advances in the diagnosis of Mansonella perstans but both immunodiagnostic and PCR tests show promise in differentiating M. streptocerca, and the latter in differentiating M.ozzardi, from Onchocerca. In addition to the human filariae, the dog parasites Dirofilaria immitis and D. repens can also occur in humans but do not produce microfilariae in them. ELISAs and PCR probes have been devised and can usefully differentiate between pulmonary dirofilariasis and lung cancer.
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Affiliation(s)
- Michael Walther
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Old Road, Headington, Oxford OX3 7LJ, UK
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Abstract
Lymphatic filariasis has afflicted people in the tropical areas of the world for thousands of years but even up to comparatively recent times it has been poorly understood and its importance under recognised. In the last 2 decades or so there has been a flurry of activity in filariasis research, which has provided new insights into the global problem of filariasis, the pathogenesis of filarial disease, diagnosis and control.
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Affiliation(s)
- Wayne D Melrose
- Lymphatic Filariasis Support Centre, School of Public Health and Tropical Medicine, James Cook University, Townsville, QLD 4811, Australia.
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Beuria MK, Bal MS, Mandal NN, Das MK. Antigenemia at 10 years after diethylcarbamazine treatment of asymptomatic microfilaraemic individuals: marginal conversion to infection-free state. Parasite Immunol 2002; 24:109-11. [PMID: 11874566 DOI: 10.1046/j.0141-9838.2001.00439.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A group of asymptomatic microfilaraemic individuals (n = 44, 29 males, 15 females) living in a Wuchereria bancrofti endemic region of Orissa, India, was treated with a standard regimen of diethylcarbamazine (12 days, 6 mg/kg) in 1990. The incidence of microfilaraemia and antigenemia (Og4C3) was determined after a gap of 10 years in 2000. Nineteen individuals reacquired microfilariae (43.2%, 11 males, eight females), five males developed hydrocele, two females became acute filarial patients and 18 subjects (13 males, five females) were asymptomatic amicrofilaraemics. Filarial antigen was detected in 36 individuals (81.2%, 27 male, nine female) comprising microfilaraemics, amicrofilaraemics and diseased. Only eight individuals (18.2%, two males, six females) remained antigen free.
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Affiliation(s)
- M K Beuria
- Division of Immunology, Regional Medical Research Center (ICMR), Chandrasekharpur, Bhubaneswar, Orissa, India
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Weerasooriya MV, Gunawardena NK, Itoh M, Qiu XG, Kimura E. Prevalence and intensity of Wuchereria bancrofti antigenaemia in Sri Lanka by Og4C3 ELISA using filter paper-absorbed whole blood. Trans R Soc Trop Med Hyg 2002; 96:41-5. [PMID: 11925989 DOI: 10.1016/s0035-9203(02)90234-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In Sri Lanka 2741 people from Matara, an endemic area for Wuchereria bancrofti, were examined in 1996/97 for microfilariae by 60-microL blood smear and for circulating filarial antigens by Og4C3 ELISA using filter paper-absorbed whole blood. The overall prevalence of microfilaraemia was 3.4%, and that of antigenaemia 14.4%. The prevalence of antigen-positive and microfilaria-negative people was 11.3%. Analysed by age-group, antigenaemia prevalence was similar in all groups, and the average number of antigen units was already very high in the age-group < 10 years, indicating that the infection started in early childhood. Among those who were antigen positive, the microfilaria prevalence was lower in females than in males. Diethylcarbamazine treatment eliminated microfilariae in 78% of the positives. However, 17 months after the treatment, antigenaemia was still positive in 76% of those who were parasitologically cured.
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Affiliation(s)
- M V Weerasooriya
- Filariasis Research Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna, P. O. Box 70, Galle, Sri Lanka
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Freedman DO, Plier DA, De Almeida AB, De Oliveira AL, Miranda J, Braga C. Effect of aggressive prolonged diethylcarbamazine therapy on circulating antigen levels in bancroftian filariasis. Trop Med Int Health 2001; 6:37-41. [PMID: 11251894 DOI: 10.1046/j.1365-3156.2001.00666.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Single dose diethylcarbamazine (DEC) as used in control programmes is effectively microfilaricidal for periods of up to a year or more but has incomplete ability to kill Wuchereria bancrofti adult parasites. These regimens can be effective in breaking transmission by suppression of circulating microfilariae available to mosquito vectors. Whether prolonged or aggressive therapy with DEC has a significant effect on adult worms, which may live up to 12 years or more, and is important in the context of the treatment of individual patients, is still incompletely understood. METHODS In order to investigate the adulticidal effect of aggressive therapy, DEC was given at 6 mg/kg/day for 12-day courses at 0, 6, 12, and 18 months and Og4C3 antigenaemia followed over two years in 38 CAg + Brazilians in a W. bancrofti endemic area. RESULTS At two year follow-up, the median level of antigenaemia was 21% of the pre-treatment value. 92% of individuals had antigen levels < 50% of pretreatment values, but only 26% had completely cleared antigenaemia. The clearance rate at 24 months was only 12% (3/26) in the asymptomatic CAg + patients but 58% (7/12) in those with clinical manifestations of filariasis. The latter individuals cleared significantly more antigen (median of 0% pretreatment antigenaemia vs. 26%; P=0.02) than asymptomatic but infected individuals. CONCLUSION Aggressive repeated therapy with DEC alone is ineffective in consistently eradicating adult W. bancrofti, especially in infected but asymptomatic individuals. Prolonged courses of combination therapy with other antifilarial drugs should be investigated for treatment of individual patients with the means to pursue aggressive personal medical care.
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Affiliation(s)
- D O Freedman
- Division of Geographic Medicine, Department of Medicine, University of Alabama, Birmingham 35294-2170, USA.
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27
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Sahoo PK, Geddam JJ, Satapathy AK, Mohanty MC, Ravindran B. Bancroftian filariasis: prevalence of antigenaemia and endemic normals in Orissa, India. Trans R Soc Trop Med Hyg 2000; 94:515-7. [PMID: 11132379 DOI: 10.1016/s0035-9203(00)90070-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- P K Sahoo
- Division of Immunology, Regional Medical Research Centre, ICMR, Bhubaneswar 751016, India
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28
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Dunyo SK, Nkrumah FK, Simonsen PE. Single-dose treatment of Wuchereria bancrofti infections with ivermectin and albendazole alone or in combination: evaluation of the potential for control at 12 months after treatment. Trans R Soc Trop Med Hyg 2000; 94:437-43. [PMID: 11127253 DOI: 10.1016/s0035-9203(00)90135-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The effect of single-dose ivermectin (150-200 micrograms/kg) and albendazole (400 mg) treatment alone and in combination on Wuchereria bancrofti microfilaraemia, antigenaemia and clinical manifestations was compared 12 months after treatment in a double-blind placebo-controlled field trial carried out in Ghana in 1996-98, to evaluate the potential of these treatments for control. Both ivermectin and combination treatments resulted in pronounced reductions in microfilaraemia among individuals who were microfilaria positive before treatment. Among individuals who were positive for circulating filarial antigen before treatment, antigen levels increased considerably over the 1-year period after treatment in the placebo group, whereas they decreased in the ivermectin and combination groups. However, the post-treatment difference reached statistical significance in neither microfilaraemia nor antigenaemia between the ivermectin and the combination groups. Albendazole treatment alone showed only a minor effect on microfilaraemia and antigenaemia. No effect of the treatments on the incidence of new cases of microfilaraemia or antigenaemia, or on clinical manifestations, was observed. Both ivermectin and combination treatment thus appeared effective for control of W. bancrofti infections, but the difference in efficacy between the 2 treatments after 12 months appeared to be minimal.
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Affiliation(s)
- S K Dunyo
- Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box 25, Legon, Ghana
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29
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Ottesen EA, Ismail MM, Horton J. The role of albendazole in programmes to eliminate lymphatic filariasis. PARASITOLOGY TODAY (PERSONAL ED.) 1999; 15:382-6. [PMID: 10461168 DOI: 10.1016/s0169-4758(99)01486-6] [Citation(s) in RCA: 156] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Citing earlier advances in the treatment of lymphatic filariasis [particularly the effectiveness of single-dose diethylcarbamazine (DEC) in reducing microfilaraemia and its enhanced effectiveness when co-administered with single-dose ivermectin], Eric Ottesen, Mahroof Ismail and John Horton consider recent studies on the antifilarial activity of albendazole that have led to the current recommendations for its use in single-dose regimens in conjunction with either DEC or ivermectin for large-scale control/elimination programmes. Furthermore, the potential of albendazole as a macrofilaricide for treating individual patients with lymphatic filarial infections is emphasized as one of a number of important research questions that remain to be explored.
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Affiliation(s)
- E A Ottesen
- Communicable Diseases Eradication and Elimination Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
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30
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Simonsen PE, Dunyo SK. Comparative evaluation of three new tools for diagnosis of bancroftian filariasis based on detection of specific circulating antigens. Trans R Soc Trop Med Hyg 1999; 93:278-82. [PMID: 10492759 DOI: 10.1016/s0035-9203(99)90022-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Three new and commercially available tools for diagnosis of Wuchereria bancrofti infections based on detection of specific circulating antigens were evaluated and compared in the same group of individuals from a highly endemic village in southern Ghana. The tests were: (1) the ICT card test for serum specimens; (2) the TropBio ELISA test for serum specimens; and (3) the TropBio ELISA test for filter-paper specimens. A high degree of positive/negative response similarity was observed for the 3 tests, and the sensitivity for detecting microfilaraemic cases was 100% for all tests. The antigen levels measured in the TropBio serum test and the TropBio filter-paper test were statistically significantly correlated. Among antigen-positive endemic individuals the antigen levels in these 2 tests furthermore showed a positive association with the microfilarial intensity, but a statistical significant correlation was seen only for the filter-paper version of the test. The results are promising for the use of the 3 tests as diagnostic tools in bancroftian filariasis.
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Affiliation(s)
- P E Simonsen
- Danish Bilharziasis Laboratory, Charlottenlund, Denmark.
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31
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Itoh M, Gunawardena NK, Qiu XG, Weerasooriya MV, Kimura E. The use of whole blood absorbed on filter paper to detect Wuchereria bancrofti circulating antigen. Trans R Soc Trop Med Hyg 1998; 92:513-5. [PMID: 9861365 DOI: 10.1016/s0035-9203(98)90896-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The Og4C3 enzyme-linked immunosorbent assay (ELISA) to detect circulating Wuchereria bancrofti antigen uses 50 microL of serum. In this study, a whole blood sample absorbed on filter paper was tested as a substitute for serum. Serum samples were obtained from 60 Sri Lankan subjects by venepuncture and finger-prick blood samples from the same individuals were directly absorbed on filter paper. Og4C3 ELISAs using serum and filter paper blood were compared. Despite the fact that the estimated amount of serum available for the ELISA with filter paper blood was only one-fifth of that available when serum was used, the 2 ELISAs gave almost identical results. Of the 39 positive serum samples, 38 were detected using filter paper blood. Employing the ELISA using filter paper blood, 619 people in Matara, Sri Lanka, were examined for antigenaemia. The positivity rate was 22.5%, 3.1 times higher than the rate of microfilaraemia detected by examination of 60 microL blood films.
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Affiliation(s)
- M Itoh
- Department of Parasitology, Aichi Medical University, Japan
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32
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Langy S, Plichart C, Luquiaud P, Williams SA, Nicolas L. The immunodominant Brugia malayi paramyosin as a marker of current infection with Wuchereria bancrofti adult worms. Infect Immun 1998; 66:2854-8. [PMID: 9596759 PMCID: PMC108281 DOI: 10.1128/iai.66.6.2854-2858.1998] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/1997] [Accepted: 03/18/1998] [Indexed: 02/07/2023] Open
Abstract
The full-length cDNA sequence encoding Brugia malayi L3 paramyosin has been isolated by immunoscreening a cDNA library with a mouse antiserum raised against Wuchereria bancrofti L3 infective larvae. A recombinant truncated form of paramyosin was expressed as a glutathione S-transferase fusion protein and used to evaluate humoral responses of adults from a W. bancrofti-endemic area in French Polynesia according to their parasitological status. Immunoglobulin G4 (IgG4) preferentially bound to paramyosin in W. bancrofti-parasitized individuals, in contrast to unparasitized individuals, who harbored neither microfilaria nor Og4C3 adult worm circulating antigen. Reduction of the anti-paramyosin IgG4 titer following combined chemotherapy with diethylcarbamazine and ivermectin was significantly correlated with a reduction in the adult worm burden. This indicates that the presence of paramyosin-reactive IgG4 is associated with the presence of parasites and that reduction can be used as an immunological marker for W. bancrofti clearance.
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Affiliation(s)
- S Langy
- Institut Territorial de Recherches Médicales Louis Malardé, Papeete, Tahiti, French Polynesia
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Nicolas L. New tools for diagnosis and monitoring of bancroftian filariasis parasitism: The polynesian experience. ACTA ACUST UNITED AC 1997; 13:370-5. [PMID: 15275149 DOI: 10.1016/s0169-4758(97)01125-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Bancroftian filariasis is endemic in French Polynesia and control programs with diethylcarbamazine, started in the 1950s, led to a sharp reduction of the microfilaria prevalence. Consequently, the control program was interrupted in 1982. Ten years later, however, the incidence of the parasitism again reached pre-control levels (20-30% microfilaremia in some islands), indicating that the adult worms (for which no diagnostic tool was available) had persisted. Apart from research on chemotherapy strategies, the Institut Malardé has been actively involved in developing and evaluating more-powerful diagnostic tools than the unique detection of microfilariae by blood smear examination. These include: (1) the detection of adult worm circulating antigens in humans, and (2) the detection of Wuchereria bancrofti larvae in mosquitoes, using DNA probes. In this paper, Luc Nicolas reviews the available diagnostic tools to detect W. bancrofti and their implementation in epidemiological areas, based on the Polynesian experience.
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Affiliation(s)
- L Nicolas
- Institut Territorial de Recherches Médicales Louis, Malardé, BP 30, Papeete Tahiti, French Polynesia.
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