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Opoku M, de Souza DK. Identification and characterisation of Mansonella perstans in the Volta Region of Ghana. PLoS One 2024; 19:e0295089. [PMID: 38848396 PMCID: PMC11161070 DOI: 10.1371/journal.pone.0295089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Mansonella spp. have been reported to have a wide global distribution. Despite the distribution and co-occurrence with other filarial parasites like Wuchereria bancrofti, Onchocerca volvulus and Loa loa, it is given little attention. There are few surveillance programmes for assessing the distribution of mansonellosis, due to the associated mild to no symptoms experienced by infected people. However, addressing this infection is critical to the onchocerciasis control program as current rapid diagnostic tools targeting O. volvulus have the tendency to cross react with Mansonella species. In this study we identified and characterised M. perstans from five sites in two districts in the Volta Region of Ghana and compared them to samples from other regions. Night blood smears and filter blood blots were obtained from individuals as part of a study on lymphatic filariasis. The Giemsa-stained smears were screened by microscopy for the presence of filarial parasites. Genomic DNA was extracted from blood blots from 39 individuals that were positive for M. perstans and Nested PCR targeting the internal spacer 1 (ITS-1) was conducted. Of these, 30 were sequenced and 24 sequences were kept for further analysis. Phylogenetic analysis of 194 nucleotide positions showed no differences in the samples collected. The similarities suggests that there could be one species in this area. However, more robust studies with larger sample sizes are required to draw such conclusions. We also observed a clustering of the samples from Ghana with reference sequences from Africa and Brazil, suggesting they could be related. This study draws further attention to a neglected infection, presents the first characterisation of M. perstans in Ghana and calls for more population-based studies across different geographical zones to ascertain species variations and disease distribution.
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Affiliation(s)
- Millicent Opoku
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Environment and Genetics Department, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Australia
| | - Dziedzom K. de Souza
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Portela CS, Mendes de Araújo CP, Moura Sousa P, Gomes Simão CL, Silva de Oliveira JC, Crainey JL. Filarial disease in the Brazilian Amazon and emerging opportunities for treatment and control. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2023; 5:100168. [PMID: 38283060 PMCID: PMC10821485 DOI: 10.1016/j.crpvbd.2023.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024]
Abstract
Following the successful eradication of Wuchereria bancrofti, there are now just three species of conventional microfilaremic human filarial parasites endemic to the Brazilian Amazon region: Mansonella ozzardi, Mansonella perstans and Onchocerca volvulus. The zoonotic filarial parasite Dirofilaria immitis is also found in the Amazon region as are several sylvatic filarial parasites, some of which have been recorded causing zoonoses and some of which have never been recorded outside the region. Onchocerca volvulus is only found in the Amazonia onchocerciasis focus in the Brazilian state of Roraima where it affects the people of the Yanomami tribe living around the densely forested Venezuela border region. Mansonella ozzardi is by far the most common filarial parasite in Brazil and has a broad but patchy distribution throughout the western Amazon region. Recorded in the Brazilian states of Acre, Roraima, Matto Grosso, and within almost every municipality of Amazonas state, it is believed that pollution of the urban stream and river systems prevents the development of the simuliid vectors of M. ozzardi and explains the parasite's reduced distribution within urban areas and an absence of recent reports from the state capital Manaus. Decades of WHO-led periodic ivermectin treatment of Yanomami tribe's people have resulted in the partial suppression of O. volvulus transmission in this focus and has also probably affected the transmission of M. ozzardi in the region. Mansonella perstans, O. volvulus and very probably M. ozzardi infections can all be treated and most likely cured with a 4-6-week treatment course of doxycycline. The Brazilian Ministry of Health does not, however, presently recommend any treatment for mansonellosis infections and thus parasitic infections outside the Amazonia focus are typically left untreated. While the long treatment courses required for doxycycline-based mansonellosis therapies preclude their use in control programmes, new fast-acting filarial drug treatments are likely to soon become available for the treatment of both onchocerciasis and mansonellosis in the Amazon region. Filarial disease management in the Brazilian Amazon is thus likely to become dramatically more viable at a time when the public health importance of these diseases is increasingly being recognized.
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Affiliation(s)
- Cleudecir Siqueira Portela
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
- Programa de Doutorado em Biologia da Interação Patógeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Amazonas, Brazil
| | - Cláudia Patrícia Mendes de Araújo
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
- Programa de Doutorado em Biologia da Interação Patógeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Amazonas, Brazil
| | - Patrícia Moura Sousa
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
- Programa de Doutorado em Biologia da Interação Patógeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Amazonas, Brazil
| | - Carla Letícia Gomes Simão
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
- Programa de Mestrado em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Manaus, Amazonas, Brazil
| | - João Carlos Silva de Oliveira
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
- Programa de Doutorado em Saúde Pública na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Manaus, Amazonas, Brazil
| | - James Lee Crainey
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Amazonas, Brazil
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Ferreira MU, Crainey JL, Gobbi FG. The search for better treatment strategies for mansonellosis: an expert perspective. Expert Opin Pharmacother 2023; 24:1685-1692. [PMID: 37477269 DOI: 10.1080/14656566.2023.2240235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/20/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Four species of the Mansonella genus infect millions of people across sub-Saharan Africa and Central and South America. Most infections are asymptomatic, but mansonellosis can be associated with nonspecific clinical manifestations such as fever, headache, arthralgia, and ocular lesions (M. ozzardi); pruritus, arthralgia, abdominal pain, angioedema, skin rash, and fatigue (M. perstans and perhaps Mansonella sp. 'DEUX'); and pruritic dermatitis and chronic lymphadenitis (M. perstans). AREAS COVERED We searched the PubMed and SciELO databases for publications on mansonelliasis in English, Spanish, Portuguese, or French that appeared until 1 May 2023. Literature data show that anthelmintics - single-dose ivermectin for M. ozzardi, repeated doses of mebendazole alone or in combination with diethylcarbamazine (DEC) for M. perstans, and DEC alone for M. streptocerca - are effective against microfilariae. Antibiotics that target Wolbachia endosymbionts, such as doxycycline, are likely to kill adult worms of most, if not all, Mansonella species, but the currently recommended 6-week regimen is relatively impractical. New anthelmintics and shorter antibiotic regimens (e.g. with rifampin) have shown promise in experimental filarial infections and may proceed to clinical trials. EXPERT OPINION We recommend that human infections with Mansonella species be treated, regardless of any apparent clinical manifestations. We argue that mansonellosis, despite being widely considered a benign infection, may represent a direct or indirect cause of significant morbidity that remains poorly characterized at present.
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Affiliation(s)
- Marcelo U Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
| | - James Lee Crainey
- Laboratory of Ecology and Transmissible Diseases in the Amazon, Leônidas and Maria Deane Institute, Fiocruz, Manaus, Brazil
| | - Federico G Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Hochberg NS, Dinculescu VV, Nutman TB. Case 17-2023: A 58-Year-Old Woman with Fatigue, Abdominal Bloating, and Eosinophilia. N Engl J Med 2023; 388:2180-2189. [PMID: 37285529 PMCID: PMC10986646 DOI: 10.1056/nejmcpc2201248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Natasha S Hochberg
- From the Department of Medicine, Boston University School of Medicine (N.S.H.), the Department of Radiology, Massachusetts General Hospital (V.V.D.), and the Department of Radiology, Harvard Medical School (V.V.D.) - all in Boston; and the Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, MD (T.B.N.)
| | - Vincent V Dinculescu
- From the Department of Medicine, Boston University School of Medicine (N.S.H.), the Department of Radiology, Massachusetts General Hospital (V.V.D.), and the Department of Radiology, Harvard Medical School (V.V.D.) - all in Boston; and the Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, MD (T.B.N.)
| | - Thomas B Nutman
- From the Department of Medicine, Boston University School of Medicine (N.S.H.), the Department of Radiology, Massachusetts General Hospital (V.V.D.), and the Department of Radiology, Harvard Medical School (V.V.D.) - all in Boston; and the Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, MD (T.B.N.)
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Sinha A, Li Z, Poole CB, Morgan RD, Ettwiller L, Lima NF, Ferreira MU, Fombad FF, Wanji S, Carlow CKS. Genomes of the human filarial parasites Mansonella perstans and Mansonella ozzardi. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1139343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
The filarial parasites Mansonella ozzardi and Mansonella perstans, causative agents of mansonellosis, infect hundreds of millions of people worldwide, yet remain among the most understudied of the human filarial pathogens. M. ozzardi is highly prevalent in Latin American countries and Caribbean Islands, while M. perstans is predominantly found in sub-Saharan Africa as well as in a few areas in South America. In addition to the differences in their geographical distribution, the two parasites are transmitted by different insect vectors, as well as exhibit differences in their responses to commonly used anthelminthic drugs. The lack of genome information has hindered investigations into the biology and evolution of Mansonella parasites and understanding the molecular basis of the clinical differences between species. In the current study, high quality genomes of two independent clinical isolates of M. perstans from Cameroon and two M. ozzardi isolates one from Brazil and one from Venezuela are reported. The genomes are approximately 76 Mb in size, encode about 10,000 genes each, and are largely complete based on BUSCO scores of about 90%, similar to other completed filarial genomes. These sequences represent the first genomes from Mansonella parasites and enabled a comparative genomic analysis of the similarities and differences between Mansonella and other filarial parasites. Horizontal DNA transfers (HDT) from mitochondria (nuMTs) as well as transfers from genomes of endosymbiotic Wolbachia bacteria (nuWTs) to the host nuclear genome were identified and analyzed. Sequence comparisons and phylogenetic analysis of known targets of anti-filarial drugs diethylcarbamazine (DEC), ivermectin and mebendazole revealed that all known target genes were present in both species, except for the DEC target encoded by gon-2 gene, which is fragmented in genome assemblies from both M. ozzardi isolates. These new reference genome sequences will provide a valuable resource for further studies on biology, symbiosis, evolution and drug discovery.
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Aniagyei W, Adjei JK, Adankwah E, Seyfarth J, Mayatepek E, Antwi Berko D, Sakyi SA, Batsa Debrah L, Debrah AY, Hoerauf A, Owusu DO, Phillips RO, Jacobsen M. Doxycycline Treatment of Mansonella perstans-Infected Individuals Affects Immune Cell Activation and Causes Long-term T-cell Polarization. Clin Infect Dis 2023; 76:e1399-e1407. [PMID: 35657028 DOI: 10.1093/cid/ciac428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Doxycycline is used for treatment of Mansonella perstans infection. Immune modulatory effects of both M. perstans and doxycycline have been described but long-term implications on host immune response are not defined. Here we determined multiple immune parameters of M. perstans-infected individuals before and after doxycycline treatment to characterize doxycycline effects on host T-cell immunity. METHODS Immune characterization of doxycycline-treated M. perstans-infected individuals was performed as part of an open-label randomized clinical trial. Immune cell population phenotyping by flow cytometry and functional in vitro T-cell assays were performed at baseline, 6 months, and "long term" (18-24 months) after treatment start. Treatment efficacy, based on peripheral blood microfilaria (mf) burden, was correlated with immune parameters and effects on immune response against concomitant Mycobacterium tuberculosis infection were determined. RESULTS Immune population phenotyping indicated changes in functional T-cell responses after doxycycline treatment. Constitutive and superantigen-induced T-cell activation and polarization towards T-helper type (TH) 1 phenotype at baseline declined after doxycycline treatment, whereas low proportions of TH17 and TH1* cells at baseline increased significantly at follow-up. In accordance, long-term decline in antigen-specific TH1 responses against concomitant M. tuberculosis infection was seen. Notably, only TH17 and TH1* changes after 6 months and TH17 at baseline were negatively correlated with M. perstans microfilaria burden or reduction, whereas long-term changes were not associated with treatment efficacy. CONCLUSIONS We found long-term immune modulatory effects of doxycycline treatment leading to decreased constitutive T-cell activation, polarization towards TH17/TH1*, and impaired immune response against concomitant M. tuberculosis infection.
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Affiliation(s)
- Wilfred Aniagyei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Jonathan Kofi Adjei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Ernest Adankwah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.,Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Julia Seyfarth
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Daniel Antwi Berko
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Linda Batsa Debrah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Alexander Yaw Debrah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.,Faculty of Allied Health Sciences of Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital of Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn-Cologne, Germany
| | - Dorcas O Owusu
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Richard O Phillips
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.,Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Marc Jacobsen
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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Rodi M, Gross C, Sandri TL, Berner L, Marcet-Houben M, Kocak E, Pogoda M, Casadei N, Köhler C, Kreidenweiss A, Agnandji ST, Gabaldón T, Ossowski S, Held J. Whole genome analysis of two sympatric human Mansonella: Mansonella perstans and Mansonella sp "DEUX". Front Cell Infect Microbiol 2023; 13:1159814. [PMID: 37124042 PMCID: PMC10145164 DOI: 10.3389/fcimb.2023.1159814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/15/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Mansonella species are filarial parasites that infect humans worldwide. Although these infections are common, knowledge of the pathology and diversity of the causative species is limited. Furthermore, the lack of sequencing data for Mansonella species, shows that their research is neglected. Apart from Mansonella perstans, a potential new species called Mansonella sp "DEUX" has been identified in Gabon, which is prevalent at high frequencies. We aimed to further determine if Mansonella sp "DEUX" is a genotype of M. perstans, or if these are two sympatric species. Methods We screened individuals in the area of Fougamou, Gabon for Mansonella mono-infections and generated de novo assemblies from the respective samples. For evolutionary analysis, a phylogenetic tree was reconstructed, and the differences and divergence times are presented. In addition, mitogenomes were generated and phylogenies based on 12S rDNA and cox1 were created. Results We successfully generated whole genomes for M. perstans and Mansonella sp "DEUX". Phylogenetic analysis based on annotated protein sequences, support the hypothesis of two distinct species. The inferred evolutionary analysis suggested, that M. perstans and Mansonella sp "DEUX" separated around 778,000 years ago. Analysis based on mitochondrial marker genes support our hypothesis of two sympatric human Mansonella species. Discussion The results presented indicate that Mansonella sp "DEUX" is a new Mansonella species. These findings reflect the neglect of this research topic. And the availability of whole genome data will allow further investigations of these species.
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Affiliation(s)
- Miriam Rodi
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Caspar Gross
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Thaisa Lucas Sandri
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Laboratory of Molecular Immunopathology, Department of Clinical Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Lilith Berner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Marina Marcet-Houben
- Life Science Department, Barcelona Supercomputing Centre (BSC-CNS), Barcelona, Spain
- Mechanisms and Defense, Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Ersoy Kocak
- NGS Competence Center Tübingen (NCCT), Tübingen, Germany
| | - Michaela Pogoda
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- NGS Competence Center Tübingen (NCCT), Tübingen, Germany
| | - Nicolas Casadei
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
- NGS Competence Center Tübingen (NCCT), Tübingen, Germany
| | - Carsten Köhler
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | - Selidji Todagbe Agnandji
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | - Toni Gabaldón
- Life Science Department, Barcelona Supercomputing Centre (BSC-CNS), Barcelona, Spain
- Mechanisms and Defense, Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Stephan Ossowski
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- *Correspondence: Jana Held,
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Pilotte N, Thomas T, Zulch MF, Sirois AR, Minetti C, Reimer LJ, Williams SA, Saunders LJ. Targeting a highly repetitive genomic sequence for sensitive and specific molecular detection of the filarial parasite Mansonella perstans from human blood and mosquitoes. PLoS Negl Trop Dis 2022; 16:e0010615. [PMID: 36580452 PMCID: PMC9833530 DOI: 10.1371/journal.pntd.0010615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/11/2023] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Mansonella perstans is among the most neglected of the neglected tropical diseases and is believed to cause more human infections than any other filarial pathogen in Africa. Based largely upon assumptions of limited infection-associated morbidity, this pathogen remains understudied, and many basic questions pertaining to its pathogenicity, distribution, prevalence, and vector-host relationships remain unanswered. However, in recent years, mounting evidence of the potential for increased Mansonella infection-associated disease has sparked a renewal in research interest. This, in turn, has produced a need for improved diagnostics, capable of providing more accurate pictures of infection prevalence, pathogen distribution, and vector-host interactions. METHODOLOGY/PRINCIPAL FINDINGS Utilizing a previously described pipeline for the discovery of optimal molecular diagnostic targets, we identified a repetitive DNA sequence, and developed a corresponding assay, which allows for the sensitive and species-specific identification of M. perstans in human blood samples. Testing also demonstrated the ability to utilize this assay for the detection of M. perstans in field-collected mosquito samples. When testing both sample types, our repeat-targeting index assay outperformed a ribosomal sequence-targeting reference assay, facilitating the identification of additional M. perstans-positive samples falsely characterized as "negative" using the less sensitive detection method. CONCLUSIONS/SIGNIFICANCE Through the development of an assay based upon the systematic identification of an optimal DNA target sequence, our novel diagnostic assay will provide programmatic efforts with a sensitive and specific testing platform that is capable of accurately mapping M. perstans infection and determining prevalence. Furthermore, with the added ability to identify the presence of M. perstans in mosquito samples, this assay will help to define our knowledge of the relationships that exist between this pathogen and the various geographically relevant mosquito species, which have been surmised to represent potential secondary vectors under certain conditions. Detection of M. perstans in mosquitoes will also demonstrate proof-of-concept for the mosquito-based monitoring of filarial pathogens not vectored primarily by mosquitoes, an approach expanding opportunities for integrated surveillance.
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Affiliation(s)
- Nils Pilotte
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
- Department of Biological Sciences, Quinnipiac University, Hamden, Connecticut, United States of America
| | - Tamara Thomas
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
| | - Michael F. Zulch
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
| | - Allison R. Sirois
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
| | - Corrado Minetti
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lisa J. Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Steven A. Williams
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Lori J. Saunders
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
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Fordjour FA, Kwarteng A. The filarial and the antibiotics: Single or combination therapy using antibiotics for filariasis. Front Cell Infect Microbiol 2022; 12:1044412. [PMID: 36467729 PMCID: PMC9712956 DOI: 10.3389/fcimb.2022.1044412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/24/2022] [Indexed: 12/01/2023] Open
Abstract
Filarial infections caused by nematodes are one of the major neglected tropical diseases with public health concern. Although there is significant decrease in microfilariae (mf) prevalence following mass drug administration (IVM/DEC/ALB administration), this is transient, in that there is reported microfilaria repopulation 6-12 months after treatment. Wolbachia bacteria have been recommended as a novel target presenting antibiotic-based treatment for filarial disease. Potency of antibiotics against filarial diseases is undoubtful, however, the duration for treatment remains a hurdle yet to be overcome in filarial disease treatment.
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Affiliation(s)
- Fatima Amponsah Fordjour
- Department of Microbiology, University for Development Studies (UDS), Tamale, Ghana
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Alexander Kwarteng
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Tamarozzi F, Rodari P, Salas-Coronas J, Bottieau E, Salvador F, Soriano-Pérez MJ, Cabeza-Barrera MI, Van Esbroeck M, Treviño B, Buonfrate D, Gobbi FG. A large case series of travel-related Mansonella perstans (vector-borne filarial nematode): a TropNet study in Europe. J Travel Med 2022; 29:6567953. [PMID: 35417002 PMCID: PMC9635058 DOI: 10.1093/jtm/taac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infection with Mansonella perstans is a neglected filariasis, widely distributed in sub-Saharan Africa, characterized by an elusive clinical picture; treatment for mansonellosis is not standardized. This retrospective study aimed to describe the clinical features, treatment schemes and evolution, of a large cohort of imported cases of M. perstans infection seen in four European centres for tropical diseases. METHODS Mansonella perstans infections, diagnosed by identification of blood microfilariae in migrants, expatriates and travellers, collected between 1994 and 2018, were retrospectively analysed. Data concerning demographics, clinical history and laboratory examinations at diagnosis and at follow-up time points were retrieved. RESULTS A total of 392 patients were included in the study. Of the 281 patients for whom information on symptoms could be retrieved, 150 (53.4%) reported symptoms, abdominal pain and itching being the most frequent. Positive serology and eosinophilia were present in 84.4% and 66.1%, respectively, of those patients for whom these data were available. Concomitant parasitic infections were reported in 23.5% of patients. Treatment, administered to 325 patients (82.9%), was extremely heterogeneous between and within centres; the most commonly used regimen was mebendazole 100 mg twice a day for 1 month. A total of 256 (65.3%) patients attended a first follow-up, median 3 months (interquartile range 2-12) after the first visit; 83.1% of patients having received treatment based on mebendazole and/or doxycycline, targeting Wolbachia, became amicrofilaremic, 41.1-78.4% of whom within 12 months from single treatment. CONCLUSIONS Lack of specific symptoms, together with the inconstant positivity of parasitological and antibody-based assays in the infected population, makes the clinical suspicion and screening for mansonellosis particularly difficult. Prospective studies evaluating prevalence of infection in migrants from endemic areas, infection-specific morbidity, presence of Wolbachia endosymbionts in M. perstans populations from different geographical areas and efficacy of treatment regimens are absolutely needed to optimize the clinical management of infection.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Paola Rodari
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | | | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Fernando Salvador
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | | | | | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Begoña Treviño
- Tropical Medicine Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Federico G Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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11
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Ehrens A, Hoerauf A, Hübner MP. Current perspective of new anti-Wolbachial and direct-acting macrofilaricidal drugs as treatment strategies for human filariasis. GMS INFECTIOUS DISEASES 2022; 10:Doc02. [PMID: 35463816 PMCID: PMC9006451 DOI: 10.3205/id000079] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Filarial diseases like lymphatic filariasis and onchocerciasis belong to the Neglected Tropical Diseases and remain a public health problem in endemic countries. Lymphatic filariasis and onchocerciasis can lead to stigmatizing pathologies and present a socio-economic burden for affected people and their endemic countries. Current treatment recommendations by the WHO include mass drug administration with ivermectin for the treatment of onchocerciasis and a combination of ivermectin, albendazole and diethylcarbamazine (DEC) for the treatment of lymphatic filariasis in areas that are not co-endemic for onchocerciasis or loiasis. Limitations of these treatment strategies are due to potential severe adverse events in onchocerciasis and loiasis patients following DEC or ivermectin treatment, respectively, the lack of a macrofilaricidal efficacy of those drugs and the risk of drug resistance development. Thus, to achieve the elimination of transmission of onchocerciasis and the elimination of lymphatic filariasis as a public health problem by 2030, the WHO defined in its roadmap that new alternative treatment strategies with macrofilaricidal compounds are required. Within a collaboration of the non-profit organizations Drugs for Neglected Diseases initiative (DNDi), the Bill & Melinda Gates Foundation, and partners from academia and industry, several new promising macrofilaricidal drug candidates were identified, which will be discussed in this review.
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Affiliation(s)
- Alexandra Ehrens
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Marc P. Hübner
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
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12
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Kwarteng A, Asiedu E, Koranteng KK, Asiedu SO. Highlighting the Relevance of CD8 + T Cells in Filarial Infections. Front Immunol 2021; 12:714052. [PMID: 34603287 PMCID: PMC8481813 DOI: 10.3389/fimmu.2021.714052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/31/2021] [Indexed: 01/06/2023] Open
Abstract
The T cell immune responses in filarial infections are primarily mediated by CD4+ T cells and type 2-associated cytokines. Emerging evidence indicates that CD8+ T cell responses are important for anti-filarial immunity, however, could be suppressed in co-infections. This review summarizes what we know so far about the activities of CD8+ T cell responses in filarial infections, co-infections, and the associations with the development of filarial pathologies.
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Affiliation(s)
- Alexander Kwarteng
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Ebenezer Asiedu
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Kelvin Kwaku Koranteng
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Samuel Opoku Asiedu
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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13
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Sandri TL, Kreidenweiss A, Cavallo S, Weber D, Juhas S, Rodi M, Woldearegai TG, Gmeiner M, Veletzky L, Ramharter M, Tazemda-Kuitsouc GB, Matsiegui PB, Mordmüller B, Held J. Molecular Epidemiology of Mansonella Species in Gabon. J Infect Dis 2021; 223:287-296. [PMID: 33099649 DOI: 10.1093/infdis/jiaa670] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 01/04/2023] Open
Abstract
Mansonella perstans, a filarial nematode, infects large populations in Africa and Latin America. Recently, a potential new species, Mansonella sp "DEUX," was reported. Carriage of endosymbiotic Wolbachia opens treatment options for Mansonella infections. Within a cross-sectional study, we assessed the prevalence of filarial infections in 834 Gabonese individuals and the presence of the endosymbiont Wolbachia. Almost half of the participants (400/834 [48%]) were infected with filarial nematodes, with Mansonella sp "DEUX" being the most frequent (295/400 [74%]), followed by Loa loa (273/400 [68%]) and Mansonella perstans (82/400 [21%]). Being adult/elderly, male, and living in rural areas was associated with a higher risk of infection. Wolbachia carriage was confirmed in M. perstans and Mansonella sp "DEUX." In silico analysis revealed that Mansonella sp "DEUX" is not detected with currently published M. perstans-specific assays. Mansonella infections are highly prevalent in Gabon and might have been underreported, likely also beyond Gabon.
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Affiliation(s)
- Thaisa Lucas Sandri
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Laboratory of Molecular Immunopathology, Department of Clinical Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Simon Cavallo
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - David Weber
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Sascha Juhas
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Miriam Rodi
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Tamirat Gebru Woldearegai
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Markus Gmeiner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Luzia Veletzky
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Benjamin Mordmüller
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Center for Infection Research, partner site Tübingen, Tübingen, Germany
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14
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Bottieau E, Huits R, Van Den Broucke S, Maniewski U, Declercq S, Brosius I, Theunissen C, Feyens AM, Van Esbroeck M, van Griensven J, Clerinx J, Soentjens P. Human filariasis in travelers and migrants: a retrospective 25-year analysis at the Institute of Tropical Medicine, Antwerp, Belgium. Clin Infect Dis 2021; 74:1972-1978. [PMID: 34463732 DOI: 10.1093/cid/ciab751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Information on human filariasis in international travelers is scarce. We describe the epidemiology, clinical presentation and outcome of these infections in a reference travel clinic over the past decades. METHODS We reviewed all cases of filariasis diagnosed at the Institute of Tropical Medicine, Antwerp, Belgium, from 1994 to 2018. Diagnosis was obtained by either parasitological methods (confirmed) or strict clinical case definitions (probable). We assessed the characteristics of cases at diagnosis and response to therapy within three to 12 months. RESULTS A total of 320 patients (median age: 41 years; 71% males) were diagnosed with 327 filarial infections (Wuchereria bancrofti = 6; Onchocerca volvulus = 33, Loa loa = 150, Mansonella perstans = 130; unspecified species = 8). Diagnosis was confirmed in 213/320 (67%) patients. European long-term travelers accounted for 166 patients (52%) and visitors/migrants from tropical countries for another 110 (34%). Central Africa was the likely region of acquisition for 294 (92%) patients. The number of filariasis cases decreased from 21.5/year in average in the nineties to 6.3/year in the last decade, when loiasis became predominant. Cases reported symptoms in > 80% of all filarial infections but mansonellosis (45/123 single infections; 37%). Lymphatic filariasis and onchocerciasis cases responded well to conventional therapy. However, 30% of patients with loiasis and mansonellosis experienced treatment failure (with diethylcarbamazine and levamisole-mebendazole, respectively). CONCLUSIONS The burden and species distribution of filariasis in travelers evolved in the past decades. Most presentations were symptomatic. Case management would benefit from more effective therapies for loiasis and mansonellosis.
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Affiliation(s)
- Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Ula Maniewski
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Steven Declercq
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Caroline Theunissen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anne-Marie Feyens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Clerinx
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Patrick Soentjens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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15
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Chai JY, Jung BK, Hong SJ. Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update. THE KOREAN JOURNAL OF PARASITOLOGY 2021; 59:189-225. [PMID: 34218593 PMCID: PMC8255490 DOI: 10.3347/kjp.2021.59.3.189] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 12/19/2022]
Abstract
The use of albendazole and mebendazole, i.e., benzimidazole broad-spectrum anthelmintics, in treatment of parasitic infections, as well as cancers, is briefly reviewed. These drugs are known to block the microtubule systems of parasites and mammalian cells leading to inhibition of glucose uptake and transport and finally cell death. Eventually they exhibit ovicidal, larvicidal, and vermicidal effects on parasites, and tumoricidal effects on hosts. Albendazole and mebendazole are most frequently prescribed for treatment of intestinal nematode infections (ascariasis, hookworm infections, trichuriasis, strongyloidiasis, and enterobiasis) and can also be used for intestinal tapeworm infections (taeniases and hymenolepiasis). However, these drugs also exhibit considerable therapeutic effects against tissue nematode/cestode infections (visceral, ocular, neural, and cutaneous larva migrans, anisakiasis, trichinosis, hepatic and intestinal capillariasis, angiostrongyliasis, gnathostomiasis, gongylonemiasis, thelaziasis, dracunculiasis, cerebral and subcutaneous cysticercosis, and echinococcosis). Albendazole is also used for treatment of filarial infections (lymphatic filariasis, onchocerciasis, loiasis, mansonellosis, and dirofilariasis) alone or in combination with other drugs, such as ivermectin or diethylcarbamazine. Albendazole was tried even for treatment of trematode (fascioliasis, clonorchiasis, opisthorchiasis, and intestinal fluke infections) and protozoan infections (giardiasis, vaginal trichomoniasis, cryptosporidiosis, and microsporidiosis). These drugs are generally safe with few side effects; however, when they are used for prolonged time (>14-28 days) or even only 1 time, liver toxicity and other side reactions may occur. In hookworms, Trichuris trichiura, possibly Ascaris lumbricoides, Wuchereria bancrofti, and Giardia sp., there are emerging issues of drug resistance. It is of particular note that albendazole and mebendazole have been repositioned as promising anti-cancer drugs. These drugs have been shown to be active in vitro and in vivo (animals) against liver, lung, ovary, prostate, colorectal, breast, head and neck cancers, and melanoma. Two clinical reports for albendazole and 2 case reports for mebendazole have revealed promising effects of these drugs in human patients having variable types of cancers. However, because of the toxicity of albendazole, for example, neutropenia due to myelosuppression, if high doses are used for a prolonged time, mebendazole is currently more popularly used than albendazole in anti-cancer clinical trials.
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Affiliation(s)
- Jong-Yil Chai
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649,
Korea
- Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080,
Korea
| | - Bong-Kwang Jung
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649,
Korea
| | - Sung-Jong Hong
- Department of Environmental Medical Biology, Chung-Ang University College of Medicine, Seoul 06974,
Korea
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16
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Ta-Tang TH, Luz SLB, Crainey JL, Rubio JM. An Overview of the Management of Mansonellosis. Res Rep Trop Med 2021; 12:93-105. [PMID: 34079424 PMCID: PMC8163967 DOI: 10.2147/rrtm.s274684] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/30/2021] [Indexed: 02/02/2023] Open
Abstract
Mansonellosis is caused by three filarial parasite species from the genus Mansonella that commonly produce chronic human microfilaraemias: M. ozzardi, M. perstans and M. streptocerca. The disease is widespread in Africa, the Caribbean and South and Central America, and although it is typically asymptomatic it has been associated with mild pathologies including leg-chills, joint-pains, headaches, fevers, and corneal lesions. No robust mansonellosis disease burden estimates have yet been made and the impact the disease has on blood bank stocks and the monitoring of other filarial diseases is not thought to be of sufficient public health importance to justify dedicated disease management interventions. Mansonellosis´s Ceratopogonidae and Simuliidae vectors are not targeted by other control programmes and because of their small size and out-door biting habits are unlikely to be affected by interventions targeting other disease vectors like mosquitoes. The ivermectin and mebendazole-based mass drug administration (iMDA and mMDA) treatment regimens deployed by the WHO´s Elimination of Neglected Tropical Diseases (ESPEN) programme and its forerunners have, however, likely impacted significantly on the mansonellosis disease burden, principally by reducing the transmission of M. streptocerca in Africa. The increasingly popular plan of using iMDA to control malaria could also affect M. ozzardi parasite prevalence and transmission in Latin America in the future. However, a potentially far greater mansonellosis disease burden impact is likely to come from short-course curative anti-Wolbachia therapeutics, which are presently being developed for onchocerciasis and lymphatic filariasis treatment. Even if the WHO´s ESPEN programme does not choose to deploy these drugs in MDA interventions, they have the potential to dramatically increase the financial and logistical feasibility of effective mansonellosis management. There is, thus, now a fresh and urgent need to better characterise the disease burden and eco-epidemiology of mansonellosis so that effective management programmes can be designed, advocated for and implemented.
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Affiliation(s)
- Thuy-Huong Ta-Tang
- Malaria and NTDs Laboratory, National Centre of Tropical Medicine, Instituto de Salud Carlos III, Madrid, Spain
| | - Sergio L B Luz
- Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas State, Brazil
| | - James L Crainey
- Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas State, Brazil
| | - José M Rubio
- Malaria & Emerging Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
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17
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Crainey JL, Costa CHA, de Oliveira Leles LF, Ribeiro da Silva TR, de Aquino Narzetti LH, Serra Dos Santos YV, Costa Conteville L, Costa Pessoa FA, Carvajal Cortés JJ, Vicente ACP, Rubio Muñoz JM, Bessa Luz SL. Deep Sequencing Reveals Occult Mansonellosis Coinfections in Residents From the Brazilian Amazon Village of São Gabriel da Cachoeira. Clin Infect Dis 2021; 71:1990-1993. [PMID: 31995172 DOI: 10.1093/cid/ciaa082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/24/2020] [Indexed: 02/02/2023] Open
Abstract
Mansonella ozzardi and Mansonella perstans infections both cause mansonellosis but are usually treated differently. Using a real-time polymerase chain reaction assay and deep sequencing, we reveal the presence of mansonellosis coinfections that were undetectable by standard diagnostic methods. Our results confirm mansonellosis coinfections and have important implications for the disease's treatment and diagnosis.
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Affiliation(s)
- James Lee Crainey
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Brazil
| | - Carlos Henrique Aguiar Costa
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Brazil.,Programa de Pós-graduação Stricto Sensu em Biologia Computacional e Sistemas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Lorena Ferreira de Oliveira Leles
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Brazil.,Programa de Pós-Graduação Stricto Sensu em Biologia da Interação Patógeno Hospedeiro, Manaus, Brazil
| | - Túllio Romão Ribeiro da Silva
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Brazil.,Programa de Pós-graduação Stricto Sensu em Biologia Parasitária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luiz Henrique de Aquino Narzetti
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Brazil
| | - Yago Vinícius Serra Dos Santos
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Brazil.,Programa de Pós-Graduação Stricto Sensu em Biologia da Interação Patógeno Hospedeiro, Manaus, Brazil
| | - Liliane Costa Conteville
- Programa de Pós-graduação Stricto Sensu em Biologia Computacional e Sistemas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Malaria & Emerging Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - Felipe Arley Costa Pessoa
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Brazil
| | - José Joaquin Carvajal Cortés
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Brazil
| | - Ana Carolina Paulo Vicente
- Malaria & Emerging Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - José Miguel Rubio Muñoz
- Malaria & Emerging Parasitic Diseases Laboratory, National Microbiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | - Sérgio Luiz Bessa Luz
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, Brazil
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18
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Bélard S, Gehringer C. High Prevalence of Mansonella Species and Parasitic Coinfections in Gabon Calls for an End to the Neglect of Mansonella Research. J Infect Dis 2021; 223:187-188. [PMID: 33099631 DOI: 10.1093/infdis/jiaa671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sabine Bélard
- Department of Paediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Christian Gehringer
- University Hospital Basel, Division of Clinical Bacteriology and Mycology, University of Basel, Basel, Switzerland.,General Practice for Family Medicine Dr Asaël, Jestetten, Germany
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19
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Schiefer A, Hübner MP, Krome A, Lämmer C, Ehrens A, Aden T, Koschel M, Neufeld H, Chaverra-Muñoz L, Jansen R, Kehraus S, König GM, Pogorevc D, Müller R, Stadler M, Hüttel S, Hesterkamp T, Wagner K, Pfarr K, Hoerauf A. Corallopyronin A for short-course anti-wolbachial, macrofilaricidal treatment of filarial infections. PLoS Negl Trop Dis 2020; 14:e0008930. [PMID: 33284808 PMCID: PMC7746275 DOI: 10.1371/journal.pntd.0008930] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/17/2020] [Accepted: 10/29/2020] [Indexed: 12/12/2022] Open
Abstract
Current efforts to eliminate the neglected tropical diseases onchocerciasis and lymphatic filariasis, caused by the filarial nematodes Onchocerca volvulus and Wuchereria bancrofti or Brugia spp., respectively, are hampered by lack of a short-course macrofilaricidal–adult-worm killing–treatment. Anti-wolbachial antibiotics, e.g. doxycycline, target the essential Wolbachia endosymbionts of filariae and are a safe prototype adult-worm-sterilizing and macrofilaricidal regimen, in contrast to standard treatments with ivermectin or diethylcarbamazine, which mainly target the microfilariae. However, treatment regimens of 4–5 weeks necessary for doxycycline and contraindications limit its use. Therefore, we tested the preclinical anti-Wolbachia drug candidate Corallopyronin A (CorA) for in vivo efficacy during initial and chronic filarial infections in the Litomosoides sigmodontis rodent model. CorA treatment for 14 days beginning immediately after infection cleared >90% of Wolbachia endosymbionts from filariae and prevented development into adult worms. CorA treatment of patently infected microfilaremic gerbils for 14 days with 30 mg/kg twice a day (BID) achieved a sustained reduction of >99% of Wolbachia endosymbionts from adult filariae and microfilariae, followed by complete inhibition of filarial embryogenesis resulting in clearance of microfilariae. Combined treatment of CorA and albendazole, a drug currently co-administered during mass drug administrations and previously shown to enhance efficacy of anti-Wolbachia drugs, achieved microfilarial clearance after 7 days of treatment at a lower BID dose of 10 mg/kg CorA, a Human Equivalent Dose of 1.4 mg/kg. Importantly, this combination led to a significant reduction in the adult worm burden, which has not yet been published with other anti-Wolbachia candidates tested in this model. In summary, CorA is a preclinical candidate for filariasis, which significantly reduces treatment times required to achieve sustained Wolbachia depletion, clearance of microfilariae, and inhibition of embryogenesis. In combination with albendazole, CorA is robustly macrofilaricidal after 7 days of treatment and fulfills the Target Product Profile for a macrofilaricidal drug. Infections with filarial roundworms can cause the disfiguring human neglected tropical diseases onchocerciasis and lymphatic filariasis. Treatment of these diseases is limited, as there is no well-tolerated treatment available that kills the adult worms after a short-term regimen. Thus, mass drug administrations (MDA) are performed with drugs that temporarily clear the microfilariae, the filarial offspring, to inhibit the transmission of the disease. As these MDA treatments have to be given 1–2 times per year for many years, the goal to eliminate onchocerciasis and lymphatic filariasis is hampered. In the present study we investigated a novel preclinical candidate for the treatment of filariasis. Corallopyronin A (CorA) is a natural compound that clears the essential Wolbachia endobacteria of filariae. Using the Litomosoides sigmodontis rodent model of filariasis we demonstrated that 2 weeks of CorA treatment clears Wolbachia endosymbionts in vivo, leading to a maintained clearance of microfilariae by inhibition of filarial embryogenesis. Combination therapy of CorA with the MDA drug albendazole allowed lower CorA doses and shortened treatment to 7 days. More importantly, it also led to the death of the adult filariae. Portfolios (Target Product Profiles) of new drugs against filariae should show adult killing efficacy like CorA.
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Affiliation(s)
- Andrea Schiefer
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Marc P. Hübner
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
| | - Anna Krome
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Bonn, Bonn, Germany
| | - Christine Lämmer
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Alexandra Ehrens
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Tilman Aden
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Marianne Koschel
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Helene Neufeld
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | | | - Rolf Jansen
- Department Microbial Drugs, Helmholtz Center for Infection Research, Braunschweig, Germany
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, Germany
| | - Stefan Kehraus
- Institute for Pharmaceutical Biology, University of Bonn, Bonn, Germany
| | - Gabriele M. König
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
- Institute for Pharmaceutical Biology, University of Bonn, Bonn, Germany
| | - Domen Pogorevc
- Department Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany
| | - Rolf Müller
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, Germany
- Department Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland, Saarbrücken, Germany
| | - Marc Stadler
- Department Microbial Drugs, Helmholtz Center for Infection Research, Braunschweig, Germany
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, Germany
| | - Stephan Hüttel
- Department Microbial Drugs, Helmholtz Center for Infection Research, Braunschweig, Germany
- German Center for Infection Research (DZIF), partner site Hannover-Braunschweig, Germany
| | - Thomas Hesterkamp
- Translational Project Management Office (TPMO), German Center for Infection Research, Braunschweig, Germany
| | - Karl Wagner
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Bonn, Bonn, Germany
| | - Kenneth Pfarr
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
- * E-mail:
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn, Germany
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Laidoudi Y, Medkour H, Levasseur A, Davoust B, Mediannikov O. New Molecular Data on Filaria and its Wolbachia from Red Howler Monkeys ( Alouatta macconnelli) in French Guiana-A Preliminary Study. Pathogens 2020; 9:pathogens9080626. [PMID: 32752052 PMCID: PMC7460519 DOI: 10.3390/pathogens9080626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
Previous studies have reported filarial parasites of the genus Dipetalonema and Mansonella from French Guiana monkeys, based on morphological taxonomy. In this study, we screened blood samples from nine howler monkeys (Alouatta macconnelli) for the presence of filaria and Wolbachia DNA. The infection rates were 88.9% for filaria and 55.6% for wolbachiae. The molecular characterization, based on the 18S gene of filariids, revealed that A. macconnelli are infected with at least three species (Mansonella sp., Brugia sp. and an unidentified Onchocercidae species.). Since the 18S and cox1 generic primers are not very effective at resolving co-infections, we developed ITS genus-specific PCRs for Mansonella and Brugia genus. The results revealed coinfections in 75% of positives. The presence of Mansonella sp. and Brugia sp. was also confirmed by the 16S phylogenetic analysis of their associated Wolbachia. Mansonella sp., which close to the species from the subgenus Tetrapetalonema encountered in New World Monkeys, while Brugia sp. was identical to the strain circulating in French Guiana dogs. We propose a novel ITS1Brugia genus-specific qPCR. We applied it to screen for Brugia infection in howler monkeys and 66.7% were found to be positive. Our finding highlights the need for further studies to clarify the species diversity of neotropics monkeys by combining molecular and morphological features. The novel Brugia genus-specific qPCR assays could be an effective tool for the surveillance and characterization of this potential zoonosis.
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Affiliation(s)
- Younes Laidoudi
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, 19–21, Bd Jean Moulin, 13005 Marseille, France; (Y.L.); (H.M.); (A.L.); (B.D.)
- Aix Marseille Univ, 19–21, Bd Jean Moulin, 13005 Marseille, France
| | - Hacène Medkour
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, 19–21, Bd Jean Moulin, 13005 Marseille, France; (Y.L.); (H.M.); (A.L.); (B.D.)
- Aix Marseille Univ, 19–21, Bd Jean Moulin, 13005 Marseille, France
| | - Anthony Levasseur
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, 19–21, Bd Jean Moulin, 13005 Marseille, France; (Y.L.); (H.M.); (A.L.); (B.D.)
- Aix Marseille Univ, 19–21, Bd Jean Moulin, 13005 Marseille, France
| | - Bernard Davoust
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, 19–21, Bd Jean Moulin, 13005 Marseille, France; (Y.L.); (H.M.); (A.L.); (B.D.)
- Aix Marseille Univ, 19–21, Bd Jean Moulin, 13005 Marseille, France
| | - Oleg Mediannikov
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, 19–21, Bd Jean Moulin, 13005 Marseille, France; (Y.L.); (H.M.); (A.L.); (B.D.)
- Aix Marseille Univ, 19–21, Bd Jean Moulin, 13005 Marseille, France
- Correspondence: ; Tel.: +3304-1373-24-01
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Puente S, Lago M, Subirats M, Sanz-Esteban I, Arsuaga M, Vicente B, Alonso-Sardon M, Belhassen-Garcia M, Muro A. Imported Mansonella perstans infection in Spain. Infect Dis Poverty 2020; 9:105. [PMID: 32703283 PMCID: PMC7376953 DOI: 10.1186/s40249-020-00729-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/15/2020] [Indexed: 01/05/2023] Open
Abstract
Background Mansonella perstans infection can be considered one of the most neglected tropical infectious diseases. Very few studies have reported on the clinical picture caused by infection with this nematode. Therefore, our study was aimed to describe the clinical patterns and treatment of imported M. perstans infection by migrants from Africa. Methods The present study evaluated a large cohort of migrants who have been diagnosed, examined and treated for imported M. perstans infection at a Spanish reference center (Hospital Carlos III Tropical Medicine Unit, Madrid, Spain) over a 19-year period. Most patients voluntarily attend the emergency unit or are referred from primary care or general hospitals in Madrid. Chi-square test was used to compare the association between categorical variables. The continuous variables were compared by Student’s t-test or the Mann–Whitney test. The corresponding regression models were used for multivariate analysis. Results Five hundred three cases of migrants from tropical and subtropical areas with M. perstans infection were identified. Two hundred sixty-four patients were female (52.5%). The mean age (± SD) was 44.6 ± 18.2 years (range: 16–93 years). The mean time (± SD) between the arrival in Spain and the first consultation was 8.6 ± 18.0 months. The major origin of the patients was Equatorial Guinea (97.6%). Regarding the clinical picture, 257 patients were asymptomatic (54.7%) and 228 were symptomatic (45.3%); 190 patients had pruritus (37.8%), 50 (9.9%) had arthralgia, 18 patients had Calabar-like swelling (3.6%), and 15 (3%) had abdominal pain. Four hundred forty-two (87.9%) migrants had hyper-IgE, and 340 (67.6%) had eosinophilia. One hundred ninety-five patients had coinfections with other filarial nematodes (38.8%), and 308 migrants had only M. perstans infection (61.2%). Four hundred thirty-seven cases (86.9%) had been treated with anti-filarial drugs; 292 cases were treated with one anti-filarial drug, and 145 cases were treated with combined anti-filarial therapy. Additionally, 20 (4%) cases received steroids and 38 (7.6%) cases received antihistamines. Conclusions A long series of M. perstans infections is presented in sub-Saharan immigrants whose data indicate that it should be included in the differential diagnosis in patients with pruritus or analytical alterations such as eosinophilia or hyper-IgE presentation, and they also have a high number of coinfections with other microorganisms whose treatment needs to be protocolized.
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Affiliation(s)
- Sabino Puente
- Unidad de Medicina Tropical, Servicio de Medicina Interna, Hospital La Paz-Carlos III, Madrid, Spain
| | - Mar Lago
- Unidad de Medicina Tropical, Servicio de Medicina Interna, Hospital La Paz-Carlos III, Madrid, Spain
| | | | | | - Marta Arsuaga
- Unidad de Medicina Tropical, Servicio de Medicina Interna, Hospital La Paz-Carlos III, Madrid, Spain
| | - Belén Vicente
- Laboratorio de Inmunología Parasitaria y Molecular, CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca, 37007, Salamanca, Spain
| | - Montserrat Alonso-Sardon
- Área de Medicina Preventiva y Salud Pública, IBSAL, CIETUS, Universidad de Salamanca, Salamanca, Spain
| | - Moncef Belhassen-Garcia
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Paseo San Vicente 58-182, 37007, Salamanca, Spain.
| | - Antonio Muro
- Laboratorio de Inmunología Parasitaria y Molecular, CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca, 37007, Salamanca, Spain
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Gobbi F, Buonfrate D, Boussinesq M, Chesnais CB, Pion SD, Silva R, Moro L, Rodari P, Tamarozzi F, Biamonte M, Bisoffi Z. Performance of two serodiagnostic tests for loiasis in a Non-Endemic area. PLoS Negl Trop Dis 2020; 14:e0008187. [PMID: 32453734 PMCID: PMC7274468 DOI: 10.1371/journal.pntd.0008187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 06/05/2020] [Accepted: 03/02/2020] [Indexed: 11/18/2022] Open
Abstract
Loiasis, caused by the filarial nematode Loa loa, is endemic in Central and West Africa where about 10 million people are infected. There is a scarcity of convenient, commercial diagnostics for L. loa. Microscopy requires trained personnel and has low sensitivity, while the serodiagnosis is currently not standardized. Individual case management is also important in non-endemic countries to treat migrants, expatriates and tourists. We retrospectively compared the performance of a Loa Antibody Rapid Test (RDT) and a commercial ELISA pan-filarial test on 170 patients, 65 with loiasis [8 with eyeworm, 29 with positive microfilaremia, 28 with neither microfilaremia nor history of eyeworm but eosinophilia and history of Calabar swelling (probable loiasis)], 95 with other common parasitic infections and no previous exposure to L. loa (37 with M. perstans, 1 with Brugia sp., 18 with strongyloidiasis, 20 with schistosomiasis, 5 with hookworm, 4 with Ascaris lumbricoides infection, 10 with hyper-reactive malarial splenomegaly), and 10 uninfected controls. The sensitivity of the RDT and of the ELISA were 93.8% (61/65) and 90.8% (59/65), respectively. For the RDT, most of the cross-reactions were observed in patients with M. perstans: 7/37 (18.9%), followed by 1/10 (10%) with hyper-reactive malarial splenomegaly and 1/20 (5%) with schistosomiasis. None of the 27 subjects infected with intestinal nematodes was found positive at this test. The ELISA is meant to be a pan-filarial assay, and reacted extensively with cases of M. perstans (95%), as expected, and also in 11/18 (61.1%) patients with strongyloidiasis and in 3/5 (60%) with hookworm infection. The RDT and the ELISA are both highly sensitive for the diagnosis of loiasis. The main difference lies in the extent of cross-reactivity with other parasites. Considering that the RDT is specifically meant for Loa loa infection, and its high sensitivity, this test could be a useful tool for the diagnosis of occult loiasis. Loa loa is a filarial worm which infects millions of people living in the forested areas of central Africa. The infection is rarely diagnosed outside Africa, but individual case management is also important in non-endemic countries to treat migrants, tourists and expatriates. Aim of this study was to describe the performance of a Rapid Test and an ELISA pan filarial test for the diagnosis of Loa loa infection. Both tests demonstrated good performance for the detection of cases of loiasis. In case of infection with other parasites, the RDT gave less false positive results.
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Affiliation(s)
- Federico Gobbi
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
- * E-mail:
| | - Dora Buonfrate
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
| | - Michel Boussinesq
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | - Cedric B. Chesnais
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | - Sebastien D. Pion
- Institut de Recherche pour le Développement (IRD), UMI 233-INSERM U1175-Montpellier University, Montpellier, France
| | - Ronaldo Silva
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
| | - Lucia Moro
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
| | - Paola Rodari
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
| | - Francesca Tamarozzi
- Department of Infectious Diseases, Foodborne and Neglected Parasitic Diseases Unit, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Biamonte
- Drugs & Diagnostics for Tropical Diseases, San Diego, California, United States of America
| | - Zeno Bisoffi
- IRCCS Sacro Cuore Don Calabria Hospital, Center for Tropical Diseases, Negrar, Verona, Italy
- Infectious Infectious Diseases and Tropical Medicine Section, Diagnostic and Public Health Department, University of Verona, Verona, Italy
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