A Randomized Trial of Doxycycline forMansonella perstansInfection

Abstract

Background Mansonella perstans infection is common in areas of Africa where Wuchereria bancrofti, a causative agent of lymphatic filariasis, is endemic. M. perstans is refractory to standard antifilarial therapies. The recent discovery of bacterial endosymbionts (e.g., wolbachia) in most filarial species, including M. perstans, provides new therapeutic options for reducing microfilaremia. Methods In an open-label, randomized trial, we recruited subjects with M. perstans microfilaremia, with or without concomitant W. bancrofti infection, from four villages in Mali and randomly assigned them to receive doxycycline, at a dose of 200 mg daily for 6 weeks (106 subjects), or no treatment (110). At 6 months, subjects who were co-infected with W. bancrofti underwent a second random assignment, to treatment with a single dose of albendazole (400 mg) and ivermectin (150 μg per kilogram of body weight) or no treatment. Subjects were monitored daily during the first 6-week study period for adverse events. M. perstans and W. bancrofti microfilarial levels were assessed at 6, 12, and 36 months. Results At 12 months, 67 of 69 subjects who had received treatment with doxycycline only (97%) had no detectable M. perstans microfilariae per 60 μl of blood, as compared with 10 of 63 subjects who had received no treatment (16%) (relative risk, 6.18; 95% confidence interval, 3.63 to 11.89; P<0.001). At 36 months, M. perstans microfilaremia remained suppressed in 48 of 64 subjects who had received treatment with doxycycline only (75%), a finding that was consistent with a macrofilaricidal effect of doxycycline. Vomiting was more frequent in the doxycycline-treated group than in the untreated group (17% vs. 4%). Conclusions These results are consistent with previous findings that M. perstans harbors the intracellular endosymbiont, wolbachia, and suggest that doxycycline is an effective therapy for M. perstans infection.

Evolutionary origin of insect– Wolbachia nutritional mutualism

“…Some F Wolbachia strains are obligatorily associated with Mansonella spp. and other filarial nematodes (29)(30)(31). However, they were placed in distinct lineages from the arthropod-associated F Wolbachia strains including wCle, although statistical supports for the groupings were not necessarily significant (Fig.…”

Elevated Levels of Plasma Angiogenic Factors Are Associated with Human Lymphatic Filarial Infections

“…Thus, all samples were collected from well-characterized patients with Wb infections, 9 or Wb / Mansonella perstans coinfections from Mali. 10 All samples were obtained after centrifugation of heparinized whole blood, that were stored at −80°C until used. Almost all of the samples had never been thawed previously, with the exception of the pre-and post-treatment samples that had been thawed only one time before use.…”

Arbonematoden - durch Arthropoden übertragbare Nematoden-Infektionen

“…Die Effizienz der Doxycylin-Behandlung gegen Mansonella perstans war in Mali mit einem Absinken der Mikrofilarienzahl im Blut nach 6 Monaten auf etwa 23% und nach 12 Monaten auf 0% sehr hoch [59], während in der unbehan-delten Kontrollgruppe nach 6 Monaten ein Abfall auf 62% und nach 12 Monaten auf 50% gemessen wurde. Die 12 Monate Effektivität der Doxycyclin-Behandlung war 97% (67 von 69 Behandelten), im Vergleich zu keiner Behandlung mit 16% (10 von 63) und zu Ivermectin-Albendazol mit 19% (5 von 27) [59].…”

“…Die 12 Monate Effektivität der Doxycyclin-Behandlung war 97% (67 von 69 Behandelten), im Vergleich zu keiner Behandlung mit 16% (10 von 63) und zu Ivermectin-Albendazol mit 19% (5 von 27) [59].…”

“…Die Doxycyclin-Vorbehandlung verhindert das Auftreten von akuten Entzündungsreak-tionen, wie der akuten Dermatolymphangioadenitis. Eine häufige Nebenwirkung der Doxycylin-Behandlung ist Erbrechen [59]. Die Nebenwirkungen der Diethylcarbazamin-Therapie waren umso größer, je höher die Anzahl der Mikrofilarien im Gewebe war und je mehr Interleukin-6 und Lipopolysaccharid-bindendes Protein freigesetzt wurde [60].…”