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[Mansonelliasis in the southeast Venezuelan Orinoquia region].

Physical exam and skin biopsy were performed and peripheral blood samples drawn from 10% of the inhabitants of 26 jungle villages of the State of Bolívar, Venezuela. One hundred and fifty three Indians and an inhabitant of mixed blood from 13 different communities were found to be infected with mansonelliasis representing a global index of 36.40% in the endemic area. The parasitosis was found to be concentrated in three areas. The largest, located in the southwest of the country and forming part of an extent infected area embarking neighboring parts of Venezuela and Brazil, contains villages with a parasite index of 80.76% and 94.44%. A second focus is located in the southeast, its carriers, as those of the first, are infected with Mansonella ozzardi. In a third, central eastern focus infections with Mansonella pertans were found. The patients infected with M. ozzardi were apparently asymptomatic and their physical exam was normal, even though individual parasite densities up to 30,000 microfilariae/ml blood and 22,000/gr skin were found.

Disease Outbreaks↗

Loa loa and Mansonella perstans filariasis in the Chaillu mountains, Congo: parasitological prevalence.

1934 Bantus and 379 Pygmies were investigated for Loa loa and Mansonella perstans filariasis in 7 villages in the Chaillu forest of the Congo. Bantus were more frequently infected with L. loa than Pygmies (18.9% of microfilariae carriers compared with 10.6%). In individuals over 30 years of age, males were more frequently infected than females. Microfilarial densities increased until the age of 20 years and then remained stable. Parasite load was not significantly different in the two ethnic groups. For mansonelliasis, the microfilarial rate was higher in the Pygmies (67.5% compared with 22.0%) and males of the 2 groups were more frequently infected than females. Microfilarial load was also higher in Pygmies than in Bantus (mean microfilarial densities (MfD 50) 13 and 2 respectively). In the Pygmy group, MfD 50 for M. perstans increased with age whereas it remained stable in the Bantus. 53.8% of the 249 questioned persons had experienced worm migration under the conjunctiva. Both ethnic groups were equally exposed to the vectors of L. loa and reasons for the difference in prevalence of microfilaria carriers are discussed. For mansonelliasis increased contact with vectors may explain the higher degree of infestation observed in Pygmies. Other filariases were infrequent in (Mansonella streptocerca), or absent from (Onchocerca volvulus and Wuchereria bancrofti), the study area.

Adolescent↗

Efficacy of ivermectin in the treatment of concomitant Mansonella perstans infections in onchocerciasis patients.

As part of an ivermectin dose-ranging study of onchocerciasis patients in Togo, 55 onchocerciasis patients with concomitant mansonelliasis received single oral doses either of ivermectin (100 to 200 micrograms/kg body weight) or placebo. As expected, Onchocerca volvulus microfilariae in the skin were greatly reduced in number soon after drug treatment, but microfilariae of Mansonella perstans reacted differently. Microfilarial densities of M. perstans were assessed with a filtration technique both before, and 4 times after, treatment. In untreated patients microfilarial densities were stable until the end of the study at 6 months. In patients receiving ivermectin, microfilarial densities dropped on average to less than 60% of the pre-treatment level and remained there until the final post-treatment examination. This partial reduction was probably not caused by a microfilaricidal effect of ivermectin, but rather by an altered distribution of microfilariae in the peripheral blood and in a suspected microfilarial reservoir.

Animals↗

The diverse expression of immunity in humans at distinct states of Onchocerca volvulus infection.

This study examined the development and persistence of immunity in humans presenting defined states of Onchocerca volvulus infection, i.e. in exposed endemic control individuals without microfilaridermia and clinical disease, in patients with patent or post-patent onchocerciasis, and in patients concurrently infected with Mansonella perstans. Onchocerca volvulus antigen (OvAg)-specific cellular reactivity was significantly diminished in microfilariae (mf)-positive patients, while the highest reactivity was measured in exposed but mf-negative endemic controls, those being free of any clinical signs of onchocercal disease. In patients who became post-patent, responses to OvAg were significantly augmented, but did not approach entirely the magnitude observed in endemic controls. In onchocerciasis patients with concurrent mansonelliasis, cellular unresponsiveness to OvAg persisted, even when mf of O. volvulus were eliminated permanently by repeated ivermectin therapy. Cells from mf-positive onchocerciasis patients produced significantly less interferon-gamma (IFN-gamma) (P < 0.01) and interleukin-5 (IL-5) (P < 0.05) in response to OvAg than those taken from endemic controls or post-patent individuals in whom IFN-gamma and IL-5 production was similarly high. In contrast, both OvAg-driven as well as spontaneous IL-10 secretion was higher in mf-positive patients than in endemic controls or post-patent cases. In all individuals examined, serological recognition of OvAg by immunoglobulins was dominated by IgG4; in mf-positive patients OvAg of 205,000-12,000 molecular weight (MW) were strongly bound. In post-patent individuals, and similarly in endemic controls. OvAg recognition by IgG4 varied from intense (with numerous antigens being recognized) to weak or absent antigen binding. Significantly elevated OvAg-specific IgG isotypes were measured in mf-positive onchocerciasis patients in comparison with endemic controls or post-patent individuals (with the exception of IgG3). IgG1, IgG2 and IgE were higher, but IgG4 was lower in endemic controls compared with post-patent onchocerciasis patients. The ratios of IgG4/IgG1 differed (P < 0.001) between endemic controls and mf-positive or post-patent onchocerciasis patients, with IgG4/IgG1 ratios of R < 3.0 being characteristic for endemic controls and post-patent O. volvulus infection. In conclusion, this cross-sectional immunoepidemiological investigation showed that distinct states of O. volvulus infection correlate with a particular cellular and humoral immune response. The mf-free condition appeared to be associated with a vigorous parasite-specific cellular reactivity and a particular cytokine production profile, while concurrent M. perstans infection depressed OvAg-specific cellular responsiveness. Antibody responses, in all likelihood, reflected the intensity and state of infection, and not the degree of acquired immunity protective against parasite aggregation.

Adolescent↗

[Mansonella ozzardi in the Federal Territory of Roraima, Brazil. Distribution and finding of a new vector in the area of Surumu River].

A survey conducted among the Makuxi Indians from 15 settlements in the northeastern part of the Territory of Roraima, Brazil, revealed the occurrence of Mansonella ozzardi in 3,2% (21/652) of the persons examined. The absence of demonstrable infection--with one exception--in persons under 15 years of age, and the low microfilaria density in adults suggest that mansonelliasis has been acquired by the Makuxi Indians outside their villages. As many Indians from the region pan gold on the Upper Maú (Ireng) river--where black flies occur in great quantity--the mining camps are probably the sites of transmission. Experimental infection with M. ozzardi of Simulium oyapockense s.l. (or Simulium roraimense) showed that this species, at the least in the Surumu river area, is capable of supporting the full development of the microfilariae. Although S. oyapockense has a wide distribution in the extreme north of Brazil, it does not appear to be an efficient vector, since only 20,6% (19/92) of the specimens collected after a blood meal on a naturally infected Indian contained larval stages of M. ozzardi (with an average of 1-2 larvae per fly). The high prevalence rate of infection found, in a previous survey, among the Sanumá and Mayongong, two Indian groups living at the Auaris river area, on the other side of the Territory of Roraima, indicates that a more competent intermediate host should exist in that region.

Animals↗

Identification of vector species (Diptera:Simuliidae) of human onchocerciasis in the amazonia focus of Brazil and Venezuela.

The taxonomic status of three Amazonian simuliid species, Simulium guianese Wise, S. oyapockense Floch & Abonnenc and S. yarzabali Ramirez Perez is reviewed. Simulium cuasisanguineum Ramirez Perez, Yarzabal & Peterson is synonymized with S. oyapockense, and S. yarzabali is revalidated from its synonymy with S. incrustatum Lutz. The role of these three species in the transmission of human onchocerciasis and mansonelliasis in Amazonia is reviewed.

Animals↗

Development of Mansonella ozzardi in Simulium amazonicum, S. argentiscutum, and Culicoides insinuatus from Amazonas, Colombia.

Simulium amazonicum, S. argentiscutum and Culicoides insinuatus were collected from the Amazon region of Colombia after having blood-fed on volunteers naturally infected with Mansonella ozzardi. Dissection of the specimens revealed that these species supported the development of the microfilaria of M. ozzardi to the infective stage. Infective larvae were obtained from Simulium within 7 days at temperatures ranging from 23-30 degrees C. S. argentiscutum ingested more microfilariae and had a correspondingly higher experimental infection rate. Three of 31 C. insinuatus dissected beyond day 5 postfeeding contained one advanced second-stage and two third-stage larvae. The current investigation indicates that Culicoides, as well as Simulium, may serve as vectors of mansonelliasis in the Comisaría of Amazonas.

Aged↗

Development of Mansonella ozzardi in a black fly species of the Simulium sanguineum group from Eastern Vaupés, Colombia.

Development of the microfilaria of Mansonella ozzardi to the infective stage in a species of the Simulium sanguineum group from the Mitú area, Comisaría del Vaupés, Colombia is described. Development was synchronous, and by day 6 third-stage larvae were observed in the head of flies which had fed on two naturally infected volunteers. Simulium biting activity was high from January-March, during the dry season. Only 261 blood-fed Culicoides were collected from an infected volunteer; 40% of 43 dissected on day 0 had ingested microfilariae. However, only one of 129 C. caprilesi specimens dissected after day 2 was positive, containing a second-stage larva thought to be M. ozzardi. It is concluded that Simulium, rather than Culicoides are the principal vectors of mansonelliasis in the Mitú area.

Animals↗

Cell adherence to microfilariae of Onchocerca volvulus: a comparative study.

The conditions were examined for in vitro antibody-mediated adherence of granulocytes to microfilariae of Onchocera volvulus and Dirofilaria immitis. Reactivity in human sera from patients in endemic foci in Sudan was specific for O. volvulus and no reactions were observed with heterologous Onchocerca species or with Mansonella perstans. Microfilariae from skin, nodules or adult female worms were satisfactory targets for cell adherence, and the cells involved were almost exclusively eosinophils. The reaction was inhibited by indomethacin but not by nordihydroguaiaretic acid, an inhibitor of leukotriene production. Agents that slowed or stopped microfilarial motility (e.g. nifedipine, lidocaine, chloroquine) inhibited the reaction, probably by reducing target/cell contact. Ivermectin did not enhance the reaction, and in the absence of cells exerted only slight effects on the movement of microfilariae at higher concentrations (greater than 10 micrograms/ml). Antibody activity was labile, and did not persist well through freeze-thaw cycles. Some differences between homologous and heterologous mixtures (microfilariae/cells/serum) were seen but they could not be resolved satisfactorily. There were no apparent geographical differences between microfilariae from different foci in Sudan. In the D. immitis system neutrophils were the dominant cell type adhering to microfilariae, and the activity was stable to storage and freeze-thaw. No enhancement was detectable with diethylcarbamazine. Antibody activity was absorbable with microfilarial antigens and was reduced by agents that inhibited microfilarial motility. In dogs, adherence-mediating antibody was seen only in amicrofilaraemic animals with occult infection, and in only a minority of these sera. In humans the relationship to clinical findings was less clear, but patients with punctate keratitis were the most likely to have positive serum and were the most reactive in the assay. This system may therefore offer some insights into disease mechanisms in vivo, and its molecular mechanisms deserve further characterization.

Animals↗

Congenital intracranial filariasis: a case report.

We present the case of a newborn with intracranial extra-axial collections which mere partially calcified. The underlying cause was shown to be filariasis which had been transmitted from the mother.

Adult↗

Hypogonadism and ecdysteroid production in Loa loa and Mansonella perstans filariasis.

Possible endocrinological repercussions of infection with Loa loa and Mansonella perstans filariae were studied in Gabonese subjects. Microfilaremic males were compared with amicrofilaremic controls. In the infected group 13/105 subjects (12%) presented only abnormally low serum levels of testosterone (less than 4 ng/ml), 25/105 (24%) only abnormally high serum levels of gonadotrophins, FSH (greater than 15 mIU/ml) and LH (greater than 20 mIU/ml), and 22/105 (21%) presented anomalies in both testosterone and gonadotrophin levels. One out of 68 control subjects had 3.6 ng/ml seric testosterone and all had normal levels of gonadotrophins. Ecdysteroids were detected (greater than 0.025 ng/ml) in the serum of 87/97 (90%) microfilaremic subjects (GM 0.123 ng/ml) compared to 12/64 (19%) controls (GM 0.030 ng/ml). Ecdysteroids were detected in the urine of all subjects, infected (GM 8.468 ng/ml) as well as control (GM 1.245 ng/ml). The hormonal perturbations were correlated with the levels of Loa loa microfilaremia but not with those of serum and urinary ecdysteroids. These results demonstrate that microfilaremic subjects often show endocrinal signs of hypogonadism and present appreciable levels of ecdysteroids in serum and urine. A direct role for parasitic ecdysteroids in hypogonadism remains to be demonstrated.

Adult↗

The occurrence of loiasis, mansonellosis and wuchereriasis in the Jarawa River Valley, central Nigeria.

In a study to assess the status of filariasis in the Jarawa River Valley of the savanna area of Nigeria, 940 self-selected residents from 10 villages were examined between March 1984 and April 1987. Overall results showed 105 (11.2%) had microfilaraemia and/or clinical signs of filariasis. Sixty-four (6.8%) and 20 (2.1%) persons, respectively, were infected with Mansonella perstans and Loa loa microfilariae (mff). Four of the 28 villagers examined had Wuchereria bancrofti mff in their night blood samples whereas 17 (1.8%) of all residents surveyed had clinical filariasis mainly due to lympho-obstructive manifestations: hydrocele (n = 11, 64.7%); enlargement of the inguinal nodes (n = 8, 47.1%) and elephantiasis (n = 2, 11.8%).

Adolescent↗

Steroid and gonadotropin hormone levels in young African women with filarial infection.

Serum levels of dehydroepiandrosterone sulfate (DHEAS), testosterone (T), progesterone (P), estradiol (E2), prolactin (PRL), cortisol (F) and gonadotropins (FSH, LH) were analysed by radioimmunoassay for 125 schoolgirls aged 14-16, in a zone of endemic filariasis 3 days after menses. Two groups were identified: the infected group in which 38 subjects had circulating Loa loa and or Mansonella perstans microfilariae as determined by the Knott's concentration technique, and the non-infected group (87 subjects without microfilaremia). All results are expressed as the mean +/- SD. No significant difference was found between the two groups for age (14.47 +/- 1.37 yr vs 14.50 +/- 1.37 yr) or for body wt (46.10 +/- 8.45 kg vs 47.06 +/- 8.26 kg). There was a tendency to lower levels of DHEAS in the infected group by comparison with controls (54.92 +/- 37.34 micrograms/dl vs 66.80 +/- 47.18 micrograms/dl) while in the same infected group more subjects had higher levels of prolactin by comparison with the control group (10.85 +/- 14.16 ng/ml vs 9.80 +/- 5.56 ng/ml). Testosterone, progesterone, estradiol levels and the LH/FSH ratio were lower in the infected group than in the non-infected group (P: 0.25 +/- 0.12 ng/ml vs 0.33 +/- 0.20 ng/ml, P less than 0.025; T: 0.55 +/- 0.17 ng/ml vs 0.62 +/- 0.19 ng/ml, P less than 0.05; E2: 32.95 +/- 19.63 pg/ml vs 66.98 +/- 54.83 pg/ml, P less than 0.001; LH/FSH: 0.91 +/- 0.44 vs 1.30 +/- 0.84, P less than 0.005) respectively. No significant difference was found between the two groups for F; however FSH levels correlated negatively with F levels only in the microfilaremia group (r = -0.38, n = 38, P less than 0.05). Our results suggest that the presence of microfilaremia in our subjects may have contributed to reduced steroid levels, perhaps by involvement of the cyclic AMP kinase system. These observations may explain the delayed menarche and androgen secretion found during puberty in a similar population living in the same zone of endemic filariasis. Microfilaremia should therefore be considered an environmental factor which mediates endocrine disorders in subjects living in tropical filariasis areas.

Adolescent↗

The prevalence and distribution of Mansonella ozzardi in coastal north Trinidad, W.I.

A day blood smear survey for Mansonella ozzardi in the north coast communities of Trinidad recorded a prevalence of 4.8% in 4,488 persons examined. Prevalence rates were highest in the four western-most communities, where the vector, Culicoides phlebotomus, is a severe nuisance problem. Prevalence rates increased with age and were higher in males than in females. Mean microfilaria densities were low in both sexes up to 50 years of age but in older males the density increased with age. Wuchereria bancrofti infections were detected in five of the ten communities surveyed.

Adolescent↗