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Short report: a case of fibrosing mediastinitis caused by Wuchereria bancrofti.

Wuchereria bancrofti is a mosquito-borne filarial nematode that commonly invades lymphatic vessels. Common clinical manifestations include elephantiasis, orchitis, epididymitis, and chyluria. This report concerns an Egyptian man who developed superior vena cava syndrome secondary to a mediastinal mass that was found to contain a filarial nematode consistent with W. bancrofti. This is the first case, to our knowledge, of this parasite causing fibrosing mediastinitis.

Aged↗

Molecular characterisation of the actin gene of the filarial parasite Wuchereria bancrofti.

Wuchereria bancrofti is the major cause of lymphatic filariasis in humans. Although it is responsible for this immensely morbid and debilitating disease, very little is known of the basic molecular biology of this parasite, and there is a vast lack of knowledge on its gene organisation. In this study, the actin gene of W. bancrofti has been characterised by sequencing a clone isolated from a genomic DNA library of this parasite. The 5' flanking region had a potential TATA box and a putative mRNA initiation site. The gene had five exons encoding 376 amino acids, and four introns ranging in size from 109 to 190bp. The 3' flanking region had a potential polyadenylation signal with the sequence ATTAAA which is a common natural variant of the conventional sequence AATAAA. The gene was AT-rich, with a GC content of 37.2%. Southern blot analysis of W. bancrofti genomic DNA indicated that the gene is possibly found as a single copy. The actin amino acid sequence of W. bancrofti showed a high degree of homology to the actin of many organisms of different taxonomic groups, but the highest homology was observed with the free-living nematode Plectus acuminatus. This suggests that P. acuminatus may bear a close evolutionary relationship to W. bancrofti.

Actins↗

In vitro differentiation of Wuchereria bancrofti (Filariidae).

Wuchereria bancrofti microfilariae were isolated from blood of infected individuals and cultured in vitro under several conditions. RPMI 1640 and TC-199 media supplemented with fetal or human serum were able to support the microfilariae for periods up to 35 days at 37 degrees C (viability greater than 85%). In contrast, in minimal essential medium the microfilariae did not survive for more than 48 h. In cultures kept at 28 degrees C, where viability was much lower (approximately 10% on day 15), microfilariae differentiated into type IV larvae ("sausage" form). The in vitro maintainance of microfilarial larval forms is particularly important in the case of W. bancrofti due to the absence of an experimental model for the disease.

Animals↗

Phylogeography of human lymphatic filarial parasite, Wuchereria bancrofti in India.

Wuchereria bancrofti, a nematode parasite causing human lymphatic filariasis is widely distributed in India. The phylogeography of this parasite was studied by constructing RAPD profiles of parasite populations collected from 71 microfilaria carriers residing in different geoclimatic regions of India. The analysis showed that the phylogeography of W. bancrofti populations is complex, with a high genetic divergence and gene flow among populations. The total genetic diversity (H(T)) and genetic differentiation (G(ST)) estimated for all the parasite populations were 0.0926 and 0.5859, respectively. The gene flow (Nm) between different regions indicated that two strains of W. bancrofti were prevalent in the country, one in the eastern side and the other on the western side of the Western Ghats. A highly significant genetic differentiation (F(ST) [theta] = 0.7978) was estimated between these two strains (chi 2 = 308.2789; P < 0.001). The gene flow between these strains was very low (0.2338). These two strains appear to have drifted genetically because of their geographic isolation by this thickly forested mountain range. The strain in the eastern side was found to be monophyletic in origin and is undergoing genetic divergence as the major parasite population in the country, spanning from eastern peninsular region to the northern plains. The variable geoclimatic factors and the antifilarial chemotherapeutical pressure on the parasite, which is in place for the past half a century, might have contributed for the high genetic heterogeneity its strains/populations in the country. The route of entry of the parasite into Indian sub-continent possibly appeared to be from an ancient origin from the countries of the Southeast Asian archipelago, through the eastern coastal line of the southern peninsula.

Animals↗

Antigenic characterization of adult Wuchereria bancrofti filarial nematodes.

Adult Wuchereria bancrofti were recovered from infected Presbytis cristatus monkeys and radio-isotope labelled extrinsically with 125I and in vitro with [35S]methionine. 125I labelling of the surface of adult W. bancrofti permitted a comparison between the major surface antigens of this species and those from the related lymphatic filariae, Brugia malayi and B. pahangi. All species bear a prominent Mr 29,000 surface antigen but among the differences observed were the strongly labelled molecules with Mr 58,000 and 67,000 in W. bancrofti which are extremely faint in the Brugia species. The [35S]methionine label was effectively incorporated into somatic parasite proteins in vitro although it was not possible to identify any secreted proteins in this way. The antigenicity of these products was investigated using a variety of sera from homologous and heterologous infections and the immunoprecipitation patterns highlighted particular differences between somatic proteins of male and female worms. One secreted antigen was detected, however, by virtue of its phosphorylcholine epitopes, in the culture medium of mixed adult worms; medium from male W. bancrofti adults was negative although homogenates of either sex of adult W. bancrofti were strongly positive in the same system.

Animals↗

Isolation and analysis of partial cDNA sequence coding for superoxide dismutase in Wuchereria bancrofti.

Molecular characterization of Wuchereria bancrofti is essential to develop suitable anti-filarial drugs and vaccines. We describe here isolation, sequence analysis and cloning of a partial cDNA of an enzyme superoxide dismutase from this parasite. The immunoscreening of a lambda zap W. bancrofti microfilarial (Mf) cDNA library with microfilaremic sera had resulted in the isolation of several seroreactive clones including, WbSOD. This clone contained a 309 bp insert and showed significant nucleotide and deduced amino acid sequence homologies to the superoxide dismutases of other nematode parasites. The antioxidant property of this enzyme may have important contribution in the defense mechanism of the parasite against host immune response.

Amino Acid Sequence↗

Immunocytochemical localization of antigens recognized by human antisera in infective larvae of Wuchereria bancrofti.

Ultrathin sections of L3 of Wuchereria bancrofti embedded in hydrophilic resin were incubated with antisera pools from individuals (1) asymptomatic microfilaremic with different microfilaria (mf) densities (1-100, 101-500, and >1,000 mf/ml); (2) chronic with hydrocele or lymphedema; and (3) with no evidence of microfilaremia or clinical filariasis but residing in an endemic area. The groups of microfilaremic subjects studied presented differences relative to the intensity of labeling, with the density of gold particles per square micrometer proportional to microfilaremia. Incubation of ultrathin sections of W. bancrofti L3 larvae in the presence of antisera from patients exhibiting chronic obstructive lymphatic pathology of hydrocele and from individuals with clear clinical evidence of lymphedema exhibited a strong reaction in the same tissues. Except for the endemic normal group, all groups studied showed reactivity against epitopes in all tissues of infective larvae of W. bancrofti. The cuticle presented an intense labeling, suggesting a possible target structure for immune response.

Adolescent↗

Immunocytochemical localization of antigens recognized by asymptomatic microfilaremic patient's antisera in microfilariae of Wuchereria bancrofti.

Ultrathin sections of microfilariae of Wuchereria bancrofti embedded in hydrophilic resin were incubated with sera from patients, using antisera from asymptomatic microfilaremic patients with different microfilarial densities [1-100 microfilariae (mf)/ml, 101-500 mf/ml, > 1,000 mf/ml]. All groups studied showed reactivity against relevant epitopes in all tissues of microfilariae of W. bancrofti, instead of being localized in a specific nematode region, although the number of colloidal per square micron was inversely proportional to the microfilaremia. Such results confirm data obtained by other authors and indicate a possible role for the humoral response in the mechanism for the destruction of circulating microfilariae.

Animals↗

Experimental transmission of Wuchereria bancrofti to monkeys.

Infective larvae of Wuchereria bancrofti from laboratory-raised Culex pipiens fatigans and Aedes togoi mosquitoes fed on human volunteers in Jakarta, Indonesia (J strain) and Kinmen Island, China (K strain) were introduced into Taiwan monkeys (Macaca cyclopis) by subcutaneous inoculation, by foot puncture, or by permitting infected mosquitoes to feed weekly on the monkeys. Some animals were splenectomized and others were treated with varying regimens of immunosuppressants. Necropsy was done on monkeys that died or were killed and the entire bodies were examined for worms. A total of 78 monkeys (43 males and 35 females) were exposed to infection and parasites were found in 29% of the females and 63% of males. In infections of 38 days or less worms were recovered from the testes of males and the pelt, carcass and lymph nodes of both sexes, but after 42 days of infection most worms were in the testes of males, and a few were recovered from lymph nodes and carcasses of females. Worms recovered at 8-11 days were third-stage, those found between 14 and 38 days fourth-stage, and ones found between 42 and 103 days were young adults. After 148 days most were adults and microfilariae were seen in the uteri of female worms at 160 days and later. The parasites continued to grow in size with time. Microfilariae were detected in the blood of nine monkeys between 8 and 18 months and the patent period varied from 5-21 months. Microfilarial densities were low and erratic, and periodicity could not be determined. The effectiveness of methods of administering infections and the value of various treatment regimens seem uncertain; monkey antilymphocytic sera, however, appeared to have some influence. Parasites were found in 36% of the Taiwan monkeys given the J strain and 54% of those given the K strain. A limited number of M. mulatta (3), M.irus (fascicularis) (3) and Aotus trivirgatus (4) were also given infective larvae and adult W. bancrofti were recovered from the testes of one male M. mulatta and one male M. irus; uterine microfilariae were found in one female worm from the latter monkey. A. trivirgatus were negative. Low numbers of infective larvae recovered from mosquitoes fed on patent monkeys were introduced intermittently into seven clean monkeys and one became microfilaremic between 11 and 17 months postinoculation.

Aedes↗

Microfilariae of Wuchereria bancrofti in cytologic smears.

Microfilariae of Wuchereria bancrofti were observed in cytologic material in 35 cases. The material included cervicovaginal smears (17 cases), effusions (14), urine (2), bronchial washings (1) and ovarian cyst fluid (1). The initial diagnosis was made from the cytologic smear in all cases; none had clinical filariasis. Symptomatic vaginal bleeding in 9 of the 17 cases with microfilaria-positive cervicovaginal smears was reflected in the large numbers of red blood cells found in the smear. Blood eosinophilia was present in 11 of 19 cases investigated. Eosinophils were seen in the smears in 20 cases. In the majority of the cases of effusions with microfilariae the effusions were malignant. Significant adherence of inflammatory cells and macrophages to microfilariae was present in 7 of the 35 cases. The significance of these findings is discussed.

Adhesiveness↗

Evidence of nonsusceptibility to diethylcarbamazine in Wuchereria bancrofti.

This study assessed Wuchereria bancrofti-infected patients who received diethylcarbamazine (DEC) to determined if drug levels were comparable between individuals who continued to harbor circulating microfilariae and those whose blood became clear of parasites, between those with high and low microfilaria counts, and between infected and noninfected persons. Haitian volunteers undergoing treatment for W. bancrofti and two nonendemic controls were enrolled. DEC levels in serum and urine samples were determined using a gas chromatographic method. No correlation was found between pre- and posttreatment microfilarial levels and drug levels. Drug levels were comparable in persons with or without residual microfilaria and in infected and uninfected persons. These results indicate that incomplete drug regimens, differences in serum drug levels, and inadequate drug dosage are not the primary causes of treatment failure and suggest there is a degree of parasite tolerance for DEC.

Animals↗

Characterization of a muscle-associated antigen from Wuchereria bancrofti.

A recombinant clone, WbN1, isolated from a genomic expression library of Wuchereria bancrofti and showing restricted specificity at the DNA level (Southern and PCR analyses) for Wuchereria bancrofti and Brugia malayi has been previously described. Sequence analysis of WbN1 indicated that it had notable similarity to myosin. Further characterization using in situ hybridization has localized the mRNA in the muscle of the adult parasite and in the microfilariae. Rabbit polyclonal antiserum, raised against the recombinant WbN1 fused to the maltose-binding protein, recognized a 200-kDa polypeptide in immunoblots containing B. malayi antigen extracts. The same antibody also recognized myosin extracted from Brugia pahangi, Onchocerca volvulus, and Caenorhabditis elegans. Localization using the rabbit antiserum revealed the presence of the antigen in the adult muscle tissue and in the microfilariae; the same antibody inhibited the binding of a monoclonal antibody 28.2 (directed toward MHC B of C. elegans myosin) to the recombinant WbN1 antigen and also to purified C. elegans myosin. Based on homology data, structural location, competitive ELISA, and immunoblot we conclude that WbN1 is related to myosin or a similar myofibrillar protein.

Amino Acid Sequence↗

The effects of diethylcarbamazine on the ultrastructure of microfilariae of Wuchereria bancrofti.

An ultrastructural study of microfilariae of Wuchereria bancrofti was performed after in vitro treatment with diethylcarbamazine. One of the first morphological alterations produced by treatment with 5, 10 or 50 microg/ml of DEC was the loss of microfilarial sheaths. Drastic effects of DEC were only detected when microfilariae were exsheathed. Microfilariae treated with 5, 10 or 50 microg/ml DEC showed severely affected organelles, formation of several vacuoles mainly in the hypodermis, and cytolysis. Some microfilariae showed extreme cellular disorganization with abundance of electron-dense degenerating organelles, numerous large vacuoles, and nuclear condensation. Lamellar bodies probably related to an assembly of endoplasmic reticulum membranes were observed in some damaged microfilariae. Thus, in vitro treatment with concentrations of DEC similar to therapeutic conditions had direct effect by causing a loss of the microfilarial sheath of W. bancrofti with subsequent damage of organelles and apoptosis.

Animals↗

Parasitological, serological, and clinical studies of Wuchereria bancrofti in Limbe, Haiti.

A survey for Wuchereria bancrofti in Limbe, Haiti (est. pop. = 10,500) revealed that 17% (231/1,450) had a patent infection. Nearly half of those surveyed harbored fewer than 10 microfilariae (mf) per 20 mm3 of finger-prick blood; the median mf density for females and males was 12.4 and 9.5, respectively. Parasitemias occurred as early as age 4. Antibody titers greater than or equal to 1:20 against adult D. viteae antigen were observed in 38% of microfilaremic individuals and in 29% of amicrofilaremic individuals. Peak antibody responsiveness (40%) was observed between 5 and 9 years of age. In all age groups there was no correlation between mf density and antibody titer. Among the mf carriers, 5.6% had no clinical symptoms. Lymphangitis was a common feature with 14.3% having lymphedema, 8.2% with edema of the lower extremities, and 1.3% reporting episodes of chyluria. Genital involvement among women was rare, but in males 5.4% had genital swelling and 4.5% had hydroceles. Culex pipiens quinquefasciatus (Say) was observed to support the complete development of W. bancrofti in Limbe.

Adolescent↗

Ultrasonographic detection of living adult Wuchereria bancrofti using a 3.5-MHz transducer.

Adult Wuchereria bancrofti can be readily detected by ultrasound in the lymphatic vessels of the spermatic cord with a 7.5-MHz transducer, but most ultrasound machines in developing countries are equipped with 3.5-MHz transducers. To assess the potential for ultrasound as a tool for diagnosis and epidemiologic assessment in lymphatic filariasis, we compared the performance of 3.5-MHz and 7.5-MHz transducers in 61 men in Recife, Brazil. All men had three ultrasound examinations using a 3.5 MHz transducer and an examination with a 7.5-MHz probe. Using the 7.5-MHz transducer, adult W. bancrofti were detected in 41 men; 81 adult worm nests were detected. Sixty-four (79%) nests were detected with the 3.5-MHz probe, each on all three examinations. The 3.5-MHz probe correctly identified 35 (85.4%) of 41 men as infected; sensitivity increased with lymphatic vessel diameter. Ultrasonographic examination with a 3.5-MHz transducer is a sensitive method for detection of adult W. bancrofti in men and merits consideration as a tool for rapid epidemiologic assessment.

Adolescent↗

A polymerase chain reaction assay for detection of the parasite Wuchereria bancrofti in human blood samples.

To identify Wuchereria bancrofti DNA sequences that could be used as the basis for a simple and rapid parasite detection assay, a genomic library of W. bancrofti was constructed and screened for highly repeated DNA. The repeat found with the highest copy number was 195 basepairs (bps) long, 77% AT, and 300 copies per haploid genome. This sequence was designated the Ssp I repeat because it has a unique recognition site for that restriction endonuclease in all or most of the repeat copies. The Ssp I repeat DNA family is dispersed, genus-specific, and exists in all of the different geographic isolates of W. bancrofti tested. Based on DNA sequence analysis of this repeat, we have developed an assay to detect very small quantities of W. bancrofti DNA using the polymerase chain reaction (PCR). With this PCR assay, the Ssp I repeat was detected in as little as 1 pg of w. bancrofti genomic DNA (about 1% of the DNA in one microfilaria) added to 100 microliters of human blood. The PCR assay also amplified Ssp I repeat DNA from geographic isolates of W. bancrofti from around the world but not from other species of filariae or from human or mosquito DNA. Microfilaria-positive human blood samples collected in Mauke, Cook Islands were shown to be Ssp I PCR-positive, while microfilaria-negative samples were PCR-negative. The specificity and sensitivity of the Ssp I PCR assay indicates that this approach has significant potential for improved screening of large human populations for active W. bancrofti infection.

Animals↗