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Mansonella infections

INTRODUCTION

Three species of Mansonella cause human infections: M. streptocerca, M. perstans, and M. ozzardi. Each species has a limited geographic distribution and typically causes mild symptoms if any at all.

The epidemiology, clinical features, diagnosis, and treatment of Mansonella infections will be reviewed here (table 1A-B). Other filarial infections, including loiasis, onchocerciasis, and lymphatic filariasis, are discussed separately. (See "Onchocerciasis" and "Epidemiology, pathogenesis, and clinical manifestations of lymphatic filariasis" and "Diagnosis, treatment and prevention of lymphatic filariasis" and "Loiasis (Loa loa infection)".)

MANSONELLA PERSTANS

Epidemiology — M. perstans is endemic in a large portion of sub-Saharan Africa, from Senegal to Uganda and south to Zimbabwe, and in Central and South America, from Panama to Argentina (figure 1) [1]. Since the majority of infected individuals are asymptomatic, the epidemiology of M. perstans has not been clearly defined. Nevertheless, it has been estimated that 114 million people may be infected and as many as 581 million people in 33 countries at risk for M. perstans infection in Africa alone [1].

In endemic regions, the probability of infection increases with age, with prevalences reaching 100 percent in highly endemic areas. Infection of travelers is uncommon, but it does occur [2]. Nonhuman primates are occasionally infected, but they do not appear to be a major reservoir of infection.

M. perstans is transmitted by biting midges (Culicoides). The lifecycle is similar to that of other filariae (figure 2). Infective larvae introduced during the bite of an infected midge mature over months into adult worms. The adult worms live in the pleural, pericardial, and peritoneal cavities, as well as the mesenteric, perirenal, and retroperitoneal tissues, where they produce unsheathed microfilariae that are found in the bloodstream at all times. Microfilariae are responsible for transmission of infection because they are taken up during the blood meal of the insect vector. The lifecycle is completed following maturation of microfilariae into infective third-stage larvae within the midge. The lifespan of the adult worms is unknown, although microfilaria-positive cases have been reported up to 10 years after the infected individual has left the endemic area [3].

                       

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Literature review current through: Jun 2014. | This topic last updated: Apr 11, 2014.
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References
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  1. Simonsen PE, Onapa AW, Asio SM. Mansonella perstans filariasis in Africa. Acta Trop 2011; 120 Suppl 1:S109.
  2. Lipner EM, Law MA, Barnett E, et al. Filariasis in travelers presenting to the GeoSentinel Surveillance Network. PLoS Negl Trop Dis 2007; 1:e88.
  3. Kiefer G, Battegay M, Gyr N, Hatz C. [Mansonella perstans filariasis after stay in Cameroon. A 19-year-old patient born in Cameroon, in Switzerland for the last 10 years]. Praxis (Bern 1994) 2002; 91:61.
  4. Klion AD, Nutman TB. Loiasis and Mansonella Infections. In: Tropical Infectious Diseases: Principles, Pathoges, and Practice, Guerrant RL, Walker DH, Weller PF. (Eds), Elsevier, 2011.
  5. Asio SM, Simonsen PE, Onapa AW. Analysis of the 24-h microfilarial periodicity of Mansonella perstans. Parasitol Res 2009; 104:945.
  6. Keiser PB, Coulibaly Y, Kubofcik J, et al. Molecular identification of Wolbachia from the filarial nematode Mansonella perstans. Mol Biochem Parasitol 2008; 160:123.
  7. Bregani ER, Rovellini A, Mbaïdoum N, Magnini MG. Comparison of different anthelminthic drug regimens against Mansonella perstans filariasis. Trans R Soc Trop Med Hyg 2006; 100:458.
  8. Drugs for parasitic infections. Med Lett Drugs Ther 2010; 8:e20.
  9. Coulibaly YI, Dembele B, Diallo AA, et al. A randomized trial of doxycycline for Mansonella perstans infection. N Engl J Med 2009; 361:1448.
  10. Nathan MB, Bartholomew CF, Tikasingh ES. The detection of Mansonella ozzardi microfilariae in the skin and blood with a note on the absence of periodicity. Trans R Soc Trop Med Hyg 1978; 72:420.
  11. Bartoloni A, Cancrini G, Bartalesi F, et al. Mansonella ozzardi infection in Bolivia: prevalence and clinical associations in the Chaco region. Am J Trop Med Hyg 1999; 61:830.
  12. Vianna LM, Martins M, Cohen MJ, et al. Mansonella ozzardi corneal lesions in the Amazon: a cross-sectional study. BMJ Open 2012; 2.
  13. Nutman TB, Nash TE, Ottesen EA. Ivermectin in the successful treatment of a patient with Mansonella ozzardi infection. J Infect Dis 1987; 156:662.
  14. Bartholomew CF, Nathan MB, Tikasingh ES. The failure of diethylcarbamazine in the treatment of Mansonella ozzardi infections. Trans R Soc Trop Med Hyg 1978; 72:423.
  15. Casiraghi M, Favia G, Cancrini G, et al. Molecular identification of Wolbachia from the filarial nematode Mansonella ozzardi. Parasitol Res 2001; 87:417.
  16. Fischer P, Bamuhiiga J, Büttner DW. Occurrence and diagnosis of Mansonella streptocerca in Uganda. Acta Trop 1997; 63:43.
  17. Fischer P, Büttner DW, Bamuhiiga J, Williams SA. Detection of the filarial parasite Mansonella streptocerca in skin biopsies by a nested polymerase chain reaction-based assay. Am J Trop Med Hyg 1998; 58:816.
  18. Fischer P, Tukesiga E, Büttner DW. Long-term suppression of Mansonella streptocerca microfilariae after treatment with ivermectin. J Infect Dis 1999; 180:1403.