High Prevalence of Mansonella ozzardi Infection in the Amazon Region, Ecuador.

We reviewed Giemsa-stained thick blood smears, obtained through the national malaria surveillance program in the Amazon region of Ecuador, by light microscopy for Mansonella spp. microfilariae. Of 2,756 slides examined, 566 (20.5%) were positive. Nested PCR confirmed that the microfilariae were those of M. ozzardi nematodes, indicating that this parasite is endemic to this region.

Inflammatory and regulatory CCL and CXCL chemokine and cytokine cellular responses in patients with patent Mansonella perstans filariasis.

Mansonella perstans (Mp) filariasis is present in large populations in sub-Saharan Africa, and to what extent patent Mp infection modulates the expression of immunity in patients, notably their cellular cytokine and chemokine response profile, remains not well known. We studied the spontaneous and inducible cellular production of chemokines (C-X-C motif) ligand 9 (CXCL9) [monokine induced by interferon (IFN)-γ (MIG)], CXCL-10 [inducible protein (IP)-10], chemokine (C-C motif) ligand 24 (CCL24) (eotaxin-2), CCL22 [macrophage-derived chemokine (MDC)], CCL13 [monocyte chemotactic protein-4 (MCP-4)], CCL18 [pulmonary and activation-regulated chemokine (PARC)], CCL17 [thymus- and activation-regulated chemokine (TARC)] and interleukin (IL)-27 in mansonelliasis patients (Mp-PAT) and mansonelliasis-free controls (CTRL). Freshly isolated peripheral mononuclear blood cells (PBMC) were stimulated with helminth, protozoan and bacterial antigens and mitogen [phytohaemagglutinin (PHA)]. PBMC from Mp-PAT produced spontaneously (without antigen stimulation) significantly higher levels of eotaxin-2, IL-27, IL-8, MCP-4 and MDC than cells from CTRL, while IFN-γ-IP-10 was lower in Mp-PAT. Helminth antigens activated IL-27 and MCP-4 only in CTRL, while Ascaris antigen, Onchocerca antigen, Schistosoma antigen, Entamoeba antigen, Streptococcus antigen, Mycobacteria antigen and PHA stimulated MIG release in CTRL and Mp-PAT. Notably, Entamoeba antigen and PHA strongly depressed (P < 0·0001) eotaxin-2 (CCL24) production in both study groups. Multiple regression analyses disclosed in Mp-PAT and CTRL dissimilar cellular chemokine and cytokine production levels being higher in Mp-PAT for CCL24, IL-27, IL-8, MCP-4, MDC and PARC (for all P < 0·0001), at baseline (P < 0·0001), in response to Entamoeba histolytica strain HM1 antigen (EhAg) (P < 0·0001), Onchocerca volvulus adult worm-derived antigen (OvAg) (P = 0·005), PHA (P < 0·0001) and purified protein derivative (PPD) (P < 0·0001) stimulation. In Mp-PAT with hookworm co-infection, the cellular chemokine production of CXCL10 (IP-10) was diminished. In summary, the chemokine and cytokine responses in Mp-PAT were in general not depressed, PBMC from Mp-PAT produced spontaneously and selectively inducible inflammatory and regulatory chemokines and cytokines at higher levels than CTRL and such diverse and distinctive reactivity supports that patent M. perstans infection will not polarize innate and adaptive cellular immune responsiveness in patients.

Hallazgo incidental de microfilarias de Mansonella ozzardi en un paciente pediátrico con linfoma T anaplásico / Incidental finding of Mansonella ozzardi in a paediatric patient with anaplastic lymphoma

Resumen Las filariasis son parasitosis producidas por nemátodos hemáticos de la familia Filariidae, la Mansonella ozzardi, es uno de los agentes etiológicos distribuido ampliamente en el continente americano y en el Caribe. Presentamos el caso de una paciente de 13 años de edad, previamente diagnosticada con linfoma T de célula grande anaplásico. Como parte de la evaluación antes del segundo ciclo B de quimioterapia, se realizó un extendido de sangre periférica en el que se encontró una microfilaría tipificada como Mansonella ozzardi, se dio manejo con una dosis única de ivermectina y se logró resultado negativo en el control a las 24 horas. Actualmente la paciente se encuentra asintomática y sin evidencia de recurrencia de la parasitemia y terminando su tratamiento oncológico.

Abstract Filariasis is caused by nematodes in the blood. Mansonella ozzardi is one of the aetiological agents widely distributed in the Americas and the Caribbean. The case is presented on a paediatric patient previously diagnosed with T-cell anaplastic large cell lymphoma. As part of the evaluation before the second cycle B chemotherapy, a peripheral blood smear was performed, in which were found microfilaria, identified as Mansonella ozzardi. The treatment was a single dose of ivermectin, with a negative result being obtained at 24 hours. The patient is currently asymptomatic and with no evidence of recurrence of the parasitaemia, and able to finish the cancer treatment.

Mansonella perstans, Onchocerca volvulus and Strongyloides stercoralis infections in rural populations in central and southern Togo.

BACKGROUND: Mansonella perstans, Onchocerca volvulus and Strongyloides stercoralis are widespread helminth parasites in the tropics. Their distribution remains difficult to determine as it may change during national disease control programs and with regional mass drug administration (MDA). Epidemiological surveys are of importance to evaluate the geographical distribution of these helminth parasites and the diseases they may cause, however, up to date epidemiological evaluations on M. perstans and S. stercoralis in Togo are rare, and surveys on O. volvulus are important especially under the aspect of MDA of ivermectin which is performed since decades. METHODS: Dry blood samples (n = 924) were collected from rural populations in the Régions Central and Plateaux in Togo, and analyzed by parasite-specific real-time PCR and ELISA techniques. RESULTS: Dry blood samples from 733 persons where investigated by real-time PCR tested for DNA of blood-circulating M. perstans microfilaria, and a prevalence of 14.9% was detected. Distinct differences were observed between genders, positivity was higher in men increasing with age, and prevalence was highest in the Région Plateaux in Togo. IgG4 responses to O. volvulus antigen (OvAg) were studied in 924 persons and 59% were found positive. The distribution of parasite infestation between age and gender groups was higher in men increasing with age, and regional differences were detected being highest in the Région Plateaux. The diagnostic approach disclosed 64,5% positive IgG4 responses to S. stercoralis infective third-stage larvae-specific antigen (SsL3Ag) in the surveyed regions. Antigen cross reactivity of SsL3Ag with parasite co-infections may limit the calculated prevalence. Singly IgG4 positive for SsL3Ag were 13.9%, doubly positive for OvAg and SsL3Ag were 35.5% and triply positive for M. perstans, O. volvulus and S. stercoralis were 9.9%. CONCLUSIONS: Mansonelliasis, onchocerciasis and strongyloidiasis remain prevalent in the surveyed regions, yet with local differences. Our observations suggest that transmission of M. perstans, O. volvulus and S. stercoralis may be ongoing. The degree of positive test results in the examined rural communities advocate for the continuation of MDA with ivermectin and albendazole, and further investigations should address the intensity of transmission of these parasites.

Sensitivity of diagnostic methods for Mansonella ozzardi microfilariae detection in the Brazilian Amazon Region

BACKGROUND The human filarial worm Mansonella ozzardi is highly endemic in the large tributaries of the Amazon River. This infection is still highly neglected and can be falsely negative when microfilariae levels are low. OBJECTIVES This study investigated the frequency of individuals with M. ozzardi in riverine communities in Coari municipality, Brazilian Amazon. METHODS Different diagnostic methods including polymerase chain reaction (PCR), blood polycarbonate membrane filtration (PCMF), Knott's method (Knott), digital thick blood smears (DTBS) and venous thick blood smears (VTBS) were used to compare sensitivity and specificity among the methods. Data were analysed using PCMF and Bayesian latent class models (BLCM) as the gold standard. We used BLCM to calculate the prevalence of mansonelliasis based on the results of five diagnostic methods. FINDINGS The prevalence of mansonelliasis was 35.4% by PCMF and 30.1% by BLCM. PCR and Knott methods both possessed high sensitivity. Sensitivity relative to PCMF was 98.5% [95% confidence interval (CI): 92.0 - 99.7] for PCR and 83.5% (95% CI: 72.9 - 90.5) for Knott. Sensitivity derived by BLCM was 100% (95% CI 93.7 - 100) for PCMF, 100% (95% CI: 93.7 - 100) for PCR and 98.3% (95% CI: 90.6 - 99.9) for Knott. The odds ratio of being diagnosed as microfilaremic increased with age but did not differ between genders. Microfilariae loads were higher in subjects aged 30 - 45 and 45 - 60 years. MAIN CONCLUSIONS PCMF and PCR were the best methods to assess the prevalence of mansonelliasis in our samples. As such, using these methods could lead to higher prevalence of mansonelliasis in this region than the most commonly used method (i.e., thick blood smears).

[Update of knowledge on Neglected Diseases in Haiti: Mansonelliasis, Tungiasis, Leprosy, and Anthrax]. / Mise à jour des connaissances concernant quatre maladies délaissées en Haïti : mansonellose, tungose, lèpre, charbon.

Haiti, like most limited-resources countries in the world, faces numerous neglected infectious diseases. They represent a real public health issue with lethal consequences especially in children. We are reviewing here the available literature on four neglected infectious diseases, mansonelliasis, tungiasis, leprosy and anthrax. Filariasis, due to Mansonella ozzardi, has been totally neglected since its discovery in 1920 in Haiti; it persists in coastal homes with a high prevalence in adults when an effective treatment is available. The skin lesions caused by Tunga penetrans have existed since the pre-Columbian period in Haiti. They persist in the most retreated and hard-to-reach areas where the population lives in precarious conditions and in extreme poverty. New available research data show the importance of the problem with very high prevalence rates in some rural communities far away from any healthcare center. Cases of leprosy are recently reemerging as no monitoring program has been in place since 2004. Finally, anthrax is still endemic; small epidemics resurfacing periodically in families in rural areas. Screening of people for these diseases and managing the cases are necessary to improve health and reduce morbidity and mortality in Haiti.

Comme dans la plupart des pays pauvres de la planète, les maladies infectieuses négligées sont nombreuses en Haïti où elles représentent un réel problème de santé publique avec des conséquences létales, surtout pour les enfants. Nous faisons le point des données accessibles pour quatre d'entre elles. Totalement délaissée depuis la découverte de sa présence en Haïti en 1920, la filariose due à Mansonella ozzardi persiste en foyers côtiers avec une prévalence élevée chez les adultes alors qu'un traitement efficace est disponible. Connues depuis la période précolombienne dans l'île d'Hispaniola, les lésions cutanées dues à Tunga penetrans persistent dans les régions les plus reculées et difficiles d'accès où la population vit dans des conditions précaires et dans une très grande pauvreté. Nous rapportons les données d'enquêtes récentes qui montrent l'importance de cette ectoparasitose en Haïti où les taux de prévalence sont très élevés dans certaines communautés rurales isolées. Des cas de lèpre resurgissent en Haïti alors qu'aucun programme de surveillance n'est effectif depuis 2004. Enfin, la maladie du charbon est endémique dans les régions d'élevage où des épidémies familiales resurgissent périodiquement en milieu rural. Le dépistage des personnes atteintes de ces maladies et leur prise en charge sont nécessaires pour une amélioration de la santé et une baisse de la mortalité en Haïti.

Pulmonary localization of Mansonella perstans in a 16 months-old male patient in a tertiary care hospital in Bukavu, Democratic Republic of Congo.

INTRODUCTION: Mansonella perstans is a human filarial parasite transmitted by biting midges (Diptera: Ceratopogonidae) belonging to the genus Culicoides and it is widely spread in sub-Saharan Africa. While most cases are asymptomatic, mansonelliasis can be associated with angioedema, arthralgia, swellings, pain in the scrotum or in serous cavities such as the pleura, the peritoneum, the pericardium, etc. Mansonelliasis can be really hard to treat, but it has been shown that an intensive treatment using albendazole can clear the parasite. CASE REPORT: Here we describe a case of a 16 months-old malnourished child with pneumonia due to M. perstans in the east of the Democratic Republic of Congo. CONCLUSION: Although our investigations confirmed M. perstans infection, this case shows that it is very difficult to come to a conclusive diagnosis.

Mansonella ozzardi in Neotropical region of Argentina: Prevalence through time (1986-2010).

Human filariasis caused by Mansonella ozzardi is a parasitic infection of a controversial pathology and poorly studied in Argentina. The aim of this study was not only to obtain data of the prevalence of M. ozzardi in Northwestern Argentina through comparison of infection rates in relation to sex and age group determining the range of distribution of mansonelliasis in the region but also to investigate the prevalence of the cases over time. Through field work carried between 1986 and 2010 by technicians of the National Ministry of Health, aiming to detect active cases of malaria in the Northwestern Argentina, blood samples were taken for smear and thick blood. 417 blood samples were examined, 381 of them (91.4%) were positive for M. ozzardi. The highest prevalence was found in Salta province (92.3%) mainly affecting the male sex (92.6%) and the age groups comprised between 48-57 years (97.0%) and ≥ 68 (90.7%). The paired t-test and Spearman coefficients showed significant differences in prevalence according to sex (t=2.677; p=0.015), and according infection rates in males and females/age (r=0.994; p=0.001; r=0.994, p=0.001, respectively). The prevalence over time showed a general pattern with the highest cases in 1986, decreasing later during the following years. Aguas Blancas, El Oculto and San Ramón de la Nueva Orán, exhibited a pattern of prevalence according to the general trend but Salvador Mazza and Tartagal, which are also localities close to the border with Bolivia, showed peaks of cases up to 2010. These results provide relevant information about M. ozzardi in Argentina, demonstrating not only its presence and endemicity after almost 100 years from its discovery in the country, but also its wide range of distribution in the region.

Mansonelliasis, a neglected parasitic disease in Haiti

Reported in Haiti as early as 1923, Mansonella ozzardi is still a neglected disease ignored by the health authorities of the country. This review is an update on the geographic distribution of the coastal foci of mansonelliasis in Haiti, the epidemiological profile and prevalence rates of microfilariae in people living in endemic areas, the clinical impact of the parasite on health and the efficiency of the transmission of the parasite among three Culicoides biting-midge species identified as vectors in Haiti. Additionally, interest in establishing a treatment programme to combat this parasite using a single dose of ivermectin is emphasised.

Mansonella ozzardi in the municipality of Tefé, Amazonas, Brazil, 60 years after the first report: an epidemiologic study

The prevalence of mansonelliasis was studied in the municipality of Tefé, state of Amazonas, Brazil. The prevalence (thick blood smear method) was 13.6% (147/1,078), higher in the Solimões River region (16.3%) than in the Tefé River region (6.3%). In the sampled communities in the Solimões River region, a higher density of cases was observed, as indicated by a kernel analysis (odds ratio 0.34; 95% confidence interval: 0.20-0.57). Males had a higher prevalence (χ2 = 31.292, p < 0.001) than women. Mansonella ozzardi prevalence was higher in retirees and farmers (28.9% and 27%, respectively). Prevalence also significantly increased with age (χ2 = -128.17, p < 0.001), with the highest numbers occurring in persons older than 67 years.

Prevalence of Mansonella ozzardi among riverine communities in the municipality of Lábrea, State of Amazonas, Brazil / Prevalências de Mansonella ozzardi entre comunidades ribeirinhas do município de Lábrea, Estado do Amazonas

INTRODUCTION: Estimate the prevalence of Mansonella ozzardi infection and calculate the parasitic infection rate (PIR) in simuliid black flies in the municipality of Lábrea, State of Amazonas, Brazil. METHODS: Prevalence was measured using the thick blood smear method collected from the fingers and was related to age, sex and occupation. Simuliidae were collected with a suction apparatus, then stained with hematoxylin and dissected to verify the PIR. RESULTS: The average prevalence rate of M. ozzardi among the 694 individuals examined was 20.7 percent. Infection was higher in men (27.6 percent) than in women (14.3 percent) (p < 0.001) and occurred in most age groups, with the highest prevalence in the following age groups: 38-47 (40 percent), 48-57 (53.1 percent) and >58 (60.5 percent). The highest prevalence rates were observed in the retired (64 percent), followed by farm workers (47.1 percent). Infection by M. ozzardi was only identified in Cerqueirellum amazonicum (Simuliidae) with a PIR of 0.6 percent. CONCLUSIONS: This study showed a high prevalence of M. ozzardi in the riverine communities of Lábrea due to the lack of policies regarding the treatment of microfilaremic individuals in the region and an abundance of competent vectors for M. ozzardi.

INTRODUÇÃO: Estimar as prevalências de Mansonella ozzardi, e calcular a taxa de infecção parasitária nos simulídeos no município de Lábrea, Estado do Amazonas. MÉTODOS: As prevalências foram obtidas através do método de gota espessa a partir do sangue coletado da polpa digital e foram relacionadas com a idade, sexo e ocupação. Os simulídeos foram coletados com capturador de sucção, posteriormente foram corados com hematoxilina e dissecados para se obter a taxa de infecção parasitária. RESULTADOS: A prevalência de M. ozzardi entre as 694 pessoas examinadas foi de 20,7 por cento. A infecção foi maior nos homens (27,6 por cento) do que nas mulheres (14,3 por cento) (p < 0,001) e ocorreu na maioria das faixas etárias com maiores prevalências nos indivíduos entre 38-47 (40 por cento), 48-57 (53,1 por cento) e >58 (60,5 por cento) anos. As maiores prevalências foram observadas nos aposentados (64 por cento) e agricultores (47,1 por cento). Somente Cerqueirellum amazonicum (Simuliidae) foi encontrado infectado com M. ozzardi com uma taxa de infecção parasitária de 0,6 por cento. CONCLUSÕES: Este trabalho mostra elevadas prevalências de M. ozzardi nas comunidades ribeirinhas de Lábrea devido à ausência de políticas de tratamento dos microfilarêmicos na região e a abundância de vetores competentes.

Nested PCR to detect and distinguish the sympatric filarial species Onchocerca volvulus, Mansonella ozzardi and Mansonella perstans in the Amazon Region

We present filaria-nested polymerase chain reaction (PCR), which is based on amplification of first internal transcribed spacer rDNA to distinguish three parasitic filarial species (Onchocerca volvulus, Mansonella ozzardiand Mansonella perstans) that can be found in the Amazon Region. Nested PCR-based identifications yielded the same results as those utilizing morphological characters. Nested PCR is highly sensitive and specific and it detects low-level infections in both humans and vectors. No cross-amplifications were observed with various other blood parasites and no false-positive results were obtained with the nested PCR. The method works efficiently with whole-blood, blood-spot and skin biopsy samples. Our method may thus be suitable for assessing the efficacy of filaria control programmes in Amazonia by recording parasite infections in both the human host and the vector. By specifically differentiating the major sympatric species of filaria, this technique could also enhance epidemiological research in the region.

Mansonella ozzardi in Amazonas, Brazil: prevalence and distribution in the municipality of Coari, in the middle Solimões River

This study investigated some epidemiological aspects of the Mansonella ozzardi in municipality of Coari, Amazonas. Clinical symptoms were correlated with the filarial infection and the parasitic infection rates (PIR) were estimated in simuliid vectors. The general M. ozzardi human prevalence rate was 13.3 percent (231/1733), of which 10.2 percent (109/1069) were from the urban area and 18.4 percent (122/664) from the rural area. The prevalence rates were higher in men (14.5 percent urban and 19.7 percent rural) than in women (6.7 percent urban and 17.2 percent rural) and occurred in most age groups. The indices of microfilaremics were higher in people > 51 years old (26.9 percent urban and 61.5 percent rural). High prevalence rates were observed in retired people (27.1 percent urban area), housewives and farmer (41.6 percent and 25 percent, respectively, in rural area). The main clinical symptoms were joint pains and sensation of leg coldness. Only Cerqueirellum argentiscutum (Simuliidae) transmits M. ozzardi in this municipality (PIR = 5.6 percent urban and 7.1 percent rural). M. ozzardi is a widely distributed parasitic disease in Coari. Thus, temporary residency in the region of people from other localities involved with the local gas exploitation might be a contributing factor in spreading the disease.

Mansonella ozzardi in Brazil: prevalence of infection in riverine communities in the Purus region, in the state of Amazonas

This study was undertaken to investigate the prevalence of Mansonella ozzardi infection and to estimate the parasitic infection rate (PIR) in simuliid black flies in the municipality of Pauini, Amazonas, Brazil. We used thick blood films to examine 921 individuals in 35 riverine communities along the Pauini and Purus Rivers. Simuliids were caught in several communities. Flies were identified, stained with haematoxylin and dissected. Overall, 44 (24.86 percent) of 177 riverines were infected in communities on the Pauini River and 183 (24.19 percent) of 744 on the Purus. The prevalence was higher in men (31.81 percent and 29.82 percent) than in women (17.98 percent and 19.18 percent) and occurred in most age groups. The prevalence increased sharply in the 28-37 (50 percent and 42.68 percent) age group and increased in the older age classes. The highest prevalence was in farmers (44 percent and 52.17 percent, respectively) in the Pauini and Purus Rivers. Only Cerqueirellum amazonicum (Simuliidae) transmits M. ozzardi in this municipality, and we found a PIR of 0-8.43 percent and infectivity rate of 0-3.61 percent. These results confirm that rates of M. ozzardi infection are high in Pauini and suggest that its prevalence may be far greater than has been previously reported due to the absence of a program for treating the population.

Current profile of Mansonella ozzardi (Nematoda: Onchocercidae) in communities along the Ituxi river, Lábrea municipality, Amazonas, Brazil

The objective of this paper was to describe the current status of Mansonella ozzardi prevalence among the inhabitants of 12 communities along the Ituxi river, in Lábrea municipality, state of Amazonas. The prevalence of M. ozzardi was determined using thick blood smears obtained by digital punctures. M. ozzardi was found in 30.23 percent of the samples collected (39/129), with similar prevalence between genders (males: 30.30 percent; females: 30.16 percent); the highest prevalence was found in homemakers (45.45 percent) followed by farmers (38.77 percent). Among age groups, males and females older than 48 exhibited the highest rates. These results show a significative increase in the prevalence when compared to a epidemiological study made 26 years ago in the same area as well as a different epidemiological profile (gender and occupation) in relation to other areas in Amazonas.

Epidemiological studies of Mansonella ozzardi (Nematoda, Onchocercidae) in indigenous communities of Pauini municipality, Amazonas, Brazil

The Mansonella ozzardi has a widespread distribution among the indigenous and riverine communities of Amazonas, Brazil. We estimated the prevalence of Mansonella ozzardi in indigenous communities of the Pauini municipality, Amazonas state, Brazil and the rate of parasitic infection in vectors. We collected thick blood smears from individuals from six Apurinã indigenous communities along the Purus River and its tributaries. Collections of simuliids were made and dissected, and the larval instars of M. ozzardi identified. The overall prevalence of M. ozzardi was 28.40 percent, with the highest incidence among males and agricultural workers. Among age groups, children 2-9 years of age had the lowest incidence, while individuals older than 58 exhibited the highest rates of infection. We found infected simuliids in three communities, with Parasitic Infection Rates (PIR) of 0.34-6.58 percent. The prevalence of M. ozzardi among the Apurinã people is high, possibly related to the diary activities of the riparian people, where a high abundance of the vectors exists.

Esse trabalho tem como objetivos estimar a prevalência de Mansonella ozzardi em comunidades indígenas do município de Pauini, Amazonas, Brasil e estimar a Taxa de Infecção Parasitária nos vetores. Foram examinados indígenas da etnia Apurinã, pelo método de gota espessa, em seis comunidades localizadas as margens e afluentes do rio Purus. A prevalência geral para M. ozzardi foi de 28,40 por cento, com maior incidência para o sexo masculino e nos indivíduos com atividade no campo (agricultores). Em relação à faixa etária, as menores prevalências foram obtidas nos indivíduos mais jovens (2-9 anos), enquanto as maiores nos indivíduos acima de 58 anos. Foram encontrados simulídeos parasitados em três comunidades, com uma Taxa de Infecção Parasitária que variou de 0,34 a 6,58 por cento. A prevalência de M. ozzardi entre os Apurinã é elevada, possivelmente relacionada às suas atividades diárias as margens dos rios, onde existe uma grande abundância dos vetores.