Detection of Onchocerca volvulus infection in low prevalence areas: a comparison of three diagnostic methods.

The standard assay for onchocerciasis diagnosis is microscopical detection of microfilariae in skin snips. Skin snipping is painful, requires appropriate sterilization of equipment, and may fail to diagnose light infections. Two alternatives are a polymerase chain reaction (PCR) test which detects parasite DNA in pieces or scrapings of skin and a test based on allergic reactions to topical application of diethylcarbamazine (DEC). We compared these 2 diagnostics with standard skin snip microscopy in 313 individuals from 2 villages in Guinea, with low prevalence after over 10 years of control by the Onchocerciasis Control Programme. Lower and upper bounds on sensitivities and specificities of these 3 tests were estimated. In addition, these parameters were estimated using 5 different statistical models. Where prevalence was low, PCR and the DEC patch test appeared to be more sensitive than skin snipping which has low sensitivity. As the DEC test is non-invasive, simple and cheap, it may provide a good alternative to skin snipping alone for surveillance in low prevalence areas.

Antibodies to diethylcarbamazine potentiate the antifilarial activity of the drug.

The antifilarial drug diethylcarbamazine citrate (DEC) is known to mediate in vivo microfilaricidal activity in conjunction with the host immune system. In this study passive transfer of antibodies to DEC elicited by immunization with methyl piperazine carboxylic acid (MPCA) coupled to bovine serum albumin (BSA), was found to potentiate microfilaricidal activity of subcurative doses of DEC in Setaria digitata infected Mastomys coucha. Active immunization of microfilaraemic animals with MPCA-BSA followed by administration of subcurative doses of DEC also resulted in rapid clearance of microfilaraemia in both S. digitata and Brugia malayi infected M. coucha indicating the synergistic activity of DEC and the antibodies to the drug. Since some of the filarial antibodies are known to react with DEC, it is proposed that such antibodies may potentiate the microfilaricidal activity of the drug in vivo.

Development of a competitive enzyme-linked immunosorbent assay for diethylcarbamazine.

A sensitive and reproducible competitive enzyme-linked immunosorbent assay (ELISA) for the determination of the concentration of diethylcarbamazine (DEC) in biological fluids was developed. Since DEC has no functional group to conjugate with bovine serum albumin (BSA), N-(2-aminoethyl)-N-ethyl-4-methyl-1-piperazinecarboxamide (DEC-NH2) was first synthesized. This compound was then converted to carboxyl DEC (DEC-COOH) and conjugated to BSA and to poly-L-lysine for use as immunogen and solid-phase marker, respectively. The competitive ELISA was conducted by simultaneously incubating DEC with mouse anti-DEC antiserum over DEC-poly-L-lysine solid phase. Subsequently, the binding of anti-DEC antibody was detected by using sheep anti-mouse IgG peroxidase conjugate as a tracer. The reliability, determined by the coefficient of variation for inter and intra-assay, was satisfactory. The cross-reactivities of anti-DEC antibodies with DEC metabolites, related compounds and ivermectin were negligible. Using this assay, DEC levels were easily determined in serum of Mongolian jirds (Meriones unguiculatus) up to 4 hours following a single dose of DEC citrate base (100 mg/kg of body weight) via intraperitoneal route.

Antibodies in human filariasis sera react with diethylcarbamazine.

We demonstrate by an ELISA the presence of antibodies in human filarial sera that react with diethylcarbamazine (DEC); they appear to be primarily filarial antibodies cross-reacting with DEC skeleton, since affinity-purified DEC antibodies strongly react with Wuchereria bancrofti microfilariae. These observations indicate a possible antigenic mimicry between the drug and some parasite component.

Antibodies to diethylcarbamazine cross-react with microfilariae of Wuchereria bancrofti.

Antibodies directed against the microfilarial sheath have been instrumental in the immune elimination of circulating microfilariae in human lymphatic filariasis. We report here that antibodies to diethylcarbamazine (DEC, the most commonly used anti-filarial drug) cross-react with the sheath of Wuchereria bancrofti microfilariae. Antibodies with reactivity to DEC were raised in rabbits by immunization with a conjugate of methylpiperazine carboxylic acid (MPCA, an acid hydrolysis product of DEC) coupled to bovine serum albumin. The reactivity of these antibodies with microfilarial sheath of W. bancrofti was demonstrated by indirect immunofluorescent assay and indirect immunoperoxidase assay. This reactivity could be effectively inhibited by pre-incubation of the antisera with different haptens such as DEC, MPCA or piperazine citrate.

Aqueous humor and serum IgE antibody in experimental ocular Onchocerca infection of guinea pigs.

Infection of inbred Strain 2 guinea pigs by subcutaneous or intradermal injection of fresh or cryopreserved living Onchocerca lienalis microfilariae, followed by a challenge intracorneal infection of microfilariae, resulted in serum and aqueous IgE antibody and in significant corneal inflammation. Systemic or intraocular infections given separately were not sufficient to elicit IgE antibody or ocular inflammation. When intravenous transfer of pooled spleen cell suspensions from systemically infected donors to normal syngeneic recipients was substituted for the course of systemic infections, a subsequent intracorneal challenge of cell transfer recipients with microfilariae produced serum and aqueous IgE antibody. Administration of diethylcarbamazine citrate to infected animals following the intracorneal challenge resulted in increased serum IgE antibody and in increased corneal inflammation.