BACKGROUND: Infection with Mansonella perstans is a neglected filariasis, widely distributed in sub-Saharan Africa, characterized by an elusive clinical picture; treatment for mansonellosis is not standardized. This retrospective study aimed to describe the clinical features, treatment schemes and evolution, of a large cohort of imported cases of M. perstans infection seen in four European centers for tropical diseases.
METHODS: M. perstans infections, diagnosed by identification of blood microfilariae in migrants, expatriates and travellers, collected between 1994-2018, were retrospectively analysed. Data concerning demographics, clinical history, and laboratory examinations at diagnosis and at follow-up time points, were retrieved.
RESULTS: A total of 392 patients were included in the study. Of the 281 patients for whom information on symptoms could be retrieved, 150 (53.4%) reported symptoms, abdominal pain and itching being the most frequent. Positive serology and eosinophilia were present in 84.4% and 66.1% respectively of those patients for whom these data were available. Concomitant parasitic infections were reported in 23.5% of patients. Treatment, administered to 325 patients (82.9%), was extremely heterogeneous between and within centers; the most commonly used regimen was mebendazole 100 mg twice a day for one month. A total of 256 (65.3%) patients attended a first follow-up, median 3 months (IQR 2-12) after the first visit; 83.1% of patients having received treatment based on mebendazole and/or doxycycline targeting Wolbachia became amicrofilaremic, 41.1%-78.4% of whom within 12 months from single treatment.
CONCLUSIONS: Lack of specific symptoms, together with the inconstant positivity of parasitological and antibody-based assays in the infected population, make the clinical suspicion and screening for mansonellosis particularly difficult. Prospective studies evaluating prevalence of infection in migrants from endemic areas, infection-specific morbidity, presence of Wolbachia endosymbionts in M. perstans populations from different geographical areas, and efficacy of treatment regimens are absolutely needed to optimize the clinical management of infection.