A large case series of travel-related Mansonella perstans (vector-borne filarial nematode): a TropNet study in Europe

Francesca Tamarozzi, Paola Rodari, Joaquín Salas-Coronas, Emmanuel Bottieau, Fernando Salvador, Manuel Jesús Soriano-Pérez, María Isabel Cabeza-Barrera, Marjan Van Esbroeck, Begoña Treviño, Dora Buonfrate, Federico G Gobbi

Research output: Contribution to journalA1: Web of Science-articlepeer-review

Abstract

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.

Original languageEnglish
JournalJournal of Travel Medicine
ISSN1195-1982
DOIs
Publication statusE-pub ahead of print - 2022

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