infectious diseases
Mansonellosis
Mansonella perstans
Mansonella perstansis transmitted by the bites of midges (Culicoides) in sub-Saharan Africa and in the Americas from Panama to Argentina. It is estimated that more than 100 million people are infected worldwide. Adult worms reside in pleural, pericardial, and peritoneal cavities and in the retroperitoneum and mesentery. Unsheathed microfilariae are found in the bloodstream. Midges acquire them when they take a blood meal from an infected human. Most infections are asymptomatic or mild. Migrating adult worms can cause transient subcutaneous swellings similar to those of Loiasis (Calabar swellings), inflammation of the pericardium or pleura, conjunctival nodules, retinal damage, and periocular inflammation. Nonspecific symptoms including pruritus, urticaria, arthralgias, and malaise. Neuropsychiatric manifestations, meningoencephalitis, and hepatitis have been attributed to is made by identifying non-sheathed microfilariae in a blood smear. Microfilariae can be identified in blood both day and night. Eosinophilia is often present. M. perstansis relatively resistant to medications, including diethylcarbamazine, used to treat other filarial diseases. Targeting the endosymbioticWolbachiabacteria in adultM. perstanswithdoxycycline(200 mg daily for 4 to 6 weeks ) which is presumed to interrupt the reproduction of adult worms can be curative.Wolbachiahas been demonstrated inM. perstansfrom Mali, Cameroon, Ghana, and Gabon. There are divergent reports of the presence ofWolbachiain Uganda, possibly due to methodological constraints or the presence of multiple strains ofM. perstans.Doxycyclinehas been shown to be effective in Mali and Ghana, but the utility ofdoxycyclinefor treatment of infections in regions whereWolbachiaare absent has not been systematically studied. In cases wheredoxycyclineis ineffective, combination therapy with diethylcarbamazine andmebendazolefor 3 weeks has improved activity relative to monotherapy. 