Mansonelliasis: a brazilian neglected disease

Mansonelliasis is a filariasis whose etiological agents are Mansonella ozzardi, Mansonella perstansand Mansonella streptocerca. Only the first two cited species occur in Brazil. M. ozzardi is widely distributed in Amazonas state and it is found along the rivers Solimões, Purus, Negro and their tributaries while M. perstans is restricted to the Upper Rio Negro. In this update, we report the occurrence of M. ozzardi in Amazonas since the 1950s, and we show that over the years this filariasis has been sustained with high prevalence, while maintaining a constant cycle of transmission in endemic areas due to the lack of treatment and control policies. M. perstans has so far only been recorded in indigenous populations in the Upper Rio Negro. However, the continuous flow of migrants to other regions may cause an expansion of this infection.

A mansonelose é uma filariose cujos agentes etiológicos são Mansonella ozzardi, M. perstans e M. strepotcerca. Somente as duas primeiras ocorrem no Brasil. M. ozzardi apresenta ampla distribuição no estado do Amazonas sendo encontrada ao longo dos rios Solimões, Purus e Negro e afluentes, ao passo que M. perstans possui distribuição restrita à região do Alto Rio Negro. Nesta atualização, é relatada a ocorrência de M. ozzardi no Amazonas desde a década de 1950 e, ao longo dos anos, esta filariose tem sustentado elevadas prevalências, mantendo um ciclo constante de transmissão nas áreas endêmicas em virtude da falta de políticas de tratamento e controle. Até o momento, M. perstans só foi registrada nas populações indígenas da região do Alto Rio Negro, mas, em razão da existência de um fluxo migratório contínuo para outras regiões, existe a possibilidade de sua expansão.

Comportamiento clínico, epidemiológico y microbiológico de las filariosis en la población de Mouila en Gabón / Clinical, epidemiological and microbiological behavior of filariases in the population of Mouila, Gabon

Introducción: las filarias son nematodos pertenecientes a la familia Filariidae, aunque existen alrededor de 200 filarias parasitas, solo unas pocas parasitan al hombre. Objetivos: realizar una breve descripción de estas parasitosis, que sirviera como guía al gran número de médicos cubanos colaboradores en países africanos, donde es particularmente frecuente este padecimiento, así como describir el comportamiento de las infecciones por filarias en pacientes atendidos en el Hospital Regional de Mouila, Gabón. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal. Se incluyeron 87 pacientes de los 2 sexos, de 15 años de edad y más, en los que se logró confirmar algún tipo de filariosis. Resultados: se observó que 3,7 por ciento de los pacientes presentó una filariosis, 93,1 por ciento por Loa loa, 5,7 por ciento por Mansonella perstans y 1,1 por ciento por coinfección de ambas. El grupo de más de 65 años y el sexo femenino resultaron los más afectados. El síntoma más frecuente fue el prurito (59,8 por ciento), seguido por la poliartralgia, el dolor lumbar y la astenia. La eosinofilia se apreció en 100 por ciento y la anemia fue más frecuente en pacientes parasitados con Mansonella perstans. La intensidad de la infección para ambos tipos de filarias fue baja. En 86,1 por ciento de los pacientes tratados con dietilcarbamazina y 82,4 por ciento de los tratados con ivermectina, la respuesta fue satisfactoria. Conclusiones: Loa loa predominó, sobre todo en mujeres; el prurito, la anemia y la eosinofilia fueron las manifestaciones principales, la respuesta tratamiento con ivermectina mostró ventajas

Introduction: filariae are nematodes from the family Filariidae. There are about 200 parasitic filariae, but only a few infect humans. Objectives: make a brief description of these parasitic diseases which may serve as guidance to the large number of Cuban cooperation doctors in African countries, where this condition is particularly common, and describe the behavior of filarial infections in patients cared for at Mouila Regional Hospital in Gabon. Methods: a cross-sectional observational descriptive study was conducted of 87 patients of both sexes aged 15 and over with confirmed filariasis. Results: it was found that 3.7 percent of patients had some kind of filariasis: 93.1 percent due to Loa loa, 5.7 percent due to Mansonella perstans and 1.1 percent due to coinfection by both. Females and persons over 65 were the most affected groups. The most common symptom was pruritus (59.8 percent), followed by polyarthralgia, lumbar pain and asthenia. Eosinophilia was present in 100 percent of subjects, and anemia was more frequent in patients infected with Mansonella perstans. Infection intensity was low in both filariases. The response was satisfactory in 86.1 percent of the patients treated with diethylcarbamazine and 82.4 percent of those treated with ivermectin. Conclusions: Loa loa was predominant mainly among women. Pruritus, anemia and eosinophilia were the main manifestations. Treatment with ivermectin was found to be effective

Population ecology of mosquitoes and the status of bancroftian filariasis in el Dakahlia governorate, the Nile Delta, Egypt

Mosquitoes were surveyed [Oct. 2010 and Apr. - Oct. 2011] in some localities representing 13 centers of El-Dakahlia Governorate. Six mosquito species were collected: Culex pipiens, Cx. antennatus, Cx. perexiguus, Ochlerotatus detritus, Anopheles pharoensis and An. tenebrosus. Culex pipiens was predominating [ca 79% larvae, 51% adults]. Culex antennatus and Cx. perexiguus were also common. Of the Four types of the breeding habitats, the drainage canals were the most productive [53.4% larvae]. For the three common species, the compiled larval density increases as water temp, increased and decreases as pH increased while adult indoor density increases as indoor and outdoor temp, and indoor RH increased and decreases as outdoor RH increased. Cx. pipiens significantly associated with Cx. antennatus [C[AB]=0.88 and I=0.48] while Cx. antennatus has a moderate association with Cx. perexiguus [C[AB]=0.47 and I=0.36]. Out of 908 examined blood samples from ten centers, 7.49% were infected with Wuchereria bancrofti. The highest infection rates in some centers were associated with high indoor densities of Cx. pipiens females, the main filariasis vector. The situation necessitates a wide vector control program to minimize lymphatic filariasis transmission in this Governorate

Perfil epidemiológico e antigênico da população não aderente ao tratamento em massa para filariose linfática no município de Olinda - PE / Antigenic and epidemiological profile of the population adheres to mass treatment for lymphatic filariasis in the city of Olinda-PE

A Organização Mundial de Saúde aponta a Filariose Linfática como endemia potencialmente eliminável. Para isso, foi criado o Programa Global de Eliminação da Filariose Linfática, que possui como uma de suas estratégias o tratamento em massa da população endêmica. A baixa adesão ao tratamento representa um sério obstáculo ao sucesso do programa. Assim, o objetivo deste estudo é descrever o perfil epidemiológico e antigênico e os fatores relacionados a não adesão ao tratamento em massa para filariose linfática no município de Olinda-PE. Trata-se de um estudo de corte transversal, cuja população foi constituída por pessoas que se recusaram a participar do tratamento em massa nos bairros Alto da Bondade e Alto da Conquista, nos anos de 2009 e 2010. Os dados foram coletados através da aplicação de questionários e do teste antigênico (ICT card test). Os indivíduos positivos pelo ICT card test foram avaliados através da filtração (teste parasitológico padrão-ouro). Para o processamento e a análise de dados foi utilizado o programa Epi-Info. Foram pesquisados 102 indivíduos, sendo 51 (50,00 por cento) moradores do Alto da Bondade e 51 (50,00 por cento) do Alto da Conquista. A maioria era do sexo feminino (63,73 por cento) com média de idade de 49,39 anos, e possuía o ensino médio (17,6 por cento). Sobre as características socioambientais, verificou-se que todos os domicílios visitados eram de alvenaria. Cerca de 90por cento possuía abastecimento de água ligado à rede geral e coleta de lixo por serviço de limpeza urbana, porém o esgotamento sanitário era feito através de fossas rudimentares. Do total de pesquisados, quatro (3,92 por cento) apresentaram-se antígeno-positivos para Wuchereria bancrofti através do teste ICT card test), porém não apresentaram positividade na filtração. Os principais motivos encontrados para a não adesão ao tratamento em massa foram o não recebimento da medicação e relacionados às reações adversas, porém tais razões não foram completamente esclarecidas. Novas estratégias são necessárias para o aumento da adesão ao tratamento em massa, dentre as quais ações de educação em saúde e campanhas de sensibilização.

Acquired alpha 1-antitrypsin deficiency in tropical pulmonary eosinophilia.

Background & objectives: Observation of an increased frequency of an intermediate deficiency of serum alpha1-antitrypsin (α1-AT) in patients with Tropical Pulmonary Eosinophilia (TPE) was earlier reported. Though the possibility of existence of an acquired deficiency was suggested, without phenotyping a hereditary α1-AT deficiency in TPE could not totally be ruled out. In this study, we have done Pi (Protease inhibitor) phenotyping to investigate the possibility of association of any heterozygous (or homozygous) α1-AT deficiency in patients with TPE. Methods: Serum a1antitrypsin (α1-AT) was measured in 103 patients (Group A) with TPE, 99 patients with pulmonary eosinophilia who had associated intestinal worm infestation (Group B) and 43 healthy volunteers who served as controls. In 19 α1-AT deficient patients (9 of Group A and 10 of Group B), α1-AT level was measured before and after treatment. In 58 patients with TPE and in 5 controls, phenotyping was done. Results: Fifteen patients of Group A and 16 from Group B showed intermediate α1-AT deficiency (150 mg % or less. None of the control subjects had α1-AT deficiency (<200 mg%). After treatment with DEC and/or deworming, in 19 patients there was a significant (P < 0.001) rise in α1-AT levels. Results of phenotyping showed that all had M1 or M2 allele and none had S or Z variant (either homozygous or heterozygous) thus ruling out any underlying genetic cause for the observed α1-AT deficiency. Interpretation & conclusions: The observed α1-AT deficiency may be due to the chronic inflammation in TPE and associated oxidative stress. However, in such α1-AT deficient patients with TPE and those with worm infested pulmonary eosinophilia, faecal α1-AT concentration and faecal α1-AT clearance should be routinely estimated to rule out the possibility of any intestinal protein loss.

L'endemie filarienne dans la ville de Bangui; Republique Centrafricaine

Dans les pays intertropicaux; les filarioses posent de sante publique; touchant environ150 millions de sujets dans le monde. La Republique Centrafricaine; a l'instar des autres pays tropicaux; n'est pas epargnee par ce fleau. Deux types de filarioses font l'objet de preoccupation a cause de leurs consequences socio-economiques et medicales; la dracunculose et l'onchocercose .Deux programmes de lutte sont en cours d'execution mais toutes les regions ne sont pas entierement couvertes.les objectifs specifiques de ce travail prospectif qui a dure 5 mois etaient de determiner la prevalence des filarioses dans la capitale et etudier les profils epidemiologiques et les aspects cliniques des personnes atteintes dans les Arrondissements et quartiers de Bangui choisis au hasard. Les sujets jeunes de 15 a 44 ans etaient 266 sur les 323 sujets de l'etude; soit 82 ; 4. Le sexe masculin representaient 44.Le prurit etait present dans 87;6des cas ; la gale 31;4;les nodules 8; 7et les depigmentations des jambes ; 15 ;5des cas .La gale etaient surtout observee dans le septiemea arrondissement .Les microfilaires dermiques etaient retrouvees dans 36; 84des cas avec une predominance masculine (57 ;5) et le septieme Arrondissement etaient plus touche que les autres .Les microfilaires sanguine etaient retrouvees dans 15 ; 79des cas .Pour ces filarioses ; Bangui est une ville mesoendemique avec cependant une forte prevalence dans les quartiers proches du Fleuve

[Blood and urinary parasitosisi8 among non resident students in Tunisia]

The authors present the results of blood and urinary parasitological check-up carried out among non resident students in Tunisia, between 1990 and 2006 in the laboratory of Parasitology-Mycology of la Rabta-s Hospital. It-s a retrospective study having interested 4016 foreign and Tunisian students having stayed in Africa [52%], in the Maghreb [26.64%], in the Middle East [15.91%], in the Far East [3.43%], in Europe [1.96%] and in America [0.05%]. Three parasitosisis were determined: malaria, urinary schistosomiasis and filariasis. One hundred twenty eight cases of malaria were diagnosed among 3476 blood smears and thick smears carried out. Plasmodium falciparum was found in 59 cases and Plasmodium malaria in 4 cases. The remaining 65 cases were of Plasmodium sp. Thirty eight cases of urinary schistosomiasis were diagnosed among 3932 urinary parasitological check-up. Eight cases of filariasis were found: 3 of Loa loa, 3 of Mansonella perstans and in the remaining 2 cases, we had a combination of these two micrifilariaes. In Tunisia, there has been no local transmission of malaria and urinary schistosomiasis since 1979 and 1984 respectively. Although these diseases had been eradicated, their re-emergence is not considered impossible. The authors insist on the necessity of systematic screening of these parasitosisis among non resident students in Tunisia as well as an early and effective treatment of the parasitic patients

Circulating filarial antigen in serum and hydrocele fluid from individuals living in an endemic area for bancroftian filariasis.

This study examined circulating filarial antigen by monoclonal antibody Og4C3-enzyme-linked immunosorbent assay (ELISA) from 114 men with hydrocele, living in an endemic area. Nocturnal blood and hydrocele fluid were collected and examined for microfilaria. ELISA was performed on serum and hydrocele fluid for detection of antigen. Amongst 114 cases, 5(4.4%) showed microfilaria in blood but none in fluid. ELISA was positive in 13(11.40%) serum and 5 (4.4%) fluid samples. All five fluid antigen positive cases were positive for antibodies and showed microfilaria in blood. These findings emphasize the use of circulating filarial antigen detection and alternative usage of hydrocele fluid for diagnosis of filariasis.

Relationship between malaria and filariasis transmission indices in an endemic area along the Kenyan Coast.

BACKGROUND AND OBJECTIVES: An entomological survey was conducted to determine the relationship between malaria and lymphatic filariasis transmission by Anopheles gambiae s.l. and An. funestus in two inland villages along the Kenyan coast. METHODS: Mosquitoes were sampled inside houses by pyrethrum spray sheet collection (PSC). In the laboratory, the mosquitoes were sorted to species, dissected for examination of filarial infection and the anophelines later tested for Plasmodium falciparum circumsporozoite proteins by an enzyme-linked immunosorbent assay (ELISA). RESULTS: From a total of 2,032 female mosquitoes collected indoors, An. gambiae s.l constituted 94.4% while the remaining 5.6% comprised of An. funestus and Culex quinquefasciatus. None of the Cx. quinquefasciatus was positive for filarial worms. P. falciparum sporozoite rate for An. gambiae s.l. from both villages was significantly higher than Wuchereria bancrofti infectivity rate. Similarly, the entomological inoculation rate for An. gambiae s.l. was significantly higher than the corresponding W. bancrofti infective biting rate and transmission potential for both the villages. Mass treatment of people with filaricidal drugs in Shakahola in the ongoing global elimination of lymphatic filariasis campaign seemed to have reduced the indices of filariasis transmission but had no effect on malaria transmission. INTERPRETATION AND CONCLUSION: These results indicate the intensity of malaria transmission by anophelines to be much higher than that of lymphatic filariasis in areas where both diseases co-exist and re-emphasise the need to integrate the control of the two diseases in such areas.

Filariasis in Ghatampur Tahsil of Kanpur Nagar District: indications of high endemicity locus.

A study in the 26 villages surveyed, the mf rate was observed to vary from 6.4% to 17.8%, the disease rate ranged from 1.9% to 10% and total infection rate from 8.2% to 26.4%. The median microfilaraemia density among positives was 10 and 90% of persons had density below 60 and in 10% above this level. The mf rate among those who never used bednets while sleeping was found to be 11.8%, 15.7% higher than 10.2% among those who ever used bednets (8.7% in regular users and 10.7% among irregular users) to protect from mosquitoes bites (p < 0.05). The lymphatic disease was found to be 3.8%; 3.7% in males and 4.1% in females. Of the males, 16.3% had acute disease, 51.8%) hydroceles of varying grades and 32% edema of different grades including elephantiasis. Of the females with lymphatic disease, 25.6% acute disease, 62.8% edema including elephantiasis and 11.6% had mastitis. The study indicates that area is endemic for filariasis and needs control programmes.

Bancroftian filariasis in an endemic area of Brazil: differences between genders during puberty

Diferenças entre os sexos quanto à susceptibilidade às doenças infecciosas têm sido observadas em vários estudos. Um inquérito de prevalência foi realizado em uma área endêmica de filariose bancroftiana na cidade de Olinda, Brasil. Todos os residentes com idade > 5 anos foram examinados pela gota espessa. Moradores com idade entre 9 e 16 anos foram entrevistados e testados para a presença de antigenemia filarial. Os dados foram analisados utilizando tabelas de contingência e modelos de regressão. O risco de microfilaraemia nos homens foi significativamente mais elevado. Meninos com idade entre 15 e 16 anos tiveram maior risco de infecção filarial do que as meninas. Os dados sugerem que variações entre os sexos na filariose podem resultar de um aumento na susceptibilidade dos homens a partir da puberdade tardia. Essa característica epidemiológica deve ser considerada ao se formularem os planos de eliminação da endemia.

Morbidity pattern and time trends of filaria cases at a PHC in Dakshina Kannada District.

A study on morbity pattern and time trends of filaria cases was carried out in a PHC of Dakshin Kannada District during November 2000 to January 2001. The age and sex distribution of all 416 filaria cases recorded revealed that 235 (56.49%) were females and maximum concentration of 263 (63.21%) was in the age group of 16-45 years. The seasonal distribution revealed that rainy season accounted the highest number of cases 197 (47.35%). The prevalence was highest, 1.96/1000 population in the year 1993 and lowest, 0.71/1000 population in the year 1995.

Impact of a filariasis control program on intestinal helminthic infections; a pilot study in Narathiwat Province, Thailand.

This study was conducted in 9 villages located in endemic areas for brugian filariasis in Narathiwat Province, Thailand. Parasitological and anthropometric examinations were cross-sectionally performed to assess the prevalence of intestinal parasitic infections of 539 villagers. Paired stool samples were collected before and after mass treatment for the filariasis control program in 150 participants in order to study the impact of the filariasis control program on intestinal helminthiasis. The results found that 50.3% of the villagers were infected with one or more types of intestinal parasites. Double and triple infections were found in 10.9% and 1.6% of infected individuals respectively. The prevalence of intestinal parasitic infections peaked in the 1-10 year old age-group, which are pre-school and young school-age children. A significant reduction of intestinal helminthic infections in the post-treatment stool sample was observed in the 150 participants who were examined six months after mass treatment. Integrating an intestinal helminthic control program alongside the existing filariasis control program would be an appropriate and cost-effective strategy in the control of intestinal helminths. However, reinfection of parasites was observed.

Infectious diseases detected among immigrants in Kuwait

The aim of this study was to detect the infectious diseases prevalent among immigrants and to control their spread in Kuwait. More than 200,000 immigrants come to Kuwait every year for residence or work, and the majority of them [75%] come from developing countries w h e re infectious diseases are endemic. All the immigrants were checked for infectious diseases like, malaria, filaria, tuberculosis, HIV and hepatitis B and C before they were issued a residence permit. These tests were performed between 1991 and 1999. The screened population consisted of 921,012 for malaria and filaria; 1,645,052 for HIV; 326,246 for hepatitis B and C and 1,645,052 for tuberculosis. The total number of persons infected with all the five diseases was 11,545 [0.2%]. About 1366 [0.15%] individuals were infected with malaria; 691 [0.08%] with filaria; 591 [0.04%] with HIV; 1194 [0.4%] with hepatitis B; 628 [0.2%] with hepatitis C and 7075 [0.4%] with tuberculosis. All the newly arrived immigrants infected with malaria were treated in the Infectious Diseases Hospital, Kuwait. Those with filaria, HIV, hepatitis B and C were deported to their country of origin because of the risk of transmission of these

Application of GIS to the characterization of filariasis transmission in Narathiwat Province.

The geographical information system (GIS) and available survey data (both from the Filariasis Annual Reports, 1985-1999 and from the published literature) for the microfilarial infection rates are used to develop the first subdistrict-level endemicity maps of lymphatic filariasis in Narathiwat Province. The maps demonstrated the subdistrict-level geographical distribution of filariasis and the subdistricts at varied degrees of infection rate. The maps also indicate that, since 1985, there was a marked decrease in endemicity at the subdistrict level and in some areas, the infection rates were zero. However, transmission remained in the subdistricts surrounding peat swamp forest (Su-ngai Padi, Paluru, Puyo, Pasemat, Bang Khunthong, and Phron subdistricts). The house locations of infected cases, as well as the vector breeding places were geo-registered and placed as symbolic dots on the base maps obtained from Landsat's Thematic Mapper (TM) 5 and the land use map of Narathiwat to display the distribution of filariasis foci. Of 102 houses mapped, there were 40 houses in primary peat swamp forest (39.22%), 26 in rice fields (25.49%), 15 in fruit orchards (14.70%), 10 in coconut fields (9.80%) and others (10.78%). All the houses were close to the larval habitats presented in the survey. A 2-km buffer zone around the conservation boundary of primary peat swamp forest was created to locate risk areas of filariasis transmission. The buffer zone covered an area of 544.11 km2 and included 88.89% of the houses of infected cases found in 2002. It was able to identify 54 villages located in the buffer area, which might help in the determination of resource needs and resource allocation for filariasis control in Narathiwat Province.

Relative abundance of Culex quinquefasciatus (Diptera: Culicidae) with reference to infection and infectivity rate from the rural and urban areas of East and West Godavari districts of Andhra Pradesh, India.

This paper describes the seasonal abundance of Culex quinquefasciatus in the rural and urban areas of the East and West Godavari districts (EGDT and WGDT) of Andhra Pradesh, India. The per man-hour density (PMHD) was collected from seven units in EGDT and two units in WGDT, which comprised rural and urban areas. The highest infection and infectivity rates were found in the rural areas of Rajahmundry (43.6%) and Amalapuram (13.2%) respectively. In urban areas, the highest infection and infectivity rates were found in Rajahmundry: 7.5% and 3.6% respectively. There was considerable difference in the infection rate and infectivity rates between the rural areas and urban areas in each unit.

Biting behavior and seasonal variation in the abundance of Anopheles minimus species A and C in Thailand.

We measured the seasonal abundance and bloodfeeding behavior of species A and C of the mosquito Anopheles minimus Theobald 1901 in an endemic malarious area of western Thailand. An. minimus s.l. is a major vector of human malarial and filarial parasites in Southeast Asia. Mosquitos were collected once a month for one year using four collection methods: human-baiting indoors, human-baiting outdoors, human-baiting in the forest, and cow-baiting. We found that both species A and C tend to feed from cows rather than humans; we did not find any preference for indoor, outdoor or forest-biting in either species. Both species had a peak biting density in October/November, at the end of the rainy season, and species C showed a second, smaller peak at the end of the cool season. These findings are discussed in relation to previous reports of the behavior of An. minimus s.l., particularly in light of suggestions that An. minimus s.l. has changed its feeding behavior in response to DDT spraying.

Health conditions in the tribal villages of South Bihar: an epidemiologic survey.

In order to understand and establish an effective approach toward sustainable rural health development in the tribal region of South Bihar, an extensive socio-medical survey on over 90% of the houses of four tribal villages was undertaken. Using both a family-based questionnaire and screening physical examinations, the vital statistics, disease prevalence rates, immunization rates, and use of maternal health services in this neglected and previously unstudied area were determined. Local health-related behaviours and attitudes as well as nutritional status and family dietary intake were also focused upon. The results indicate that disease prevalence and mortality rates are significantly higher than expected and that existing services are less effective than previously thought. More importantly, the survey offers evidence that the fundamental obstacle toward improved community health remains a vast lack of health awareness and education in the villages; specifically in the areas of nutrition, immunization, diarrhoea prevention and treatment, maternity care, and family planning. Surveys of this kind provide vital information to health professionals working in underserved areas in India and should be an integral part of any such developmental undertaking.