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Background Mansonella perstans infection is common in areas of Africa where Wuchereria bancrofti, a causative agent of lymphatic filariasis, is endemic. M. perstans is refractory to standard antifilarial therapies. The recent discovery of bacterial endosymbionts (e.g., wolbachia) in most filarial species, including M. perstans, provides new therapeutic options for reducing microfilaremia.
Methods In an open-label, randomized trial, we recruited subjects with M. perstans microfilaremia, with or without concomitant W. bancrofti infection, from four villages in Mali and randomly assigned them to receive doxycycline, at a dose of 200 mg daily for 6 weeks (106 subjects), or no treatment (110). At 6 months, subjects who were coinfected with W. bancrofti underwent a second random assignment, to treatment with a single dose of albendazole (400 mg) and ivermectin (150 µg per kilogram of body weight) or no treatment. Subjects were monitored daily during the first 6-week study period for adverse events. M. perstans and W. bancrofti microfilarial levels were assessed at 6, 12, and 36 months.
Results At 12 months, 67 of 69 subjects who had received treatment with doxycycline only (97%) had no detectable M. perstans microfilariae per 60 µl of blood, as compared with 10 of 63 subjects who had received no treatment (16%) (relative risk, 6.18; 95% confidence interval, 3.63 to 11.89; P<0.001). At 36 months, M. perstans microfilaremia remained suppressed in 48 of 64 subjects who had received treatment with doxycycline only (75%), a finding that was consistent with a macrofilaricidal effect of doxycycline. Vomiting was more frequent in the doxycycline-treated group than in the untreated group (17% vs. 4%).
Conclusions These results are consistent with previous findings that M. perstans harbors the intracellular endosymbiont, wolbachia, and suggest that doxycycline is an effective therapy for M. perstans infection. (ClinicalTrials.gov number, NCT00340691
[ClinicalTrials.gov]
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Source Information
From the Faculty of Medicine, Pharmacy and Odontostomatology, University of Bamako (Y.I.C., B.D., A.A.D., S.S.D., S.Y.C., S.K., D.A.D., D.Y., O.K.D., S.F.T.); the Center for Disease Control (A.K.T.); and the Department of Radiology, Hospital at Point G (A.D. Keita) — all in Bamako, Mali; and the Biostatistics and Research Branch (E.M.L., M.P.F.) and Laboratory of Parasitic Diseases (J.K., T.B.N., A.D. Klion), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
Address reprint requests to Dr. Klion at the Laboratory of Parasitic Diseases, National Institutes of Health, Bldg. 50, Rm. 6351, Bethesda, MD 20892, or at aklion{at}nih.gov.
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