A Randomized Trial of Doxycycline for Mansonella perstans Infection

• Published in: The New England journal of medicine Vol. 361; no. 15; pp. 1448 - 1458
• Main Authors: Coulibaly, Siaka Y, Coulibaly, Yaya I, Dembele, Benoit, Diallo, Dapa A, Diallo, Abdallah A, Lipner, Ettie M, Doumbia, Salif S, Konate, Siaka, Yalcouye, Daniel, Kubofcik, Joseph, Doumbo, Ogobara K, Traore, Sekou F, Traore, Abdel K, Keita, Adama D, Fay, Michael P, Nutman, Thomas B, Klion, Amy D
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 08.10.2009
• Subjects: Adolescent; Adult; Aged; Albendazole - therapeutic use; Animals; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Doxycycline - administration & dosage; Doxycycline - adverse effects; Doxycycline - therapeutic use; Drug Therapy, Combination; Elephantiasis, Filarial - complications; Elephantiasis, Filarial - drug therapy; Female; Filaricides - therapeutic use; General aspects; Humans; Infections; Ivermectin - therapeutic use; Male; Mansonella - isolation & purification; Mansonelliasis - complications; Mansonelliasis - drug therapy; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Rickettsiaceae Infections - complications; Rickettsiaceae Infections - drug therapy; Symbiosis; Treatment Outcome; Wolbachia; Wuchereria bancrofti - isolation & purification; Young Adult; Tetracycline derivatives; Infection; Medicine; Antibiotic; Mansonella perstans; Randomization; Doxycycline; Helmintha; Clinical trial; Nemathelminthia; Protein synthesis inhibitor; Invertebrata; Antibacterial agent; Nematoda
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa0900863

There is no effective therapy for Mansonella perstans , a cause of lymphatic filariasis. In this study, patients were randomly assigned to receive treatment with doxycycline for 6 weeks, targeting the endosymbiont wolbachia, or no treatment. M. perstans microfilaremia was undetectable at 12 months in 67 of 69 treated patients (97%), as compared with 10 of 63 untreated patients (16%). Patients were randomly assigned to receive treatment with doxycycline for 6 weeks, targeting the endosymbiont wolbachia, or no treatment. M. perstans microfilaremia was undetectable at 12 months in 97% of treated patients, as compared with 16% of untreated patients. The filarial parasite Mansonella perstans is endemic in central and western Africa, with a distribution that overlaps that of Wuchereria bancrofti , Loa loa , and Onchocerca volvulus . Transmitted through the bite of an infected midge (culicoides species), infective M. perstans larvae develop over the course of months into adult worms that reside in the serous cavities and mesentery and retroperitoneal tissues. Microfilariae are carried through the bloodstream, and those of M. perstans can be distinguished from those of L. loa and W. bancrofti by their small size, lack of periodicity, and the absence of a sheath. As is . . .