1
|
Ramharter M, Butler J, Mombo-Ngoma G, Nordmann T, Davi SD, Zoleko Manego R. The African eye worm: current understanding of the epidemiology, clinical disease, and treatment of loiasis. THE LANCET. INFECTIOUS DISEASES 2024; 24:e165-e178. [PMID: 37858326 DOI: 10.1016/s1473-3099(23)00438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 10/21/2023]
Abstract
Loa loa, the African eye worm, is a filarial pathogen transmitted by blood-sucking flies of the genus Chrysops. Loiasis primarily affects rural populations residing in the forest and adjacent savannah regions of central and west Africa, where more than 20 million patients are chronically infected in medium and high transmission regions. For a long time, loiasis has been regarded as a relatively benign condition. However, morbidity as measured by disability-adjusted life-years lost might be as high as 400 per 100 000 residents, and the population attributable fraction of death is estimated at 14·5% in highly endemic regions, providing unequivocal evidence for the substantial disease burden that loiasis exerts on affected communities. The clinical penetrance of loiasis is variable and might present with the classic signs of eye worm migration or transient Calabar swellings, but might include common, unspecific symptoms or rare but potentially life-threatening complications. Although adult worm migration seems most closely linked to symptomatic disease, high levels of microfilaraemia are associated with clinically important complications and death. Loiasis remains difficult to diagnose, treat, and control due to an absence of reliable point-of-care diagnostic assays, safe and efficacious drugs, and cost-effective prevention strategies. This Review summarises the major advances in our understanding of loiasis made over the past decade and highlights the many gaps that await to be addressed urgently.
Collapse
Affiliation(s)
- Michael Ramharter
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Centre de Recherche Médicale de Lambaréné, Lambaréné, Gabon; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
| | | | - Ghyslain Mombo-Ngoma
- Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Centre de Recherche Médicale de Lambaréné, Lambaréné, Gabon; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Tamara Nordmann
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Saskia Dede Davi
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Rella Zoleko Manego
- Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Centre de Recherche Médicale de Lambaréné, Lambaréné, Gabon
| |
Collapse
|
2
|
Zoleko-Manego R, Kreuzmair R, Veletzky L, Ndzebe-Ndoumba W, Ekoka Mbassi D, Okwu DG, Dimessa-Mbadinga-Weyat LB, Houtsa-Temgoua RD, Mischlinger J, McCall MBB, Kresmner PG, Agnandji ST, Lell B, Adegnika AA, Mombo-Ngoma G, Ramharter M. Efficacy, safety, and tolerability of albendazole and ivermectin based regimens for the treatment of microfilaraemic loiasis in adult patients in Gabon: A randomized controlled assessor blinded clinical trial. PLoS Negl Trop Dis 2023; 17:e0011584. [PMID: 37639396 PMCID: PMC10491396 DOI: 10.1371/journal.pntd.0011584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 09/08/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND There is a lack of systematic evidence for strategies to control loiasis transmission in highly endemic regions. Here we assessed albendazole and ivermectin based treatment regimens to reduce Loa loa microfilaraemia in Gabon. METHODS Eligible adult patients with L. loa microfilaraemia between 5,000 and 50,000 microfilariae/ml were randomized to either a control or one of three intervention groups (1:2:2:2 allocation ratio) consisting of three-week twice daily 400mg oral albendazole followed by 1) no treatment, 2) two further weeks of twice daily 400mg albendazole, or 3) a single dose of ivermectin in this open label randomized assessor blinded controlled clinical trial. The primary outcome was the proportion of participants with L. loa microfilaraemia ≤ 100 mf/ml at Day 168. RESULTS In the efficacy-population of 42 patients 0 (0%; control group), 1 (9%; 3-week albendazole), 5 (39%; 5-weeks albendazole) and 2 (22%; 3-week albendazole plus single dose ivermectin) participants met the primary outcome of microfilaraemia below 100/ml at day 168. A 80-90% reduction of microfilaraemia was observed in the active treatment groups. CONCLUSION The 5-week regimen of albendazole or a 3-week regimen of albendazole followed by ivermectin were most efficacious to reduce microfilaraemia. All therapeutic regimens were well tolerated and safe. TRIAL REGISTRATION Trial registered at the Pan-African Clinical Trials Registry: PACTR201807197019027.
Collapse
Affiliation(s)
- Rella Zoleko-Manego
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research–Partner Sites Hamburg-Lübeck-Borstel-Riems, Germany
| | - Ruth Kreuzmair
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Radboud University Medical Center, Nijmegen, Netherlands
| | - Luzia Veletzky
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research–Partner Sites Hamburg-Lübeck-Borstel-Riems, Germany
| | | | - Dorothea Ekoka Mbassi
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research–Partner Sites Hamburg-Lübeck-Borstel-Riems, Germany
| | - Dearie G. Okwu
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | | | - Johannes Mischlinger
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research–Partner Sites Hamburg-Lübeck-Borstel-Riems, Germany
| | | | - Peter G. Kresmner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research–Partner Site Tübingen, Germany
| | - Selidji T. Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Betrand Lell
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Ayôla A. Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- German Center for Infection Research–Partner Site Tübingen, Germany
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research–Partner Sites Hamburg-Lübeck-Borstel-Riems, Germany
| |
Collapse
|
3
|
Subbarao S, Thompson R, Klion A, Hauck FR, Thomas TA. Cases of Loiasis Among a Congolese Family: Screening for Loiasis Among Newly Arrived Refugees From Endemic Areas. J Nurse Pract 2023; 19:104505. [PMID: 36936748 PMCID: PMC10019557 DOI: 10.1016/j.nurpra.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Loiasis is a parasitic infection caused by the filarial nematode Loa loa within endemic regions of West and Central Africa. These regions include areas co-endemic for other nematode infections. Although loiasis is rarely seen in the United States (US), primary care providers who regularly see refugees from endemic areas should be aware of its clinical presentation, diagnostic work-up, and initial management. Given the challenges of diagnosing loiasis, especially in low prevalence settings, we present cases of four family members, two of whom were diagnosed with loiasis, and discuss an approach to screening populations from endemic regions during their initial Refugee Health Examination upon arrival to the US.
Collapse
Affiliation(s)
- Shalini Subbarao
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Reagan Thompson
- School of Nursing, University of Virginia, Charlottesville, VA, USA
- Department of Population Health, University of Virginia, Charlottesville, VA, USA
| | - Amy Klion
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Fern R Hauck
- Department of Family Medicine, University of Virginia, Charlottesville, VA, USA
| | - Tania A Thomas
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
4
|
Whittaker C, Chesnais CB, Pion SDS, Kamgno J, Walker M, Basáñez MG, Boussinesq M. Factors associated with variation in single-dose albendazole pharmacokinetics: A systematic review and modelling analysis. PLoS Negl Trop Dis 2022; 16:e0010497. [PMID: 36306320 PMCID: PMC9662735 DOI: 10.1371/journal.pntd.0010497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/14/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Albendazole is an orally administered anti-parasitic medication with widespread usage in a variety of both programmatic and clinical contexts. Previous work has shown that the drug's pharmacologically active metabolite, albendazole sulfoxide, is characterised by substantial inter-individual pharmacokinetic variation. This variation might have implications for the efficacy of albendazole treatment, but current understanding of the factors associated with this variation remains incomplete. METHODOLOGY/PRINCIPAL FINDINGS We carried out a systematic review to identify references containing temporally disaggregated data on the plasma concentration of albendazole and/or (its pharmacologically-active metabolite) albendazole sulfoxide following a single oral dose. These data were then integrated into a mathematical modelling framework to infer albendazole sulfoxide pharmacokinetic parameters and relate them to characteristics of the groups being treated. These characteristics included age, weight, sex, dosage, infection status, and whether patients had received a fatty meal prior to treatment or other drugs alongside albendazole. Our results highlight a number of factors systematically associated with albendazole sulfoxide pharmacokinetic variation including age, existing parasitic infection and receipt of a fatty meal. Age was significantly associated with variation in albendazole sulfoxide systemic availability and peak plasma concentration achieved; as well as the clearance rate (related to the half-life) after adjusting for variation in dosage due to differences in body weight between children and adults. Receipt of a fatty meal prior to treatment was associated with increased albendazole sulfoxide systemic availability (and by extension, peak plasma concentration and total albendazole sulfoxide exposure following the dose). Parasitic infection (particularly echinococcosis) was associated with altered pharmacokinetic parameters, with infected populations displaying distinct characteristics to uninfected ones. CONCLUSIONS/SIGNIFICANCE These results highlight the extensive inter-individual variation that characterises albendazole sulfoxide pharmacokinetics and provide insight into some of the factors associated with this variation.
Collapse
Affiliation(s)
- Charles Whittaker
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Cédric B. Chesnais
- Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIHMI), University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
| | - Sébastien D. S. Pion
- Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIHMI), University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
| | - Joseph Kamgno
- Centre for Research on Filariasis & other Tropical Diseases, and Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Martin Walker
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, United Kingdom
| | - Maria-Gloria Basáñez
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Michel Boussinesq
- Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIHMI), University of Montpellier, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
| |
Collapse
|
5
|
Tagboto S, Orish V. Drug development for onchocerciasis-the past, the present and the future. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.953061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Onchocerciasis affects predominantly rural communities in Africa, and with small foci in South America and the Yemen. The disease is a major cause of blindness and other significant morbidity and mortality. Control programs have achieved a major impact on the incidence and prevalence of onchocerciasis by interrupting transmission with vector control programs, and treatment with mass drug administration using the microfilaricide ivermectin. Over the last few decades, several microfilaricides have been developed. This initially included diethylcarbamazine, which had significant side effects and is no longer used as such. Ivermectin which is a safe and highly effective microfilaricide and moxidectin which is a longer acting microfilaricide are presently recognized therapies. Suramin was the first effective macrofilaricide but was prohibitively toxic. Certain antibiotics including doxycycline can help eliminate adult worms by targeting its endosymbiont bacteria, Wolbachia pipientis. However, the dosing regimens may make this difficult to use as part of a mass disease control program in endemic areas. It is now widely recognized that treatments that are able to kill or permanently sterilize adult filarial worms should help achieve the elimination of this disease. We summarize in detail the historic drug development in onchocerciasis, including prospective future candidate drugs.
Collapse
|
6
|
Bottieau E, Huits R, Van Den Broucke S, Maniewski U, Declercq S, Brosius I, Theunissen C, Feyens AM, Van Esbroeck M, van Griensven J, Clerinx J, Soentjens P. Human filariasis in travelers and migrants: a retrospective 25-year analysis at the Institute of Tropical Medicine, Antwerp, Belgium. Clin Infect Dis 2021; 74:1972-1978. [PMID: 34463732 DOI: 10.1093/cid/ciab751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Information on human filariasis in international travelers is scarce. We describe the epidemiology, clinical presentation and outcome of these infections in a reference travel clinic over the past decades. METHODS We reviewed all cases of filariasis diagnosed at the Institute of Tropical Medicine, Antwerp, Belgium, from 1994 to 2018. Diagnosis was obtained by either parasitological methods (confirmed) or strict clinical case definitions (probable). We assessed the characteristics of cases at diagnosis and response to therapy within three to 12 months. RESULTS A total of 320 patients (median age: 41 years; 71% males) were diagnosed with 327 filarial infections (Wuchereria bancrofti = 6; Onchocerca volvulus = 33, Loa loa = 150, Mansonella perstans = 130; unspecified species = 8). Diagnosis was confirmed in 213/320 (67%) patients. European long-term travelers accounted for 166 patients (52%) and visitors/migrants from tropical countries for another 110 (34%). Central Africa was the likely region of acquisition for 294 (92%) patients. The number of filariasis cases decreased from 21.5/year in average in the nineties to 6.3/year in the last decade, when loiasis became predominant. Cases reported symptoms in > 80% of all filarial infections but mansonellosis (45/123 single infections; 37%). Lymphatic filariasis and onchocerciasis cases responded well to conventional therapy. However, 30% of patients with loiasis and mansonellosis experienced treatment failure (with diethylcarbamazine and levamisole-mebendazole, respectively). CONCLUSIONS The burden and species distribution of filariasis in travelers evolved in the past decades. Most presentations were symptomatic. Case management would benefit from more effective therapies for loiasis and mansonellosis.
Collapse
Affiliation(s)
- Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Ula Maniewski
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Steven Declercq
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Caroline Theunissen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anne-Marie Feyens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Clerinx
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Patrick Soentjens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
7
|
Chai JY, Jung BK, Hong SJ. Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update. THE KOREAN JOURNAL OF PARASITOLOGY 2021; 59:189-225. [PMID: 34218593 PMCID: PMC8255490 DOI: 10.3347/kjp.2021.59.3.189] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 12/19/2022]
Abstract
The use of albendazole and mebendazole, i.e., benzimidazole broad-spectrum anthelmintics, in treatment of parasitic infections, as well as cancers, is briefly reviewed. These drugs are known to block the microtubule systems of parasites and mammalian cells leading to inhibition of glucose uptake and transport and finally cell death. Eventually they exhibit ovicidal, larvicidal, and vermicidal effects on parasites, and tumoricidal effects on hosts. Albendazole and mebendazole are most frequently prescribed for treatment of intestinal nematode infections (ascariasis, hookworm infections, trichuriasis, strongyloidiasis, and enterobiasis) and can also be used for intestinal tapeworm infections (taeniases and hymenolepiasis). However, these drugs also exhibit considerable therapeutic effects against tissue nematode/cestode infections (visceral, ocular, neural, and cutaneous larva migrans, anisakiasis, trichinosis, hepatic and intestinal capillariasis, angiostrongyliasis, gnathostomiasis, gongylonemiasis, thelaziasis, dracunculiasis, cerebral and subcutaneous cysticercosis, and echinococcosis). Albendazole is also used for treatment of filarial infections (lymphatic filariasis, onchocerciasis, loiasis, mansonellosis, and dirofilariasis) alone or in combination with other drugs, such as ivermectin or diethylcarbamazine. Albendazole was tried even for treatment of trematode (fascioliasis, clonorchiasis, opisthorchiasis, and intestinal fluke infections) and protozoan infections (giardiasis, vaginal trichomoniasis, cryptosporidiosis, and microsporidiosis). These drugs are generally safe with few side effects; however, when they are used for prolonged time (>14-28 days) or even only 1 time, liver toxicity and other side reactions may occur. In hookworms, Trichuris trichiura, possibly Ascaris lumbricoides, Wuchereria bancrofti, and Giardia sp., there are emerging issues of drug resistance. It is of particular note that albendazole and mebendazole have been repositioned as promising anti-cancer drugs. These drugs have been shown to be active in vitro and in vivo (animals) against liver, lung, ovary, prostate, colorectal, breast, head and neck cancers, and melanoma. Two clinical reports for albendazole and 2 case reports for mebendazole have revealed promising effects of these drugs in human patients having variable types of cancers. However, because of the toxicity of albendazole, for example, neutropenia due to myelosuppression, if high doses are used for a prolonged time, mebendazole is currently more popularly used than albendazole in anti-cancer clinical trials.
Collapse
Affiliation(s)
- Jong-Yil Chai
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649,
Korea
- Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080,
Korea
| | - Bong-Kwang Jung
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649,
Korea
| | - Sung-Jong Hong
- Department of Environmental Medical Biology, Chung-Ang University College of Medicine, Seoul 06974,
Korea
| |
Collapse
|
8
|
Gobbi F, Buonfrate D, Tamarozzi F, Degani M, Angheben A, Bisoffi Z. Efficacy of High-Dose Albendazole with Ivermectin for Treating Imported Loiasis, Italy. Emerg Infect Dis 2019; 25:1574-1576. [PMID: 31310225 PMCID: PMC6649345 DOI: 10.3201/eid2508.190011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe the outcomes of 16 cases of imported loiasis in Italy. Patients had microfilaremia <20,000/mL and were treated with high-dose albendazole for 28 days and a single dose of ivermectin. This combination might be an effective treatment option in nonendemic areas, when diethylcarbamazine, the drug of choice, is not available.
Collapse
|
9
|
Gobbi F, Tamarozzi F, Buonfrate D, Rodari P, Tais S, Bisoffi Z. Laboratory Parameters after Treatment for Loa loa and Mansonella perstans: The Experience of a Single Referral Center for Tropical Diseases in a Non-Endemic Area. Am J Trop Med Hyg 2019; 100:914-920. [PMID: 30693861 PMCID: PMC6447121 DOI: 10.4269/ajtmh.18-0693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Infections due to Loa loa and Mansonella perstans are common yet elusive neglected filariases. Parasitological cure after treatment is very difficult to assess, as adult parasites are not accessible. Therefore, outside transmission areas, patients require a long follow-up period to ascertain the therapeutic outcome, which is impractical for non-sedentary populations such as migrants. We studied the change over time of microfilaremia, eosinophil counts, and antifilarial antibodies tested with a commercial ELISA test (Bordier Affinity Products, Crissier, Switzerland), in a retrospective cohort of patients with confirmed L. loa and M. perstans infections, to evaluate the role of serology in clinical practice. After treatment, all 22 eligible patients diagnosed in our center between 2015 and 2017 reached amicrofilaremia, with microfilarial counts decreasing sharply within 2 months. Paralleling eosinophil counts, antibodies decreased in all patients, 36% of whom reached sero-reversion or near-sero-reversion in < 20 months. These findings suggest that positive serology is not just residual from a past infection, and may be used for diagnosis even when microfilaremia is negative or cannot be performed. Interestingly, antibodies and eosinophil counts increased following some, but not all, re-treatment courses. If the rise in these parameters reflects death of macrofilariae, caution is required in interpreting high eosinophil counts and antibody titers shortly after treatment, as these may reflect no need for further treatment. To optimize patients' management, it is now pivotal to ascertain the interval between treatment and macrofilarial death and therefore whether re-treatments are required for complete clearance of parasites.
Collapse
Affiliation(s)
- Federico Gobbi
- Department of Infectious and Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - Francesca Tamarozzi
- Department of Infectious and Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - Dora Buonfrate
- Department of Infectious and Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - Paola Rodari
- Department of Infectious and Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - Stefano Tais
- Department of Infectious and Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - Zeno Bisoffi
- Infectious Diseases and Tropical Medicine Section, Diagnostic and Public Health Department, University of Verona, Verona, Italy.,Department of Infectious and Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| |
Collapse
|
10
|
Gobbi F, Bottieau E, Bouchaud O, Buonfrate D, Salvador F, Rojo-Marcos G, Rodari P, Clerinx J, Treviño B, Herrera-Ávila JP, Neumayr A, Calleri G, Angheben A, Rothe C, Zammarchi L, Guerriero M, Bisoffi Z. Comparison of different drug regimens for the treatment of loiasis-A TropNet retrospective study. PLoS Negl Trop Dis 2018; 12:e0006917. [PMID: 30383753 PMCID: PMC6233929 DOI: 10.1371/journal.pntd.0006917] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 11/13/2018] [Accepted: 10/11/2018] [Indexed: 11/18/2022] Open
Abstract
Background Loa loa infection is endemic in limited areas of West-Central Africa. Loiasis has been associated with excess mortality, but clinical studies on its treatment are scant, particularly outside endemic areas, due to the rarity of cases diagnosed. Methodology/Principal findings With this retrospective TropNet (European Network for Tropical Medicine and Travel Health) study, we aimed at outlining the treatment schedules followed by different reference centers for tropical medicine across Europe. We gathered information about 238 cases of loiasis, 165 of which had follow up data. The regimens followed by the different centers were heterogeneous. The drugs most frequently administered were: diethylcarbamazine alone (74/165, 45.1%), ivermectin alone (41/165, 25%), albendazole + ivermectin (21/164, 11.6%), ivermectin + diethylcarbamazine (16/165, 9.7%). Conclusions/Significance The management of loiasis substantially differs across specialized travel clinics in Europe. These discrepancies could be due to different local protocols as well as to (un)availability of the drugs. An harmonization of clinical protocols for the treatment of loiasis would be suggested across reference centers for tropical medicine in Europe. Loa loa is a worm which infects millions of people living in wide forested areas of central Africa. The infection is rarely diagnosed outside Africa, and cases are mainly referred to referral centers on tropical medicine. Aim of this study was to describe the treatment and management of patients diagnosed with loiasis in some referral centers for tropical medicine in Europe. The results showed that different health centers treat the patients with different drugs/drug combinations. On the basis of the availability of the drugs and on the data observed, common protocols might be recommended for the participating centers.
Collapse
Affiliation(s)
- Federico Gobbi
- IRCCS Center for Tropical Diseases, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
- * E-mail:
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Olivier Bouchaud
- Service des Maladies Infectieuses et Tropicales, CHU Avicenne, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Dora Buonfrate
- IRCCS Center for Tropical Diseases, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Fernando Salvador
- Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Gerardo Rojo-Marcos
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Paola Rodari
- IRCCS Center for Tropical Diseases, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Jan Clerinx
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Begoña Treviño
- International Health Unit Vall d’Hebron-Drassanes, PROSICS Barcelona, Barcelona, Spain
| | | | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Guido Calleri
- Unit A of Infectious and Tropical Diseases, Amedeo di Savoia Hospital, Turin, Italy
| | - Andrea Angheben
- IRCCS Center for Tropical Diseases, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Camilla Rothe
- University Hospital Medical Centre, Hamburg, Germany
- LMU Medical Centre, Munich, Germany
| | - Lorenzo Zammarchi
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Zeno Bisoffi
- IRCCS Center for Tropical Diseases, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| |
Collapse
|
11
|
Abstract
A variety of arthropods, protozoa, and helminths infect the skin and subcutaneous tissues and may be identified by anatomic pathologists in standard cytology and histology preparations. The specific organisms seen vary greatly with the patient's exposure history, including travel to or residence in endemic countries. Arthropods are the most commonly encountered parasites in the skin and subcutaneous tissues and include Sarcoptes scabei, Demodex species, Tunga penetrans, and myiasis-causing fly larvae. Protozoal parasites such as Leishmania may also be common in some settings. Helminths are less often seen, and include round worms (eg, Dirofilaria spp.), tapeworms (eg, Taenia solium, Spirometra spp.), and flukes (eg, Schistosoma spp.). This review covers the epidemiologic and histopathologic features of common parasitic infections of the skin and subcutaneous tissues.
Collapse
|
12
|
Cheke RA. Factors affecting onchocerciasis transmission: lessons for infection control. Expert Rev Anti Infect Ther 2017; 15:377-386. [PMID: 28117596 DOI: 10.1080/14787210.2017.1286980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Onchocerca volvulus infects in excess of 15 million people. The vectors are Simulium blackflies, varieties of which differ in their ecologies, behavior and vectorial abilities. Control of the vectors and mass administrations of ivermectin have succeeded in reducing prevalences with elimination achieved in some foci, particularly in Central and southern America. In Africa, progress towards elimination has been less successful. Areas covered: Even with community directed treatment with ivermectin (CDTI), control has been difficult in African areas with initial prevalences in excess of 55%, especially if only annual treatments are dispensed. This is partly attributable to insufficient coverage, but the appearance of incipiently resistant non-responding parasites and lack of attention to vector biology in modeling and planning outcomes of intervention programmes have also played their parts, with recrudescence now appearing in some treated areas. Expert commentary: The biology of onchocerciasis is complex involving different vectors with differing abilities to transmit parasites, diverse pathologies related to geographical and parasite variations and endosymbionts in both parasite and vector. Modeling to predict epidemiological and control outcomes is addressing this complexity but more attention needs to be given to the vectors' roles to further understanding of where and when control measures will succeed.
Collapse
Affiliation(s)
- Robert A Cheke
- a Agriculture, Health and Environment Department, Natural Resources Institute , University of Greenwich at Medway , Kent , UK.,b Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary's campus) , Imperial College London , London , UK
| |
Collapse
|
13
|
Identification and Validation of Loa loa Microfilaria-Specific Biomarkers: a Rational Design Approach Using Proteomics and Novel Immunoassays. mBio 2016; 7:e02132-15. [PMID: 26884435 PMCID: PMC4791851 DOI: 10.1128/mbio.02132-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Immunoassays are currently needed to quantify Loa loa microfilariae (mf). To address this need, we have conducted proteomic and bioinformatic analyses of proteins present in the urine of a Loa mf-infected patient and used this information to identify putative biomarkers produced by L. loa mf. In total, 70 of the 15,444 described putative L. loa proteins were identified. Of these 70, 18 were L. loa mf specific, and 2 of these 18 (LOAG_16297 and LOAG_17808) were biologically immunogenic. We developed novel reverse luciferase immunoprecipitation system (LIPS) immunoassays to quantify these 2 proteins in individual plasma samples. Levels of these 2 proteins in microfilaremic L. loa-infected patients were positively correlated to mf densities in the corresponding blood samples (r = 0.71 and P < 0.0001 for LOAG_16297 and r = 0.61 and P = 0.0002 for LOAG_17808). For LOAG_16297, the levels in plasma were significantly higher in Loa-infected (geometric mean [GM], 0.045 µg/ml) than in uninfected (P < 0.0001), Wuchereria bancrofti-infected (P = 0.0005), and Onchocerca volvulus-infected (P < 0.0001) individuals, whereas for LOAG_17808 protein, they were not significantly different between Loa-infected (GM, 0.123 µg/ml) and uninfected (P = 0.06) and W. bancrofti-infected (P = 0.32) individuals. Moreover, only LOAG_16297 showed clear discriminative ability between L. loa and the other potentially coendemic filariae. Indeed, the specificity of the LOAG_16297 reverse LIPS assay was 96% (with a sensitivity of 77%). Thus, LOAG_16297 is a very promising biomarker that will be exploited in a quantitative point-of-care immunoassay for determination of L. loa mf densities. Loa loa, the causative agent of loiasis, is a parasitic nematode transmitted to humans by the tabanid Chrysops fly. Some individuals infected with L. loa microfilariae (mf) in high densities are known to experience post-ivermectin severe adverse events (SAEs [encephalopathy, coma, or death]). Thus, ivermectin-based mass drug administration (MDA) programs for onchocerciasis and for lymphatic filariasis control have been interrupted in parts of Africa where these filarial infections coexist with L. loa. To allow for implementation of MDA for onchocerciasis and lymphatic filariasis, tools that can accurately identify people at risk of developing post-ivermectin SAEs are needed. Our study, using host-based proteomics in combination with novel immunoassays, identified a single Loa-specific antigen (LOAG_16297) that can be used as a biomarker for the prediction of L. loa mf levels in the blood of infected patients. Therefore, the use of such biomarker could be important in the point-of-care assessment of L. loa mf densities.
Collapse
|
14
|
Imported loiasis in Italy: an analysis of 100 cases. Travel Med Infect Dis 2014; 12:713-7. [PMID: 25131142 DOI: 10.1016/j.tmaid.2014.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 07/15/2014] [Accepted: 07/22/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND loiasis is a neglected filariasis, affecting millions of individuals living in the rainforest areas of West and Central Africa. Aim of this study was to compare clinical and parasitological manifestations of loiasis between subjects born in endemic areas and expatriates/travelers. METHODS we report clinical and parasitological manifestations of 100 patients with imported loiasis seen between 1993 and 2013 at the Center of Tropical Diseases, Negrar, Italy. RESULTS among the 100 patients, 30 were African immigrants, 70 were Europeans (59 long-term expatriates and 11 travelers). Thirty-five patients (19 Africans and 16 Europeans) had positive microfilaremia. Calabar swellings were twice as frequent in Europeans (90%) than in Africans (46.7%), while a history of "eyeworm" was recorded in a higher proportion of Africans (43.3%) than in Europeans (17.4%). The median duration of exposure in the non-endemic group was also fairly long (14.6 years). Different drug regimens were used for treatment. CONCLUSIONS we suggest that the differences between Africans and Europeans are more likely to be related to genetic differences, rather than to chronicity. Moreover the management of imported loiasis needs standardization.
Collapse
|
15
|
Metzger WG, Mordmüller B. Loa loa—does it deserve to be neglected? THE LANCET. INFECTIOUS DISEASES 2014; 14:353-7. [DOI: 10.1016/s1473-3099(13)70263-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Antinori S, Schifanella L, Million M, Galimberti L, Ferraris L, Mandia L, Trabucchi G, Cacioppo V, Monaco G, Tosoni A, Brouqui P, Gismondo MR, Giuliani G, Corbellino M. Imported Loa loa filariasis: three cases and a review of cases reported in non-endemic countries in the past 25 years. Int J Infect Dis 2012; 16:e649-62. [PMID: 22784545 DOI: 10.1016/j.ijid.2012.05.1023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/13/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to highlight the increasing chance of Western physicians encountering patients (both immigrants and expatriates/travelers) seeking help for loiasis. METHODS We describe three cases of imported loiasis observed at two hospitals in Italy and France, and present a review of all previously published cases in the medical literature in the last 25 years (1986-2011). The search was performed using PubMed and Scopus databases using the terms "Loa loa" AND "loiasis". RESULTS We reviewed 101 cases of imported loiasis of which 61 (60.4%) were reported from Europe and 31 (30.7%) from the USA. Seventy-five percent of infestations were acquired in three countries: Cameroon, Nigeria, and Gabon. Overall, peripheral blood microfilariae were detected in 61.4% of patients, eosinophilia in 82.1%, eye worm migration in 53.5%, and Calabar swellings in 41.6%. However, Calabar swellings and eosinophilia were more common among expatriates/travelers, whereas African immigrants were more likely to have microfilaremia. Eye worm migration was observed in a similar proportion in the two groups. Only 35 patients (including the three described here) underwent clinical follow-up for a median period of 10.5 months (range 1-84 months); clinical relapse occurred in three of these patients and persistence or reappearance of blood microfilaria in another two. CONCLUSIONS Due to increasing travel and the migration of people from the endemic countries of West Africa to Europe and the USA, we speculate on the possible emergence of loiasis. Western physicians should be aware of the typical (eye worm migration and Calabar swellings) as well as unusual clinical presentations.
Collapse
Affiliation(s)
- Spinello Antinori
- Department of Clinical Sciences L Sacco, Section of Infectious Diseases and Immunopathology, Università degli Studi di Milano, Via GB Grassi, 74, 20157 Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Díaz-Menéndez M, Norman F, Monge-Maillo B, Pérez-Molina JA, López-Vélez R. [Filariasis in clinical practice]. Enferm Infecc Microbiol Clin 2012; 29 Suppl 5:27-37. [PMID: 22305667 DOI: 10.1016/s0213-005x(11)70041-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Filariases are infections caused by distinct species of nematodes. These infections are transmitted through insect bites and primarily affect lymph nodes and skin. Filariases are classified as neglected diseases and affect millions, producing severe disability and social stigma. This type of infection is rarely diagnosed in travellers, as prolonged stays in endemic areas are usually required acquire infection. Infections may be asymptomatic, and clinical manifestations depend on the host immune response to the infection and the parasite burden. Diagnosis is based on the demonstration of microfilariae in blood or skin, but there are other methods that support the diagnosis. Individual treatment is effective, but community interventions, mostly mass drug administration, have helped to diminish the incidence of filariases.
Collapse
Affiliation(s)
- Marta Díaz-Menéndez
- Unidad de Medicina Tropical, Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España
| | | | | | | | | |
Collapse
|
18
|
|
19
|
A Technique for Capturing Migratory Periocular Worms: A Case Series and Review of Literature. Ophthalmic Plast Reconstr Surg 2010; 26:323-6. [DOI: 10.1097/iop.0b013e3181c563e9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Abstract
Filarial infections including loiasis, onchocerciasis, and lymphatic filariasis are important causes of morbidity in endemic populations worldwide, and they present a risk to travelers to endemic areas. Definitive diagnosis is complicated by overlap in the geographic distribution and clinical manifestations of the different filarial parasites, as well as similarities in their antigenic and nucleic acid composition. This has important implications for treatment, because the efficacies and toxicities of available antifilarial agents differ dramatically among filarial species. Recent advances, including the visualization of adult filarial worms in vivo by high-frequency ultrasound and the identification of the bacterial endosymbiont, Wolbachia, have greatly improved our understanding of the pathogenesis of filarial infection and have led to novel approaches to the diagnosis and treatment of travelers and immigrants from filarial-endemic regions.
Collapse
Affiliation(s)
- Amy D Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Building 4, Room 126, 4 Center Drive, Bethesda, MD 20892, USA.
| |
Collapse
|
21
|
|
22
|
Abstract
Loiasis, caused by the filarial nematode Loa loa, is often asymptomatic but frequently manifests as episodic angioedema and periocular migration of adult worms. Hence also known as the eye worm.(1) It is rarely encountered in the United States among travelers and immigrants. This report describes a case of loiasis in a Cameroonian student seen at a US university clinic.
Collapse
Affiliation(s)
- Sadia Ali
- Section of Infectious Diseases, West Virginia University, Morgantown, WV, USA.
| | | | | |
Collapse
|
23
|
Abstract
Loiasis affects millions of individuals living in the forest and savannah regions of Central Africa. In some areas, this disease constitutes one of the most common reasons for medical consultation. The burden posed by loiasis is probably under-estimated and, in addition, individuals harbouring high Loa microfilarial loads are at risk of developing serious neurological reactions after treatment with diethylcarbamazine or ivermectin. These events are currently significantly hampering the development of the African Programme for Onchocerciasis Control, and operational research is required to address the issue. The results of recent studies, involving either human populations from endemic areas or monkey models, have provided much more detail of the mechanisms associated with amicrofilaraemic or so-called 'occult' loiasis. New diagnostic tools have also been developed in the last decade, and various protocols are now available for the risk-free treatment of loiasis cases.
Collapse
Affiliation(s)
- M Boussinesq
- Institut de Recherche pour le Développement (IRD), UR024, Département Sociétés et Santé, 213 rue La Fayette, 75480 Paris Cedex 10, France.
| |
Collapse
|
24
|
Abstract
In 1961 Brown and his team discovered that thiobendazoles were highly effective against gastrointestinal nematodes. This discovery led to the development of albendazole, the most recent of the benzimidazolic drugs. Albendazole is used against numerous animal and human parasites and it is the authors' first choice as drug treatment of cutaneous larva migrans.
Collapse
Affiliation(s)
- Giancarlo Albanese
- Dermatology and Tropical Dermatology, CAM Medical Centre, Viale Brianza, 21 20052 Monza (MI), Italy.
| | | |
Collapse
|
25
|
Abstract
BACKGROUND Owing to the increase of an immigrant population and of Italian citizens travelling for tourism or on business, it is nowadays possible to observe clinical pictures characteristic of tropical regions, often with indistinct symptoms. One of these is Loa loa infestation, or loiasis, a form of filariasis caused by Loa loa and transmitted by the Chrysops fly. We present the case of a male immigrant from Cameroon. Characteristic symptoms were intense xerosis, mostly of the third inferior part of the legs, intensely pruritic, with numerous lesions from scratching. No benefit was obtained by emollient topics, anti-acarus and systemic antihistamines. METHOD Serum samples and Giemsa, haematoxylin, haematoxylin + Giemsa concentration-on-membrane stains, have evidenced the presence of Loa loa microfilariae. RESULTS A diagnosis for L. loa (loiasis) infestation was made. CONCLUSIONS At the beginning of the migration phenomenon, particularly from Africa, Italian physicians, especially dermatologists, were eagerly looking for 'tropical' diseases; this approach can be defined as 'Salgari's syndrome' from the name of the Italian novelist who, though never travelling out of Italy, had perfectly described environments and habits typical of far away countries. Now, conversely, we have to avoid the opposite approach of considering real tropical diseases as related to social or psychological difficult conditions.
Collapse
Affiliation(s)
- A Morrone
- Istituto Dermatologico S. Gallicano (IRCCS), Servizio di Medicina Preventiva delle Migrazioni, del Turismo e di Dermatologia Tropicale, Rome, Italy
| | | | | | | | | |
Collapse
|