Trial of doxycycline for Mansonella perstans infection

Wuchereria bancrofti vespid, Immune response, Serum immune complexes diagnosis, Diethylcarbamazine (DEC), Wolbachia in filarial parasites, Interdigital skin lesions, Urban Filariasis, Doxycycline, mass drug administration program, Filarial Lymphedema Care, Detection of filarial parasites, Albendazole, research abstracts

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Trial of doxycycline for Mansonella perstans infection

Postby patoco » Thu Jan 21, 2010 10:47 am

A randomized trial of doxycycline for Mansonella perstans infection.

A randomized trial of doxycycline for Mansonella perstans infection.
Coulibaly YI, Dembele B, Diallo AA, Lipner EM, Doumbia SS, Coulibaly SY, Konate S, Diallo DA, Yalcouye D, Kubofcik J, Doumbo OK, Traore AK, Keita AD, Fay MP, Traore SF, Nutman TB, Klion AD.

Faculty of Medicine, Pharmacy and Odontostomatology, University of Bamako, Bamako, Mali.
Comment in:

N Engl J Med. 2009 Oct 8;361(15):1502-4.

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 microg 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 microl 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%).

[color=#400080]CONCLUSIONS[/color]: 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.) 2009 Massachusetts Medical Society

PMID: 19812401 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/1981 ... inalpos=16
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