背景:曼森氏菌感染是一种被忽视的丝虫病,广泛分布在撒哈拉以南非洲,以难以捉摸的临床表现为特征;曼森氏菌病的治疗方法不规范。这项回顾性研究旨在描述临床特征,治疗方案和进化,在四个欧洲热带疾病中心发现的大量进口的M.perstans感染病例。
方法:M.Perstans感染,通过识别移民中的血微丝虫来诊断,外籍人士和旅行者,收集于1994年至2018年之间,进行了回顾性分析。有关人口统计的数据,临床病史,以及诊断和随访时间点的实验室检查,被检索。
结果:共392例患者纳入研究。在281名可以检索症状信息的患者中,150例(53.4%)报告症状,腹痛和瘙痒是最常见的。在有这些数据的患者中,血清学和嗜酸性粒细胞分别为84.4%和66.1%。在23.5%的患者中报告了伴随的寄生虫感染。治疗,325名患者(82.9%),中心之间和中心内的差异非常大;最常用的方案是甲苯咪唑100mg,每天两次,持续一个月。共有256名(65.3%)患者参加了首次随访,首次访视后的中位数为3个月(IQR2-12);83.1%接受基于甲苯咪唑和/或多西环素靶向Wolbachia的治疗的患者变为无微膜血症,41.1%-78.4%的患者在单次治疗后12个月内。
结论:缺乏特定症状,加上感染人群中寄生虫学和基于抗体的检测的不恒定阳性,使临床怀疑和筛查曼森氏菌病特别困难。前瞻性研究评估来自流行地区的移民的感染率,感染特异性发病率,来自不同地理区域的M.perstans种群中存在Wolbachia内共生体,和治疗方案的疗效绝对需要优化感染的临床管理。
Infection with Mansonella perstans is a neglected filariasis, widely distributed in sub-Saharan Africa, characterized by an elusive clinical picture; treatment for mansonellosis is not standardized. This retrospective study aimed to describe the clinical features, treatment schemes and evolution, of a large cohort of imported cases of M. perstans infection seen in four European centres for tropical diseases.
Mansonella perstans infections, diagnosed by identification of blood microfilariae in migrants, expatriates and travellers, collected between 1994 and 2018, were retrospectively analysed. Data concerning demographics, clinical history and laboratory examinations at diagnosis and at follow-up time points were retrieved.
A total of 392 patients were included in the study. Of the 281 patients for whom information on symptoms could be retrieved, 150 (53.4%) reported symptoms, abdominal pain and itching being the most frequent. Positive serology and eosinophilia were present in 84.4% and 66.1%, respectively, of those patients for whom these data were available. Concomitant parasitic infections were reported in 23.5% of patients. Treatment, administered to 325 patients (82.9%), was extremely heterogeneous between and within centres; the most commonly used regimen was mebendazole 100 mg twice a day for 1 month. A total of 256 (65.3%) patients attended a first follow-up, median 3 months (interquartile range 2-12) after the first visit; 83.1% of patients having received treatment based on mebendazole and/or doxycycline, targeting
Wolbachia, became amicrofilaremic, 41.1-78.4% of whom within 12 months from single treatment.
Lack of specific symptoms, together with the inconstant positivity of parasitological and antibody-based assays in the infected population, makes the clinical suspicion and screening for mansonellosis particularly difficult. Prospective studies evaluating prevalence of infection in migrants from endemic areas, infection-specific morbidity, presence of
Wolbachia endosymbionts in M. perstans populations from different geographical areas and efficacy of treatment regimens are absolutely needed to optimize the clinical management of infection.