Am. J. Trop. Med. Hyg., 78(6), 2008, pp. 854-855
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene
Bancroftian Filariasis—Absence of Wolbachia after Doxycycline Treatment
Sabine Mand*,
Dietrich W. Büttner, AND
Achim Hoerauf
Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Clinic Bonn, Bonn, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
A 59 year-old Ghanaian presented with scrotal enlargement for 5 years. Ultrasonography showed a hydrocele with dilated lymphatic vessels (0.61 cm) in the left supratesticular area (spermatic cord) containing motile adult filariae1 (Figure 1A
, arrowheads; Figure 1B, Pulse Wave Doppler-mode and video clip displaying filarial movements).
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FIGURE 1. A, Hydrocele fluid (echo-free area) and a worm nest (arrowheads) in a dilated lymphatic vessel in the supratesticular area (B-mode). This figure can be seen as video at www.ajthm.org. B, Irregular peaks in the Pulse Wave Doppler-mode reflecting movements of adult filariae. C and D, Section of a female W. bancrofti, excised 6 weeks after doxycycline treatment with degenerated embryos (arrows in C) and without Wolbachia endobacteria in the hypodermis (arrowheads), embryos, and oocytes (arrows in D). E, Untreated female W. bancrofti with many bacteria in oocytes (arrows). Immunohistologic staining using antiserum against Wolbachia surface protein. Scale bars = 30 µm. This figure appears in color at www.ajtmh.org.
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Laboratory results showed 2,040 microfilariae/mL and 65,804 units of circulating filarial antigen.2,3 The patient was treated with 200 mg doxycycline/d for 6 weeks. He underwent ultrasound-guided hydrocelectomy 6 weeks after the end of treatment. The tissue was fixed in ethanol for immunohistology. Adult worm sections (Figure 1C
) showed degenerated embryos after doxycycline treatment. No Wolbachia were detected in the hypodermis, embryos, or oocytes using Wolbachia-specific antibodies (Figures 1C and 1D), whereas worm sections of an untreated patient contained many Wolbachia (Figure 1E). The treated patient was amicrofilaremic at the 12- and 24-month follow-ups. Antigen units dropped to 5,092 and 968 units (borderline positive), respectively, with no relapse of the hydrocele. Ultrasound re-examinations showed no worm nests.
Received January 27, 2008.
Accepted for publication March 20, 2008.
* Address correspondence to Sabine Mand, Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Clinic Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany. E-mail: mand{at}parasit.meb.uni-bonn.de 
Note: A supplemental video clip appears online at www.ajtmh.org.
Authors’ addresses: Sabine Mand and Achim Hoerauf, Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Clinic Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany, Tel: 49-228-287-15675, Fax: 49-228-287-19573, E-mails: mand{at}parasit.meb.uni-bonn.de and hoerauf{at}parasit.meb.uni-bonn.de. Dietrich W. Büttner, Bernhard Nocht Institute for Tropical Medicine, Berhard-Nocht-Str. 74, 20359 Hamburg, Germany, Tel: 49-40-42818-410, Fax: 40-40-42818-400, E-mail: buettner{at}bni-hamburg.de.
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REFERENCES
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- Mand S, Marfo-Debrekyei Y, Dittrich M, Fischer K, Adjei O, Hoerauf A, 2003. Animated documentation of the filaria dance sign (FDS) in bancroftian filariasis. Filaria J 2: 3.[Medline]
- Hoerauf A, Mand S, Fischer K, Kruppa T, Marfo-Debrekyei Y, Debrah AY, Pfarr KM, Adjei O, Büttner DW, 2003. Doxycycline as a novel strategy against bancroftian filariasis-depletion of Wolbachia endosymbionts from Wuchereria bancrofti and stop of microfilaria production. Med Microbiol Immunol (Berl) 192: 211–216.[Medline]
- Debrah AY, Mand S, Specht S, Marfo-Debrekyei Y, Batsa L, Pfarr K, Larbi J, Lawson B, Taylor M, Adjei O, Hoerauf A, 2006. Doxycycline reduces plasma VEGF-C/sVEGFR-3 and improves pathology in lymphatic filariasis. PLoS Pathol 2: e92.
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