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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

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  • 1 Department of Infectious and Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy;
  • | 2 Infectious Diseases and Tropical Medicine Section, Diagnostic and Public Health Department, University of Verona, Verona, Italy
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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.

Author Notes

Address correspondence to Federico Gobbi, Centre for Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Via Don A. Sempreboni n.5, Negrar 37024 Italy. E-mail: federico.gobbi@sacrocuore.it

Authors’ addresses: Federico Gobbi, Francesca Tamarozzi, Dora Buonfrate, Paola Rodari, and Stefano Tais, Centre for Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy, E-mails: federico.gobbi@sacrocuore.it, francesca.tamarozzi@sacrocuore.it, dora.buonfrate@sacrocuore.it, paola.rodari@sacrocuore.it, and stefano.tais@sacrocuore.it. Zeno Bisoffi, Centre for Tropical Diseases, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy, and Infectious Diseases and Tropical Medicine Section, Diagnostic and Public Health Department, University of Verona, Verona, Italy, E-mail: zeno.bisoffi@sacrocuore.it.

These authors contributed equally to this work.

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