Attaelmannan M, Levinson SS, 2000. Understanding and identifying monoclonal gammopathies. Clin Chem 46: 1230–1238.
O’Connell TX, Horita TJ, Kasravi B, 2005. Understanding and interpreting serum protein electrophoresis. Am Fam Physician 71: 105–112.
Seifert M, Scholtysik R, Küppers R, 2013. Origin and pathogenesis of B cell lymphomas. Methods Mol Biol 971: 1–25.
Feron D et al. 2013. Chronic infection, a neglected cause of development of monoclonal gammopathy of undetermined significance (MGUS) and myeloma. Blood 122: 3116.
Tete SM, Bijl M, Sahota SS, Bos NA, 2014. Immune defects in the risk of infection and response to vaccination in monoclonal gammopathy of undetermined significance and multiple myeloma. Front Immunol 5: 257.
Bühler S, Laitinen K, Holthöfer H, Järvinen A, Schauman KO, Hedman K, 2002. High rate of monoclonal gammopathy among immunocompetent subjects with primary cytomegalovirus infection. Clin Infect Dis 35: 1430–1433.
Lu CM, Dezube BJ, Pantanowitz L, 2003. HIV infection masquerading as monoclonal gammopathy of undetermined significance. N Engl J Med 349: 1192–1193.
Sharma V, Agarwal MP, Giri S, 2010. Monoclonal gammopathy associated with visceral leishmaniasis. Braz J Infect Dis 14: 297–298.
Stoimenis D, Spyridonidou C, Papaioannou N, 2012. Transient monoclonal gammopathy induced by disseminated Staphylococcus aureus infection. Case Rep Med 2012: 607104.
Hermouet S, Corre I, Gassin M, Bigot-Corbel E, Sutton CA, Casey JW, 2003. Hepatitis C virus, human herpesvirus 8, and the development of plasma-cell leukemia. N Engl J Med 348: 178–179.
Herrick JA, Metenou S, Makiya MA, Taylar-Williams CA, Law MA, Klion AD, Nutman TB, 2015. Eosinophil-associated processes underlie differences in clinical presentation of loiasis between temporary residents and those indigenous to Loa-endemic areas. Clin Infect Dis 60: 55–63.
Simonse PE, Fischer PU, Hoerauf A, Weil GJ, 2013. The filariases. Farrar J, Hotez PJ, Junghanss T, Kang G, Lalloo D, White NJ, eds. Manson’s Tropical Diseases. St. Louis, MO: Saunders Ltd., 737–765.
Klion A, Nutman TB, 2011. Loiasis and Mansonella infections. Guerrant R, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens and Practice. Philadelphia, PA: Saunders Elsevier, 735.
Zouré HG, Wanji S, Noma M, Amazigo UV, Diggle PJ, Tekle AHT, Remme JHF, 2011. The geographic distribution of Loa loa in Africa: results of large-scale implementation of the Rapid Assessment Procedure for Loiasis (RAPLOA). PLoS Negl Trop Dis 5: e1210.
Wanji S, Akotshi DO, Mutro MN, Tepage F, Ukety TO, Diggle PJ, Remme JH, 2012. Validation of the rapid assessment procedure for loiasis (RAPLOA) in the Democratic Republic of Congo. Parasit Vectors 5: 25.
Chesnais CB, Takougang I, Pagueìleì M, Pion SD, Boussinesq M, 2017. Excess mortality associated with loiasis: a retrospective population-based cohort study. Lancet Infect Dis 17: 108–116.
Metzger WG, Mordmüller B, 2014. Loa loa—does it deserve to be neglected? Lancet Infect Dis 14: 353–357.
Cho HY, Lee YJ, Shin SY, Song HO, Ahn MH, Ryu JS, 2008. Subconjuctival Loa loa with Calabar swelling. J Korean Med Sci 23: 731–733.
Gantois N, Rapp C, Gautret P, Ficko C, Savini H, Larreché S, Saidi R, Crevon L, Simon F, 2013. Imported loiasis in France: a retrospective analysis of 47 cases. Travel Med Infect Dis 11: 366–373.
Beaver PC, Jung RC, Cupp EW, 1984. Clinical Parasitology. Philadelphia, PA: Lea and Febiger.
Antinori S et al. 2012. 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 16: e649–e662.
Churchill DR, Morris C, Fakoya A, Wright SG, Davidson RN, 1996. Clinical and laboratory features of patients with loiasis (Loa Ioa filariasis) in the U.K. J Infect 33: 103–109.
Saito M, Armstrong M, Boadi S, Lowe P, Chiodini PL, Doherty T, 2015. Clinical features of imported loiasis: a case series from the Hospital for Tropical Diseases, London. Am J Trop Med Hyg 93: 607–611.
Nutman TB, Withers AS, Ottesen EA, 1985. In vitro parasite antigen-induced antibody responses in human helminth infections. J Immunol 135: 2794–2799.
Akue JP, Devaney E, Wahl G, Moukana H, 2002. Expression of filarial-specific IgG subclasses under different transmission intensities in a region endemic for loiasis. Am J Trop Med Hyg 66: 245–250.
Akue JP, Makouloutou P, Moutsimbi RM, Moukana H, Leroy E, 2016. Influence of infective stage (L3) dose on the outcome of microfilaremia, peripheral white blood cells and humoral immune response in Loa loa experimentally infected Mandrillus sphinx. J Parasitol Vect Biol 8: 39–46.
de Caprariis D, Sasanelli M, Paradies P, Otranto D, Lia R, 2009. Monoclonal gammopathy associated with heartworm disease in a dog. J Am Anim Hosp Assoc 45: 296–300.
Braun-Falco O, Plewig G, Wolff HH, Burgdorf W, 2000. Dermatology. Heidelberg, Germany: Springer-Verlag, [Loiasis] 391.
Eveland LK, Yermakov V, Kenney M, 1975. Loa loa infection without microfilaraemia. Trans R Soc Trop Med Hyg 69: 3454–3455.
Touré FS, Bain O, Nerrienet E, Millet P, Wahl G, Toure Y, Doumbo O, Nicolas L, Georges AJ, McReynolds LA, Egwang TG, 1997. Detection of Loa loa-specific DNA in blood from occult-infected individuals. Exp Parasitol 86: 163–170.
Farcas GA, Zhong KJY, Lovegrove FE, Graham CM, Kain KC, 2003. Evaluation of the Binax NOW® ICT test versus polymerase chain reaction and microscopy for the detection of malaria in returned travelers. Am J Trop Med Hyg 69: 589–592.
Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH, 2007. A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg 77 (Suppl 6): 119–127.
Iqbal J, Sher A, Rab A, 2000. Plasmodium falciparum histidine-rich protein 2-based immunocapture diagnostic assay for malaria: cross-reactivity with rheumatoid factors. J Clin Microbiol 38: 1184–1186.
Lee JH, Jang JW, Cho CH, Kim JY, Han ET, Yun SG, Lim CS, 2014. False-positive results for rapid diagnostic tests for malaria in patients with rheumatoid factor. J Clin Microbiol 52: 3784–3787.
Alere Scarborough, Inc., 2015. BinaxNOW® Malaria Manufacturer’s Kit Insert. Scarborough, Maine: Alere Scarborough, Inc. Available at: https://ensur.invmed.com/ensur/broker/ensurbroker.aspx?code=IN665000&cs =26709298. Accessed December 3, 2017.
Kristinsson SY, Tang M, Pfeiffer RM, Björkholm M, Goldin LR, Blimark C, Mellqvist UH, Wahlin A, Turesson I, Landgren O, 2012. Monoclonal gammopathy of undetermined significance and risk of infections: a population-based study. Haematologica 97: 854–858.
Bida JP, Kyle RA, Therneau TM, Melton LJ, Plevak MF, Larson DR, Dispenzieri A, Katzmann JA, Rajkumar SV, 2009. Disease associations with monoclonal gammopathy of undetermined significance: a population-based study of 17,398 patients. Mayo Clin Proc 84: 685–693.
Kyle RA, Larson DR, Therneau TM, Dispenzieri A, Kumar S, Cerhan JR, Rajkumar SV, 2018. Long-term follow-up of monoclonal gammopathy of undetermined significance. N Engl J Med 378: 241–249.
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A 63-year-old woman who migrated from Nigeria to the United States was found to have an elevated total serum protein, anemia, and eosinophilia. Serum protein electrophoresis (SPEP) and serum protein immunofixation electrophoresis (SPIFE) demonstrated monoclonal immunoglobulin G (IgG) κ restricted bands (IgG 3,820 mg/dL; κ/λ ratio 4.47), indicative of monoclonal gammopathy of unknown significance (MGUS). A rapid diagnostic test (RDT) for malaria was positive for Plasmodium falciparum (BinaxNOW®; Alere Scarborough Inc., Scarborough, ME). Giemsa-stained blood smears were negative for malarial parasites, however, Loa loa microfilariae were identified. Reverse transcription polymerase chain reaction for P. falciparum, Plasmodium ovale, Plasmodium malariae, and Plasmodium vivax yielded a negative result. She was treated for loiasis with diethylcarbamazine and received no malaria medication. Treatment resulted in a resolution of the microfilaremia and eosinophilia, a negative RDT for malaria, and marked reduction in the monoclonal gammopathy. This is the first reported human case of MGUS associated with loiasis and its resolution after antiparasitic treatment.
Ethics: The patient was treated under a protocol approved by the Institutional Review Board (IRB # 1071388-1; FDA IND # 57,944). Informed consent was obtained from the patient for this article.
Authors’ addresses: Derek B. Laskar and Raavi Gupta, Department of Pathology, State University of New York, Downstate Medical Center, Brooklyn, NY, E-mails: derek.laskar@downstate.edu and raavi.gupta@downstate.edu. Michael Rose, Division of Infectious Diseases, Department of Medicine, Kings County Hospital Center, Brooklyn, NY, E-mail: michael.rose@nychhc.org. Herbert B. Tanowitz, Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, and Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, E-mail: herbert.tanowitz@einstein.yu.edu. M. A. Haseeb, Department of Cell Biology, State University of New York, Downstate Medical Center, Brooklyn, NY, Department of Pathology, State University of New York, Downstate Medical Center, Brooklyn, NY, Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, and Department of Pathology, Kings County Hospital center, Brooklyn, NY, E-mail: haseeb.siddiqi@downstate.edu.
Attaelmannan M, Levinson SS, 2000. Understanding and identifying monoclonal gammopathies. Clin Chem 46: 1230–1238.
O’Connell TX, Horita TJ, Kasravi B, 2005. Understanding and interpreting serum protein electrophoresis. Am Fam Physician 71: 105–112.
Seifert M, Scholtysik R, Küppers R, 2013. Origin and pathogenesis of B cell lymphomas. Methods Mol Biol 971: 1–25.
Feron D et al. 2013. Chronic infection, a neglected cause of development of monoclonal gammopathy of undetermined significance (MGUS) and myeloma. Blood 122: 3116.
Tete SM, Bijl M, Sahota SS, Bos NA, 2014. Immune defects in the risk of infection and response to vaccination in monoclonal gammopathy of undetermined significance and multiple myeloma. Front Immunol 5: 257.
Bühler S, Laitinen K, Holthöfer H, Järvinen A, Schauman KO, Hedman K, 2002. High rate of monoclonal gammopathy among immunocompetent subjects with primary cytomegalovirus infection. Clin Infect Dis 35: 1430–1433.
Lu CM, Dezube BJ, Pantanowitz L, 2003. HIV infection masquerading as monoclonal gammopathy of undetermined significance. N Engl J Med 349: 1192–1193.
Sharma V, Agarwal MP, Giri S, 2010. Monoclonal gammopathy associated with visceral leishmaniasis. Braz J Infect Dis 14: 297–298.
Stoimenis D, Spyridonidou C, Papaioannou N, 2012. Transient monoclonal gammopathy induced by disseminated Staphylococcus aureus infection. Case Rep Med 2012: 607104.
Hermouet S, Corre I, Gassin M, Bigot-Corbel E, Sutton CA, Casey JW, 2003. Hepatitis C virus, human herpesvirus 8, and the development of plasma-cell leukemia. N Engl J Med 348: 178–179.
Herrick JA, Metenou S, Makiya MA, Taylar-Williams CA, Law MA, Klion AD, Nutman TB, 2015. Eosinophil-associated processes underlie differences in clinical presentation of loiasis between temporary residents and those indigenous to Loa-endemic areas. Clin Infect Dis 60: 55–63.
Simonse PE, Fischer PU, Hoerauf A, Weil GJ, 2013. The filariases. Farrar J, Hotez PJ, Junghanss T, Kang G, Lalloo D, White NJ, eds. Manson’s Tropical Diseases. St. Louis, MO: Saunders Ltd., 737–765.
Klion A, Nutman TB, 2011. Loiasis and Mansonella infections. Guerrant R, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens and Practice. Philadelphia, PA: Saunders Elsevier, 735.
Zouré HG, Wanji S, Noma M, Amazigo UV, Diggle PJ, Tekle AHT, Remme JHF, 2011. The geographic distribution of Loa loa in Africa: results of large-scale implementation of the Rapid Assessment Procedure for Loiasis (RAPLOA). PLoS Negl Trop Dis 5: e1210.
Wanji S, Akotshi DO, Mutro MN, Tepage F, Ukety TO, Diggle PJ, Remme JH, 2012. Validation of the rapid assessment procedure for loiasis (RAPLOA) in the Democratic Republic of Congo. Parasit Vectors 5: 25.
Chesnais CB, Takougang I, Pagueìleì M, Pion SD, Boussinesq M, 2017. Excess mortality associated with loiasis: a retrospective population-based cohort study. Lancet Infect Dis 17: 108–116.
Metzger WG, Mordmüller B, 2014. Loa loa—does it deserve to be neglected? Lancet Infect Dis 14: 353–357.
Cho HY, Lee YJ, Shin SY, Song HO, Ahn MH, Ryu JS, 2008. Subconjuctival Loa loa with Calabar swelling. J Korean Med Sci 23: 731–733.
Gantois N, Rapp C, Gautret P, Ficko C, Savini H, Larreché S, Saidi R, Crevon L, Simon F, 2013. Imported loiasis in France: a retrospective analysis of 47 cases. Travel Med Infect Dis 11: 366–373.
Beaver PC, Jung RC, Cupp EW, 1984. Clinical Parasitology. Philadelphia, PA: Lea and Febiger.
Antinori S et al. 2012. 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 16: e649–e662.
Churchill DR, Morris C, Fakoya A, Wright SG, Davidson RN, 1996. Clinical and laboratory features of patients with loiasis (Loa Ioa filariasis) in the U.K. J Infect 33: 103–109.
Saito M, Armstrong M, Boadi S, Lowe P, Chiodini PL, Doherty T, 2015. Clinical features of imported loiasis: a case series from the Hospital for Tropical Diseases, London. Am J Trop Med Hyg 93: 607–611.
Nutman TB, Withers AS, Ottesen EA, 1985. In vitro parasite antigen-induced antibody responses in human helminth infections. J Immunol 135: 2794–2799.
Akue JP, Devaney E, Wahl G, Moukana H, 2002. Expression of filarial-specific IgG subclasses under different transmission intensities in a region endemic for loiasis. Am J Trop Med Hyg 66: 245–250.
Akue JP, Makouloutou P, Moutsimbi RM, Moukana H, Leroy E, 2016. Influence of infective stage (L3) dose on the outcome of microfilaremia, peripheral white blood cells and humoral immune response in Loa loa experimentally infected Mandrillus sphinx. J Parasitol Vect Biol 8: 39–46.
de Caprariis D, Sasanelli M, Paradies P, Otranto D, Lia R, 2009. Monoclonal gammopathy associated with heartworm disease in a dog. J Am Anim Hosp Assoc 45: 296–300.
Braun-Falco O, Plewig G, Wolff HH, Burgdorf W, 2000. Dermatology. Heidelberg, Germany: Springer-Verlag, [Loiasis] 391.
Eveland LK, Yermakov V, Kenney M, 1975. Loa loa infection without microfilaraemia. Trans R Soc Trop Med Hyg 69: 3454–3455.
Touré FS, Bain O, Nerrienet E, Millet P, Wahl G, Toure Y, Doumbo O, Nicolas L, Georges AJ, McReynolds LA, Egwang TG, 1997. Detection of Loa loa-specific DNA in blood from occult-infected individuals. Exp Parasitol 86: 163–170.
Farcas GA, Zhong KJY, Lovegrove FE, Graham CM, Kain KC, 2003. Evaluation of the Binax NOW® ICT test versus polymerase chain reaction and microscopy for the detection of malaria in returned travelers. Am J Trop Med Hyg 69: 589–592.
Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH, 2007. A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg 77 (Suppl 6): 119–127.
Iqbal J, Sher A, Rab A, 2000. Plasmodium falciparum histidine-rich protein 2-based immunocapture diagnostic assay for malaria: cross-reactivity with rheumatoid factors. J Clin Microbiol 38: 1184–1186.
Lee JH, Jang JW, Cho CH, Kim JY, Han ET, Yun SG, Lim CS, 2014. False-positive results for rapid diagnostic tests for malaria in patients with rheumatoid factor. J Clin Microbiol 52: 3784–3787.
Alere Scarborough, Inc., 2015. BinaxNOW® Malaria Manufacturer’s Kit Insert. Scarborough, Maine: Alere Scarborough, Inc. Available at: https://ensur.invmed.com/ensur/broker/ensurbroker.aspx?code=IN665000&cs =26709298. Accessed December 3, 2017.
Kristinsson SY, Tang M, Pfeiffer RM, Björkholm M, Goldin LR, Blimark C, Mellqvist UH, Wahlin A, Turesson I, Landgren O, 2012. Monoclonal gammopathy of undetermined significance and risk of infections: a population-based study. Haematologica 97: 854–858.
Bida JP, Kyle RA, Therneau TM, Melton LJ, Plevak MF, Larson DR, Dispenzieri A, Katzmann JA, Rajkumar SV, 2009. Disease associations with monoclonal gammopathy of undetermined significance: a population-based study of 17,398 patients. Mayo Clin Proc 84: 685–693.
Kyle RA, Larson DR, Therneau TM, Dispenzieri A, Kumar S, Cerhan JR, Rajkumar SV, 2018. Long-term follow-up of monoclonal gammopathy of undetermined significance. N Engl J Med 378: 241–249.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 36 | 36 | 7 |
Full Text Views | 675 | 99 | 1 |
PDF Downloads | 258 | 43 | 1 |