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Albendazole for the treatment of Mansonella perstans filariasis
TRANSACTIONS
OFTHE
1 Short Report Albendazole Mansonella
ROYAL
SOCIETY
OFTROPICAL
MEDICINE
1
for the treatment perstans filariasis
of
Filippo Biglino’
Lipanil, Pietro Caramellol, Albert0 and Claudia Sacchi2 lAmedeo di Savoia Hospital for Infectious Diseases, Torino, Italy; 21nstitute of Internal Keywords:
zole
Medicine,
Torino,
Italy
filariasis, Mansonella perstuns, treatment, albenda-
A 29 years old Italian woman developed cough, wheezing, dyspnoea, transient swelling of wrists and face, pruritus and arthralgias 3 months after a sojourn of 30 d in Benin, a country she had already visited the year before. She sought medical attention only 3 months later. The patient’s general condition was good. On examination, she presented swelling of her hands and wrists, pruritus, dyspnoea and wheezing; neither lymphadenopathy nor hepatosplenomegaly was detected. She had takeri no drug in the previous 6 months and did not report a history of allergic diathesis. Radiography of the chest showed a diffuse reticular infiltrative pattern. The white blood cell (WBC) count was 46.6x1091L with absolute eosinonhilia (66.6% of the total WBC. absolute \ count=3 1 eosinophilsxl 09/L, confirmed in 2 consecutive counts); the immunoglobulin (Ig) E level was 1624.8 ,@L (normal value ~240 pg/L); IgG, was absent. Serological tests for Trichinella, Cysticercus, filariae and Toxocara, and stool examinations for Stron&oides stercoralis, ova and other parasites on 3 consecutive days were negative. Blood samples taken both at noon and at night, examined by MicroporeTM filtration and Giemsa staining followed by microscopy (MOODY, 1996), revealed Munsonella perstans microfilariae (1 OO/mL). Some eosinophilia is present in most cases of M. perstuns infection, but high-grade eosinophilia and tropical pulmonary eosinophiiia have not pr&iously been described. Mebendazole is the drug. of choice in the treatment of M. perstans filariasis, in a’ dose of 100 mg 2 to 3 times daily for 28-45 d (VAN HOEGAERDEN et al., 1987). Neither diethylcarbamazine (DEC) nor ivermectin is effective (OTTESEN & CAMPBELL. 1994: McMAHON
& SIMON~EN,
1996).
Our patient refused to take mebendazole, because she had experienced unpleasant side effects (abdominal pain and diarrhoea) while taking the drug for the treatment of taeniasis a few years before. Therefore, we ad-
AND
HYGIENE
(1997) 91,221
221
ministered albendazole, 400 mg twice daily for 45 d. Albendazole has a broad spectrum of antiparasitic activity, and is very effective in the treatment of intestinal nematode infection; its use in the treatment of filariasis is debated. The drug’s activitv is nredominantlv macrofilaricidal (ZAHNER-& SCH.&&. 1993), and little is known about its microfilaricidal properties. Even if albendazole did not kill all microfilariae of Onchocherca voZvuZus,it reduced microfilarial densities over one year, probably by interfering with embryogenesis (CLINE et al., 1992). The patient rapidly improved. She did not complain of arthralgias, swellings, cough, dyspnoea or wheezing any longer. Eosinophil and IgE levels declined to normal values. Radiographs of the chest returned to normal. Microfilaraemia decreased slowly and, since we still found rare microfilariae (YmL) after 30 d of treatment, we decided to administer a second cycle of albendazole after 2 weeks of rest. No side effect of the drug was recorded. Subsequently, examination of blood films on several occasions revealed no microfilaria, and, after 11 months of follow-up, the patient is well and microfilariae have never again been detected. We suggest that albendazole, in a high dose and for a prolonged period of time (at least 2 cycles of 400 mg twice daily for 45 d, followed by 14 d of rest) can be effective for the treatment of M. perstans filariasis, and it deserves to be evaluated in a large number of patients. References Cline, B. L., Hernandez, J. L., Mather, F. J., Bartholomew, R., De Maza, S. N., Rodulfo, S., Welborn, C. A., Eberhard, M. L. & Co&it. T. i1992). Aibendazole in the treatment ofonchocerciasis: double&lind clinical trial in Venezuela. American Journal of Tropical Medicine and Hygiene, 41, 5 12-520. McMahon, J. E. & Simonsen, l? E. (1996). Filariases. In: Manson’s Tropical Diseasese, 20th edition, Cook, G. C. (editor). London: W. B. Saunders Company,.pp. 1321-1368‘. Moody, A. H. (1996). Laboratory diagnosis. In: Munson’s Tropical Diseases, 20th edition, Cook, G. C. (editor). London: W. B. Saunders Company, pp. 1737-1749. Ottesen, E. A. & Campbell, W. C. (1994). Ivermectin in human medicine. Journal of Antimicrobial Chemotherapy, 34, 195-203. Van Hoegaerden, M., Ivanoff, B., Flocard, F., Salle, A. & Chabaud, B. (1987). The use of mebendazole in the treatment of glariases die to Loa loa and Mansonella perstans. Annals of Tropical Medicine and Parasitology, 81, 275-282. Zahner, H. & Schares, G. (1993). Experimental chemotherapy of filariasis: comparative evaluation of the efficacy of filaritidal compounds in Mastomys coucha infected with Litomosoides carinii, Acanthocheilonema vitae, Brugia malayi and B. pahangi. Acta Tropica, 52,221-226. Received 10 October 1996; accepted for publication tober 1996
16 Oc-
OFTHE
1 Short Report Albendazole Mansonella
ROYAL
SOCIETY
OFTROPICAL
MEDICINE
1
for the treatment perstans filariasis
of
Filippo Biglino’
Lipanil, Pietro Caramellol, Albert0 and Claudia Sacchi2 lAmedeo di Savoia Hospital for Infectious Diseases, Torino, Italy; 21nstitute of Internal Keywords:
zole
Medicine,
Torino,
Italy
filariasis, Mansonella perstuns, treatment, albenda-
A 29 years old Italian woman developed cough, wheezing, dyspnoea, transient swelling of wrists and face, pruritus and arthralgias 3 months after a sojourn of 30 d in Benin, a country she had already visited the year before. She sought medical attention only 3 months later. The patient’s general condition was good. On examination, she presented swelling of her hands and wrists, pruritus, dyspnoea and wheezing; neither lymphadenopathy nor hepatosplenomegaly was detected. She had takeri no drug in the previous 6 months and did not report a history of allergic diathesis. Radiography of the chest showed a diffuse reticular infiltrative pattern. The white blood cell (WBC) count was 46.6x1091L with absolute eosinonhilia (66.6% of the total WBC. absolute \ count=3 1 eosinophilsxl 09/L, confirmed in 2 consecutive counts); the immunoglobulin (Ig) E level was 1624.8 ,@L (normal value ~240 pg/L); IgG, was absent. Serological tests for Trichinella, Cysticercus, filariae and Toxocara, and stool examinations for Stron&oides stercoralis, ova and other parasites on 3 consecutive days were negative. Blood samples taken both at noon and at night, examined by MicroporeTM filtration and Giemsa staining followed by microscopy (MOODY, 1996), revealed Munsonella perstans microfilariae (1 OO/mL). Some eosinophilia is present in most cases of M. perstuns infection, but high-grade eosinophilia and tropical pulmonary eosinophiiia have not pr&iously been described. Mebendazole is the drug. of choice in the treatment of M. perstans filariasis, in a’ dose of 100 mg 2 to 3 times daily for 28-45 d (VAN HOEGAERDEN et al., 1987). Neither diethylcarbamazine (DEC) nor ivermectin is effective (OTTESEN & CAMPBELL. 1994: McMAHON
& SIMON~EN,
1996).
Our patient refused to take mebendazole, because she had experienced unpleasant side effects (abdominal pain and diarrhoea) while taking the drug for the treatment of taeniasis a few years before. Therefore, we ad-
AND
HYGIENE
(1997) 91,221
221
ministered albendazole, 400 mg twice daily for 45 d. Albendazole has a broad spectrum of antiparasitic activity, and is very effective in the treatment of intestinal nematode infection; its use in the treatment of filariasis is debated. The drug’s activitv is nredominantlv macrofilaricidal (ZAHNER-& SCH.&&. 1993), and little is known about its microfilaricidal properties. Even if albendazole did not kill all microfilariae of Onchocherca voZvuZus,it reduced microfilarial densities over one year, probably by interfering with embryogenesis (CLINE et al., 1992). The patient rapidly improved. She did not complain of arthralgias, swellings, cough, dyspnoea or wheezing any longer. Eosinophil and IgE levels declined to normal values. Radiographs of the chest returned to normal. Microfilaraemia decreased slowly and, since we still found rare microfilariae (YmL) after 30 d of treatment, we decided to administer a second cycle of albendazole after 2 weeks of rest. No side effect of the drug was recorded. Subsequently, examination of blood films on several occasions revealed no microfilaria, and, after 11 months of follow-up, the patient is well and microfilariae have never again been detected. We suggest that albendazole, in a high dose and for a prolonged period of time (at least 2 cycles of 400 mg twice daily for 45 d, followed by 14 d of rest) can be effective for the treatment of M. perstans filariasis, and it deserves to be evaluated in a large number of patients. References Cline, B. L., Hernandez, J. L., Mather, F. J., Bartholomew, R., De Maza, S. N., Rodulfo, S., Welborn, C. A., Eberhard, M. L. & Co&it. T. i1992). Aibendazole in the treatment ofonchocerciasis: double&lind clinical trial in Venezuela. American Journal of Tropical Medicine and Hygiene, 41, 5 12-520. McMahon, J. E. & Simonsen, l? E. (1996). Filariases. In: Manson’s Tropical Diseasese, 20th edition, Cook, G. C. (editor). London: W. B. Saunders Company,.pp. 1321-1368‘. Moody, A. H. (1996). Laboratory diagnosis. In: Munson’s Tropical Diseases, 20th edition, Cook, G. C. (editor). London: W. B. Saunders Company, pp. 1737-1749. Ottesen, E. A. & Campbell, W. C. (1994). Ivermectin in human medicine. Journal of Antimicrobial Chemotherapy, 34, 195-203. Van Hoegaerden, M., Ivanoff, B., Flocard, F., Salle, A. & Chabaud, B. (1987). The use of mebendazole in the treatment of glariases die to Loa loa and Mansonella perstans. Annals of Tropical Medicine and Parasitology, 81, 275-282. Zahner, H. & Schares, G. (1993). Experimental chemotherapy of filariasis: comparative evaluation of the efficacy of filaritidal compounds in Mastomys coucha infected with Litomosoides carinii, Acanthocheilonema vitae, Brugia malayi and B. pahangi. Acta Tropica, 52,221-226. Received 10 October 1996; accepted for publication tober 1996
16 Oc-