1
TRANSACTIONS OFTHE ROYAL SOCIETY OFTROPICAL MEDICINE AND HYGIENE (1998) 92,459 459 Decrease in Mansonella perstans microfilaraemia after albendazole treatment Thanh Hai Duongl, Maryvonne Kombila2, Alain Ferrerl*, Christophe Nguiri2 and Dominique Richard-Lenoble’ ‘Laboratoire de Parasitologic, My- cologie et M&?ecine Tropicale, Faculti de Midecine, 2 bis boulevard Tonne&, 37032 Tours cedex, France; 2Dt!partement de Parasitologic, Mycologic et Midecine Tropicale, Faculti de Midecine et Sciences de la Sank, BP 4009, Libreville, Gabon Keywords: filariasis, Mansonella perstans, chemotherapy, al- bendazole, Gabon Mansonella perstans filariasis is difficult to treat. VAN DEN ENDEN et al. (1992) found that albendazole (400 mg/d for 3-4 d) had no effect on 10 patients infected with M. perstans. More recently, LIPANI et al. (1997) treated one infected patient with 2 cycles of 400 mg of albendazole, given twice daily for 45 d, with a 14 d rest interval between them. They observed no microfilaria in the patient’s blood and the effect of the treatment per- sisted for 11 months. mia was expressed as the number of microfilariae per mL of blood. Student’s paired t test was used to analyse the data. The treatment was well tolerated; no side effect was observed either during or after treatment. Most of the clinical signs of M. perstuns infection disappeared rapid- ly after treatment, except for the itching, which persist- ed for 30 d in 4% of patients. It was difficult to monitor the treated patients be- cause some did not return for all (or any) consultations, resulting in a large fluctuation in the number of patients examined (Table). Patients were not generally amicro- filariaemic until 30 d after treatment. The percentage of amicrofilariaemic patients increased abruptly from day 30 to 50-70%. The low percentage on day 90 was prob- ably due to the small sample size. The microfilaraemia decreased from day 10 and the maximum count also de- creased with time (Table). The treatment success was evaluated as the decrease in microfilaraemia expressed as a percentage of the initial count. This decrease was slow-56.6% on day 10, 90.5% on day 60, and 86.6% on day 90 (PcO.05 compared with the initial count). Our results therefore showed that albendazole (400 mg twice daily) given for 10 d decreased M. perstans mi- crofilaraemia until at least 90 d after treatment. The fewer the number of doses of albendazole required, the easier it will be to use the drug in Africa. Nevertheless, the very high cost of the treatment makes it presently impossible to conduct a mass treatment campaign against M. perstans in endemic zones. This expensive treatment is reserved for use in western countries, where this filariasis is rarely found. Mass treatment of popula- Table. Treatment of Munsonella perstans infections with albendazole 0 10 Days after start of treatmenta 20 30 60 90 No. of patients 47 15 No. amicrofilaraemic Microfilaraemia (mf/mL)b 16.4(0.&371.8) 7.1( 1.00-60.0) 3.6(0.6-41.7) aAlbendazole 400 mg twice daily, starting on day 0. bGeometric mean (range in parentheses; mf=microfilariae). The present study was carried out in Libreville (Ga- bon), where 47 patients (27 women, 20 men, mean age 37.4 years, range 12-72) were recruited at the Facultk de Medecine. Pregnant or nursing women and children less than 12 years old were excluded. All the patients agreed to participate in the study. Initial clinical moni- toring concentrated mainly on looking for itching, local swelling, joint pain (arthralgesia) and skin eruptions. The number of M. perstans microfilariae in 5 mL sam- ples of venous blood taken from the forearm into anti- coagulant was determinated after lysis of the erythrocytes with saponin (PETITHORY et al., 1963). All the patients were given oral albendazole, 400 mg twice daily for 10 d, accompanied by an anti-histamine HI an- tagonist for the same period. The microfilariae were counted on the first day of treatment (day 0) and 10,20, 30, 60 and 90 d after treatment, and the microfilarae- tions infected by Mansonella in Africa must therefore in- evitably await a decrease in the number of doses required or the cost of the albendazole used. References Lipani, F., Caramello, P., Biglino, A. & Sacchi, C. (1997). Al- bendazole for the treatment of Mansonella perstans filariasis. Transactions of the Royal Society of Tropical Medicine and Hy- giene, 91,221. Petithory, J. & Ho Thi Sang (1963). Techniques de concentra- tion des microfilaires sanguicoles. Bulletin de la Socitk de Pathologic Exotique, 56, 197-206. Van den Enden, E., Van Gompel, A., Vervoort, T., Van Der Stuyft, I? & Van den Ende, J. (1992). Mamonella perstans filariasis: failure of albendazole treatment. Annales de la So- cit!d Belge de Mkdecine Tropicale, 72,2 15-2 18. Received 10 March 1998; revised 15 April 1998; accepted for publication 1.5 April 1998 *Author for correspondence.

Decrease in Mansonella perstans microfilaraemia after albendazole treatment

Embed Size (px)

Citation preview

Page 1: Decrease in Mansonella perstans microfilaraemia after albendazole treatment

TRANSACTIONS OFTHE ROYAL SOCIETY OFTROPICAL MEDICINE AND HYGIENE (1998) 92,459 459

Decrease in Mansonella perstans microfilaraemia after albendazole treatment

Thanh Hai Duongl, Maryvonne Kombila2, Alain Ferrerl*, Christophe Nguiri2 and Dominique Richard-Lenoble’ ‘Laboratoire de Parasitologic, My- cologie et M&?ecine Tropicale, Faculti de Midecine, 2 bis boulevard Tonne&, 37032 Tours cedex, France; 2Dt!partement de Parasitologic, Mycologic et Midecine Tropicale, Faculti de Midecine et Sciences de la Sank, BP 4009, Libreville, Gabon

Keywords: filariasis, Mansonella perstans, chemotherapy, al- bendazole, Gabon

Mansonella perstans filariasis is difficult to treat. VAN DEN ENDEN et al. (1992) found that albendazole (400 mg/d for 3-4 d) had no effect on 10 patients infected with M. perstans. More recently, LIPANI et al. (1997) treated one infected patient with 2 cycles of 400 mg of albendazole, given twice daily for 45 d, with a 14 d rest interval between them. They observed no microfilaria in the patient’s blood and the effect of the treatment per- sisted for 11 months.

mia was expressed as the number of microfilariae per mL of blood. Student’s paired t test was used to analyse the data.

The treatment was well tolerated; no side effect was observed either during or after treatment. Most of the clinical signs of M. perstuns infection disappeared rapid- ly after treatment, except for the itching, which persist- ed for 30 d in 4% of patients.

It was difficult to monitor the treated patients be- cause some did not return for all (or any) consultations, resulting in a large fluctuation in the number of patients examined (Table). Patients were not generally amicro- filariaemic until 30 d after treatment. The percentage of amicrofilariaemic patients increased abruptly from day 30 to 50-70%. The low percentage on day 90 was prob- ably due to the small sample size. The microfilaraemia decreased from day 10 and the maximum count also de- creased with time (Table). The treatment success was evaluated as the decrease in microfilaraemia expressed as a percentage of the initial count. This decrease was slow-56.6% on day 10, 90.5% on day 60, and 86.6% on day 90 (PcO.05 compared with the initial count).

Our results therefore showed that albendazole (400 mg twice daily) given for 10 d decreased M. perstans mi- crofilaraemia until at least 90 d after treatment. The fewer the number of doses of albendazole required, the easier it will be to use the drug in Africa. Nevertheless, the very high cost of the treatment makes it presently impossible to conduct a mass treatment campaign against M. perstans in endemic zones. This expensive treatment is reserved for use in western countries, where this filariasis is rarely found. Mass treatment of popula-

Table. Treatment of Munsonella perstans infections with albendazole

0 10 Days after start of treatmenta

20 30 60 90

No. of patients 47 15 No. amicrofilaraemic Microfilaraemia (mf/mL)b 16.4(0.&371.8) 7.1( 1.00-60.0) 3.6(0.6-41.7)

aAlbendazole 400 mg twice daily, starting on day 0. bGeometric mean (range in parentheses; mf=microfilariae).

The present study was carried out in Libreville (Ga- bon), where 47 patients (27 women, 20 men, mean age 37.4 years, range 12-72) were recruited at the Facultk de Medecine. Pregnant or nursing women and children less than 12 years old were excluded. All the patients agreed to participate in the study. Initial clinical moni- toring concentrated mainly on looking for itching, local swelling, joint pain (arthralgesia) and skin eruptions. The number of M. perstans microfilariae in 5 mL sam- ples of venous blood taken from the forearm into anti- coagulant was determinated after lysis of the erythrocytes with saponin (PETITHORY et al., 1963). All the patients were given oral albendazole, 400 mg twice daily for 10 d, accompanied by an anti-histamine HI an- tagonist for the same period. The microfilariae were counted on the first day of treatment (day 0) and 10,20, 30, 60 and 90 d after treatment, and the microfilarae-

tions infected by Mansonella in Africa must therefore in- evitably await a decrease in the number of doses required or the cost of the albendazole used.

References Lipani, F., Caramello, P., Biglino, A. & Sacchi, C. (1997). Al-

bendazole for the treatment of Mansonella perstans filariasis. Transactions of the Royal Society of Tropical Medicine and Hy- giene, 91,221.

Petithory, J. & Ho Thi Sang (1963). Techniques de concentra- tion des microfilaires sanguicoles. Bulletin de la Socitk de Pathologic Exotique, 56, 197-206.

Van den Enden, E., Van Gompel, A., Vervoort, T., Van Der Stuyft, I? & Van den Ende, J. (1992). Mamonella perstans filariasis: failure of albendazole treatment. Annales de la So- cit!d Belge de Mkdecine Tropicale, 72,2 15-2 18.

Received 10 March 1998; revised 15 April 1998; accepted for publication 1.5 April 1998

*Author for correspondence.