Imported Mansonella perstans infection in Spain
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Abstract
Background: Mansonella perstans infection can be considered one of the most neglected tropical infectious diseases. Very few studies have reported on the clinical picture caused by infection with this nematode. Therefore, our study was aimed to describe the clinical patterns and treatment of imported M. perstans infection by migrants from Africa. Methods: The present study evaluated a large cohort of migrants who have been diagnosed, examined and treated for imported M. perstans infection at a Spanish reference center (Hospital Carlos III Tropical Medicine Unit, Madrid, Spain) over a 19-year period. Most patients voluntarily attend the emergency unit or are referred from primary care or general hospitals in Madrid. Chi-square test was used to compare the association between categorical variables. The continuous variables were compared by Student’s t- test or the Mann–Whitney test. The corresponding regression models were used for multivariate analysis. Results: Five hundred three cases of migrants from tropical and subtropical areas with M. perstans infection were identified. Two hundred sixty-four patients were female (52.5%). The mean age (± SD) was 44.6 ± 18.2 years (range: 16–93 years). The mean time (± SD) between the arrival in Spain and the first consultation was 8.6 ± 18.0 months. The major origin of the patients was Equatorial Guinea (97.6%). Regarding the clinical picture, 257 patients were asymptomatic (54.7%) and 228 were symptomatic (45.3%); 190 patients had pruritus (37.8%), 50 (9.9%) had arthralgia, 18 patients had Calabar-like swelling (3.6%), and 15 (3%) had abdominal pain. Four hundred forty-two (87.9%) migrants had hyper-IgE, and 340 (67.6%) had eosinophilia. One hundred ninety-five patients had coinfections with other filarial nematodes (38.8%), and 308 migrants had only M. perstans infection (61.2%). Four hundred thirty-seven cases (86.9%) had been treated with anti-filarial drugs; 292 cases were treated with one anti-filarial drug, and 145 cases were treated with combined anti-filarial therapy. Additionally, 20 (4%) cases received steroids and 38 (7.6%) cases received antihistamines. Conclusions: A long series of M. perstans infections is presented in sub-Saharan immigrants whose data indicate that it should be included in the differential diagnosis in patients with pruritus or analytical alterations such as eosinophilia or hyper-IgE presentation, and they also have a high number of coinfections with other microorganisms whose treatment needs to be protocolized.
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Mebendazole alone or in combination with DEC is currently acknowledged as the most effective antiparasitic treatment to treat M. perstans infection.
“Thus, mebendazole alone [238] or in combination with DEC is currently acknowledged as the most effective antiparasitic treatment to treat M. perstans infection [237].”
From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [238]
The Introduction (page not provided) says no standard treatment exists, and the Discussion says M. perstans is relatively resistant to both DEC and mebendazole while describing doxycycline as effective. Although Table 3 reports healing in all three patients given DEC plus mebendazole, the paper does not acknowledge that combination as the most effective treatment and cautions that its treatment-effectiveness conclusions are weak. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredGranulocytopenia, alopecia, pruritus, skin abscess, and arthritis were reported in patients treated with high doses of mebendazole.
“Granulocytopenia, alopecia, pruritus, skin abscess, and arthritis were reported in patients treated with high doses of mebendazole [36,238,327].”
From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [238]
The Results (Treatment and outcome, Table 3; page not available) report adverse effects in 9 of 267 patients given mebendazole alone, but do not identify those effects as granulocytopenia, alopecia, pruritus, skin abscess, or arthritis. The Results (Clinical and laboratory data; page not available) list pruritus and arthralgia as clinical manifestations of infection, not as effects reported after high-dose mebendazole. (LLM, conf=0.85)
Experimental — accuracy not yet measuredM. perstans is the most important and most difficult species to treat and is relatively resistant to standard antifilarial agents, including DEC, ivermectin, albendazole, and mebendazole.
“M. perstans is the most important and most difficult species to treat [237] and relatively resistant to standard antifilarial agents, including DEC, ivermectin, albendazole, and mebendazole [238]”
From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [238]
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- Authors
- Puente, S., Lago, M., Subirats, M., Sanz-Esteban, I., Arsuaga, M., Vicente, B., Alonso-Sardon, M., Belhassen-Garcia, M., & Muro, A.
- Affiliations
- Hospital Universitario La Paz (ES)
- Universidad Europea de Madrid (ES)
- Universidad de Salamanca (ES)
- Venue
- Infectious Diseases of Poverty
- Published
- 2020-07-23
- Volume
- 9
- Issue
- 1
- Pages
- 105-105
- ISSN
- 2049-9957 (ISSN-L)
- PMC
- PMC7376953
- OpenAlex
- W3045202313
- Cited by
- 23
- References
- 26
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 8 · 2022: 6 · 2021: 2 · 2020: 1
- FWCI
- 0.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Infectious Diseases of Poverty (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Gredos (University of Salamanca) (publishedVersion, cc-by)
- Hispana (publishedVersion, cc-by)
- ABACUS. Repositorio de Producción Científica (Universidad Europea) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Parasitic Diseases Research and Treatment
- Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Research on Leishmaniasis Studies
- Keywords
- Mansonella perstans, imported parasitic infection, filarial nematodes, African immigrants, Equatorial Guinea, clinical features, hyper-IgE syndrome, eosinophilia, co-infection, pruritus, Calabar swelling, neglected tropical diseases, Spain, Madrid, travel medicine, antihistamines, corticosteroids
- MeSH terms
- Communicable Diseases, Imported, Adolescent, Adult, Africa, Aged, Aged, 80 and over, Animals, Antiparasitic Agents, Female, Humans, Male, Mansonella, Mansonelliasis, Middle Aged, Spain, Transients and Migrants, Treatment Outcome, Young Adult
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