Clinical And Therapeutic Studies Of Human Filariasis and Related Diseases

National Institute Of Allergy And Infectious Diseases

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Abstract

Because the clinical expression of filarial infections in expatriates is significantly different from that in those exposed from birth to the parasite, we have continued to define more precisely the differences between travelers (or long term residents) and those native to filarial-endemic regions. Thus, we have collated our long-term data to demonstrate quite definitively the differences in both risk of acquisition of these infections as well as the clinical manifestations of infection. Our data suggest that eosinophil-mediated processes are responsible for many of the differences seen. We have done a similar retrospective study of a large number of patients with onchocerciasis that suggests that the skin dwelling O. volvulus drives responses in both temporary residents and those with lifelong exposure that are very different than what has been seen for the blood-borne filarial infections (Showler et al, AJTMH, 2018). Because of the severe post treatment reactions seen in loiasis, new methods of safer treatment have been sought. Unlike many of the other filarial infections Loa loa does not contain the intracellular Wolbachia endosymbiont. Thus, a Test and (Not) Strategy (TaNT) was devised and the newly discovered LoaScope was used to implement this strategy at a district-wide level in Cameroon. In the past year, we have been able to operationalize this approach (Kamgno et al, Int Health, 2018) and perform cost analysis that should provide a framework for using this throughout Central Africa (Lenk et al, Clin Infect Dis, 2019) Molecular diagnostic approaches have been used to identify new (or newly emerging) parasitic pathogens. In the past year, we have demonstrated that the metacestode Versteria was responsible for a disseminated human infection (Lehman et al, Emerg Infect Dis, 2019) and that zoonotic Ancylostoma ceylanicum was the most prevalent hookworm species affecting refugees from Myanmar and/or Thailand (OConnell et al, Emerg Infect Dis, 2018).