TRANSACTIONS OFTHE ROYAL SOCIETY OFTROPICAL MEDICINE AND HYGIENE (1997) 91,221 221

1 Short Report 1

Albendazole for the treatment of Mansonella perstans filariasis

Filippo Lipanil, Pietro Caramellol, Albert0 Biglino’ and Claudia Sacchi2 lAmedeo di Savoia Hospital for Infectious Diseases, Torino, Italy; 21nstitute of Internal Medicine, Torino, Italy

Keywords: filariasis, Mansonella perstuns, treatment, albenda- zole

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 lat- er. The patient’s general condition was good. On exam- ination, she presented swelling of her hands and wrists, pruritus, dyspnoea and wheezing; neither lymphaden- opathy nor hepatosplenomegaly was detected. She had takeri no drug in the previous 6 months and did not re- port 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 ab- solute eosinonhilia (66.6% of the total WBC. absolute \ count=3 1 eosinophilsxl 09/L, confirmed in 2 consecu- tive counts); the immunoglobulin (Ig) E level was 1624.8 ,@L (normal value ~240 pg/L); IgG, was ab- sent. 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), re- vealed Munsonella perstans microfilariae (1 OO/mL).

Some eosinophilia is present in most cases of M. per- stuns infection, but high-grade eosinophilia and tropical pulmonary eosinophiiia have not pr&iously been de- scribed. Mebendazole is the drug. of choice in the treat- ment 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 ivermec- tin is effective (OTTESEN & CAMPBELL. 1994: McMA- HON & 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 treat- ment of taeniasis a few years before. Therefore, we ad-

ministered albendazole, 400 mg twice daily for 45 d. Albendazole has a broad spectrum of antiparasitic activ- ity, 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 macro- filaricidal (ZAHNER-& SCH.&&. 1993), and little is known about its microfilaricidal properties. Even if al- bendazole 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 nor- mal values. Radiographs of the chest returned to nor- mal. Microfilaraemia decreased slowly and, since we still found rare microfilariae (YmL) after 30 d of treat- ment, we decided to administer a second cycle of alben- dazole 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 micro- filariae 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 ef- fective for the treatment of M. perstans filariasis, and it deserves to be evaluated in a large number of patients.

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Received 10 October 1996; accepted for publication 16 Oc- tober 1996