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Prevalence of Loa Loa and Mansonella Perstans Detection in Urban Areas of Southeast Gabon

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Prevalence of Loa Loa and Mansonella Perstans Detection in Urban Areas of Southeast Gabon Vol. 12(2), pp. 44-51, July-December 2020 DOI: 10.5897/JPVB2020.0390 Article Number: 29A046465474 ISSN: 2141-2510 Copyright ©2020 Journal of Parasitology and Author(s) retain the copyright of this article http://www.academicjournals.org/JPVB Vector Biology Full Length Research Paper Prevalence of Loa loa and Mansonella perstans detection in urban areas of Southeast Gabon Eyang-Assengone Elsa Rush1, Roland Dieki2, Mvoula Odile Ngounga3, Antoine Roger Mbou Moutsimbi2, Jean Bernard Lekana-Douki2 and Jean Paul Akue2* 1Department of Tropical Infectiology, Ecole Doctorale Régionaled‟ Afrique Centrale, Franceville, Gabon. 2Department of Parasitology, Interdisciplinary Center for Medical Research of Franceville, Franceville, Gabon. 3Department of Health, Ministry of National Defense, Gabon. Received 19 May 2020 Accepted 20 October 2020 Loa loa and Mansonella perstans are two filarial species commonly found in Gabon loiasis has gained attention because of severe adverse events occurring in individuals harboring very high L. loa microfilarial loads after treatment with ivermectin. However, most studies were carried out in rural areas. This work aimed at the study of the prevalence of filarial infections in different urban areas of southeast Gabon. The cross-sectional survey was conducted between May and December 2018 in Franceville, Moanda, and Mvengue. Participants provided written informed consent, a questionnaire to collect data on demographics and related clinical signs (ocular passage of the worm, Calabar swelling, and pruritus). Blood was collected to search for filarial infections. Plasma and blood pellets were separated after centrifugation. The plasma was used for detection of specific IgG4 by ELISA. In total, 545 were samples collected, the overall prevalence of filarial infection in the three cities was 4.77% (95% CI: 3.06–7.97). The prevalence of L. loa infection was 4.59% (95% CI: 3.05–6.79), and 0.18% (95% CI: 0.01–1.18) for M. perstans. The prevalence of ocular passage of the worm, Calabar swelling and pruritus was 27.71% (95% CI: 24.03–31.07), 17.98% (95% CI: 17.90–24.52) and 48.99% (95% CI: 44.72– 53.27), respectively. The overall prevalence of specific IgG4 producers was 15.60% (95% CI: 12.71– 19.98). There was no correlation between the density of microfilaremia and ocular passage of the worm (p=0.074), but there was a correlation with Calabar swelling (p=0.0005) and between the level of IgG4 subclass and microfilaremic status (p=0.001). This study reveal that the prevalence of L. loa and Mansonella perstans was low in these urban areas, compared with that in rural areas of the same region which was 20.4% for L. loa and 10.2% for M. perstans. These results suggest a different pattern of filarial infection between rural and urban areas. Keywords: Prevalence, Loa loa, M. perstans, urban area, specific IgG4 INTRODUCTION Gabon is located in an area in which filariasis is endemic. Loa loa, Onchocerca volvulus, Mansonella perstans, *Corresponding author. E-mail: [email protected]. Tel: +24166274162. Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License Eyang-Assengone et al. 45 Mansonella streptocerca, and Mansonella rodhaini have (Boussinesq, 2006). In contrast to L.loa, which seems to endemic foci in Gabon (Zouré et al., 2011). The most be found only in central Africa and in some west African prevalent filarial worms in Gabon are L. loa and M. countries, M. perstans is widely spread in many countries perstans (Akue et al., 2011). Loiasis is endemic in heavily and is endemic in a large part of sub-Saharan Africa as forested areas of Central Africa, including Cameroon, the well as in South America (Simonsen et al., 2011). Democratic Republic of the Congo (DRC), Gabon, and However, few studies have been carried out on M. Nigeria (Richardson et al., 2012). In Gabon, the perstans filaria. Although very prevalent, the potential prevalence of L. loa infection is greater than 20% (Zouré consequences of the infection by this filarial parasite are et al., 2011). The parasite is transmitted to humans by not well known. Attenuated anemia and a tabanids belonging to the genus Chrysops: Chrysops proinflammatory response were shown to be associated dimidiata and Chrysops silacea. Weather transformission with M. perstans infection (Housseini et al. 2012). has great effect on vectors and vector borne diseases Hyper-eosinophilia caused by M. perstans (Fux et al., having potential effect (Sumbria and Singla, 2017). They 2006) and the intraocular localization of M. perstans have are blood sucking flies mainly found in high trees of rainy also been reported (Bregani et al., 2002). In a study in forests (Ratmanov and Mediannikov, 2013). Loiasis Uganda the pattern of microfilaremia M. perstans and causes a variety of disease symptoms such as Calabar clinical manifestations were analyzed (Asio et al., 2009). swelling, the migration of the adult worm under the bulbar This study suggested that the host's regulatory responses conjunctiva, and pruritus. It is estimated that more than are downregulated in M. perstans infections. 10 million people in Africa have loiasis (Saito et al., Furthermore, most of the reports on both filariae are 2015). L. loa infection has attracted considerable based on rural populations, with no study performed on attention in the context of onchocerciasis control the pattern of the filarial transmissions in urban areas. In programs (Mischlinger et al., 2018) owing to the serious this era of mass control of parasitic diseases, information side effects associated with the use of ivermectin and/or on the prevalence and the distribution of filarial parasites diethylcarbamazine as a mass treatment to eliminate is necessary for an appropriate planning strategy. The onchocerciasis and lymphatic filariasis in endemic areas objective of the present research was to study the (Boussinesq and Gardon, 1997). Because of the co- prevalence of Loa loa and M. perstans in different cities endemicity, administration of anthelmintic drugs requires of the southeast of Gabon. great caution especially in patients with loiasis and particularly in individuals with a high load of L. loa microfilaria. It is now accepted that the most effective MATERIALS AND METHODS drugs for L. loa infection are not safe for heavily infected Study area individuals (>30,000 microfilariae per milliliter of blood), and the safer ones are not completely effective Sampling was carried out in three different urban areas of Haut- (Mogoung-Wafo et al., 2019). A study conducted (Akue et Ogooué province: Mvengue, Franceville, and Moanda (Figure 1). al., 2011) on the epidemiology of concomitant infection Haut-Ogooué is in the southeast of Gabon. The geographic region due to L. loa and M. perstans in Gabon showed that there of the three cities is characterized by isolated areas of savannah and forest. is a spatial relationship between the prevalence and intensity of parasitemia in populations living in rural areas. In fact, rural environments in Gabon, are Study population characterized by low levels of urbanization: There are no hospitals but only dispensaries, no road, and houses are The study was conducted from May to July 2018 and October to surrounded by forest and/ or savannah. The principal December 2018 depending on the availability of individual (Holiday, etc.). Blood was collected during day time between 10 a.m. to 2 activities are field work for women and fishing and p.m. A cross-sectional survey was carried out among citizens of hunting for men, food is cooked with fire wood. All these Franceville, Moanda, and Mvengue. In order to determine the conditions, are favorable for the development of period prevalence of L. loa and M. perstans, a probability sampling infectious diseases. In 2017, a study carried outin rural technique using a stratified sampling method was carried out department of Tsamba-Magotsi, located in the central among civil servant from the three cities. The size of the sample was determined according to the formula n=P(100p) Z2/E2.. With P part of Gabon, found that the environment is afflicted by as the percentage of occurrence of the L. loa and M. perstans the burden of infectious diseases, in particular malaria microfilaria determined during a previous survey in the area (Akue and neglected tropical diseases (Manego et al., 2017). et al., 2011); E is the percentage maximum error required and Z the Microfilaria of L. loa and M. perstans were the most value corresponding to the level of confidence. Each person who prevalent parasitic infections affecting the local agreed to participate was assigned a code number and was population (Manego et al., 2017). Furthermore, the interviewed. All volunteers, including the guardians of all children, provided written, individual informed consent. The National Ethics prevalence of L. loa microfilaremia varies from country to Committee of Gabon (PROT N00001/20/6/3/SG/CNE) approved the country (Boussinesq and Gardon, 1997) as well as within project for this research. The rationale and objective of the study a country and even within a given geographic area were explained and a one-page questionnaire was administered to 46 J. Parasitol. Vector Biol. Figure 1. Study site in Gabon, showing the different sampling areas in the province of Haut Ogooue (Moanda, Mvengué, and Franceville).Departments in which the three study sites are located are shown. The map was created using ArcGIS (ArcMap v10.3). all participants. The reliability of the questionnaire was assumed Parasitological analyses following the procedure developed for the RAPLOA method (Zouré et al., 2011). The question on a history of eye worm was: „„Have A systematic analysis was initiated by direct examination of a 10-µl you ever experienced or noticed worms moving in your eye or sample of blood under an optical microscope, followed by a under the eyelid?” The questions on Calabar swellings and pruritus concentration technique.
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