Skip to content

Content

Home
Patient case
Patient Case: Perstans Filariasis

Patient Case: Perstans Filariasis

Discussion

A 42-year-old male farmer from a rural region in Sub-Saharan Africa presents to a local clinic with complaints of persistent fatigue, dizziness, and episodes of fainting over the past several months. He reports intermittent fever, night sweats, and significant weight loss. On examination, he has mild pallor, postural hypotension, and splenomegaly. Blood smears and laboratory tests reveal microfilaria with Loa loa ruled out. Further testing confirms Mansonella perstans infection.

Despite the absence of severe symptoms like lymphatic obstruction, the patient’s chronic fatigue and anemia significantly impact his daily activities. He started a course of appropriate antiparasitic therapy, along with iron supplementation for anemia, and advised on vector control measures to reduce reinfection risk.

Questions
  1. Which clinical symptom is most characteristic of Mansonella perstans infection in this patient?
    A) Lymphedema
    B) Persistent fatigue and anemia
    C) Skin nodules
    D) Hemoptysis
  2. What is the primary mode of transmission for Mansonella perstans?
    A) Mosquito bite
    B) Blackfly bite
    C) Tsetse fly bite
    D) Biting midges (Culicoides species)
  3. Why was Loa loa ruled out in this case?
    A) Absence of Calabar swellings and migratory eye worm
    B) Negative thick blood smear
    C) Negative antigen detection test
    D) Absence of eosinophilia
  4. What is the best initial approach to treatment for this patient?
    A) Albendazole alone
    B) Diethylcarbamazine (DEC)
    C) Doxycycline targeting Wolbachia symbionts
    D) Ivermectin and supportive care

 

Reveal answers

Answers

  1. Answer: B) Persistent fatigue and anemia
    • Mansonella perstans infection is often asymptomatic but can lead to chronic fatigue, anemia, and general malaise due to prolonged immune activation. Unlike Wuchereria bancrofti or Brugia malayi, it does not cause lymphedema (A). Skin nodules (C) are more characteristic of Onchocerca volvulus. Hemoptysis (D) is not a typical feature.
  2. Answer: D) Biting midges (Culicoides species)
    • Mansonella perstans is transmitted by Culicoides biting midges, which differ from the mosquito vectors (A) of Wuchereria bancrofti. Blackflies (B) are responsible for Onchocerca volvulus, and tsetse flies (C) transmit Trypanosoma brucei (sleeping sickness).
  3. Answer: A) Absence of Calabar swellings and migratory eye worm
    • Loa loa presents with transient Calabar swellings and adult worms migrating across the eye, which were not reported in this patient. A negative thick blood smear (B) does not completely rule out Loa loa, as periodicity may affect detection. Antigen tests (C) are not standard for Loa loa, and eosinophilia (D) is common but not specific.
  4. Answer: A) Albendazole alone
    • Albendazole is the preferred treatment for Mansonella perstans, as other antifilarial drugs like DEC (B) and ivermectin (D) have limited efficacy. Unlike Onchocerca and Wuchereria, M. perstans does not harbor Wolbachia, making doxycycline (C) ineffective. Supportive care, including iron for anemia, is also essential.

Are you a Medical Doctor?

Yes, I'm a Doctor
No, I'm not