Filarial disease in the Brazilian Amazon and emerging opportunities for treatment and control

Cleudecir Siqueira Portela , Cláudia Patrícia Mendes de Araújo , Patrícia Moura Sousa , Carla Letícia Gomes Simão , João Carlos Silva de Oliveira , James Lee Crainey
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Abstract

Following the successful eradication of Wuchereria bancrofti, there are now just three species of conventional microfilaremic human filarial parasites endemic to the Brazilian Amazon region: Mansonella ozzardi, Mansonella perstans and Onchocerca volvulus. The zoonotic filarial parasite Dirofilaria immitis is also found in the Amazon region as are several sylvatic filarial parasites, some of which have been recorded causing zoonoses and some of which have never been recorded outside the region. Onchocerca volvulus is only found in the Amazonia onchocerciasis focus in the Brazilian state of Roraima where it affects the people of the Yanomami tribe living around the densely forested Venezuela border region. Mansonella ozzardi is by far the most common filarial parasite in Brazil and has a broad but patchy distribution throughout the western Amazon region. Recorded in the Brazilian states of Acre, Roraima, Matto Grosso, and within almost every municipality of Amazonas state, it is believed that pollution of the urban stream and river systems prevents the development of the simuliid vectors of M. ozzardi and explains the parasiteʼs reduced distribution within urban areas and an absence of recent reports from the state capital Manaus. Decades of WHO-led periodic ivermectin treatment of Yanomami tribeʼs people have resulted in the partial suppression of O. volvulus transmission in this focus and has also probably affected the transmission of M. ozzardi in the region. Mansonella perstans, O. volvulus and very probably M. ozzardi infections can all be treated and most likely cured with a 4–6-week treatment course of doxycycline. The Brazilian Ministry of Health does not, however, presently recommend any treatment for mansonellosis infections and thus parasitic infections outside the Amazonia focus are typically left untreated. While the long treatment courses required for doxycycline-based mansonellosis therapies preclude their use in control programmes, new fast-acting filarial drug treatments are likely to soon become available for the treatment of both onchocerciasis and mansonellosis in the Amazon region. Filarial disease management in the Brazilian Amazon is thus likely to become dramatically more viable at a time when the public health importance of these diseases is increasingly being recognized.

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巴西亚马逊河流域的丝虫病以及治疗和控制的新机遇
在成功根除班克罗非虫(Wuchereria bancrofti)之后,巴西亚马逊地区目前仅流行三种传统的微丝人类丝虫寄生虫:Mansonella ozzardi、Mansonella perstans 和 Onchocerca volvulus。亚马逊地区还发现了人畜共患的丝虫寄生虫--密螺旋体二螺旋体,以及几种鞘翅目丝虫寄生虫,其中一些已被记录为人畜共患寄生虫,另一些则从未在该地区以外出现过。盘尾丝虫只出现在巴西罗赖马州的亚马孙盘尾丝虫病重点地区,在那里,生活在森林茂密的委内瑞拉边境地区的雅诺马米部落的人们受到了盘尾丝虫的影响。Mansonella ozzardi 是迄今为止巴西最常见的丝虫寄生虫,广泛但零星地分布在亚马逊西部地区。据认为,城市溪流和河流系统的污染阻碍了 M. ozzardi 的蚋类媒介的发展,这也是该寄生虫在城市地区分布减少以及该州首府马瑙斯近期没有报告的原因。几十年来,世界卫生组织对雅诺玛米部落的人定期进行伊维菌素治疗,部分抑制了伏虫在该地区的传播,同时也可能影响了 M. ozzardi 在该地区的传播。只要服用强力霉素 4-6 周的疗程,就能治疗并很有可能治愈蠕虫曼森氏杆菌、伏虫和很有可能的奥扎尔德氏杆菌感染。不过,巴西卫生部目前并不建议对曼氏菌病感染进行任何治疗,因此亚马孙地区以外的寄生虫感染通常得不到治疗。以强力霉素为基础的曼森氏杆菌病疗法需要较长的疗程,因此无法用于控制计划,但新的速效丝虫药物疗法可能很快就会问世,用于治疗亚马逊地区的盘尾丝虫病和曼森氏杆菌病。因此,当人们越来越认识到这些疾病对公共卫生的重要性时,巴西亚马逊地区的丝虫病防治工作可能会变得更加可行。
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