BackgroundMansonellosis was first reported in Ghana by Awadzi in the 1990s. Co-infections of Mansonella perstans have also been reported in a small cohort of patients with Buruli ulcer and their contacts. However, no study has assessed the exact prevalence of the disease in a larger study population. This study therefore aimed to find out the prevalence of M. perstans infection in some districts in Ghana and to determine the diversity of Culicoides that could be potential vectors for transmission.MethodsFrom each participant screened in the Asante Akim North (Ashanti Region), Sene West and Atebubu Amantin (Brong Ahafo Region) districts, a total of 70 μl of finger prick blood was collected for assessment of M. perstans microfilariae. Centre for Disease Control (CDC) light traps as well as the Human Landing Catch (HLC) method were used to assess the species diversity of Culicoides present in the study communities.ResultsFrom 2,247 participants, an overall prevalence of 32% was recorded although up to 75% prevalence was demonstrated in some of the communities. Culicoides inornatipennis was the only species of Culicoides caught with the HLC method. By contrast, C. imicola (47%), C. neavei (25%) and C. schultzei (15%) were caught by the CDC light trap method. A wide diversity of other Culicoides spp. was also identified but correlation was only found between the prevalence of C. inornatipennis and M. perstans during the dry season.ConclusionsHere we demonstrate for the first time that M. perstans is highly prevalent in three districts in Ghana. We found a wide spectrum of Culicoides spp. Culicoides inornatipennis was the most anthropophilic and is therefore likely to be the species responsible for transmission of infection but formal proof has yet to be obtained.Trial registration NCT02281643. Registered October 26, 2014. ‘Retrospectively registered’. Trial Registry: ClinicalTrials.gov.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-016-1960-0) contains supplementary material, which is available to authorized users.

. Treating Mansonella perstans is challenged by the low efficacy of registered antihelminthics. Wolbachia endobacteria provide an alternative treatment target because depletion results in amicrofilaremia in filarial infections with Wuchereria bancrofti and Onchocerca volvulus infections. This open-label, randomized study sought to confirm that i) Wolbachia are present in M. perstans in Ghana and ii) doxycycline treatment will deplete Wolbachia and cause a slow, sustained decline in microfilariae (MF). Two hundred and two Ghanaians with M. perstans infection were randomized into early (immediate) and delayed (6 months deferred) treatment groups, given doxycycline 200 mg/day for 6 weeks, and monitored for MF and Wolbachia levels at baseline, 4, 12, and 24 months after the study onset (= time of randomization and start of treatment for the early group). Per protocol analysis revealed that the median MF/mL in the early group declined from 138 at baseline to 64 at month 4 and further to 0 at month 12. In the delayed group, MF load did not change from a baseline median of 97 to 102 at month 4 but declined to 42 at month 12, that is, 6 months after receiving treatment, trailing the early group as expected. By month 24, both treatment groups had reached a median MF level of 0. After treatment, Wolbachia were depleted from MF by ≥ 1-log drop compared with baseline levels. We conclude that M. perstans in Ghana harbor Wolbachia that are effectively depleted by doxycycline with subsequent reduction in MF loads, most likely because of interruption of fertility of adult worms.

Background Culicoides (Diptera; Ceratoponidae) are tiny, stout, blood-sucking flies with a near worldwide distribution. When present, they are often considered a biting nuisance but in addition, they are involved in the transmission of pathogens to humans, domestic and wild animals. Data on Culicoides species in the South-West region of Cameroon dates back to the 1950s. Over the decades, ecological transformation due to agriculture and deforestation may have affected the population dynamics of Culicoides and therefore our study provides an update of their bio-ecology in the region. Furthermore, the role of various Culicoides species in the transmission of parasitic filariae of the genus Mansonella remains inconclusive in this region. This study was designed to address these unknown issues and expand on current scientific knowledge. Results Eight species of Culicoides ( C. bedfordi , C. inornatipennis , C. fulvithorax , C. grahamii , C. imicola , C. milnei , C. neavei and C. kumbaensis ) were collected using light traps and human baits. Culicoides grahamii was the most abundant species, followed closely by C. milnei . Three species ( C. milnei , C. grahamii and C. inornatipennis ) were common in all observed larval development sites. Only four species ( C. inornatipennis , C. fulvithorax , C. grahamii and C. milnei ) were collected on humans. Anthropophilic species were more abundant ( P < 0.001) in the evening (4–7 pm) when compared to the morning collections (6–9 am). After overnight fly collections using a drop trap with a human microfilaremic donor, C. milnei emerged as the potential host for transmitting Mansonella perstans . Substantial heterogeneity was observed between the trap visiting cycles of the various species ( P < 0.001). The biting cycle of the main vector, C. milnei , showed two peaks (10–11 pm and 4–5 am), the highest being 10–11 pm. Conclusions The Culicoides fauna of the South-West region of Cameroon has not changed significantly since the 1950s. Culicoides milnei was demonstrated to be the major vector of M. perstans in this part of Cameroon. It is essentially a nocturnal species which peaks in abundance bet...

Background Lymphatic filariasis (LF) causes chronic morbidity, which usually manifests as lymphedema or hydrocele. Mass drug administration (MDA) began in Kassena Nankana East Municipal (KNEM) and Nabdam, two hotspot districts in the Upper East Region in Ghana, in 2000 and 2005, respectively. This cross-sectional study evaluated the impact of 15 years of MDA on the control of LF as determined by circulating filarial antigen (CFA) and microfilariae assessment in the KNEM and the Nabdam districts. Methodology/Principal findings A total of 7,453 participants from eight sub-districts in the two hotspot districts (KNEM: N = 4604; Nabdam: N = 2849) were recruited into the study. The overall CFA prevalence as determined by the FTS was 19.6% and 12.8% in the KNEM and Nabdam districts, respectively. Manyoro, a sub-district on the border with Burkina Faso, recorded the highest CFA prevalence of 26% in the KNEM. Assessment of microfilariae and Og4C3 antigen was done from 1009 (KNEM: N = 799 (79.2%); Nabdam: N = 210 (20.8%)) randomly selected FTS-positive (N = 885) and FTS-negative (N = 124) individuals. The Og4C3 antigen was found in 22.6%/23.0% of the selected individuals (KNEM/Nabdam), whereas the night blood revealed microfilariae in only 0.7%/0.5%. Conclusions/Significance Using the WHO endorsed FTS, CFA prevalence exceeded the long-standing <2% threshold—which may need revision and validation. Surprisingly, the Og4C3 ELISA showed positive results in only about one-fifth of the FTS positive samples. However, even this result would not have met the <2% CFA criteria for LF elimination. In contrast, projections from the microfilariae results revealed a halt in LF transmission. The global elimination target was due in 2020 but has been extended to 2030 since this could not be met. Focused MDA intervention intensification on seasonal migrants and non-compliers, and implementation of alternative treatment strategies may suffice for the elimination of the disease.

Background Onchocerciasis is the world’s second leading cause of infectious blindness and a major public health problem in many parts of the world, including Ghana, with severe impact on the skin also. Mass drug administration (MDA) with ivermectin began in the Sefwi Akontombra district of the Western North Region of Ghana in 1994. The aim of this cross-sectional study was to evaluate the impact of about three decades of MDA on onchocerciasis and its clinical manifestations by investigating the current nodule and microfilaria (MF) prevalence in the Sefwi Akontombra district using established protocols. Methodology This cross-sectional study had participants examined for signs of dermal/skin onchocerciasis and palpated, and those with ≥ 1 palpable sub-cutaneous nodule had skin snips taken from the left and right iliac crests for later parasitological (microfilariae) assessment. Logistic regression models were used to identify independent predictive and risk factors significantly associated with nodule and MF prevalence. Results A total of 1980 participants from 25 communities in three sub-districts were recruited. Compliance to the MDA intervention in the district was 93.7%. The study recorded Onchocerca nodule prevalence of 35.4% (N = 701), out of which 31.5% (N = 221) were MF positives, with district community microfilariae load (CMFL) and geometric mean intensity of 0.25 MF/ss and 0.26 MF/ss respectively. Adawu, the central community among the 25 surveyed recorded the highest CMFL (0.77 MF/ss)— with 14 communities being hypoendemic and 11, mesoendemic for the onchocerciasis infection. The overall estimated district onchocerciasis MF prevalence was 11.2%, making the district hypoendemic. Of the 17 participants who presented with dermal symptoms, acute papular onchodermatitis (41.2%) was the most prevalent. Age, ivermectin intake and gender were the independent predictive factors significantly associated (p < 0.05) with onchocerciasis in the district. Conclusion Despite decades of ivermectin administration in the district, the MF prevalence in the district was > the 1% threshold required for elimination. As the focus of the Ghana Onchocerciasis Control Programme has changed from control to elimination, MDA should be intensified in areas with MF prevalence > 1%. Though the district’s CMFL was far below the 5.0 MF/ss public health problem threshold, macrofilaricidal drugs should be explored to complement the microfilaricidal ivermectin.

BackgroundOnchocerciasis is the world’s second leading cause of infectious blindness and a major public health problem in many parts of the world, including Ghana, with severe impact on the skin also. Mass drug administration (MDA) with ivermectin began in the Sefwi Akontombra district of the Western North Region of Ghana in 1994. The aim of this cross-sectional study was to evaluate the impact of about three decades of MDA on onchocerciasis and its clinical manifestations by investigating the current nodule and microfilaria (MF) prevalence in the Sefwi Akontombra district using established protocols. MethodologyThis cross-sectional study had participants examined for signs of dermal/skin onchocerciasis and palpated, and those with ≥1 palpable sub-cutaneous nodule had skin snips taken from the left and right iliac crests for later parasitological (microfilariae) assessment. Logistic regression models were used to identify independent predictive and risk factors significantly associated with nodule and MF prevalence.ResultsA total of 1980 participants from 25 communities in three sub-districts were recruited. Compliance to the MDA intervention in the district was 93.7%. The study recorded Onchocerca nodule prevalence of 35.4% (N=701), out of which 31.5% (N=221) were MF positives, with district community microfilariae load (CMFL) and geometric mean intensity of 0.25 MF/ss and 0.26 MF/ss respectively. Adawu, the central community among the 25 surveyed recorded the highest CMFL (0.77 MF/ss)— with 14 communities being hypoendemic and 11, mesoendemic for the onchocerciasis infection. The overall estimated district onchocerciasis MF prevalence was 11.2%, making the district hypoendemic. Of the 17 participants who presented with dermal symptoms, acute papular onchodermatitis (41.2%) was the most prevalent. Age, ivermectin intake and gender were the independent predictive factors significantly associated (p<0.05) with onchocerciasis in the district.ConclusionDespite decades of ivermectin administration in the district, the MF prevalence in the district was > the 1% threshold required for elimination. As the focus of the Ghana Onchocerciasis Control Programme has changed from control to elimination, MDA should be intensified in areas with MF prevalence >1%. Though the district’s CMFL was far below the 5.0 MF/ss public health problem threshold, macrofilaricidal drugs should be explored to complement the microfilaricidal ivermectin.