Effect of Concomitant Mansonella Perstans Microfilaremia on Immune Responses Following Single Dose Praziquantel in People With Schistosomiasis
Effect of Concomitant Mansonella Perstans Microfilaremia on Immune Responses Following Single Dose Praziquantel in People With Schistosomiasis
Background:

 Schistosomiasis is a chronic infection. It is caused by parasitic worms called Schistosoma
 haematobium (Sh) that are spread by snails that live in rivers. It can lead to liver problems
 or bladder cancer. Praziquantel (PZQ) is a drug used to treat this infection. After taking
 it, some people develop increased resistance to reinfection with Sh. Some people with Sh
 infection can be infected with another worm called Mansonella perstans (Mp). Mp is spread
 through a biting insect called a midge. It rarely causes symptoms. However, researchers think
 that Mp infection could affect the body s response to PZQ treatment for or risk of
 reinfection with Sh.

 Objective:

 To find out the effects of Mp infection on the response to PZQ treatment for Sh infection.

 Eligibility:

 Men and women ages 14-80 who:

 -  Live in Tieneguebougou, Bougoudiana, or surrounding villages in Mali

 -  Are not pregnant

 -  Have Sh infection

 -  Have no other chronic medical conditions

 Design:

 -  Participants will be screened with:

 -  Medical history

 -  Physical exam

 -  Blood and urine tests

 -  Stool samples

 -  Participants will be treated with a single dose of PZQ by mouth.

 -  After receiving PZQ, participants will return to the clinic for blood and urine tests at
 the following times:

 -  4, 8, 24, 48, and 72 hours later

 -  5, 7, 9, and 14 days later

 -  1, 3, and 6 months later

 Participants who are infected with Sh at the 6-month visit will get another treatment with
 PZQ.

 ...
Chronic filarial infection is associated with downregulation of immune responses to both
 helminth and non-helminth antigens. Praziquantel (PZQ) treatment of schistosomiasis is
 associated with a dramatic interleukin-5 (IL-5)-dependent increase in eosinophilia that is
 correlated with resistance to reinfection. We hypothesize that chronic filarial infection
 with Mansonella perstans (Mp) may attenuate post-treatment eosinophilia and thus impact
 resistance to reinfection. To address the first part of this question, we plan to compare
 post-PZQ reactions and reinfection rates in 20 subjects with schistosomiasis and Mp infection
 to those in 20 subjects with schistosomiasis and no evidence of filarial infection in an area
 coendemic for both infections in Mali. Signs and symptoms, complete blood counts,
 intracellular and serum cytokine levels, and markers of eosinophil activation will be
 assessed at baseline, 4 and 8 hours, and 1, 2, 3, 5, 7, 9, and 14 days post-treatment and
 compared between the two treatment groups. Schistosoma haematobium reinfection rates will
 also be compared at 1, 3, and 6 months post-treatment.
-  INCLUSION CRITERIA (SCREENING):

 1. Male or non-pregnant female subjects

 2. Age 14-80 years (per participant self-report)

 3. Resident of Tienegubougou, Bougoudiana or surrounding villages

 5. Consent to a blood draw to screen for filarial infection and a urine exam to screen
 for schistosomiasis

 6. Must be willing to have blood samples stored.

 EXCLUSION CRITERIA (SCREENING):

 1. Known to be pregnant (by history)

 2. Chronic medical conditions, including but not limited to diabetes, renal or hepatic
 insufficiency, immunodeficiency, psychiatric disorder, seizure, that in the
 investigators judgments are deemed to be clinically significant

 3. History of hypersensitivity reaction to PZQ.

 4. Weight less than 20 kg

 INCLUSION CRITERIA (INTERVENTIONAL STUDY):

 1. S. haematobium infection documented at screening and within 14 days prior to the
 baseline visit

 2. The subject agrees to storage of samples for study.

 EXCLUSION CRITERIA (INTERVENTIONAL STUDY):

 1. Pregnancy (by urine beta-HCG)

 2. Chronic kidney or liver disease

 3. Hgb <10 mg/dL

 4. PZQ treatment since the screening visit

 5. Concomitant Schistosoma mansoni, Wuchereria bancrofti (Wb) or Onchocerca volvulus
 infection

 6. Use of immunosuppressive therapies, including steroids, within the past month

 7. Any condition that in the investigator s opinion places the subject at undue risk by
 participating in the study.

 EXCLUSION OF CHILDREN AND PREGNANT WOMEN:

 Pregnant women will be excluded from this study since it involves administration of
 medications contraindicated in pregnancy. Children less than 14 years old will be excluded
 because of the amount of blood required for the immunologic studies. The age of consent in
 Mali is 18 years of age, so children aged 14 to 17 years will sign an assent form in
 addition to the consent form to be signed by a parent or tutor. However, married women
 between the ages of 14 and 17 will sign consent as adults in view of the laws governing
 emancipation of women in Mali. Subjects who do not participate in this study will receive
 PZQ as part of the national schistosomiasis control program.

 Participation of Women:

 -Pregnancy: The effects of praziquantel on the developing human fetus are unknown
 (pregnancy category B). For this reason, females of

 childbearing-age must have a negative pregnancy test result prior to receiving
 praziquantel. Since the half-life of praziquantel is short (3-4 hours), contraceptive
 measures will not be required post-treatment.

 -Breast feeding: Praziquantel is known to be present in breast milk for up to 3 days
 following a single dose and is not approved for use in children under the age of 4 years.
 Consequently, women will be asked to suspend breastfeeding after treatment with PZQ for 3
 days. Formula will be provided for breastfed children affected by their mother s
 participation during this time to ensure adequate nutrition. Depending on the age of the
 child, formula may be given. A pediatric nurse will be present during this time to provide
 assistance and counsel to the mothers.