The search for better treatment strategies for mansonellosis: an expert perspective.

Introduction: Four species of the genus infect millions of people across sub-Saharan Africa and Central and South America. Most infections are asymptomatic, but mansonellosis can be associated with nonspecific clinical manifestations such as fever, headache, arthralgia, and ocular lesions (); pruritus, arthralgia, abdominal pain, angioedema, skin rash, and fatigue ( and perhaps sp. 'DEUX'); and pruritic dermatitis and chronic lymphadenitis ().

Areas Covered: We searched the PubMed and SciELO databases for publications on mansonelliasis in English, Spanish, Portuguese, or French that appeared until 1 May 2023. Literature data show that anthelmintics - single-dose ivermectin for , repeated doses of mebendazole alone or in combination with diethylcarbamazine (DEC) for , and DEC alone for - are effective against microfilariae. Antibiotics that target endosymbionts, such as doxycycline, are likely to kill adult worms of most, if not all, species, but the currently recommended 6-week regimen is relatively impractical. New anthelmintics and shorter antibiotic regimens (e.g. with rifampin) have shown promise in experimental filarial infections and may proceed to clinical trials.

Expert Opinion: We recommend that human infections with species be treated, regardless of any apparent clinical manifestations. We argue that mansonellosis, despite being widely considered a benign infection, may represent a direct or indirect cause of significant morbidity that remains poorly characterized at present.