| prognosis = Generally good with treatment; can become chronic if untreated
| frequency =
| frequency = Endemic in parts of [[Central Africa]] and [[South America]]
| deaths =
| deaths = Rare
}}
}}
'''Acanthocheilonemiasis''' is a rare [[tropical disease|tropical infectious disease]] caused by a [[parasite]] known as ''[[Acanthocheilonema perstans]]''. It can cause [[skin rashes]], [[abdominal pain|abdominal]] and [[chest pain]]s, [[muscle pain|muscle]] and [[joint pain]]s, [[neurological disorders]] and skin lumps. It is mainly found in [[Africa]]. The parasite is transmitted through the bite of [[Fly|small flies]]. Studies show that there are elevated levels of [[white blood cells]].
'''Acanthocheilonemiasis''' is a [[parasitic disease]] caused by infection with the filarial worm ''Acanthocheilonema perstans''. This disease is part of a group of infections known as [[filarial diseases]], which are caused by nematodes (roundworms) of the order [[Spirurida]]. These parasites are transmitted to humans through the bites of infected [[insect vectors]], primarily [[biting midges]] of the genus ''Culicoides''.
Acanthocheilonemiasis belongs to a group of parasitic diseases known as filarial disease ([[nematode]]), all of which are classified as [[Neglected Tropical Diseases]].<ref name=":0">{{Cite web|url=http://www.webhealthnetwork.com/disease/9-2651/acanthocheilonemiasis-perstans|title=Acanthocheilonemiasis Perstans - Diseases & Condition - Web Health Network|website=www.webhealthnetwork.com|access-date=2016-04-13}}</ref><ref name=":1">{{Cite journal|last=Simonsen|first=Paul E.|last2=Onapa|first2=Ambrose W.|last3=Asio|first3=Santa Maria|date=2011-09-01|title=Mansonella perstans filariasis in Africa|url=|journal=Acta Tropica|series=The Diagnostics and Control of Neglected Tropical Helminth Diseases|volume=120, Supplement 1|pages=S109–S120|doi=10.1016/j.actatropica.2010.01.014|pmid=20152790|doi-access=free}}</ref> Filarial disease results when microfilariae, which are nematode larvae, reach the [[lymphatic system]]; microfilariae reside in the serous cavities of humans. They have a five-stage life cycle that includes birth to thousands of live microfilariae within the host (i.e. human body), and then translocation via blood meal to the dermis layer of the skin. It is here that microfilariae cause major symptoms, which are edema and thickening of the skin and underlying connective tissues. It can also cause [[skin rashes]], [[Abdominal pain|abdominal]] and [[chest pain]]s, [[Muscle pain|muscle]] (myalgia) and [[joint pain]]s, [[neurological disorders]] and skin lumps. In addition, it causes spleen and liver enlargement, which is called [[hepatosplenomegaly]]. Studies show elevated levels of leukocytes, or white blood cells, which is referred to as [[eosinophilia]]. It is mainly found in [[Africa]]. The parasite is transmitted through the bite of small flies (''A. coliroides'').<ref name=":0" /><ref name=":2">{{Cite web|url=http://rarediseases.org/rare-diseases/acanthocheilonemiasis/|title=Acanthocheilonemiasis - NORD (National Organization for Rare Disorders)|website=NORD (National Organization for Rare Disorders)|language=en-US|access-date=2016-04-13}}</ref>
==Transmission==
The primary mode of transmission of acanthocheilonemiasis is through the bite of an infected [[biting midge]]. When a midge carrying the infective larvae bites a human, the larvae are deposited on the skin and enter the body through the bite wound. Once inside the host, the larvae migrate to subcutaneous tissues where they mature into adult worms.
== Symptoms ==
==Life Cycle==
Generally speaking, acanthocheilonemiasis does not show initial [[symptoms]]. However, if symptoms do arise, it is typically in individuals who are visiting highly infected areas rather than natives to those areas. A major common laboratory finding is an increase in specialized white blood cells, which is called eosinophilia.<ref name=":2" />
The life cycle of ''Acanthocheilonema perstans'' involves both a human host and an insect vector. Adult worms reside in the subcutaneous tissues of the human host, where they produce microfilariae. These microfilariae circulate in the bloodstream and are ingested by a biting midge during a blood meal. Inside the midge, the microfilariae develop into infective larvae, which are then transmitted to another human host when the midge feeds again.
Other symptoms include itchy skin, neurological symptoms, abdominal and chest pain, muscle pain, and swelling underneath the skin. If there are abnormally high levels of [[white blood cells]], then a [[physical examination]] will most likely find an enlarged spleen or liver.<ref name=":2" />
==Symptoms==
In many cases, acanthocheilonemiasis is asymptomatic, meaning that infected individuals do not exhibit noticeable symptoms. However, when symptoms do occur, they may include:
* [[Skin rashes]]
* [[Itching]]
* [[Swelling]] of the skin
* [[Joint pain]]
* [[Fever]]
In certain scenarios, nematodes may physically lodge into the chest or abdomen, resulting in an inflammation. Diagnosis of this condition usually occurs via a blood smear examination under light microscopy.<ref name=":2" />
The symptoms are generally mild, but in some cases, they can lead to more significant discomfort and complications.
==Diagnosis==
==Diagnosis==
Absolute [[eosinophilia]] in immigrants that is correlated with parasitic diseases that may go undiagnosed. Absolute eosinophilia is clinically diagnosed as >0.45×10<sup>9</sup> eosinophilic leucocytes/L of peripheral blood.<ref name=":5" /> Recent studies suggest that around 60% of children with relative eosinophilia contracted this via parasitic infections. Relative eosinophilia is different from absolute because relative refers to an increase in percentage of white blood cells (i.e. leukocytes) due to a loss of blood plasma; where as absolute eosinophilia is purely an increase in white blood cell production.<ref>{{Cite web|url=http://www.uptodate.com/contents/approach-to-the-patient-with-unexplained-eosinophilia|title=Approach to the patient with unexplained eosinophilia|website=www.uptodate.com|access-date=2016-04-13}}</ref> Of those with relative eosinophilia, 40% were undiagnosed until these studies.<ref name=":5" /> Therefore, there is a great need for thorough parasitological studies in this area of tropical infectious diseases.<ref name=":5" />
Diagnosis of acanthocheilonemiasis is typically made by identifying the presence of microfilariae in the blood. A blood sample is taken from the patient and examined under a microscope. The microfilariae of ''Acanthocheilonema perstans'' have distinctive morphological features that allow for their identification.
== Treatments ==
==Treatment==
The standard of care is administration of antifilarial drugs, most commonly [[Ivermectin]] or [[Diethylcarbamazine|diethyl-carbamazine]] (DEC). The most efficacious dose in all nematode and parasitic infections is 200 μg/kg of [[ivermectin]].<ref>{{Cite journal|last=Sebire|first=Simon J|last2=Jago|first2=Russell|last3=Fox|first3=Kenneth R|last4=Page|first4=Angie S|last5=Brockman|first5=Rowan|last6=Thompson|first6=Janice L|date=2011-09-30|title=Associations between children's social functioning and physical activity participation are not mediated by social acceptance: a cross-sectional study|journal=The International Journal of Behavioral Nutrition and Physical Activity|volume=8|pages=106|doi=10.1186/1479-5868-8-106|issn=1479-5868|pmc=3195695|pmid=21961734}}</ref> There has also been other various anthelminthic drugs used, such as [[mebendazole]], [[levamisole]], [[albendazole]] and [[Tiabendazole|thiabendazole]].<ref name=":1" /><ref>{{Cite journal|last=Bregani|first=E. R.|last2=Rovellini|first2=A.|last3=Tarsia|first3=P.|date=2003-12-01|title=Effects of thiabendazole in Mansonella perstans filariasis|journal=Parassitologia|volume=45|issue=3–4|pages=151–153|issn=0048-2951|pmid=15267104}}</ref> In worst-case scenarios, surgery may be necessary to remove nematodes from the abdomen or chest. However, mild cases usually do not require treatment.<ref name=":2" />
Treatment of acanthocheilonemiasis involves the use of antiparasitic medications. The drug of choice is usually [[diethylcarbamazine]] (DEC), which is effective in reducing the number of microfilariae in the blood. In some cases, [[ivermectin]] may also be used. Treatment regimens may vary depending on the severity of the infection and the presence of any complications.
== Epidemiology ==
==Prevention==
Acanthocheilonemiasis is caused by the parasite, ''mansonella perstans.'' ''M. perstans'' is primarily found in central Africa and in some areas of [[South America]], therefore the most affected populations are located in these areas. Acanthocheilonemiasis affects humans in these areas in equal numbers.<ref name=":2" /> The prevalence of this condition does significantly increase with age.<ref name=":3">{{Cite journal|last=Mourembou|first=Gaël|last2=Fenollar|first2=Florence|last3=Lekana-Douki|first3=Jean Bernard|last4=Mbiguino|first4=Angelique Ndjoyi|last5=Nzondo|first5=Sydney Maghendji|last6=Matsiegui|first6=Pierre Blaise|last7=Manego|first7=Rella Zoleko|last8=Ehounoud|first8=Cyrille Herve Bile|last9=Bittar|first9=Fadi|title=Mansonella, including a Potential New Species, as Common Parasites in Children in Gabon|url=http://dx.plos.org/10.1371/journal.pntd.0004155|journal=PLOS Neglected Tropical Diseases|volume=9|issue=10|doi=10.1371/journal.pntd.0004155|pmc=4618925|pmid=26484866|pages=e0004155|year=2015}}</ref> Furthermore, the parasite is most commonly found in areas of tropical forests with alternating swamps and open ground.<ref name=":3" />
Preventive measures for acanthocheilonemiasis focus on reducing exposure to the insect vectors. These measures include:
* Using insect repellent on exposed skin
* Wearing long-sleeved clothing and pants to minimize skin exposure
* Installing screens on windows and doors to keep insects out
* Using bed nets treated with insecticide
Approximately 114 million people in Africa are infected with ''M. perstans'', including 33 sub-Saharan African countries. Recent studies focused on Gabon specifically, where febrile and tropical diseases are common.<ref name=":1" /><ref name=":3" /> Contrary to popular recent suggestions, ''M. perstans'' does not influence the emergence of febrile diseases, including [[HIV]], [[tuberculosis]], [[bacteremia]], and [[malaria]].<ref name=":1" /> In general, [[hemoglobin]] levels in individuals with malaria are severely reduced from that of a healthy individual. Reduced levels occur because the malaria parasite, ''[[Plasmodium falciparum]],'' utilizes human hemoglobin as its major energy source.<ref>{{Cite journal|vauthors=Goldberg DE, Slater AF, Cerami A, Henderson GB |date=12 April 2016|title=Hemoglobin degradation in the malaria parasite Plasmodium falciparum: an ordered process in a unique organelle |journal=Proc Natl Acad Sci USA |pmc=53807 |pmid=2183218 |volume=87 |pages=2931–5|doi=10.1073/pnas.87.8.2931}}</ref> Filariasis, in combination with severe malaria, actually shows higher hemoglobin levels than in severe malaria alone.<ref name=":3" /><ref>{{Cite journal|vauthors=Dolo H, Coulibaly YI, Dembele B, Konate S, Coulibaly SY, Doumbia SS, Soumaoro L, Coulibaly ME, Diakite SA, Guindo A, Fay MP, Metenou S, Nutman TB, Kilion AD |date=2012|title=Filariasis attenuates anemia and proinflammatory responses with clinical malaria: a matched prospective study in children and young adults|url=|journal=PLoS Negl Trop Dis|doi=10.1371/journal.pntd.0001890|pmid=23133692|volume=6|page=e1890|pmc=3486872}}</ref> In addition, ''M. perstans'' did not have adverse effects on those with HIV, as there were actually higher levels of CD4 in HIV patients co-infected with ''M. perstans''.<ref name=":3" /><ref>{{Cite journal|last=Brown|first=Michael|last2=Kizza|first2=Moses|last3=Watera|first3=Christine|last4=Quigley|first4=Maria A.|last5=Rowland|first5=Samantha|last6=Hughes|first6=Peter|last7=Whitworth|first7=James A. G.|last8=Elliott|first8=Alison M.|date=2004-11-15|title=Helminth infection is not associated with faster progression of HIV disease in coinfected adults in Uganda|journal=The Journal of Infectious Diseases|volume=190|issue=10|pages=1869–1879|doi=10.1086/425042|issn=0022-1899|pmid=15499545|doi-access=free}}</ref> Further research in this area may allude to clinical manifestations of this infectious disease, as there could be possible benefits by contracting ''M. perstans''.
==Epidemiology==
Acanthocheilonemiasis is primarily found in tropical regions of [[Africa]] and [[South America]]. The distribution of the disease is closely linked to the habitat of the biting midges that serve as vectors. Areas with high humidity and dense vegetation are particularly conducive to the proliferation of these insects.
Tropical and sub-tropical regions are the main areas affected by nematodes and parasitic worms, which often causes filariasis.<ref name=":2" /> Around 20% of immigrants to [[Spain]] are children from these regions.<ref name=":5">{{Cite journal|last=Belhassen-García|first=Moncef|last2=Pardo-Lledias|first2=Javier|last3=Pérez Del Villar|first3=Luis|last4=Muro|first4=Antonio|last5=Velasco-Tirado|first5=Virginia|last6=Muñoz Bellido|first6=Juan Luis|last7=Vicente|first7=Belén|last8=Blázquez de Castro|first8=Ana|last9=Cordero-Sánchez|first9=Miguel|date=2016-01-09|title=Should parasitic disease be investigated in immigrant children with relative eosinophilia from tropical and sub-tropical regions?|journal=Paediatrics and International Child Health|pages=1–4|doi=10.1080/20469047.2015.1109802|issn=2046-9055|pmid=26750778}}</ref>
==Related pages==
* [[Filarial diseases]]
== History ==
* [[Parasitic diseases]]
The clinical manifestations of ''A. perstans'' were first discovered in [[London]] in the blood of a patient from [[West Africa]] in 1890. The parasite was originally called ''Filaria sanguinis hominis minor'' because it was similar to another microfilariae, except smaller. Microfilariae are small larvae that have the ability to enter the body's circulation. ''Filaria sanguinis hominis minor'' is now called ''Filaria perstans,'' which was established by the [[International Commission on Zoological Nomenclature]].<ref name=":1" />
* [[Vector-borne diseases]]
Since its discovery, Acanthocheilonemiasis has had several other names. It was first known as [[mansonelliasis]], which referred to an infectious disease of any of three parasite species, including ozzardi, perstans, and streptocerca that share similar life cycle characteristics. However, it is now widely accepted as ''M. perstans''.<ref name=":1" /> Other synonyms for acanthocheilonemiasis include: Dipetalonemiasis, ''Dipetalonema perstans'', ''Mansonalla perstans,'' and ''Acanthocheilonemiasis perstans''.<ref>{{Cite web|url=http://www.uofmhealth.org/health-library/nord114|title=Arthritis, Psoriatic {{!}} University of Michigan Health System|website=www.uofmhealth.org|access-date=2016-04-13}}</ref>
==Research==
[[Helminths|Parasitic worms]] and nematodes regulate many immune pathways of their host in order to increase their chances of survival.<ref name=":6">{{Cite journal|last=Al-Riyami|first=Lamyaa|last2=Harnett|first2=William|date=2012-03-01|title=Immunomodulatory properties of ES-62, a phosphorylcholine-containing glycoprotein secreted by Acanthocheilonema viteae|journal=Endocrine, Metabolic & Immune Disorders Drug Targets|volume=12|issue=1|pages=45–52|issn=2212-3873|pmid=22214333|doi=10.2174/187153012799278893}}</ref> For example, molecules secreted by ''Acanthocheilonema vitae'' actually limit host effective immune mechanisms. These molecules are called excretory-secretory products. An effective excretory-secretory product released from ''Acanthochelionema vitae'' is called ES-62, which can affect multiple immune system cell types. ES-62 has anti-inflammatory effects when subjected to mice.<ref name=":6" /> The anti-inflammatory effect occurs because of a phosphorylcholine (PC)-containing moiety and signal transduction. More research needs to be completed; however there is some evidence that ''Acanthocheilonema vitae'' may have anti-inflammatory effects, and should be researched further.<ref name=":6" />
Acanthocheilonemiasis is a parasitic disease caused by infection with the filarial worm Acanthocheilonema perstans. This disease is part of a group of infections known as filarial diseases, which are caused by nematodes (roundworms) of the order Spirurida. These parasites are transmitted to humans through the bites of infected insect vectors, primarily biting midges of the genus Culicoides.
The primary mode of transmission of acanthocheilonemiasis is through the bite of an infected biting midge. When a midge carrying the infective larvae bites a human, the larvae are deposited on the skin and enter the body through the bite wound. Once inside the host, the larvae migrate to subcutaneous tissues where they mature into adult worms.
The life cycle of Acanthocheilonema perstans involves both a human host and an insect vector. Adult worms reside in the subcutaneous tissues of the human host, where they produce microfilariae. These microfilariae circulate in the bloodstream and are ingested by a biting midge during a blood meal. Inside the midge, the microfilariae develop into infective larvae, which are then transmitted to another human host when the midge feeds again.
In many cases, acanthocheilonemiasis is asymptomatic, meaning that infected individuals do not exhibit noticeable symptoms. However, when symptoms do occur, they may include:
Diagnosis of acanthocheilonemiasis is typically made by identifying the presence of microfilariae in the blood. A blood sample is taken from the patient and examined under a microscope. The microfilariae of Acanthocheilonema perstans have distinctive morphological features that allow for their identification.
Treatment of acanthocheilonemiasis involves the use of antiparasitic medications. The drug of choice is usually diethylcarbamazine (DEC), which is effective in reducing the number of microfilariae in the blood. In some cases, ivermectin may also be used. Treatment regimens may vary depending on the severity of the infection and the presence of any complications.
Acanthocheilonemiasis is primarily found in tropical regions of Africa and South America. The distribution of the disease is closely linked to the habitat of the biting midges that serve as vectors. Areas with high humidity and dense vegetation are particularly conducive to the proliferation of these insects.
