Nanduri J, Kazura J W
Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
Clin Microbiol Rev. 1989 Jan;2(1):39-50. doi: 10.1128/CMR.2.1.39.
Human filarial infections afflict over 150 million persons worldwide and are major causes of morbidity in many developing countries. Onchocerca volvulus infection is a leading preventable cause of blindness, while bancroftian and brugian filariasis may produce lymphatic obstruction of the genitalia and extremities (elephantiasis). Definitive diagnosis of these helminthic infections currently depends on demonstration of microfilariae in host tissues, i.e., the skin in the case of O. volvulus and the bloodstream in the cases of Wuchereria bancrofti and Brugia malayi. Many investigations are now directed at developing specific and sensitive serum antigen assays that will allow diagnosis of active infection (i.e., presence of adult-stage parasites) in the absence of detectable microfilariae. With respect to the immunology of these parasitic infections, efforts are being directed at elucidating the role of T- and B-cell responses in the development of pathologic lesions and resistance to reinfection. These data as well as molecular biologic approaches to identify and study filarial molecules which are immunogenic are discussed. Finally, since treatment of filariases at present depends on antiparasitic drugs, the clinical indications and dosages of diethylcarbamazine and ivermectin are summarized.
人体丝虫感染在全球影响着超过1.5亿人，是许多发展中国家发病的主要原因。盘尾丝虫感染是可预防的主要致盲原因，而班氏丝虫病和马来丝虫病可导致生殖器和四肢的淋巴阻塞（象皮肿）。目前，这些蠕虫感染的确切诊断依赖于在宿主组织中发现微丝蚴，即盘尾丝虫病在皮肤中，班氏吴策线虫和马来布鲁线虫病在血液中。现在许多研究都致力于开发特异性和敏感性高的血清抗原检测方法，以便在无法检测到微丝蚴的情况下诊断活动性感染（即存在成虫期寄生虫）。关于这些寄生虫感染的免疫学，研究工作旨在阐明T细胞和B细胞反应在病理损伤发展及抵抗再感染中的作用。文中讨论了这些数据以及用于鉴定和研究具有免疫原性的丝虫分子的分子生物学方法。最后，由于目前丝虫病的治疗依赖于抗寄生虫药物，本文总结了乙胺嗪和伊维菌素的临床适应证和剂量。
