The effects of Mansonella perstans infections on concomitant mycobacterial infections and BCG vaccination efficacy in Ghana, Cameroon, and Benin

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Mansonella perstans (M. perstans) is one of the most prevalent parasites in sub-Saharan Africa with estimated 100 million infected individuals in endemic regions. Children and adolescents are infected early by this nematode species. Although Mansonellosis itself may be less relevant for public health issues because of its asymptomatic or mild clinical picture, M. perstans can modulate or impede immunity against concomitant infections (co-infections). Initial studies from Ghana indicate co-infections of M. perstans in children with Buruli ulcer disease (BUD). Since essential Wolbachia endosymbionts were detected in these M. perstans isolates, co-infected individuals are susceptible to antibiotic treatment. These observations form the basis for the proposed epidemiological, clinical, and immunological studies performed by five partner institutions from Ghana, Benin, Cameroon, and Germany (Düsseldorf and Bonn). We address the questions whether immune polarization due to co-infection with M. perstans affects i) susceptibility to mycobacterial diseases (i.e. BUD, Tuberculosis (TB), ii) disease course and recovery of BUD/TB, and iii) BCG vaccination efficacy in children. Doxycycline-mediated deworming of M. perstans infected healthy adolescents will be applied to determine the influence co-infections on anti-mycobacterial immunity. Finally, we aim to improve diagnosis by establishing and implementing PCR-based and serological methods. In this regard a crucial factor will be establishment of an M. perstans animal model to identify specific antigens of adult worms. The expected results of this project may have crucial implications for public health politics in M. perstans endemic countries. Major efforts will be undertaken to catalyze interactions between African and German partners including technology transfer and capacity building. This will improve ongoing and facilitate future collaborations between researchers with different cultural and linguistic background from sub-Saharan Africa.