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Am. J. Trop. Med. Hyg., 77(5), 2007, pp. 878-882
Copyright © 2007 by The American Society of Tropical Medicine and Hygiene

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Right arrow Onchocerciasis

No Depletion of Wolbachia from Onchocerca volvulus after a Short Course of Rifampin and/or Azithromycin

Frank O. Richards, Jr.*, Josef Amann, Byron Arana, George Punkosdy, Robert Klein, Carlos Blanco, Beatriz Lopez, Carlos Mendoza, Alfredo Domínguez, Jeannette Guarner, James H. Maguire, AND Mark Eberhard
Centers For Disease Control and Prevention, Atlanta, Georgia; Universidad del Valle, Guatemala City, Guatemala; Ministry Of Health, Guatemala City, Guatemala; Onchocerciasis Elimination Program for the Americas, The Carter Center, Guatemala City, Guatemala

Endosymbionic Wolbachia bacteria inside adult Onchocerca volvulus worms (causing river blindness) are necessary for female worm fertility. We evaluated whether rifampin and/or azithromycin used in a five-day course could kill Wolbachia. In an open-label trial in Guatemala, 73 patients with 134 palpable onchocercal nodules were randomized into four treatment groups: rifampin, azithromycin, a combination of the two drugs, and controls (multivitamins). After five days of antibiotic treatment, all participants received a single dose of ivermectin on day 6. Nine months after treatment, the nodules were removed and the worms were examined. Skin snips to determine microfilariae were obtained at baseline and nine months. There were no significant differences between any of the treatment groups in the condition of the worms in the nodules, the presence of Wolbachia surface protein, or the number of microfilariae in skin. Short courses with these antibiotics will not clear Wolbachia from O. volvulus.

Received July 20, 2007. Accepted for publication August 2, 2007.

Acknowledgments: We thank Pedro Mejia Chocho (health promoter) and Alberto Arreaga for assistance with the patients and in communications; Edy Vela Perez for help during the enrollment phase; the Guatemalan Ministry of Health, including Julio Castro, Victor Chocal, Walfred Cohon, Hector Santiago Garcia, Pedro Yax, Victor Manuel Maroquin, Miriam Pastor, Marco Julio Pietro, and Alturo Sanchez for assistance; Charles Knirsch for assistance in obtaining Zythromax® from Pfizer; Merck and Co. for providing ivermectin (Mectizan®); Jacquelin M. Roberts for assistance with the statistical analysis; Rosalyn Ajigbeda for help in preparing the manuscript; and Jeanine Bartlett for preparing histologic sections.

* Address correspondence to Frank O. Richards Jr., River Blindness Program, The Carter Center, 1 Copenhill Avenue, 453 Freedom Parkway, Atlanta, GA 30307. E-mail: frichards{at}cdc.gov

Authors’ addresses: Frank O. Richards, River Blindness Program, The Carter Center, 1 Copenhill Avenue, 453 Freedom Parkway, Atlanta, GA 30307, Telephone: 770–488–4511, Fax: 770–488–4532, E-mail: frichards{at}cdc.gov. Josef Amann, Centers for Infectious Disease, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop D69, Atlanta, GA 30333, E-mail: jamann{at}cdc.gov. Byron Arana, Robert Klein, Beatriz Lopez, and Carlos Mendoza, Universidad del Valle de Guatemala, 18 Avenida 11–95, Zona 15, V.H. 111, Guatemala City, Guatemala, Telephone: 502–2364–0336/40. George Punkosdy, Centers for Infectious Disease, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-22, Atlanta, GA 30341. Carlos Blanco, Ministro de Salud Publica y Asistencia Social, 6 Calle 3–45, Zona 11, Guatemala City, Guatemala. Alfredo Domínguez, Programa para la Eliminacion de la Oncocercosis en las Americas, 14 Calle 3–51, Zona 10, Edificio Murano Center, Oficina 1401, Ciudad de Guatemala 01010, Guatemala City, Guatemala, Telephone: 502–2366–6106/09, Fax: 502–2366–6127, E-mail: oepa{at}oepa.net. Jeannette Guarner, Centers for Infectious Disease, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop G32, Atlanta, GA 30333, E-mail: jguarner{at}cdc.gov. James H. Maguire, Centers for Infectious Disease, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-36, Atlanta, GA 30341. Mark Eberhard, Centers for Infectious Disease, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-22, Atlanta, GA 30341, E-mail: meberhard{at}cdc.gov.






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