Mansonella perstans is a vector-borne human filarial nematode, transmitted by tiny bloodsucking flies called .

Mansonella perstans is one of two filarial nematodes that cause Serous Cavity Filariasis in humans. The other filarial nematode is Mansonella ozzardi. Mansonella perstans is in many parts of Sub-Saharan Africa, parts of Central and South America, and the Caribbean. with other filarial parasites such as Wuchereria bancrofti, Brugia malayi, and Loa loa, Mansonella infections are . However, the pathogenicity of M. perstans infection has been recently in . These studies have that M. perstans has the to a of clinical features, including angioedema Calabar-like , , fever, headache, high eosinophilia, and abdominal pain. The overall disability among populations in regions where filariae are endemic has been difficult to determine because of high rates of co-infeciton with other filariae and the non-specificity of M. perstan infections. Furthermore, treatment of M. perstans is challenging because the most anti-filarial drugs such as ivermectin, Diethylcarbamazine and albendazole are not effective. The optimal treatment for M. perstans infection still remains . Most current studies are focused on 1) co-infection of M. perstans with other filarial parasites and 2) the study of Wolbachia bacteria as endosymbionts in M. perstans and other filarial parasites.

Clinical Presentation in Humans

While Mansonella infections are often asymptomatic, they can be with angioedema (similar to Calabar swellings of loaisis) , fever, headaches, arthralgia(it is a symptom of injury, infection, illnesses or an allergic reaction to [4] medication.[3]), and . Eosinophilia, headache, fever or abdominal pain may also be present. M. perstans may also present with a condition known as Kampala, or Ugandan eye worm.[5] This occurs when adult worms of M. perstans invade the conjunctiva or periorbital connective tissues in the eye. This condition was first attributed to M. perstans in Uganda, when six patients presented with nodules in the conjunctiva. [5] The adult worms were identified as adult female M. perstans in five out of these six cases. The symptoms of M. perstans may be confounded with those of other filarial infections such as onchocerciasis, lymphatic filariasis and loiasis, because co-infection often occurs. [6]

Life cycle
Step 1: During a blood meal, an infected midge (Culicoides grahami and C. austeni) introduces third-stage (L3) filarial larvae onto the skin of the human host, where they penetrate into the bite wound . It is likely that the body temperature activates the larva and prompts it to leave the vector and actively penetrate the skin. Step 2: The third-stage larvae develop into adults that live in body cavities , most commonly the pleural and peritoneal cavities. They also can live in mesentery , peri-renal spaces, retroperitoneal spaces or the pericardium

 and mature into adults. The pericardium is the fluid filled sac that surrounds the heart and the proximal ends of the aorta, vena cava, and the pulmonary artery. Step 3: Adults in the body cavities mate and produce unsheathed and subperiodic microfilariae that reach the blood stream. The microfilariae can also be found in the cerebrospinal fluid. While the periodicity of these midges has been unclear, the most recent study suggests that microfilariae indicate a weak but significant diurnal periodicity with a peak around 8 am.[10] Step 4: A Culicoides midge ingests microfilarae during a blood meal. Step 5: After ingestion, the microfilariae migrate from the midges midgut through the hemocoel to the thoracic muscles of the midge. In the thoracic muscles, the microfilariae develop into firststage larvae (L1). Step 6: They subsequently develop into third-stage larvae, which are infective. Step 7: The third stage larvae migrate to the midges proboscis Step 8: Third-stage larvae can infect another human when the midge takes a blood meal.[4]