Immune response in a symptomatic case of Tetrapetalonema perstans infection

The immune response in a 49-year-old Italian nun affected by Tetrapetalomena (Dipetalonema) perstans following an eight-year stay in Cameroon is reported. On admission the patient presented with polyarthralgia, conjunctival pruritus and irritation, oedema of the limbs, generalized itching, hypereosinophilia and low total IgE titre. During diethylcarbamazine treatment and, subsequently, during mebendazole administration, an exacerbation of her symptoms was observed. At the same time, activation of the alternative complement pathway and the appearance of circulating immune complexes were noted, suggesting a type III hypersensitivity reaction. Circulating immune complexes and diethylcarbamazine-induced release of parasitic antigens may also be considered responsible for the decrease of OKT3 and OKT4 positive lymphocytes.