Mansonella perstans - the forgotten filaria.

Mansonella perstans is the most prevalent human filarial parasite, infecting over 100 million people worldwide. Despite its wide distribution, it remains one of the most neglected parasitic infections, largely due to its asymptomatic clinical presentation and the difficulty in isolating adult worms. These factors have limited our understanding of its biology, including lifespan, reproductive behaviour, and migration patterns. Its strong immunomodulatory capacity can impair host immunity, increase susceptibility to coinfections, and reduce vaccine efficacy. This, combined with the lack of efficacy of single-dose ivermectin, underscores the urgent need for new treatment strategies. Encouragingly, recent advances in drug development, diagnostics, molecular tools, and experimental models are beginning to bridge key knowledge gaps, offering new insights into transmission dynamics, host-parasite interactions, and therapeutic options.