title: A bipolar disorder patient becoming asymptomatic after adjunctive anti-filiarasis treatment: a case report.
abstract: BACKGROUND
  Evidence suggests that neurotropic infectious agents might be involved in bipolar disorder. So far, few have been written for the association between parasitic infection and bipolar disorder. Filariasis is a parasitic disease acting ruthlessly via mosquitos and affecting more than 120 million people worldwide. We present here, to our knowledge, the first description of a filariasis infected manic bipolar disorder patient fully improved in terms of psychiatric symptoms by anti-heminthic treatment.
  
  
  METHODS
  The patient is a 31 years-old man native of Congo. At inclusion, he presented a severe manic episode with dangerous behaviour unresolved by classic treatments. A diagnosis of filariasis bancrofti infection was made after the discovery of a systemic hypereosinophilia. Therefore, a bi-therapy of anthelmintics was conducted allowing a successful improvement with clear reduction of agitation and aggressive behaviours that could not be attributed to a modification of psychotropic treatments or filarial encephalopathy or acute disseminated encephalomyelitis.
  
  
  CONCLUSIONS
  The ineffectiveness of psychotropic treatment of a manic episode requires the evaluation of co-morbid medical conditions such as infections which can interfere with adequate mood stabilizing medication. Filariasis by inducing chronic inflammation and immunopathologic reactions seems to play a major role in infected affective disorders patients by changing levels of cytokines of the Th1 system or indirectly damaging the brain tissue. The beneficial combination of antihelmintics and mood stabilizers, in this case, could be explained by the potential of such association to downregulate neuroinflammation and excitotoxicity processes.Altogether, these data pinpoint the requirement to explore the parasitic infectious status in case of bipolar disorder patients resistant to classic treatments and originating or living in endemic geographical areas.
authors.affiliation: Faculté de médecine, Université Paris Est, Créteil 94000, France. nora.hamdani@ach.aphp.fr
authors.forename: Nora
authors.initials: N
authors.lastname: Hamdani
authors.forename: Raphaël
authors.initials: R
authors.lastname: Doukhan
authors.forename: Aline
authors.initials: A
authors.lastname: Picard
authors.forename: Ryad
authors.initials: R
authors.lastname: Tamouza
authors.forename: Marion
authors.initials: M
authors.lastname: Leboyer
mesh_terms: D000328:Adult; D000871:Anthelmintics / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications* / Q000188:drug therapy; D005368:Filariasis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012075:Remission, Spontaneous
chemical_list: D000871:Anthelmintics; D014150:Antipsychotic Agents