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Background  The control of lymphatic filariasis (LF) caused by  Wuchereria bancrofti  in the Central African Region has been hampered by the presence of  Loa loa  due to severe adverse events that arise in the treatment with ivermectin. The immunochromatographic test (ICT) cards used for mapping LF demonstrated cross-reactivity with  L. loa  and posed the problem of delineating the LF map. To verify LF endemicity in forest areas of Cameroon where mass drug administration (MDA) has not been ongoing, we used the recently developed strategy that combined serology, microscopy and molecular techniques.    Methods  This study was carried out in 124 communities in 31 health districts (HDs) where  L. loa  is present. At least 125 persons per site were screened. Diurnal blood samples were investigated for circulating filarial antigen (CFA) by FTS and for  L. loa  microfilariae (mf) using TBF. FTS positive individuals were further subjected to night blood collection for detecting  W. bancrofti . qPCR was used to detect DNA of the parasites.    Results  Overall, 14,446 individuals took part in this study, 233 participants tested positive with FTS in 29 HDs, with positivity rates ranging from 0.0 to 8.2%. No  W. bancrofti  mf was found in the night blood of any individuals but  L. loa  mf were found in both day and night blood of participants who were FTS positive. Also, qPCR revealed that no  W. bancrofti  but  L.loa  DNA was found with dry bloodspot. Positive FTS results were strongly associated with high  L. loa  mf load. Similarly, a strong positive association was observed between FTS positivity and  L loa  prevalence.    Conclusions  Using a combination of parasitological and molecular tools, we were unable to find evidence of  W. bancrofti  presence in the 31 HDs, but  L. loa  instead. Therefore, LF is not endemic and LF MDA is not required in these districts.

bmc infectious diseases

Mapping lymphatic filariasis in Loa loa endemic health districts naïve for ivermectin mass administration and situated in the forested zone of Cameroon