Evidence suggests that neurotropic infectious agents might be involved in bipolar disorder. Therefore, specific treatments have been proposed as Amantadine, an antiviral compound against BDV (Borna Disease Virus), which seem to exert an antiviral and an antidepressive action in depressive infected bipolar type I patients [
1]. Isoniazid which has been developed for prevention and treatment of tuberculosis, exhibits antidepressant properties. Minocycline, a tetracycline seems to reduce depressive symptoms among bipolar disorder patient [
2] while clarithromycin, ciprofloxacin, erythromycin and amoxicillin [
3,
4] can lead to a manic episode and therefore are called “antibiomania” [
5]. It has been suggested that mood stabilizing properties of macrolides could act via their interference in the mitochondrial functioning of neurons [
6]. Filariasis is a parasitic disease acting ruthlessly
via mosquitos in regions of Asia, Africa, Central, South America and Pacific Island nations, with more than 120 million people infected. 90% of this infection is caused by W. bancrofti with about 80 countries known to be endemic areas [
7].The most important filarial disease for humans is lymphatic filariasis in which the adult worms are present in the lymphatic system [
7]. Males are more frequently affected (sex ratio 10:1) in their third or 4
th decade [
7]. The incubation period from mosquito bite may be comprised between 4 weeks and more than six months [
7]. Usually asymptomatic, rare cases of neurological symptoms have been described. In monkeys, filarial worms were observed in the bulb, the protuberance, and the cervical cord [
8]. In humans, several authors described cases with paralysis [
9], hemiplegia [
10,
11], troubles of consciousness [
12]. In addition, filariasis is suspected to cause insomnia, mental depression, irritability and severe headaches [
13]. A relationship between central nervous symptoms and filariasis appears to be established in these cases, since the surgical removal of adult
L.
boa, and treatment of the
W.
bancrofti infections with specific treatment, was followed by the disappearance of symptoms. For to the authors, the neuropsychiatric symptoms observed may be due to the presence of adult worms in vital organs, but the possibility of systemic reactions caused by allergic sensitization of the host to filarial protein has to be considered, regardless of the location of the worms [
13]. A post mortem study of filarial encephalitis showed a diffuse inflammation of the white matter (in a less extent, the grey matter), perivascular inflammation and a dramatic allergic reaction explaining serious neurologic symptoms [
14].
Chemotherapy (antihelmintics) is now considered as the most cost-effective tool to potentially interrupt transmission even among asymptomatic patients.
We report successful improvement of manic symptoms when adding anthelmintics among an infected bipolar disorder patient refractory to usual treatments.