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Lymphatic filariasis 

Lymphatic filariasis

Chapter:
Lymphatic filariasis
Author(s):

Richard Knight

and D.H. Molyneux

DOI:
10.1093/med/9780199204854.003.070902_update_001

Update:

Global Programme for Elimination of Lymphatic Filariasis—progress and changes.

Mass drug therapy—impacts on clinical condition of individuals with hydrocele and lymphoedem.

‘Beyond LF’ benefits of preventive chemotherapy on other conditions increasingly recognized.

Drugs for lymphatic filariasis—revised, with emphasis on value of doxycycline for treatment symptomatic individuals.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 23 April 2017

Wuchereria bancrofti, Brugia malayi, and B. timori are mosquito-borne nematode parasites that are important causes of morbidity, disability, and social stigma in tropical and subtropical countries. Bancroftian filariasis due to W. bancrofti, which has no animal reservoir, accounts for 90% of human infections worldwide.

Clinical features

Acute lymphatic filariasis—(1) lymphadenitis and lymphangitis—most common in the inguinal and femoral nodes; (2) acute genital—usually tender fusiform or cylindrical swelling of the spermatic cord; (3) abscess and fever—affected nodes may break down to produce an open ulcer.

Chronic lymphatic filariasis—(1) lymphoedema and elephantiasis—initially transient pitting oedema occurs during acute inflammatory episodes in proximal nodes; eventually brawny, nonpitting oedema becomes permanent; (2) chronic genital—most commonly hydrocele; (3) chronic lymphadenitis and lymphangitis; (4) chyluria and lymphuria; (5) nonlymphatic pathology—including tropical pulmonary eosinophilia, filarial arthritis, and filarial glomerulonephritis.

Diagnosis and treatment

Diagnosis—microfilariae are typically found in Giemsa-stained blood films; the sample is best taken at night (22.00–02.00), except in Oceania and parts of South-East Asia. Microfilariae are also sometimes found in aspirates from lymph varix, hydrocele, lymphocele of the cord, or in urine. A rapid antigen detection test allows the mapping of prevalence and assessment of the impact of mass drug distribution.

Treatment—diethylcarbamazine, which may provoke both local and systemic reactions, or doxycycline are needed in some situations, including infected visitors, people leaving infected areas, and those with tropical pulmonary eosinophilia or other clinical features where elimination of adult worms is a priority. Concurrent bacterial infection requires prompt treatment with antibiotics, and supportive bandaging can reduce chronic oedema.

Prevention

The Global Programme for the Elimination of Lymphatic Filariasis involves annual rounds of drug administration to all eligible persons to interrupt transmission by reducing the numbers of circulating microfilariae, together with (in appropriate circumstances) vector control.

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