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PubMed1998

The potential role of peripheral health workers and community key informants in the rapid assessment of community burden of disease: the example of lymphatic filariasis.

Data for planning disease control programs in most developing countries is often not available because they are usually expensive to gather. This study explored the potential use of peripheral health staff and community key informants in gathering community-level data about lymphatic filariasis. Agreement between findings of health workers and those of physicians was very high (kappa 0.66-0.87) for the clinical conditions examined. The prevalence of hydrocele was found to be a good predictor of communities at risk of filariasis. Community key informants provided very useful qualitative and quantitative data on the prevalence of clinical filariasis. The need to use nontraditional health professionals in gathering data for planing control programs is discussed.

Community Health Workers↗
PubMed2000

A programme to eliminate lymphatic filariasis in Tamil Nadu state, India: compliance with annual single-dose DEC mass treatment and some related operational aspects.

This paper reports on DEC distribution and compliance with treatment in a large-scale annual single-dose mass treatment programme to eliminate lymphatic filariasis in the south Indian state of Tamil Nadu. 76.9% of households (82.5% in rural areas and 58.0% in urban areas) were aware of drug distribution for control of filariasis. DEC was given to 70% (= distribution rate) (range 0-92%) of the population and 53.5% (range 12-89%) complied with treatment. The distribution rate was more than 75% in 74% of the villages and compliance was in the range of 51-75% in 76% of the villages. About 5% of the treated population reported side-effects. Distribution and compliance were higher in rural than urban areas and similar between males and females. Qualitative data showed that some socio-economic factors, logistic and drug-related problems and people's poor knowledge and perceived benefits of treatment played a role in a proportion of the population not receiving or taking the drug. The Tamil Nadu programme showed that large-scale repeated annual DEC mass treatment is feasible and that existing health services are capable of delivering the drug to all communities. While even poor to moderate compliance rates can reduce the vector transmission of infection to some extent, improved drug distribution and compliance with treatment are necessary to consolidate the gains of earlier rounds of treatment and achieve the goal of filariasis elimination within a reasonable time frame.

Animals↗
PubMed2001

Community-directed treatment: the way forward to eliminating lymphatic filariasis as a public-health problem in Ghana.

The elimination of lymphatic filariasis as a public-health problem is currently dependent on the delivery of annual drug treatments to at least 80% of the eligible members of endemic populations for at least 5 years. However, for various reasons, this goal may not be achievable by the health systems of most endemic countries in sub-Saharan Africa, particularly if treatment is not community-directed. In Ghana, community-directed ivermectin treatment involving the regular public-health services at the implementation level (ComDT/HS) has recently been compared with mass-treatment in which only the health services participated (HST). Health staff and the target communities appreciated the ComDT/HS approach more than the HST approach and were more willing to participate in the community-directed scheme. The treatment coverage achieved by ComDT/HS (74.5%) was not only much higher than that of HST (43.5%) but also probably adequate for filariasis elimination. HST coverage was particularly poor in villages located > 5 km from a health facility, but distance from such a facility had no significant effect on treatment coverage in the ComDT/HS arm. As virtually all the subjects who received drugs swallowed them, compliance with treatment was not a problem. The ComDT/HS approach is therefore recommended, especially for areas where access to health facilities is poor and the health workers are over-stretched. The implications of these findings for the global programme for filariasis elimination are discussed.

Adolescent↗
PubMed1991

Experimental chemotherapy of lymphatic filariasis. A review.

An intense global collaborative effort under the leadership of the Steering Committee of the Filariasis Scientific Working Group of the Tropical Diseases Research Programme, World Health Organization, has brought together researchers, pharmaceutical chemists and clinicians in the development and search for antifilarial compounds which are more effective and more convenient to administer than diethylcarbamazine citrate, the current drug of choice for lymphatic filariasis. The Brugia spp.-rodent model has been used extensively for the primary screening and B. pahangi infections in the dog or cat for the secondary screening, of potential filaricides. Recently, the leaf-monkey (Presbytis spp.) infected with subperiodic B. malayi or Wuchereria kalimantani has been used for the tertiary evaluation and pharmacokinetic studies of compounds which have shown effectiveness in the primary and secondary screens. Both P. cristata and P. melalophos are extremely susceptible to subperiodic B. malayi infection, but the former is a better host as a higher peak microfilaremia and adult worm recovery rate were obtained. Although more than 30 potential filaricides have been evaluated in the tertiary screen, only a few compounds have shown some promise against lymphatic filariasis. CGP 20376, a 5-methoxyl-6-dithiocarbamic-S-(2-carboxy-ethyl) ester derivative of benzothiazole, had complete adulticidal and microfilaricidal activities against the parasite at a single oral dose of 20 mg kg-1. However, as the compound or its metabolites caused hepatotoxicity, its clinical use in the present formulation is not recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

A comparative study of the efficacy and tolerability of single and split doses of ivermectin and diethylcarbamazine in periodic brugian filariasis.

The use of ivermectin in lymphatic filariasis (both bancroftian and brugian) has been recently explored in several studies. We report in this paper, for the first time, a direct comparison of the efficacy and tolerability of single doses of ivermectin and diethylcarbamazine (DEC) in brugian filariasis. We also present our findings on the use of split doses of ivermectin and DEC on microfilaraemia levels and the occurrence of adverse reactions. Fifty male, asymptomatic microfilaremics drawn from the Alleppey District, Kerala, India, were allocated one of the following five treatment regimens in a double blind randomized study: (1) single oral 6 mg/kg dose of DEC; (2) single oral 6 mg/kg dose of DEC preceded by 1 mg/kg DEC primer; (3) single oral 220 micrograms/kg dose of ivermectin; (4) single oral 200 micrograms/kg dose of ivermectin preceded by a 20 micrograms/kg ivermectin primer; or (5) a single oral 400 micrograms/kg dose of ivermectin preceded by a 20 micrograms/kg ivermectin primer. The kinetics of microfilaria clearance differed in the two (DEC/ivermectin) groups in the first month post-treatment. At the end of 1 year there were no differences in the microfilaria levels in the two DEC-tested groups and the 420 micrograms/kg ivermectin group. The safety of the 400 micrograms/kg dose of ivermectin was established in this study which has also shown that, currently, this dose would be the best choice for brugian filariasis. Patients in the ivermectin groups had significantly lower adverse reaction scores than patients who had received DEC. There was no advantage in splitting the dose of either DEC or ivermectin, either in terms of efficacy or tolerability.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

A monoclonal antibody-based enzyme immunoassay for detecting parasite antigenemia in bancroftian filariasis.

We evaluated a monoclonal antibody-based enzyme immunoassay for detecting soluble parasite antigen in sera collected in an area in South India endemic for Wuchereria bancrofti. Filarial antigen was detected in sera from 56 of 57 microfilaremic patients, 9 of 64 aminofilaremic patients with clinical filariasis, and 11 of 70 endemic controls. Antigen was not detected in sera from patients from nonendemic areas who had a variety of other filarial and nonfilarial helminth infections. Parasite antigen titers were significantly correlated with microfilarial counts in night blood smears (r = .64, P less than .01). Negative antigen tests in patients with clinical filariasis may be explained in part by antibody-mediated clearance of circulating antigen. Antibodies to circulating W. bancrofti antigen were detected in 41 of 55 antigen-negative sera from patients with clinical filariasis. Despite this limitation, detecting parasite antigen by enzyme immunoassay provides significant advantages over previously available methods for diagnosing active W. bancrofti infection.

Antibodies↗
PubMed1994

The association between microfilaraemia and disease in lymphatic filariasis.

A standard tenet in the epidemiology of lymphatic filariasis is that patent infection is negatively related to chronic disease. We examine the empirical evidence for this relation by using published data from field studies carried out in a variety of bancroftian filariasis endemic areas. Meta-analysis of the individual study results for each disease category of hydrocele in males only, lymphoedema only, and both conditions combined (total chronic disease) indicate, contrary to expectation, no evidence for a negative association between infection and disease. Indeed, the trend of the empirical evidence is towards the opposite direction, with the majority of studies showing equal propensity of disease in microfilaraemics (mf+ves) and amicrofilaraemics (mf-ves), and more studies indicating a positive rather than a negative relation. There was also a trend for more positive studies for hydrocele compared to lymphoedema. Theoretical analysis suggests that between-study differences in blood sample volumes are unlikely to confound this finding. Analysis of between-study heterogeneity suggests that variations in the local incidence or prevalence of infection rather than unique geographical, including vector, differences might underlie the observed between-study variability in the microfilaraemia-disease association. These results are discussed in terms of dynamic explanations for infection-disease relations in lymphatic filariasis.

Animals↗
PubMed2002

Development of antigen detection ELISA for the diagnosis of brugian and bancroftian filariasis using antibodies to recombinant filarial antigens Bm-SXP-1 and Wb-SXP-1.

Antibodies specific to recombinant filarial antigens Wb-SXP-1 and Bm-SXP-1 have been used to develop a sandwich ELISA for the detection of circulating filarial antigen (CFA) in sera from patients with lymphatic filariasis caused by Wuchereria bancrofti of Brugia malayi. In patients with W. bancrofti infections, a high proportion of microfilaria (mf) positive (MF) and low proportions of patients with chronic pathology (CP) and endemic normals (EN) showed the presence of CFA. Similarly in patients with brugian infections a high proportion of mf positive individuals contained CFA while none of the patients with chronic pathology or endemic normals showed the presence of CFA. Sera from patients with other parasitic infections (OPI) like O. volvulus, Loa loa, Ascaris lumbricoides and from individuals residing in areas non-endemic to filariasis did not exhibit any reactivity. This assay shows promise for the detection of microfilaremic infections in lymphatic filariasis and its usefulness as a diagnostic tool especially in B. malayi infections, needs to be further evaluated.

Animals↗
PubMed2004

Effectiveness of two annual, single-dose mass drug administrations of diethylcarbamazine alone or in combination with albendazole on soil-transmitted helminthiasis in filariasis elimination programme.

A longitudinal community-trial on the control of soil-transmitted helminths (STHs), as part of a lymphatic filariasis elimination campaign, was taken up in two revenue blocks of southern India in the years 2001 and 2002 to assess the impact of two annual single-dose mass drug administration (MDA) of diethylcarbamazine (DEC) + albendazole (ALB) with that of DEC alone. The prevalences and intensities of STHs were studied among cross-sectional samples of school children aged 9-10 years by using the Kato-Katz technique at baseline and 11 months after each MDA. The combined drug mass treatment produced a higher reduction in the prevalence (RIP) (51-77%) and the egg reduction rate (ERR) (92-98%) compared with 12-15% RIP and 58-62% ERR of DEC alone mass treatment. The effect of two-drug therapy after two annual treatments was relatively long lasting as shown by RIP and ERR indicating that the reinfection rates were relatively lower in this approach than single-drug therapy. This study demonstrates that mass drug co-administration of DEC + ALB in Global Programme for Elimination of Lymphatic Filariasis (GPELF) targeted at the community had a synergistic and sustainable effect against soil-transmitted helminthiasis and provided considerable 'beyond filariasis' benefits. The additional advantages accrued to the community underscore the importance of scaling-up GPELF to cover the entire population at risk.

Albendazole↗
PubMed2006

Short communication: Negative spatial association between lymphatic filariasis and malaria in West Africa.

OBJECTIVE: To determine the relationship between human lymphatic filariasis, caused by Wuchereria bancrofti, and falciparum malaria, which are co-endemic throughout West Africa. METHODS: We used geographical information systems and spatial statistics to examine the prevalence of lymphatic filariasis in relation to malaria prevalence, mosquito species distributions, vegetation and climate. RESULTS: A negative spatial association between W. bancrofti and falciparum malaria prevalence exists. Interspecies competition between parasites, seasonality, differences in the distribution and vector competence of Anopheles vectors, agricultural practices and insecticide resistance may be factors driving current (and potentially future) spatial distributions. CONCLUSION: Further investigating these factors will become crucial as large-scale lymphatic filariasis and malaria control programmes are implemented in West Africa that may influence the epidemiology of both diseases.

Africa, Western↗
PubMed2006

Interdigital skin lesions of the lower limbs among patients with lymphoedema in an area endemic for bancroftian filariasis.

OBJECTIVES: An estimated 15 million persons suffer from lymphoedema of the leg in filariasis-endemic areas of the world. A major factor in the progression of lymphoedema severity is the incidence of acute dermatolymphangioadenitis (ADLA), which is triggered by bacteria that gain entry through damaged skin, especially in the toe web spaces ('interdigital skin lesions'). Little is known about the epidemiology of these skin lesions or about patients' awareness of them. METHODS: We interviewed and examined 119 patients (89% women) with lymphoedema of the leg in Recife, Brazil, an area endemic for bancroftian filariasis. RESULTS: We detected 412 interdigital skin lesions in 115 (96.6%) patients (mean, 3.5 lesions per patient, range 0-8). The number of interdigital skin lesions was significantly associated with lymphoedema stage (P<0.001) and frequency of ADLA (P<0.0001). Only 20 (16.8%) patients detected their own interdigital skin lesions or considered them abnormal. Patients reported a mean of 3.6 ADLA episodes during the previous 12 months (range, 0-20); reported ADLA incidence was associated with lymphoedema stage (P<0.0001) and the number of interdigital skin lesions detected by the examining physician (P<0.0001). CONCLUSIONS: These data suggest that interdigital skin lesions are a significant risk factor for ADLA and that persons with lymphoedema in filariasis-endemic areas are unaware of their presence or importance. Prevention of ADLA through prompt recognition and treatment of interdigital skin lesions will require that patients be taught to identify lesions, especially between the toes and to recognize them as abnormal.

Acute Disease↗
PubMed2001

Lymphatic filariasis of the ovary and mesosalpinx.

We report 2 cases of filariasis, one in the ovary and the other in the mesosalpinx. In the first case, the patient underwent panhystrectomy and in the second case, right ovarian cystectomy with right salpingectomy were performed under general anaesthesia. Histopathology showed adult filarial worms in the dilated lymphatics of the right ovary, in the first case and in the mesosalpinx, in the second case. Both patients presented with complaints related to gynecological problems and not filariasis. Reports of filariasis in the literature and possible treatments and prevention strategies are also discussed.

Abdominal Pain↗
PubMed2000

The abundant larval transcript-1 and -2 genes of Brugia malayi encode stage-specific candidate vaccine antigens for filariasis.

Lymphatic filariasis is a major tropical disease caused by the mosquito-borne nematodes Brugia and Wuchereria. About 120 million people are infected and at risk of lymphatic pathology such as acute lymphangitis and elephantiasis. Vaccines against filariasis must generate immunity to the infective mosquito-derived third-stage larva (L3) without accentuating immunopathogenic responses to lymphatic-dwelling adult parasites. We have identified two highly expressed genes, designated abundant larval transcript-1 and -2 (alt-1 and alt-2), from each of which mRNAs account for >1% of L3 cDNAs. ALT-1 and ALT-2 share 79% amino acid identity across 125 residues, including a putative signal sequence and a prominent acidic tract. Expression of alt-1 and alt-2 is initiated midway through development in the mosquito, peaking in the infective larva and declining sharply following entry into the host. Humans exposed to Brugia malayi show a high frequency of immunoglobulin G1 (IgG1) and IgG3 antibodies to ALT-1 and -2, distinguishing them from adult-stage antigens, which are targeted by the IgG4 isotype. Immunization of susceptible rodents (jirds) with ALT-1 elicited a 76% reduction in parasite survival, the highest reported for a single antigen from any filarial parasite. ALT-1 and the closely related ALT-2 are therefore strong candidates for a future vaccine against human filariasis.

Amino Acid Sequence↗
PubMed2003

Influence of maternal filariasis on childhood infection and immunity to Wuchereria bancrofti in Kenya.

To determine whether maternal filariasis influences the risk of infection by and immunity to Wuchereria bancrofti in children, we performed a cross-sectional study in an area of Kenya where filariasis is endemic. Residents of 211 households were enrolled; 376 parents and 938 of their offspring between the ages of 2 and 17 years were examined for filarial infection status as determined by blood-borne microfilariae and filarial antigenemia. Children of infected mothers had a three- to fourfold increased risk of filarial infection, as ascertained by circulating filarial antigen, relative to children of uninfected mothers (P < 0.001). Paternal infection did not correlate with childhood infection status, indicating a specific maternal effect. Peripheral blood mononuclear cells from children of filaria-infected mothers (n = 33) had higher levels of constitutive interleukin-5 (IL-5) and IL-10, increased microfilarial antigen-specific IL-5 production, and diminished microfilarial antigen-driven lymphocyte proliferation than cells from children of uninfected mothers (n = 46; P < 0.05). In contrast, there were no differences between the two groups in adult worm antigen-driven gamma interferon, IL-2, IL-4, IL-5, and IL-10 production and lymphocyte proliferation. These data indicate that maternal filarial infection increases childhood susceptibility to W. bancrofti and skews filaria-specific immunity toward a Th2-type cytokine response. The results support the notion that in utero exposure to filarial antigens affects the natural history of filariasis during childhood.

Adolescent↗
PubMed2002

The use of spatial analysis in mapping the distribution of bancroftian filariasis in four West African countries.

The geographical distribution of human infection with Wuchereria bancrofti was investigated in four West African countries (Benin, Burkina Faso, Ghana and Togo), using a commercial immunochromatographic test for filarial antigen. Efforts were made to cover each health-system implementation unit and to ensure no sampling point was >50 km from another, but otherwise the 401 study communities were selected at random. The aim was to enable spatial analysis of the data, to provide a prediction of the overall spatial relationships of the infection. The results, which were subjected to an independent random validation in Burkina Faso and Ghana, revealed that prevalence in the adult population of some communities exceeded 70% and that, over large areas of Burkina Faso, community prevalences were between 30% and 50%. Most of Togo, southern Benin and much of southern Ghana appeared completely free of the infection. Although there were foci on the Ghanaian coast with prevalences of 10%-30%, such high prevalences did not extend into coastal Togo or costal Benin. The prevalence map produced should be useful in prioritizing areas for filariasis control, identifying potential overlap with ivermectin-distribution activities undertaken by onchocerciasis-control programmes, and enabling inter-country and sub-regional planning to be initiated. The results indicate that bancroftian filariasis is more widely distributed in arid areas of Burkina Faso than hitherto recognized and that the prevalences of infection have remained fairly stable for at least 30 years. The campaign to eliminate lymphatic filariasis as a public-health problem in Africa will require significantly more resources (human, financial, and logistic) than previously anticipated.

Adolescent↗
PubMed2003

A qualitative study of the perceptions, practices and socio-psychological suffering related to chronic brugian filariasis in Kerala, southern India.

Lymphatic filariasis is a major health problem in many parts of the tropical world. Although the disease itself is rarely fatal, the disability caused by the swollen extremities, the acute attacks of adenolymphangitis and the consequent sufferings of those afflicted are considerable. The economic burden imposed by lymphatic filariasis is not fully quantified and information on the social and psychological problems caused by the disease is scanty. Semi-structured interviews were therefore used, in southern India, to assess the perceptions, practices and socio-psychological problems of 127 patients with brugian filariasis. The patients were aware of the causative factors and the precautions to be taken to prevent progression of the disease. However, depression and loss of job opportunities were common in the study population. Patients also complained that the disease eroded their standing in the community and diminished their prospects of marriage. Awareness of these factors will be of help in planning suitable disability-management packages, including the rehabilitation of those who find it difficult to carry on with their existing jobs because of the severity of their disease.

Activities of Daily Living↗
PubMed2005

Rapid assessment of the geographical distribution of lymphatic filariasis in Uganda, by screening of schoolchildren for circulating filarial antigens.

To permit improvements in the targeting of control activities, the geographical distribution of lymphatic filariasis in Uganda was assessed by using a rapid immunochromatographic card test to check school-aged children for Wuchereria bancrofti-specific circulating filarial antigens (CFA). Survey sites were selected to represent the various ecological and topographical diversities in the country. Overall, 17,533 children from 76 sites were examined. CFA-positive cases were detected at 31 of the sites, with prevalences ranging from 0.4% to 30.7%. There appeared to be strikingly more lymphatic filariasis in the north of the country than in the south. The main focus was north of the Victoria Nile, where 27 (66%) of 41 sites had CFA-positive cases, often at high prevalences. Only four (11.4%) of the 35 sites south of the Victoria Nile had CFA-positive cases, and all four were along the western rift valley and had relatively low CFA prevalences. Geostatistical interpolation was used to create a map showing the geographical distribution of CFA prevalences in Uganda (by ordinary kriging), and to assess the population exposed to W. bancrofti transmission. Estimates based on population data from 2002 indicated that approximately 8.7 million people (35.3% of the national population) lived in areas where > 1% of the school-aged children were CFA-positive. CFA prevalences generally decreased with increasing altitude, and no CFA-positive cases were found at sites that were > 1300 m above sea level. Although it gives an under-estimate of the overall community prevalence (a fact that should be taken into account when interpreting the present results and comparing them with the results of other surveys), the screening of schoolchildren for CFA was found to be a simple and useful approach for mapping the geographical distribution of lymphatic filariasis.

Adolescent↗
PubMed2005

Bancroftian filariasis in children and adolescents: clinical-pathological observations in 22 cases from an endemic area.

In areas where bancroftian filariasis is endemic, the clinical manifestations of the disease, which are often very varied, appear most frequently during early adulthood or later. In consequence, very little attention, if any, has been given to the signs and symptoms of the disease in childhood. In an attempt to fill this gap, clinical and pathological observations were made, in Brazil, on 22 children (aged 2-15 years) who were infected with Wuchereria bancrofti. There was a predominance of lymph-node involvement. In all but three (14%) of the children (who had adult parasites in their intrascrotal lymphatic vessels), the adult worms were located in the afferent or efferent vessels of draining lymph nodes, predominantly in the inguinal region. None of the patients presented with distal lymphoedema, and the adenopathy was characterized by painless, localized, lymph-node enlargement, without signs of inflammation in the overlying skin. Histologically, the alterations in the lymphatic vessels and surrounding structures were similar to those described in adult patients, and depended essentially on adult-parasite viability. The localization of the adult worms in the paediatric cases was peculiar and distinct from that observed in adult patients, in whom the adult parasites are usually found in extra-nodal lymphatic vessels. In areas endemic for bancroftian filariasis, therefore, filarial infection should be considered as a possible cause of adenopathy. For the differential diagnosis of adenopathy in young patients from endemic areas, the authors recommend the use of ultrasound and other non-invasive diagnostic tools, as alternatives to excisional biopsies, which are often unnecessary in bancroftian filariasis.

Adolescent↗