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PubMedDate not supplied

Acute attacks in the extremities of persons living in an area endemic for bancroftian filariasis: differentiation of two syndromes.

The natural history of lymphatic disease in human filariasis remains unclear, but recurrent episodes of acute lymphangitis are believed to constitute a major risk factor for the development of chronic lymphoedema and elephantiasis. Prospective analysis of 600 patients referred to the filariasis clinic of the Centro de Pesquisas Aggeu Magalhães/FIOCRUZ in Recife, Brazil, indicated that 2 distinct acute syndromes accompanied by lymphangitis occur in residents of this filariasis-endemic area. One syndrome, which we call acute filarial lymphangitis (AFL), is caused by the death of adult worms. It is relatively uncommon in untreated persons, usually is asymptomatic or has a mild clinical course, and rarely causes residual lymphoedema. The second syndrome, of acute dermatolymphangioadenitis (ADLA), is not caused by filarial worms per se, but probably results from secondary bacterial infections. ADLA is a common cause of chronic lymphoedema and elephantiasis in Recife as well as in other areas of Brazil where lymphatic filariasis is not present. The syndromes of AFL and ADLA can be readily distinguished from each other by simple clinical criteria.

Acute Disease↗
PubMed2001

Towards elimination of lymphatic filariasis in India.

The global initiatives to eliminate lymphatic filariasis as a public health problem by the year 2020 have generated a great deal of debate in India, the largest endemic country. This has led to a shift in the focus from control to elimination of the disease. Although the campaign to eliminate filariasis has begun, much more needs to be done. Several recent research studies have provided an insight into various operational issues and prospects of elimination of lymphatic filariasis. In this article, the current scenario, recent research results, logistics and the prospects of eliminating lymphatic filariasis in India will be discussed.

Animals↗
PubMed2002

Transmission dynamics of lymphatic filariasis: density-dependence in the uptake of Wuchereria bancrofti microfilariae by vector mosquitoes.

Gaining a better understanding of parasite infection dynamics in the vector mosquito (Diptera: Culicidae) population is central to improving knowledge regarding the transmission, persistence and hence control of lymphatic filariasis. Here, we use data on mosquito feeding experiments collated from the published literature to examine the available evidence regarding the functional form of the first component of this parasite-vector relationship for Wuchereria bancrofti (Filarioidea: Onchocercidae) causing Bancroftian filariasis, i.e. the rate of microfilariae (mf) uptake from the blood of infected humans by the feeding mosquito vector. Using a simple logarithmic regression model for describing the observed relationships between the mean numbers of mf ingested per mosquito and parasite load in humans in each study, and a linear mixed-effects meta-analytical framework for synthesizing the observed regressions across studies, we show here for the first time clear evidence for the existence of density-dependence in this process for all the three major filariasis transmitting mosquito vectors. An important finding of this study is that this regulation of mf uptake also varies significantly between the vector genera, being weakest in Culex, comparatively stronger in Aedes and most severe and occurring at significantly lower human mf loads in Anopheles mosquitoes. The analysis of the corresponding mf uptake prevalence data has further highlighted how density-dependence in mf uptake may influence the observed distributions of mf in vector populations. These results show that whereas strong regulation of mf uptake, especially when it leads to saturation in uptake at low human parasite intensities, can lead to static distributions of mf per mosquito with host parasite intensity, a weaker regulation of mf ingestion can give rise to changes in both mean mf loads and in the frequency distribution of parasites/mosquito with increasing human parasite intensity. These findings highlight the importance of considering local vector infection dynamics when attempting to predict the impacts of community-based filariasis control. They also emphasize the value of developing and applying robust meta-analytic methods for estimating functional relationships regarding parasitic infection from population ecological data.

Animals↗
PubMed1996

Knowledge and beliefs about transmission, prevention and control of lymphatic filariasis in rural areas of south India.

To identify the gaps in people's knowledge of lymphatic filariasis, we collected descriptive and quantitative information in rural areas of Tamil Nadu, South India. People are well aware of filariasis in their communities and recognize its different clinical manifestations. Only 9% of those with and 20% of those without the disease knew that filariasis is caused through mosquito bites; the rest attributed it to many other causes. People's knowledge about transmission and prevention of filariasis is also very poor. The study identifies the rationale for people's misconceptions about the disease. Misconceptions and ignorance could adversely affect personal protection measures against mosquito bites and the use of appropriate treatment. Health education campaigns aimed at highlighting the role of mosquitoes in transmission and the importance of early diagnosis should help people in taking personal protection measures and seeking appropriate treatment.

Adolescent↗
PubMed1999

Treatment costs and loss of work time to individuals with chronic lymphatic filariasis in rural communities in south India.

This year-round case-control study investigated treatment costs and work time loss to people affected by chronic lymphatic filariasis in two rural communities in south India. About three-quarters of the patients sought treatment for filariasis at least once and 52% of them paid for treatment, incurring a mean annual expenditure of Rs. 72 (US $2.1; range Rs. 0-1360 (US $39.0)). Doctor's fees and medicines constituted 57% and 23% of treatment costs. The proportion of people seeking treatment was smaller and treatment costs constituted a higher proportion of household income in lower income groups. Most patients did not leave work, but spent only 4.36+/-3.41 h per day on economic activity compared to 5.25+/-3.52 h worked by controls; the mean difference of 0.89+/-4.20 h per day was highly significant (P<0.01). This loss of work time is perpetual, as chronic disease manifestations are mostly irreversible. An estimated 8% of potential male labour input is lost due to the disease. Regression analyses revealed that lymphatic filariasis has a significant effect on work time allotted to economic activity (P<0.05) but not on absenteeism from work (P>0.05). Female patients spent 0.31+/-1.42 h less on domestic activity compared to their matched controls (P<0.05). The results clearly show that the chronic form of lymphatic filariasis inflicts a considerable economic burden on affected individuals.

Absenteeism↗
PubMed2003

Short communication: concomitant malaria and filariasis infections in Georgetown, Guyana.

Lymphatic filariasis and malaria are endemic in Guyana, South America. To determine the prevalence of concomitant infections, we conducted a 1-year survey of febrile patients attending the malaria (day) and filariasis (night) clinics in Georgetown. In all, 1278 thick blood smears were collected: 769 for filariasis, of which 103 were positive for Wuchereria bancrofti, and three for both W. bancrofti and malaria parasites; and 509 for malaria, 21 of which tested positive for malaria and 17 for both malaria and filariasis. The age groups and sex of the infected persons with malaria and W. bancrofti are described. These results suggest that the incidence of concomitant infections in Guyana may be quite low but efforts should be made to reduce the disease burden in Georgetown, Guyana.

Adolescent↗
PubMed1990

Antibodies to microfilarial sheath in bancroftian filariasis--prevalence and characterization.

Antibodies directed towards the sheaths of microfilariae have been implicated in the elimination of circulating microfilariae, both in experimental and human filariasis. In the present study antisheath antibodies have been detected in human sera by indirect immunoperoxidase assay (IPA) using fixed Wuchereria bancrofti microfilariae as antigen. One hundred and eighteen sera collected from an area endemic for Bancroftian filariasis were tested. While 80% of sera from microfilariae carriers had no demonstrable antisheath antibodies, more than 80% of amicrofilaraemic samples (chronic filariasis cases and endemic normals) had antisheath antibodies. The antibody activity was found in IgG, IgM and also IgE isotypes. IgG subclass typing with monospecific antisera revealed significantly higher antisheath activity in IgG2 in comparison with other IgG subclasses. The determinants on sheathed microfilariae reacting with antisheath antibodies were found to be thermostable (100 degrees C for 30 minutes), resistant to protease treatment and significantly sensitive to sodium periodate treatment, indicating the possible role of carbohydrate moieties in eliciting protective antisheath antibodies in Bancroftian filariasis.

Animals↗
PubMed1993

Correlation between the preferred biting site of Culex quinquefasciatus and the region of the body affected by clinical filariasis.

Entomological and filariasis surveys were conducted simultaneously in a rural and an urban environment in West Bengal from September 1986 to August 1987. The aim of the surveys was to see if any correlation existed between the preferred biting site of Culex quinquefasciatus, the filarial vector, and the region of the body affected by clinical filariasis. Significantly more mosquitoes (> 55%) attacked the thighs, legs and feet of human volunteers than other sites on their bodies, whether the volunteers were indoors or outdoors, in rural or urban environments. Significantly more patients had clinical filariasis of these lower body parts than of the upper parts. The vector's preferred biting sites and the anatomical sites most affected by clinical filariasis were therefore the same.

Adult↗
PubMed2000

Comparative epidemiological studies on lymphatic filariasis, between tribal and non-tribal populations of Bankura district, West Bengal, India.

There is little information on the epidemiology of lymphatic filariasis, caused by infection with Wuchereria bancrofti, in West Bengal. That which is known mostly relates to Calcutta and its suburbs, and there have been few studies on the disease among the tribal populations of the state. The present study was designed to compare the epidemiology of filariasis in tribal and non-tribal populations living in Bankura district. Blood samples were collected at night from 2076 tribal and 4985 non-tribal subjects and checked, microscopically, for microfilariae (mff). Each subject was also examined clinically, for any manifestations of the disease. The results revealed that the tribal subjects had not only lower prevalences of microfilaraemia (3.17% v. 8.86%) and of symptomatic filariasis (5.92% v. 13.74%) than the non-tribal, but also less intense infections (with mean counts for the microfilaraemics of 6.50 v. 13.55 mff/20 microliters blood). Filariasis endemicity, measured as the percentage of subjects with microfilaraemia and/or disease, was therefore much lower among the tribal subjects (8.95%) than the non-tribal (22.12%).

Adolescent↗
PubMed1998

Prevention of acute adenolymphangitis in brugian filariasis: comparison of the efficacy of ivermectin and diethylcarbamazine, each combined with local treatment of the affected limb.

Acute attacks of adenolymphangitis (ADL) not only force patients with lymphatic filariasis to seek medical attention but also hasten the progression of filarial oedema. Patients with filariasis-associated ADL are currently treated with repeated courses of the antifilarial drug diethylcarbamazine (DEC), with or without antibiotics and anti-inflammatory agents. In this double-blind, placebo-controlled study, the efficacy of local treatment of the affected limb combined with repeated doses of ivermectin or DEC, in preventing the occurrence of ADL in Brugia malayi lymphatic filariasis, was examined. Overall, 120 patients who had each had at least two ADL attacks in the previous year were each admitted to the study at the time of an ongoing episode of ADL. The patients were randomly allocated to receive 12, monthly treatments of ivermectin (400 micrograms/kg), DEC (10 mg/kg) or placebo, in addition to local care of the affected limbs. There was a significant reduction in the frequency of ADL attacks in each of the three groups during the 2-year study period (P < 0.001 for each comparison). Most importantly, there were no significant differences in frequency of attacks between the three groups, either at the end of the treatment phase or at the end of the post-treatment phase (P > 0.15 for each comparison), suggesting that foot care combined with appropriate use of local antibiotics or antifungals is adequate to reduce the number of ADL attacks. The implications of these observations for planning morbidity control in lymphatic filariasis are discussed.

Acute Disease↗
PubMed1996

The presence or absence of active infection, not clinical status, is most closely associated with cytokine responses in lymphatic filariasis.

Twenty-eight Brazilians from an area in which Wuchereria bancrofti is endemic were classified as asymptomatic microfilaremic or having clinical filariasis with active infection or without current active infection. Total accumulation of antigen-specific interleukin (IL)-4 and IL-5 in 48 h peripheral blood mononuclear cell supernatants was not significantly different between groups. However, when cytokine kinetics were examined, responses segregated according to infection status. Sustained production of IL-4 and IL-5 beyond the first 24 h of stimulation and production of interferon-gamma were seen only in the group with clinical filariasis without active infection. CD8 T cells were the major source of IL-5 production in this group, while CD8 production of IL-5 was undetectable in any subject with active infection (asymptomatic microfilaremic or with clinical filariasis and active infection). These findings indicate that active infection, rather than clinical status, is most closely associated with cytokine patterns in lymphatic filariasis.

Adult↗
PubMed2005

Lymphatic filariasis in Ghana: establishing the potential for an urban cycle of transmission.

Lymphatic filariasis is a significant public health and economic problem in many tropical and sub-tropical regions. Unplanned urbanization leading to a lack of proper sanitary conditions has resulted in an increase in the urban-based transmission of a number of vector-borne diseases, including lymphatic filariasis. It has been well established that lymphatic filariasis is endemic in rural areas of Ghana. The goal of this study was to determine if there is a potential of establishing urban transmission cycles in Ghana's major cities. We clinically and immunologically assessed 625 individuals from the three major urban areas (Bawku, Bolgatanga and Secondi/Takoradi), finding that the prevalence of infection with Wuchereria bancrofti ranged from 0 to 12.5%. The results of a polymerase chain reaction based analysis of mosquitoes collected from these areas suggested that there is a low but detectable prevalence of mosquitoes infected with W. bancrofti. We conclude that there may be a potential for an established urban transmission of lymphatic filariasis in Ghana.

Adult↗
PubMedDate not supplied

Cytomorphologic profile of lymphatic filariasis.

OBJECTIVE: To review the cytologic findings in 34 cases of lymphatic filariasis reported on fine needle aspiration cytology for the identification of various parasitic structures. STUDY DESIGN: Retrospective study of consecutive cytologically diagnosed lymphatic filariasis in a nine-year period. RESULTS: Thirty-three cases were confirmed as filariasis; 30 had microfilariae (group 1). Three cases (group 2) showed no microfilariae. The diagnosis in group 2 was based on the identification of an adult male worm (1 case), nongravid female worm (1 case) and fertilized eggs (1 case). Thirteen cases in group 1 also had fragments of gravid female worm. CONCLUSION: Lymphatic filariasis can be diagnosed in the absence of microfilariae by identifying other parasitic fragments.

Animals↗
PubMed2005

Epidemiology of episodic adenolymphangitis: a longitudinal prospective surveillance among a rural community endemic for bancroftian filariasis in coastal Orissa, India.

BACKGROUND: The epidemiological knowledge on acute condition of lymphatic filariasis is essential to understand the burden and issues on management of the disease. METHODS: A one year long longitudinal prospective surveillance of acute adenolymphangitis (ADL) was carried out in rural population of Orissa, India. RESULTS: The annual incidence of ADL per 1000 individuals is 85.0, and is slightly higher (P > 0.05) in male (92.0) than in female (77.6). A steady rise in the incidence of ADL episodes along with the age is recorded. The distribution indicates that persons with chronic disease are more prone to ADL attacks. The average number of episodes per year is 1.57 (1.15 SD) per affected person, and is gender dependent. Duration of the episode varies from 1 to 11 days with mean duration of 3.93 (1.94 SD) days. The chronic disease is the significant predictor for the duration of the episode. The data show that fever and swelling at inguinal regions are most common symptoms. CONCLUSION: The incidence, frequency and duration of ADL episodes in this community are similar to that of other endemic areas. As the loss due to these ADL episodes is substantial, it should be considered while further estimating the burden due to lymphatic filariasis. The disability and loss caused by chronic forms of filariasis is higher, and the additional incapacity caused by the ADL episode, majority of which occur among chronic filariasis patients, further poses the burden on individuals and their families. Hence, morbidity management measures to prevent ADL episodes among endemic communities are to be implemented.

Acute Disease↗
PubMed1998

[Bancroftian filariasis in Brazil].

The past and present distribution of Bancroftian filariasis in Brazil is reviewed. Parasitological and entomological surveys were conducted between 1951 and 1958, the autochthonous transmission of Wuchereria bancrofti having been found only in 11 places in the country as follows, with the corresponding prevalences; Ponta Grossa (SC), 14.5% Belém (PA), 9.8%; Barra de Laguna (SC), 9.4%; Recife (PE), 6.9%; Castro Alves (BA), 5.9%; Florianópolis (SC), 1.4%; São Luis (MA), 0.6%; Salvador (BA), 0.4%; Maceió (AL), 0.3%; Manaus (AM). 0.2% and Porto Alegre (RS), 0.1%. The distribution of infection was urban and focal, occurring mainly along the coast. Control measures carried out against filariasis achieved considerable success, reducing infection and transmission, only Belém and Recife being considered endemic areas. Recent studies show the active transmission of filariasis with higher prevalences than those observed in the past, in Maceió, considered to be free from infection, and in Recife. The knowledge of the present status of Bancroftian filariasis in Brazil is important as baseline information, because it will allow for the establishment of control measures by Public Health organizations.

Animals↗
PubMedDate not supplied

The present situation regarding lymphatic filariasis in Cabo de Santo Agostinho, Pernambuco, Northeast Brazil.

A cross-sectional population-based survey on the occurrence of lymphatic filariasis was carried out in the municipality of Cabo de Santo Agostinho, Pernambuco, Northeast Brazil. 7,650 individuals of both sexes were examined (from 1,416 households) of whom six tested positive for microfilaria according to the thick blood diagnostic test. The age of the individuals examined varied from 0 to 98 (averaging 26.6 years), whilst the age of the microfilaria-positive individuals varied from 11 to 29, averaging 22.5 years. Five of the six positive cases were male. These cases were residents of the following areas: Pista Preta (one case); Ponte dos Carvalhos (four cases); and Pontezinha (one case). This last case from Pontezinha was autochthonous. Of the individuals examined, 109 (1.4%) cited complaints relating to filariasis. These results suggest that filariasis is being transmitted in the municipality of Cabo de Santo Agostinho, a finding that establishes the need to carry out disease control activities, and to collaborate with the planning of the national programme for the elimination of filariasis.

Adult↗
PubMedDate not supplied

[Recommendations for the treatment of bancroftian filariasis in symptomless and diseased patients].

The goals of treatment for lymphatic filariasis are: to prevent, reverse, or halt progression of disease; and to interrupt transmission of the parasite. Selecting the appropriate therapy for the patient with lymphatic filariasis requires knowledge of the various clinical features of filarial disease and their pathogenesis. In the past, treatment of lymphatic filariasis has focused primarily on antiparasitic chemotherapy; however, for many of the acute and chronic manifestations of lymphatic filariasis, it is now clear that supportive or other forms of clinical care are even more important than antiparasitic medication in order to prevent worsening of the disease. Regardless of the clinical manifestations of filarial disease in a particular patient, the following three components of treatment should, in general, be considered: supportive or disease specific clinical care (including hygiene and diet), patient education and counseling and finally, antiparasitic chemotherapy with diethylcarbamazine (DEC) and/or the combination of DEC with ivermectin. The authors also describe the proportional efficacy of diethylcarbamazine and ivermectin, alone or in combination, for use in mass treatment aiming at transmission interruption and the use of hygiene as a public health approach for lymphedema prevention.

Animals↗
PubMed1988

[Studies on the current epidemiological situation of brugian filariasis in endemic areas of Korea]

An epidemiological study on brugian filariasis was carried out in endemic areas including Cheju Island in Korea, with a brief review of literatures.The results showed that the incidence among residents has remarkably decreased in Cheju Island, which was the main endemic area. Reviewing available informations on the prevalence of filariasis reported in recent years and also judging from the present socio-economic conditions which enable people to practice personal protection against mosquitos, it can be said with confidence that filariasis has almost disappeared from Cheju Island and inland areas. The disease is considered to remain at a low level of endemicity in Hugsan Islands. Certainly mass diethylcarbamazine (DEC) treatment carried out in Cheju Island in the 1960s and 1970s and remarkable economic growth followed by improved living standard and altered life-style of inhabitants could all have combined effects on the disappearance of this mosquito-borne diseae in this island. If the present trends go on, the possibility of resurgence of filariasis in Cheju Island is hardly postulated.

Journal Article↗