Lymphatic filariasis

Filarial infections are grouped into 3 categories of disease based on the location of disease: lymphatic, cutaneous, and body cavity

-Lymphatic filariasis is caused by three filarial nematodes: Wuchereria bancrofti (most common), Brugia malayi, and Brugia timori

-it is found mostly in South Asia and Africa 

-Humans are infected by the bites of infected mosquitoes

-Larvae move to the lymphatics and lymph nodes, where they mature into adult worms, which produce large numbers of microfilariae

Symptoms & Signs 

-Classical lesion: Lymphadenitis in the femoral area as a red, enlarged and tender lump spreading centrifugally down the lymphatic channels of the leg (centripetal spread in bacterial lymphangitis) 

-recurrent bouts of “filarial fevers” lasting 2 to 3 weeks

-High fever, transient local edema, lymphatic inflammation – Acute adenolymphangitis (ADL)

-Elephantiasis, thickening of the subcutaneous tissues, brawny edema

-Conjunctivitis, headache, photophobia, vertigo, scrotal pain, orchitis, epididymitis, elephantiasis of breasts, vulva 

Diagnosis 

Detection of microfilariae in peripheral blood, hydrocele fluid; Periodicity determines the best time for blood collection;  blood samples for Wuchereria and Brugia are only positive if drawn at night

Serology: Antigen assays, PCR 

High-frequency ultrasound: can show motile adult worms 

Treatment 

Effective agents: Diethylcarbamazine (Drug of choice), Albendazole, Doxycycline, ivermectin 

Diethylcarbamazine can cause hypersensitivity reaction with antigen liberation from dead microfilariae 

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