Most patients affected by Bancroftian filariasis (BF) are asymptomatic, with the development of features correlating with the number of adult worms residing in the body [1]. Clinical manifestations occur in one-third of cases.

The course of the disease is broadly divided into 3 phases: an asymptomatic stage of microfilaremia, an acute stage characterized by acute adenolymphangitis (ADL) and a chronic phase of irreversible lymphedema; the latter may be superimposed by recurrent episodes of ADL.

Acute adenolymphangitis is seen due to an immune-mediated reaction to the dying adult nematodes, with patients presenting with bouts of sudden onset of fever and painful lymphadenopathy [2]. The most common sites encompass the inguinal lymph nodes and the lower limbs. It may involve the genitalia in males [3]. In general, the inflammation subsides in 4-7 days. Recurrences occur commonly, being directly correlated with the severity of lymphedema [4]. The breakdown of skin barriers may lead to secondary bacterial infections in the skin covering the inflamed lymph nodes [5].

Other acute manifestations include self-limited episodes of pyrexia, termed filarial fever. Tropical pulmonary eosinophilia (TPE) may be present in a few individuals. Characterized by nocturnal wheezing and a dry cough, TPE is thought to be a hyperimmune reaction to the microfilariae trapped inside the lungs [6].

The primary chronic manifestation of BF is lymphedema, which refers to a localized limb swelling arising due to chronic inflammation of the lymphatic vessels. It is characterized by pitting/non-pitting edema with the overlying skin hyperpigmented and hyperkeratotic. Severe lymphatic obstruction is referred to as elephantiasis.

Some individuals may also develop proteinuria, hematuria or polyarthritis, presumably resulting from immune complex depositions [7].

• Laboratory Technician

  Slides were examined independently by bright field microscopy (magnification x100), by two experienced laboratory technicians. [journals.plos.org]

• Noncompliance

  Objective: The aim was to assess the coverage, compliance, factors-related to noncompliance to MDA. [tropicalparasitology.org]

• Large Joint Involvement

  All had large joint involvement, the commonest joint affected being the knee joint. Involvement was monoarticular in 10 and binarticular in 9. Joint pain was present in 18 and effusion in 12. Five patients had recurrent episodes. [link.springer.com]

• Swelling of Hand

  Fever and swelling of hands/body were reported as symptoms by 7.87% and 6.74%, respectively [Table 4]. [tropicalparasitology.org]

• Incontinence

  Severe cases can lead to toxaemia, altered senses, and urinary incontinence. [mdpi.com]

• Excitement

  In an early laboratory experiment, this idea was put into practice with exciting results which suggested that the method could be used in still water breeding sites, as long as protection from wind was ensured, to prevent dispersal of the balls (Reiter [scielo.br]

  The entrance of warm blood into the mosquito may excite the young larvae, causing them pass down the proboscis into the human skin’ [ 7, 62, 63 ]. [mdpi.com]

• Frontal Headache

  Of those who received albendazole alone, one individual reported frontal headache, 2 dizziness, 1 adenitis and another 1 oedema of the right arm. [filariajournal.biomedcentral.com]

• Forgetful

  […] the drugs. [18] In their study from Purba Medinipur, West Bengal, India Chattopadhyay, et al. revealed "fear of side-effects" as the most common cause (41.5%) of noncompliance. [19] This high rate of noncompliance might be multifactorial, for example, forgetfulness [tropicalparasitology.org]

Diagnostic panel for Bancroftian filariasis comprises of blood smears for the detection of microfilariae and serologic tests.

The microscopic examination must be performed in all individuals suspected of having filariasis [8]. The nematodes tend to demonstrate nocturnal periodicity; microfilariae are maximally found in the blood between 10 pm and 2 am. Blood should thus, ideally be withdrawn during this time interval. Notable exceptions include certain South Pacific variants that may be seen during the day. Generally, Wright’s or Giemsa stains are used.

Serologic exams are done to identify either the circulating filarial antigens or the antifilarial antibodies. Antigen assays using immunochromatographic techniques qualitatively depict the presence of filarial adult worms. Antigen levels are known to be stable throughout the day and can hence, be performed at any time. Serologic tests may demonstrate elevated levels of immunoglobulins (Ig) G and IgE. Specific IgG4 antibodies are thought to be a marker of active filarial infection. However, these tests show cross-reactivity with other helminthic worms and may not be useful in differentiating the past from a current infection.

Ultrasonography and scintigraphy may be used to detect the presence of adult worms residing in the lymphatic vessels [9] [10]. Polymerase chain reaction (PCR) techniques are available to diagnose filarial infections.

This could render doxycycline treatment an additional tool for the treatment of microfilaria-associated diseases in bancroftian filariasis, such as tropical pulmonary eosinophilia and microfiluria. [ncbi.nlm.nih.gov]

The study supports the earlier view that filarial antigenaemia is relatively common in amicrofilaraemic and asymptomatic subjects in endemic areas and further studies are needed to determine the clinical significance, prognosis and effective management [ncbi.nlm.nih.gov]

Prognosis The outlook is good in early or mild cases, especially if the patient can avoid being infected again. The disease is rarely fatal, and with continued WHO medical intervention, even gross elephantiasis is now becoming rare. [encyclopedia.com]

University Main Campus, India. keywords: lymphatic filariasis symptoms, lymphatic filariasis pictures, lymphatic filariasis treatment, lymphatic filariasis life cycle, lymphatic filariasis history, lymphatic filariasis diagnosis, lymphatic filariasis prognosis [techgape.com]

Prognosis The prognosis in filariasis is good if infection is recognized and treated early. Filarial diseases are rarely fatal, but the consequences of infection can cause significant personal and socioeconomic hardship for those who are affected. [emedicine.medscape.com]

The findings from this study suggests that, blood elevated cytokine profile is not the main etiological factor in the inflammatory responses developing after treatment of bancroftian filariasis infections and pathology with DEC. [ncbi.nlm.nih.gov]

However, the high incidence of these lesions is related to multiple etiological factors rather than to filarial infection alone. The true proportion of filarial lesions cannot be established by the available methods. [ajtmh.org]

In the survey of Goto Islands of Nagasaki Prefecture, we formulated an etiological hypothesis that a combination of repeated exposure to filaria antigen and ATL virus(ATLV) might have played an important role in the etiology of ATL. [agris.fao.org]

Grune & Stratton, New York, 1969, pp 642-643 Danaraj TJ: Etiology and pathology of eosinophilic lung. [isradiology.org]

(See Pathophysiology and Etiology.) [13] As with most helminths, adult filarial parasites replicate in a definitive host. The adult worm burden in an individual cannot increase unless the host is exposed to additional microfilaria. [emedicine.medscape.com]

The results of this study, based on a battery of currently available parasitological and immunological methods, provide an epidemiological update on lymphatic filariasis on the northern Kenyan coast. [ncbi.nlm.nih.gov]

Pathophysiology Pathogenesis The pathogenesis of lymphedema and its progression to elephantiasis is controversial. [wikidoc.org]

Pathophysiology The filarial life cycle, like that of all nematodes, consists of 5 developmental (larval) stages in a vertebral host and an arthropod intermediate host and vector. [emedicine.medscape.com]

Abstract The goals of treatment for lymphatic filariasis are: to prevent, reverse, or halt progression of disease; and to interrupt transmission of the parasite. [ncbi.nlm.nih.gov]

In the United States, DEC is available from the Centers for Disease Control and Prevention (CDC) after laboratory confirmation of filariasis. [msdmanuals.com]

In this topic Bancroftian and Brugian Lymphatic Filariasis • Symptoms and Signs • Diagnosis • Treatment • Prevention • Key Points Lymphatic filariasis is infection with any of 3 species of Filarioidea. [univadis.co.uk]

Centers for Disease Control and Prevention. 1999. Health Information for International Travel 1999-2000. DHHS, Atlanta, GA. Isselbacher, K.J., J.B Martin, E. Braunwald, A.S. Fauci, J.D. Wilson, D.L. Kasper (eds). 1994. [geo.arc.nasa.gov]

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5. Dreyer G, Medeiros Z, Netto MJ, Leal NC, de Castro LG, Piessens WF. Acute attacks in the extremities of persons living in an area endemic for bancroftian filariasis: differentiation of two syndromes. Trans R Soc Trop Med Hyg. 1999;93:413–417.
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