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].

• Fever

  The most common are dizziness, nausea, fever, headache, and pain in muscles or joints, which are thought to be related to release of filarial antigens. [msdmanuals.com]

  Other acute manifestations include self-limited episodes of pyrexia, termed filarial fever. Tropical pulmonary eosinophilia (TPE) may be present in a few individuals. [symptoma.com]

  IL-1 produced by macrophages and epithelial cells activates vascular endothelium, tissue destruction, fever, mobilization of polymorphonuclear leukocytes and induction of acute phase proteins(CRP). [sanarialab.com]

  Acute symptoms include fever, lymphadenitis, lymphangitis, funiculitis, and epididymitis. Chronic symptoms include abscesses, hyperkeratosis, polyarthritis, hydroceles, lymphedema, and elephantiasis. [merckmanuals.com]

• Asymptomatic

  This study was performed to investigate the association between polymorphisms of the TLR2 gene and susceptibility to asymptomatic bancroftian filariasis. [ncbi.nlm.nih.gov]

  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. Clinical manifestations occur in one-third of cases. [symptoma.com]

• Swelling

  Clinical examination revealed swelling and tenderness of the scrotum more on the right ( figure 1A ). Fro Figure 1 (A) A 33-year- old man with right-sided testicular swelling. [casereports.bmj.com]

  He complains of recurrent pain and swelling in the inguinal region. He has lost sex drive. He is getting fever from time to time along with swelling and tenderness in the scrotum. [sanarialab.com]

  The primary chronic manifestation of BF is lymphedema, which refers to a localized limb swelling arising due to chronic inflammation of the lymphatic vessels. [symptoma.com]

  Infection with LF through the bite of an infected mosquito, can lead to the development of the condition known as elephantiasis, where swelling due to oedema leads to loss of function in the affected area and thickening of the skin, ‘like an elephant’ [mdpi.com]

  The disease, scientifically known as Bancroftian filariasis, is spread by mosquitoes and causes cruel and severe disfigurement with debilitating swelling of the limbs. [freethesaurus.com]

• Disability

  Abstract Filariasis is a common disabling parasitic disease in this region and cytological diagnosis is often not required. Cytology has important role in diagnosis of sub-clinical filariasis. [ncbi.nlm.nih.gov]

  Lymphatic Filariasis (LF) is a disfiguring, historic disease found in Sri Lanka which causes permanent disability leading to social stigma, economic loss with a heavy burden on health systems. [filariasiscampaign.health.gov.lk]

  About 120 million people are infected all over the world, of which 43 million are affected with overt physical disabilities from filarial infection. [loststory.net]

  This novel approach to the treatment of bancroftian filariasis, which is "one of the most common causes of global disability," was developed on the basis of the fact that the parasites depend on Wolbachia endosymbionts for survival, and antibiotic treatment [freethesaurus.com]

  Though the disease is not fatal yet it leads to disfigurement of the body parts, reduces mobility and causes long term disability. [techgape.com]

• Lymphedema

  Chronic pitting lymphedema of a lower extremity can progress to elephantiasis (chronic lymphatic obstruction). W. bancrofti can cause hydrocele and scrotal elephantiasis. [msdmanuals.com]

  The primary chronic manifestation of BF is lymphedema, which refers to a localized limb swelling arising due to chronic inflammation of the lymphatic vessels. [symptoma.com]

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

  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 [ncbi.nlm.nih.gov]

  The management of lymphedema depends on its severity. Mild degrees are best treated with elevation of the foot of the bed and an elastic stocking. [notesread.com]

• Cough

  Characterized by nocturnal wheezing and a dry cough, TPE is thought to be a hyperimmune reaction to the microfilariae trapped inside the lungs. [symptoma.com]

  Side reactions were encountered in almost all patients, the commonest being fever. headache, weakness, myalgia and cough which occured most prominently 12 to 72 hours after treatment. [eprints.nirt.res.in]

  Pulmonary eosinophilia associated with cough, asthmatic bronchitis, arthritis, recurrent URI, pneumonitis, etc. were observed in children in filaria endemic areas responding to DEC therapy. [loststory.net]

  Symptoms of tropical pulmonary eosinophilia syndrome include cough, shortness of breath, and wheezing. The eosinophilia is often accompanied by high levels of IgE (Immunoglobulin E) and antifilarial antibodies. 21. DIAGNOSIS 1. [slideshare.net]

• Paroxysmal Cough

  Lymphoedema Grade The major occult filarial manifestations include tropical pulmonary eosinophilia (resulting from allergic reaction to parasite and characterised by nocturnal paroxysmal cough and hypereosinophilia), glomerulopathies, endomyocardial fibrosis [loststory.net]

  Another indication of LF is pulmonary eosinophila which is characterized by paroxysmal cough and wheezing and, even though the patient harbours adult worms, there are no microfilarias in the blood ( 5 ). [canada.ca]

  Tropical pulmonary eosinophilia (TPE) • Distinct syndrome in some individuals • Paroxysmal cough and wheezing • Weight loss, low grade fever, pronounced blood eosinophilia • Total serum IgE and antifilarial Ab titres raised • Responds well to treatment [slideshare.net]

• Constipation

  What Is Convulsions;Causes And Treatment You Must Know What Is Constipation;Causes,Symptoms And Natural Treatment [notesread.com]

• Pruritus

  AEs, particularly fever, myalgias, pruritus, and proteinuria/hematuria, occurred in 83% vs 50% of those receiving triple-drug compared to 2-drug treatment respectively (P = .021); all resolved within 7 days after treatment. [ncbi.nlm.nih.gov]

  If symptoms are present, they may include fever, pruritus, skin lumps, lymphadenitis, and abdominal pain. See Clinical Presentation for more detail. [emedicine.medscape.com]

• Suggestibility

  Assuming higher validity of the filarial antigenaemia results, the crude data do not suggest a gender difference in the 9-16 age range. [scielo.br]

  The absence of other aetiological factors suggests that the glomerulonephritis may have been of filarial origin. [ncbi.nlm.nih.gov]

• Neglect

  Related links WHO fact sheets on lymphatic filariasis Lymphatic filariasis Neglected tropical diseases website [who.int]

  Tropical Diseases, E PLoS Neglected Tropical Diseases, Emerging Infectious Diseases, Transactions of Royal Society of Tropical Medicine and Hyegine, Tropical Medicine & International Health, Acta Tropica, Journal of Communicable Diseases, Indian Journal [qiup.edu.my]

  PMID: 15667713 Cited by Socio-ecological dynamics and challenges to the governance of Neglected Tropical Disease control. Michael E, Madon S. Michael E, et al. Infect Dis Poverty. 2017 Feb 6;6(1):35. doi: 10.1186/s40249-016-0235-5. [pubmed.ncbi.nlm.nih.gov]

  Diseases & Neglected Children: Health and Poverty Linkages A Study on Poverty & Health-Related Quality of Life of Children & Adolescents with Lymphatic Filariasis in South Ethiopia General Social sciences LAP LAMBERT Academic Publishing (2014-10-01) [morebooks.de]

  As a result, neglected tropical diseases affect the health of poor populations, and they mire infected individuals in poverty. [techgape.com]

• Irritability

  When applying insect repellents to children, avoid their hands, around the eyes, and cut or irritated skin. Do not allow children to handle insect repellents. When using on children, apply to your own hands and then put it on the child. [malariaprotection.com]

  A case report of a 12-year-old girl from India who presented with irritation, watering of the eye and swelling of conjunctiva has been described. [ijo.in]

  An additional manifestation of loiasis results from migration of the parasite across the conjunctiva, causing discomfort and irritation of the eye. Mansonelliasis Mansonella infections are usually asymptomatic. [emedicine.medscape.com]

  This condition (podoconiosis) is caused by irritating micro-particles from the soil [ 45 ]. [journals.plos.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.

• Wuchereria Bancrofti

  Development of Wuchereria bancrofti in the domestic cat. Med J Malaya. 1966 Jun;20(4):333–333. [PubMed] [Google Scholar] Ash LR, Schacher JF. Early life cycle and larval morphogenesis of Wuchereria bancrofti in the jird, Meriones unguiculatus. [ncbi.nlm.nih.gov]

  In the present study antisheath antibodies have been detected in human sera by indirect immunoperoxidase assay (IPA) using fixed Wuchereria bancrofti microfilariae as antigen. [researchers.mq.edu.au]

  Lymphatic filariasis is mainly caused by the filarial nematodes Wuchereria bancrofti and Brugia malayi. [pubag.nal.usda.gov]

  Figure 1 Figure 1: Photomicrograph showing coiled microfilaria of Wuchereria bancrofti (10X). Figure 2 Figure 2: Microfilaria of Wuchereria bancrofti with neutrophils in the background (40X). [ispub.com]

• Brugia Malayi

  […] genetics), Thailand Abstract: Lymphatic filariasis is mainly caused by the filarial nematodes Wuchereria bancrofti and Brugia malayi. [pubag.nal.usda.gov]

  The levels of four IgG subclasses and IgE antibodies against Brugia malayi microfilarial excretory-secretory (Bm mf ES) antigen as well as circulating filarial antigen level were evaluated in 84 individuals belonging to different groups in an endemic [ncbi.nlm.nih.gov]

  Filariasis malayi. Brugia malayi infection. Wuchereria malayi infection. Brug's filariasis. Malayan filariasis. Brugia timori infection. Brugian zoonoses. Sp : Filariasis. Fr : Filarioses. Ger : Filariosen Erkrankungen durch Filaria. [isradiology.org]

• Dirofilaria Immitis

  Abstract We used Dirofilaria immitis adult worm antigens to develop an IgG-ELISA, then used this to evaluate 30 serum samples of patients with proven Wuchereria bancrofti infection, 131 samples of patients with other parasitic diseases and 30 serum samples [ncbi.nlm.nih.gov]

  JAMA 198:665-667, 1966 Bradham RR, et al: Bilateral pulmonary nodules caused by Dirofilaria immitis. Ann Thorac Surg 50:312-313, 1990 Cordero M, et al: Transient solitary pulmonary nodule caused by Dirofilaria immitis. [isradiology.org]

  Prevalência da filariose canina causada por Dirofilaria immitis e Dipetalonema reconditum em Maceió, Alagoas, Brasil. Cad Saude Publica 2001; 17:1497-1504. 20. Christensen BM, Sutherland DR, Gleason LN. [zdoc.site]

  Serology : Tests for filaria-specific IgG are based on antigens derived from B. malayi or the dog heartworm, Dirofilaria immitis, but cannot distinguish between the different filaria, when the infection occurred, or whether it has been successfully treated [the-travel-doctor.com]

  Other species of filariae may cause incomplete infections because they are unable to reach adult maturity in human hosts and therefore cannot produce first-stage larvae, known as microfilariae (eg, Dirofilaria immitis [dog heartworm], Dirofilaria [ Nochtiella [emedicine.medscape.com]

Plasma levels of cellular (cytokines) responses during treatment revealed a proportion of symptomatic patients. Prior to treatment, patients with hydroecoele had high levels of IL-6 than those without the pathology. [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]

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]

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]

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]

Keywords: Lymphatic filariasis, epidemiology, control strategy, elimination, India How to cite this article: Sabesan S, Vanamail P, Raju K, Jambulingam P. Lymphatic filariasis in India: Epidemiology and control measures. [jpgmonline.com]

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]

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

Even after surgery the care of the limb should be continued for life, to prevent recurrence of the swelling. 8. [ijdvl.com]

Prevention The best method of preventing filariasis is to prevent being repeatedly bitten by the mosquitoes that carry the disease. [encyclopedia.com]

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