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].

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 Blood should thus, ideally be withdrawn during this time interval.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.

• Anergy

  Article PubMed CAS Google Scholar King, C.L., Mahanty, S., Kumaraswami, V., Abrams, J.S., Ragunathan, J., Jayaraman, K., Ottesen, E.A., Nutman, T.B. (1993) Cytokine control of parasite specific anergy in human lymphatic Filariasis Preferential induction [link.springer.com]

METHODS: Serum samples were collected from 30 bancroftian microfilaremic (Mf) carriers pre-treatment and at sequential intervals (7,30,60,90,180 and 365 days) following treatment with diethylcarbamazine (DEC:6mg/kg body weight, single dose), 30 lymphoedema [ncbi.nlm.nih.gov]

Treatment with albendazole and ivermectin was significantly better than treatment with albendazole alone. [filariajournal.biomedcentral.com]

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]

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]

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]

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]

Weakly Epidemiological Records. 79, 358-365. 2.J W Ridley. (2012) Parasitology for Medical and Clinical Laboratory Professionals. [openaccesspub.org]

Lymphatic filariasis in Brazil: epidemiological situation and outlook for elimination. [parasitesandvectors.biomedcentral.com]

Qualifications: MBBS (1977) MD (Microbiology 1983) Ph D (Epidemiology 1990) Teaching & Research Experience: Teaching and research from 1980 TEACHING Microbiology / Epidemiology / Professional Development for following courses: PhD (guidance), MD, DPH, [qiup.edu.my]

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]

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. [cdpc.weebly.com]

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

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

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