LYMPHATIC FILARIASIS

Lymphatic filariasis is a disease caused by tissue dwelling nematode, transmitted by the Aedes aegypti mosquito bite

Causes

  • Wuchereria bancrofti

Clinical features

Acute

  • Adenolymphangitis- inflammation of lymph nodes and lymphatic vessels (lower limbs, external genitalia, testis, epididymis or breast)
  • With or without general signs like fever, nausea, vomiting
  • Attacks resolve spontaneously in one week and recur regularly in patients with chronic disease

Chronic

  • Lymphoedema (chronic hard swelling) of limbs or external genitalia, hydrocele, chronic epididymo orchitis, initially reversible but progressively chronic and severe (elephantiasis)

Differential diagnosis

  • DVT
  • Cellulitis

Investigations

  • Blood slide for Microfilaria (collect specimen between 9 pm and 3 am)

Management

Case treatment

  • Supportive treatment during an attack (bed rest, limb elevation, analgesics, cooling, hydration)
  • Doxycycline 100 mg twice a day for 4-6 weeks (do not administer antiparasitic treatment during an acute attack)

Chronic case

  • Supportive treatment: bandage during the day, elevation of affected limb at rest, analgesics and surgery (hydrocelectomy)

Large scale treatment/preventive chemotherapy
Give annually to all population at risk, for 4-6 years

  • Ivermectin 150-200 mcg/kg plus albendazole 400 mg single dose
    • Not effective against adult worms
    • Ivermectin is not recommended in children < 5 years, pregnancy, or breast-feeding mothers
    • No food or alcohol to be taken within 2 hours of a dose

    Prevention

    • Use of treated mosquito nets
    • Patient Education