LYMPHATIC FILARIASIS / MedUrgent

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LYMPHATIC FILARIASIS

Three species of filarial worms are known to cause lymphatic filariasis Wuchereria bancrofti, Brugia malayi and Brugia timori. It is a mosquitotransmitted disease. The larvae injected by the mosquito in man, migrates to lymphatics in the groins and axillae where they develop into adult worms.

CLINICAL FEATURES

Acute filarial lymphangitis:

Death of adult filaria leads to distally spreading lymphangitis, fever, rigors, headache, myalgia, arthralgia and delirium.

Acute dermatolymphangioadenitis:

Secondary bacterial infection leads to spread of lymphangitis in an ascending manner; however, they exhibit features of cellulitis and systemic manifestations as above. 

Chronic lymphatic filariasis:

Recurrent acute attacks damage the lymphatics leading to hydrocoele lymphoedema (elephantiasis) of legs, chyluria, lymphuria and hematuria. Arthritis, endomyocardial fibrosis, thrombophlebitis, skin rash and nerve palsies have all been reported as complications of the disease.






Investigations

• Blood film for microfilaria

• Circulating filarial antigens (Simple Card Test)

• Serological tests                


TREATMENT

• Albendazole 400mg BID orally for 3 weeks and Diethylcarbamazine (DEC) 6mg/kg orally once, or Ivermectin 200mg/kg.

• Doxycycline 100mg BID orally for 6 weeks to eradicate bacteria (Wolbachia) and improves the lymphoedema.

• Raising the affected limb at night help promote lymph flow.

• Surgical treatment for hydrocoele.

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