Lymphatic Filariasis

What is it? Lymphatic Filariasis (LF) known as Elephantiasis is a parasitic and incurable disease that lives in the human lymphatic system. How common is the disease? Lymphatic Filariasis is one of the leading causes of permanent and long-term disability in the world. WHO estimates there are a billion people at risk in about 80 countries. Over 120 million have already been affected by it, and over 40 million of these are seriously incapacitated and disfigured by the disease. One third of the people infected with the disease live in India, one third are in Africa and the rest are in South Asia, the Western Pacific and parts of Central and South America. In Guyana, persons living on the coastline (Regions 2, 3, 4, 5, 6, 7 and 10) are more at risk of contracting Lymphatic Filariasis. Symptoms

The adult worms damage the lymphatic system, causing fluid to collect and cause swelling in the arms, legs, breasts and genitals. This is called lymphoedema. Acute episodes of local inflammation involving skin, lymph nodes and lymphatic vessels often precede or accompany lymphoedema. Some of these are caused by the body's immune response to the parasite, but most are the result of bacterial infection of skin where normal defenses have been partially lost due to underlying lymphatic damage. Such infections cause a grotesque hardening and thickening of the skin, known as elephantiasis. In endemic communities, 10-to-50 per cent of men suffer from genital damage, especially Hydrocele (fluid-filled balloon-like enlargement of the sacs around the testes) and elephantiasis of the penis and scrotum. Elephantiasis of the entire leg, the entire arm, the vulva, or the breast - swelling up to several times their normal size - can affect up to 10 per cent of men and women in these communities. Men can develop Hydrocele or swelling of the scrotum after the death of an adult worm.

Causes The thread-like, parasitic filarial worms Wuchereria bancrofti and Brugia malayi that cause LF live almost exclusively in humans. These worms lodge in the lymphatic system, the network of nodes and vessels that maintain the delicate fluid balance between the tissues and blood and are an essential component for the body's immune defense system. Each adult worm lives for an estimated six years in the lymphatic system, and female worms release millions of microfilariae (immature worms) that circulate in the blood. How is the disease transmitted?

LF is transmitted from person to person by mosquitoes. The mosquitoes bite infected humans and pick up the microfilariae from the blood. The microfilariae then develop inside the mosquito into the infective larval stage in a process that usually takes seven to 21 days. The larvae then migrate to the mosquitoes' mouth, ready to enter the bloodstream of the next unsuspecting individual the mosquito bites. The larvae migrate from the site of the bite to the lymphatic system, thus completing the life cycle. Diagnosis Since lymphatic Filariasis does not always result in clinical symptoms, the most accurate way to determine if someone is infected is a blood test. In most parts of the world, the parasites have a "nocturnal periodicity" that restricts their appearance in the blood to only the hours of 10pm 2am. Therefore, the diagnosis of lymphatic Filariasis traditionally has depended on the laboratory examination of blood taken between 10pm and 2am when microfilaria is most common in peripheral blood. However, an antigen-detection test that is simple, sensitive and specific, called an ICT, is now available. The ICT test can detect infection within minutes and unlike previous tests - can be carried out at any time of day. Treatment The strategy for interrupting transmission is an annual single co-administration of two drugs for at least five years with a single dose of Albendazole (400mg) plus Diethylcarbamazine (DEC) (6mg/kg/body wt).

Diethylcarbamazine (DEC) developed over 50 years ago, is an inexpensive and effective anti-filarial drug which is used to treat LF in many countries. DEC is available in tablet form and in a fortified salt formulation for daily intake at meal times. Albendazole for LF prevention is a well-established anti-parasitic treatment, given to an estimated 500-800 million people, mostly children, for intestinal infections over the past 20 years. The combination of Albendazole with DEC has been proven to enhance the effectiveness of the individual drug treatments in reducing the numbers of parasites in the blood.

How can we manage LF? Because of the many different presentations of clinical disease related to LF, there is no single drug or treatment that is effective for all cases. However, for all patients, three issues should be considered:

anti-parasitic drug therapy supportive clinical care and patient education and counseling.

Anti-Parasitic Drug Therapy To prevent possible transmission of LF to others, patients with clinical disease are treated with a regimen of anti-parasitic drugs.

Clinical Care Lymphoedema management Adult worms cause permanent damage to the lymphatic system. However, symptoms can be managed by reducing the frequency of acute attacks and stopping the disease from getting worse. Patients can easily learn hygiene measures that are effective in minimizing infection and promoting lymph flow. These simple measures to be undertaken by the patient include:

Washing the affected parts twice daily with soap and clean, cool water, and drying carefully Raising the affected limb at night Exercising the limb regularly Keeping the nails and spaces between the toes clean Wearing comfortable shoes Using medicated creams or antibiotics to treat small wounds or abrasions

Through these methods, even the worst case of elephantiasis can be improved over time. Prevention To eliminate lymphatic Filariasis (LF) as a public health problem, we must stop the spread of infection. Levels of worm larvae (microfilaria) in the blood of infected persons must be reduced so that mosquitoes can not transmit the worms from one human to another. The Goal of Prevention is to protect persons from becoming infected by breaking the cycle of infection between mosquitoes and humans. This is as simple as:

Sleeping under a mosquito net Wearing long sleeves and trousers. And using mosquito repellent on exposed skin between dusk and dawn.