Filariasis, Lymphatic

Infectious Agent

Filarial nematodes Wuchereria bancrofti, Brugia malayi , and B. timori .

Transmission

Through the bite of infected Aedes, Culex, Anopheles , and Mansonia mosquitoes.

Epidemiology

Found in sub-Saharan Africa, Egypt, southern Asia, the western Pacific Islands, the northeastern coast of Brazil, Guyana, Haiti, and the Dominican Republic. Travelers are at low risk, although infection has been documented in long-term travelers. Most infections are seen in immigrants and refugees.

Clinical Presentation

Most infections are asymptomatic, but lymphatic dysfunction may lead to lymphedema of the leg, scrotum, penis, arm, or breast years after infection. Acute episodes in people with lymphatic dysfunction are associated with painful swelling of an affected limb, fever, or chills due to bacterial superinfection. Tropical pulmonary eosinophilia is a potentially serious progressive lung disease that presents with nocturnal cough, wheezing, and fever, resulting from immune hyperresponsiveness to microfilariae in the pulmonary capillaries.

Diagnosis

Microscopic detection of microfilariae on an appropriately timed thick blood film. Determination of serum antifilarial IgG is also a diagnostically useful test. This assay is available through the Parasitic Diseases Laboratory at the National Institutes of Health (301-496-5398) or through CDC (www.cdc.gov/dpdx; 404-718-4745; parasites@cdc.gov). Microfilariae are usually not detected in patients with tropical pulmonary eosinophilia. Diagnosis requires epidemiologic risk and filarial antibody testing.

Treatment

The drug of choice, diethylcarbamazine, can be obtained from CDC under an investigational new drug protocol. Patients with lymphedema and hydrocele can benefit from lymphedema management and, in the case of hydrocele, surgical repair. There is evidence that a 4- to 8- week course of doxycycline (200 mg daily) can both sterilize adult worms and improve lymphatic pathologic features.

Prevention

Mosquito precautions (see Chapter 2, Protection against Mosquitoes, Ticks, & Other Arthropods).

CDC website: www.cdc.gov/parasites/lymphaticfilariasis

Bibliography

  1. Debrah AY, Mand S, Specht S, Marfo-Debrekyei Y, Batsa L, Pfarr K, et al. Doxycycline reduces plasma VEGF-C/sVEGFR-3 and improves pathology in lymphatic filariasis. PLoS pathogens. 2006 Sep;2(9):e92.  [PMID:17044733]
  2. Eberhard ML, Lammie PJ. Laboratory diagnosis of filariasis. Clin Lab Med. 1991 Dec;11(4):977–1010.  [PMID:1802532]
  3. Lipner EM, Law MA, Barnett E, Keystone JS, von Sonnenburg F, Loutan L, et al. Filariasis in travelers presenting to the GeoSentinel Surveillance Network. PLoS Negl Trop Dis. 2007;1(3):e88.  [PMID:18160987]
  4. Magill AJ, Ryan ET, Hill DR, Solomon T. Hunter’s Tropical Medicine and Emerging Infectious Diseases. 9th ed. New York: Elsevier Inc.; 2013.
  5. Taylor MJ, Makunde WH, McGarry HF, Turner JD, Mand S, Hoerauf A. Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial. Lancet. 2005 Jun 18-24;365(9477):2116–21.  [PMID:15964448]

Author

LeAnne M. Fox