Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Diagnosis, treatment and prevention of lymphatic filariasis

INTRODUCTION

Filariasis is caused by nematodes (roundworms) that inhabit the lymphatics and subcutaneous tissues. Three species cause lymphatic filariasis: Wuchereria bancrofti, Brugia malayi, and Brugia timori. Infection is transmitted by mosquito vectors; humans are definitive hosts. Lymphatic filariasis is a major cause of disfigurement and disability in endemic areas, leading to significant economic and psychosocial impact.

The diagnosis, treatment, and prevention of lymphatic filariasis will be reviewed here. The epidemiology, pathogenesis, and clinical features of lymphatic filariasis and other filarial infections, including onchocerciasis, loiasis, and mansonellosis, are discussed separately. (See "Epidemiology, pathogenesis, and clinical manifestations of lymphatic filariasis" and "Onchocerciasis" and "Loiasis (Loa loa infection)".)

DIAGNOSIS

A diagnosis of lymphatic filariasis should be considered in any patient with an appropriate exposure history who presents with characteristic signs and symptoms or unexplained eosinophilia. (See "Epidemiology, pathogenesis, and clinical manifestations of lymphatic filariasis".)

Definitive diagnosis can be made by detection of circulating filarial antigen (for W. bancrofti infection only), demonstration of microfilariae or filarial DNA in the blood, or of adult worms in the lymphatics. Rarely, microfilariae and/or adult worms are identified incidentally in tissue biopsies or cytological specimens [1]. Peripheral blood eosinophilia is common and may exceed 3000/microL. The frequency of eosinophilia due to filariasis is difficult to determine since other helminth infections frequently coexist among individuals in endemic areas [2]. Other nonspecific laboratory findings include elevated serum IgE, microscopic hematuria, and proteinuria. (See "Epidemiology, pathogenesis, and clinical manifestations of lymphatic filariasis", section on 'Renal involvement'.)

Circulating antigen detection — Circulating filarial antigen (CFA) assays have been developed for diagnosis of W. bancrofti infections but are not yet available for Brugian filariasis. These tests detect antigens released by adult filarial worms, so may be positive even in amicrofilaremic individuals [3]. In addition, antigen levels remain stable during the day and night, so these tests can be performed at any time.

                        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Aug 2014. | This topic last updated: Aug 22, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Kumar B, Karki S, Yadava SK. Role of fine needle aspiration cytology in diagnosis of filarial infestation. Diagn Cytopathol 2011; 39:8.
  2. Ottesen EA, Weller PF. Eosinophilia following treatment of patients with schistosomiasis mansoni and Bancroft's filariasis. J Infect Dis 1979; 139:343.
  3. Weil GJ, Ramzy RM. Diagnostic tools for filariasis elimination programs. Trends Parasitol 2007; 23:78.
  4. Chanteau S, Moulia-Pelat JP, Glaziou P, et al. Og4C3 circulating antigen: a marker of infection and adult worm burden in Wuchereria bancrofti filariasis. J Infect Dis 1994; 170:247.
  5. Chandrasena TG, Premaratna R, Abeyewickrema W, de Silva NR. Evaluation of the ICT whole-blood antigen card test to detect infection due to Wuchereria bancrofti in Sri Lanka. Trans R Soc Trop Med Hyg 2002; 96:60.
  6. Weil GJ, Jain DC, Santhanam S, et al. A monoclonal antibody-based enzyme immunoassay for detecting parasite antigenemia in bancroftian filariasis. J Infect Dis 1987; 156:350.
  7. Nicolas L, Plichart C, Nguyen LN, Moulia-Pelat JP. Reduction of Wuchereria bancrofti adult worm circulating antigen after annual treatments of diethylcarbamazine combined with ivermectin in French Polynesia. J Infect Dis 1997; 175:489.
  8. Rocha A, Addiss D, Ribeiro ME, et al. Evaluation of the Og4C3 ELISA in Wuchereria bancrofti infection: infected persons with undetectable or ultra-low microfilarial densities. Trop Med Int Health 1996; 1:859.
  9. Turner P, Copeman B, Gerisi D, Speare R. A comparison of the Og4C3 antigen capture ELISA, the Knott test, an IgG4 assay and clinical signs, in the diagnosis of Bancroftian filariasis. Trop Med Parasitol 1993; 44:45.
  10. Weil GJ, Lammie PJ, Richards FO Jr, Eberhard ML. Changes in circulating parasite antigen levels after treatment of bancroftian filariasis with diethylcarbamazine and ivermectin. J Infect Dis 1991; 164:814.
  11. McCarthy JS, Guinea A, Weil GJ, Ottesen EA. Clearance of circulating filarial antigen as a measure of the macrofilaricidal activity of diethylcarbamazine in Wuchereria bancrofti infection. J Infect Dis 1995; 172:521.
  12. Weller PF, Ottesen EA, Heck L, et al. Endemic filariasis on a Pacific island. I. Clinical, epidemiologic, and parasitologic aspects. Am J Trop Med Hyg 1982; 31:942.
  13. Mak JW, Cheong WH, Yen PK, et al. Studies on the epidemiology of subperiodic Brugia malayi in Malaysia: problems in its control. Acta Trop 1982; 39:237.
  14. Dissanayake S, Rocha A, Noroes J, et al. Evaluation of PCR-based methods for the diagnosis of infection in bancroftian filariasis. Trans R Soc Trop Med Hyg 2000; 94:526.
  15. Lucena WA, Dhalia R, Abath FG, et al. Diagnosis of Wuchereria bancrofti infection by the polymerase chain reaction using urine and day blood samples from amicrofilaraemic patients. Trans R Soc Trop Med Hyg 1998; 92:290.
  16. Ramzy RM, Farid HA, Kamal IH, et al. A polymerase chain reaction-based assay for detection of Wuchereria bancrofti in human blood and Culex pipiens. Trans R Soc Trop Med Hyg 1997; 91:156.
  17. Lammie PJ, Weil G, Noordin R, et al. Recombinant antigen-based antibody assays for the diagnosis and surveillance of lymphatic filariasis - a multicenter trial. Filaria J 2004; 3:9.
  18. Kubofcik J, Fink DL, Nutman TB. Identification of Wb123 as an early and specific marker of Wuchereria bancrofti infection. PLoS Negl Trop Dis 2012; 6:e1930.
  19. Mand S, Marfo-Debrekyei Y, Dittrich M, et al. Animated documentation of the filaria dance sign (FDS) in bancroftian filariasis. Filaria J 2003; 2:3.
  20. Mand S, Debrah A, Batsa L, et al. Reliable and frequent detection of adult Wuchereria bancrofti in Ghanaian women by ultrasonography. Trop Med Int Health 2004; 9:1111.
  21. Dreyer G, Noroes J, Amaral F, et al. Direct assessment of the adulticidal efficacy of a single dose of ivermectin in bancroftian filariasis. Trans R Soc Trop Med Hyg 1995; 89:441.
  22. Norões J, Dreyer G, Santos A, et al. Assessment of the efficacy of diethylcarbamazine on adult Wuchereria bancrofti in vivo. Trans R Soc Trop Med Hyg 1997; 91:78.
  23. Freedman DO, de Almeida Filho PJ, Besh S, et al. Lymphoscintigraphic analysis of lymphatic abnormalities in symptomatic and asymptomatic human filariasis. J Infect Dis 1994; 170:927.
  24. http://www.cdc.gov/parasites/lymphaticfilariasis/treatment.html (Accessed on July 01, 2013).
  25. Moore TA, Reynolds JC, Kenney RT, et al. Diethylcarbamazine-induced reversal of early lymphatic dysfunction in a patient with bancroftian filariasis: assessment with use of lymphoscintigraphy. Clin Infect Dis 1996; 23:1007.
  26. Debrah AY, Mand S, Marfo-Debrekyei Y, et al. Reduction in levels of plasma vascular endothelial growth factor-A and improvement in hydrocele patients by targeting endosymbiotic Wolbachia sp. in Wuchereria bancrofti with doxycycline. Am J Trop Med Hyg 2009; 80:956.
  27. Mand S, Pfarr K, Sahoo PK, et al. Macrofilaricidal activity and amelioration of lymphatic pathology in bancroftian filariasis after 3 weeks of doxycycline followed by single-dose diethylcarbamazine. Am J Trop Med Hyg 2009; 81:702.
  28. Mand S, Debrah AY, Klarmann U, et al. Doxycycline improves filarial lymphedema independent of active filarial infection: a randomized controlled trial. Clin Infect Dis 2012; 55:621.
  29. Greene BM, Taylor HR, Cupp EW, et al. Comparison of ivermectin and diethylcarbamazine in the treatment of onchocerciasis. N Engl J Med 1985; 313:133.
  30. Lariviere M, Vingtain P, Aziz M, et al. Double-blind study of ivermectin and diethylcarbamazine in African onchocerciasis patients with ocular involvement. Lancet 1985; 2:174.
  31. Hoerauf A. Filariasis: new drugs and new opportunities for lymphatic filariasis and onchocerciasis. Curr Opin Infect Dis 2008; 21:673.
  32. Tisch DJ, Michael E, Kazura JW. Mass chemotherapy options to control lymphatic filariasis: a systematic review. Lancet Infect Dis 2005; 5:514.
  33. Frayha GJ, Smyth JD, Gobert JG, Savel J. The mechanisms of action of antiprotozoal and anthelmintic drugs in man. Gen Pharmacol 1997; 28:273.
  34. Maizels RM, Bundy DA, Selkirk ME, et al. Immunological modulation and evasion by helminth parasites in human populations. Nature 1993; 365:797.
  35. Klion AD, Ottesen EA, Nutman TB. Effectiveness of diethylcarbamazine in treating loiasis acquired by expatriate visitors to endemic regions: long-term follow-up. J Infect Dis 1994; 169:604.
  36. Hise AG, Gillette-Ferguson I, Pearlman E. The role of endosymbiotic Wolbachia bacteria in filarial disease. Cell Microbiol 2004; 6:97.
  37. Taylor MJ, Cross HF, Bilo K. Inflammatory responses induced by the filarial nematode Brugia malayi are mediated by lipopolysaccharide-like activity from endosymbiotic Wolbachia bacteria. J Exp Med 2000; 191:1429.
  38. Centers for Disease Control and Prevention - Parasites. www.cdc.gov/ncidod/dpd/professional/drgsrv_drug_table.htm (Accessed on December 11, 2009).
  39. Cao WC, Van der Ploeg CP, Plaisier AP, et al. Ivermectin for the chemotherapy of bancroftian filariasis: a meta-analysis of the effect of single treatment. Trop Med Int Health 1997; 2:393.
  40. Addiss DG, Beach MJ, Streit TG, et al. Randomised placebo-controlled comparison of ivermectin and albendazole alone and in combination for Wuchereria bancrofti microfilaraemia in Haitian children. Lancet 1997; 350:480.
  41. Shenoy RK, Kumaraswami V, Rajan K, et al. Ivermectin for the treatment of periodic malayan filariasis: a study of efficacy and side effects following a single oral dose and retreatment at six months. Ann Trop Med Parasitol 1992; 86:271.
  42. Kazura JW. Ivermectin and human lymphatic filariasis. Microb Pathog 1993; 14:337.
  43. Ottesen EA, Campbell WC. Ivermectin in human medicine. J Antimicrob Chemother 1994; 34:195.
  44. Chodakewitz, J. Ivermectin and Lymphatic Filariasis: A Clinical Update. Parasitol Today 1995; 11:233.
  45. Ottesen EA, Vijayasekaran V, Kumaraswami V, et al. A controlled trial of ivermectin and diethylcarbamazine in lymphatic filariasis. N Engl J Med 1990; 322:1113.
  46. Dreyer G, Addiss D, Williamson J, Norões J. Efficacy of co-administered diethylcarbamazine and albendazole against adult Wuchereria bancrofti. Trans R Soc Trop Med Hyg 2006; 100:1118.
  47. Stolk WA, de Vlas SJ, Habbema JD. Anti-Wolbachia treatment for lymphatic filariasis. Lancet 2005; 365:2067.
  48. Hoerauf A, Volkmann L, Hamelmann C, et al. Endosymbiotic bacteria in worms as targets for a novel chemotherapy in filariasis. Lancet 2000; 355:1242.
  49. Taylor MJ. Wolbachia bacteria of filarial nematodes in the pathogenesis of disease and as a target for control. Trans R Soc Trop Med Hyg 2000; 94:596.
  50. Taylor MJ, Makunde WH, McGarry HF, et al. Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial. Lancet 2005; 365:2116.
  51. Debrah AY, Mand S, Specht S, et al. Doxycycline reduces plasma VEGF-C/sVEGFR-3 and improves pathology in lymphatic filariasis. PLoS Pathog 2006; 2:e92.
  52. Debrah AY, Mand S, Marfo-Debrekyei Y, et al. Macrofilaricidal effect of 4 weeks of treatment with doxycycline on Wuchereria bancrofti. Trop Med Int Health 2007; 12:1433.
  53. Gayen P, Nayak A, Saini P, et al. A double-blind controlled field trial of doxycycline and albendazole in combination for the treatment of bancroftian filariasis in India. Acta Trop 2013; 125:150.
  54. Supali T, Djuardi Y, Pfarr KM, et al. Doxycycline treatment of Brugia malayi-infected persons reduces microfilaremia and adverse reactions after diethylcarbamazine and albendazole treatment. Clin Infect Dis 2008; 46:1385.
  55. http://www.lymphnet.org (Accessed on January 28, 2013).
  56. Thomas G, Richards FO Jr, Eigege A, et al. A pilot program of mass surgery weeks for treatment of hydrocele due to lymphatic filariasis in central Nigeria. Am J Trop Med Hyg 2009; 80:447.
  57. Global Programme to eliminate lymphatic filariasis: progress report on mass drug administration, 2010. Wkly Epidemiol Rec 2011; 86:377.
  58. Hopkins DR. Disease eradication. N Engl J Med 2013; 368:54.
  59. Gardon J, Gardon-Wendel N, Kamgno J, et al. Serious reactions after mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet 1997; 350:18.
  60. Twum-Danso NA. Loa loa encephalopathy temporally related to ivermectin administration reported from onchocerciasis mass treatment programs from 1989 to 2001: implications for the future. Filaria J 2003; 2 Suppl 1:S7.
  61. Ottesen EA. Major progress toward eliminating lymphatic filariasis. N Engl J Med 2002; 347:1885.
  62. World Health Organization. Global Programme to eliminate Lymphatic Filariasis. Wkly Epidemiol Rec 2006; 81:211.
  63. Reimer LJ, Thomsen EK, Tisch DJ, et al. Insecticidal bed nets and filariasis transmission in Papua New Guinea. N Engl J Med 2013; 369:745.
  64. Grieve RB, Wisnewski N, Frank GR, Tripp CA. Vaccine research and development for the prevention of filarial nematode infections. Pharm Biotechnol 1995; 6:737.