Lymphatic filariasis: Difference between revisions
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==Background== | ==Background== | ||
*Also known as elephantiasis | *Also known as elephantiasis | ||
*Causative agents: | *Causative agents (transmitted by mosquito): | ||
**Wuchereria bancrofti | **''Wuchereria bancrofti'' | ||
**Brugia malayi | **''Brugia malayi'' | ||
**Brugia timori | **''Brugia timori'' | ||
*No known natural animal reservoir<ref name="Chandy">Chandy A, Thakur AS, Singh MP, Manigauha A. A review of neglected tropical diseases: filariasis. Asian Pac J Trop Med. 2011 Jul;4(7):581-6. doi: 10.1016/S1995-7645(11)60150-8.</ref> | |||
*Larvae migrate to lymphatic vessels and mature into adults (can take 6-12 months<ref name="Chandy" />) | |||
**These worms block lymphatic vessels, which causes the clinical presentation of the disease | |||
*Coinfection is common (filiariae cause immunosuppression and allows for malaria and/or TB to thrive) | |||
==Clinical Features== | ==Clinical Features== | ||
* | *2/3 will be asymptomatic<ref name="Taylor">Mark J Taylor, Achim Hoerauf, Moses Bockarie. Lymphatic filariasis and onchocerciasis. Lancet 2010; 376: 1175–85</ref> | ||
* | *Chronic infection leads to massive peripheral edema with thickening of overlying skin particularly in lower extremities and genitalia | ||
*Recurrent [[cellulitis]] is common | *Recurrent [[cellulitis]] is common | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
== | |||
==Evaluation== | |||
*Establish possible exposure in endemic areas | |||
*Serology (peripheral blood) - draw at night due to periodicity of filiariae | |||
*Tests for ''W. bancrofti'' | |||
**PCR | |||
**Antigen detection | |||
**Ultrasound may occasionally show movement of adult filiariae | |||
==Management== | ==Management== | ||
*Diethylcarbamazine: | *Diethylcarbamazine (DEC): | ||
**Day 1: | **Day 1: 50mg PO | ||
**Day 2: | **Day 2: 50mg TID | ||
**Day 3: | **Day 3: 100mg TID | ||
**Days 4-21: | **Days 4-21: 6mg/kg/day divided TID | ||
*Combined treatment with diethylcarbamazine | *Ivermectin + Albendazole | ||
*Combined treatment with diethylcarbamazine/albendazole may be more effective than single drug treatment | |||
*Meticulous skin care to prevent superinfection/cellulitis | *Meticulous skin care to prevent superinfection/cellulitis | ||
*Surgical management of scrotal elephantiasis and chronic lymphatic obstruction | *Surgical management of scrotal elephantiasis and chronic lymphatic obstruction | ||
==Disposition== | ==Disposition== | ||
*Generally may be discharged unless complicated by other factors. | |||
==See Also== | ==See Also== | ||
| Line 34: | Line 47: | ||
==External Links== | ==External Links== | ||
== | |||
==References== | |||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Tropical Medicine]] | ||
Revision as of 03:55, 28 July 2016
Background
- Also known as elephantiasis
- Causative agents (transmitted by mosquito):
- Wuchereria bancrofti
- Brugia malayi
- Brugia timori
- No known natural animal reservoir[1]
- Larvae migrate to lymphatic vessels and mature into adults (can take 6-12 months[1])
- These worms block lymphatic vessels, which causes the clinical presentation of the disease
- Coinfection is common (filiariae cause immunosuppression and allows for malaria and/or TB to thrive)
Clinical Features
- 2/3 will be asymptomatic[2]
- Chronic infection leads to massive peripheral edema with thickening of overlying skin particularly in lower extremities and genitalia
- Recurrent cellulitis is common
Differential Diagnosis
Evaluation
- Establish possible exposure in endemic areas
- Serology (peripheral blood) - draw at night due to periodicity of filiariae
- Tests for W. bancrofti
- PCR
- Antigen detection
- Ultrasound may occasionally show movement of adult filiariae
Management
- Diethylcarbamazine (DEC):
- Day 1: 50mg PO
- Day 2: 50mg TID
- Day 3: 100mg TID
- Days 4-21: 6mg/kg/day divided TID
- Ivermectin + Albendazole
- Combined treatment with diethylcarbamazine/albendazole may be more effective than single drug treatment
- Meticulous skin care to prevent superinfection/cellulitis
- Surgical management of scrotal elephantiasis and chronic lymphatic obstruction
Disposition
- Generally may be discharged unless complicated by other factors.
See Also
External Links
References
- ↑ 1.0 1.1 Chandy A, Thakur AS, Singh MP, Manigauha A. A review of neglected tropical diseases: filariasis. Asian Pac J Trop Med. 2011 Jul;4(7):581-6. doi: 10.1016/S1995-7645(11)60150-8.
- ↑ Mark J Taylor, Achim Hoerauf, Moses Bockarie. Lymphatic filariasis and onchocerciasis. Lancet 2010; 376: 1175–85