Filariasis Guide

The treatment for the tropical disease filariasis is determined by the stage of the infection and the extent of parasitic infestation into the lymphatic system. Classified as a Neglected Tropical Disease by global health organizations, this disease can lead to significant suffering as a result of its debilitating and disfiguring side effects.

Filariasis is most often associated with two different species of worm larvae, Wuchereria bancrofti and Brugia malayi, which are transmitted by mosquitos. The adult worms thrive in the human lymphatic system, a critical body system responsible for maintaining proper fluid balance and fighting infections. If left untreated, filariasis can lead to chronic lymphedema, elephantiasis, tropical pulmonary eosinophilia, and an increased risk of secondary bacterial infections.

Clinical treatment options are determined by the broad classification of the disease, asymptomatic, acute adenolymphangitis, or chronic irreversible lymphedema.

Asymptomatic lymphatic filariasis, in an area without the presence of onchocerciasis, can be treated with a combination of anthelmintics, a class of drugs that effectively treats parasitic infections. A combination of the oral medication diethylcarbamazine 6 mg/kg and albendazole 400 mg/kg can be administered in an outpatient setting. In most of Africa, where onchocerciasis, also called river blindness, is a threat a combination of albendazole 400 mg/kg and ivermectin 150-200 mg/kg is used. Each drug combination effectively reduces the number of microfilariae in the blood.

Acute adenolymphangitis is the sudden development of fever and swelling of the lymph nodes. It can occur when large amounts of adult worms infest the lymph nodes. In areas where onchocerciasis does not exist, a course of diethylcarbamazine combined with analgesics is effective. Otherwise, albendazole along with ivermectin is recommended. Bacterial infections associated with this condition can be prevented and treated with proper body and wound cleansing. Antibiotics are used to treat any secondary infections that develop. Additionally, antihistamines and steroids can reduce swelling and hypersensitivity to the microfilariae.

Management of chronic conditions that include hydrocele, lymphedema, and elephantiasis is determined by the severity of the condition. Elevation of the affected limb and compression bandages are traditional recommendations to reduce swelling associated with chronic lymphedema. Steroids can be used to reduce inflammation and soften the swollen lymphedematous tissue. In some cases, surgical procedures may be used to remove large hydrocele or correct gross limb elephantiasis.