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Lymphatic filariasis

Lymphatic filariasis

Lymphatic filariasis is caused by parasitic nematodes such as Wuchereria bancrofti (most common), Brugia malayi, Brugia timori. It is transmitted by mosquito bites (mainly Culex, Anopheles, Aedes)

Pathophysiology:
  • Adult worms live in lymphatic vessels → lymphatic obstruction → chronic inflammation and fibrosis → lymphoedema and elephantiasis

Clinical features:
  • Often asymptomatic initially
  • Acute: Fever, lymphangitis, lymphadenitis, epididymo-orchitis
  • Chronic: Lymphoedema of limbs, scrotal swelling (hydrocoele), thickened skin (elephantiasis)

Diagnosis:
  • Microscopy: Microfilariae in night blood film (Giemsa stain)
  • Antigen detection: Circulating filarial antigen test (rapid card test)
  • Ultrasound: 'Filarial dance sign' (motile worms in lymphatics)

Management:
  • Drug of choice: Diethylcarbamazine
  • Mass programmes: Diethylcarbamazine + Albendazole (or Ivermectin + Albendazole)
  • Adjunct: Doxycycline (targets Wolbachia bacteria)
  • Supportive: Limb hygiene, exercise, management of secondary infection

Complications:
  • Chronic lymphoedema
  • Elephantiasis
  • Hydrocoele
  • Secondary bacterial infections
+PassMedicine Notes

Lymphatic filariasis is caused by parasitic nematodes such as Wuchereria bancrofti (most common), Brugia malayi, Brugia timori. It is transmitted by mosquito bites (mainly Culex, Anopheles, Aedes)

Pathophysiology:
  • Adult worms live in lymphatic vessels → lymphatic obstruction → chronic inflammation and fibrosis → lymphoedema and elephantiasis
Clinical features:
  • Often asymptomatic initially
  • Acute: Fever, lymphangitis, lymphadenitis, epididymo-orchitis
  • Chronic: Lymphoedema of limbs, scrotal swelling (hydrocoele), thickened skin (elephantiasis)
Diagnosis:
  • Microscopy: Microfilariae in night blood film (Giemsa stain)
  • Antigen detection: Circulating filarial antigen test (rapid card test)
  • Ultrasound: 'Filarial dance sign' (motile worms in lymphatics)
Management:
  • Drug of choice: Diethylcarbamazine
  • Mass programmes: Diethylcarbamazine + Albendazole (or Ivermectin + Albendazole)
  • Adjunct: Doxycycline (targets Wolbachia bacteria)
  • Supportive: Limb hygiene, exercise, management of secondary infection
Complications:
  • Chronic lymphoedema
  • Elephantiasis
  • Hydrocoele
  • Secondary bacterial infections


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