Lymphatic filariasis is a parasitic infection by the microfilarial worm Wuchereria bancrofti involving the lymphatic channels of the extremities, the breasts and the genitalia. Anopheles mosquito is the vector. It is the second commonest cause of disability in the world.

SYMPTOMS and SIGNS

Lymphatic filariasis presents in three forms:

• Asymptomatic in which there may be no symptoms at all. Diagnosis can only be made through blood film smear for microfilariae, immunochromatographic antigen test (ICT) and ultrasound scan of lymphatics

• Acute presentations: Infection of entry skin lesions with fever, chills, pain and swelling, epididymitis, epididymoorchitis, adenolymphangitis, and acute filarial lymphangitis

• Chronic manifestations: hydroceles, lymphangiectasia, lymphoedema and elephantiasis

INVESTIGATIONS

• Night blood smears for microfilariae. The blood should be taken between 11pm and 2am
• ICT antigen test
• Full blood count
• Urinalysis for chyluria, red blood cells
• Ultrasound scan

TREATMENT

Non-Pharmacological Treatment

• Hygiene and washing affected areas with soap and water and keeping them clean

• Elevation of affected limbs in lymphoedema and elephantiasis. Surgery should be avoided in elephantiasis of the limbs because it worsens the disease in the long run

• Gentle controlled exercises of affected limbs

• Application of cold compresses during acute attacks

Pharmacological Treatment

(Evidence Level: A)

• Ivermectin, oral, 150 microgram/kg body weight plus Albendazole, oral, 400 mg given every 6-12 months

• Antibiotics for infected skin lesions
Flucloxacillin or Amoxicillin (Amoxycillin), oral, 500 mg 8 hourly for 5 days.

• NSAIDs for pain and inflammation - Diclofenac,oral, 25-50 mg 3 times daily

Surgical

Hydrocelectomy for hydroceles.