Filariasis

Synonyms of Filariasis
Bancroftian Filariasis
Filarial Elephantiasis
Filariasis Malayi
Malayi Tropical Eosinphilia
Wuchereriasis

General Discussion
Filariasis is an infectious tropical disease caused by any one of several thread-like
parasitic round worms. The two species of worms most often associated with this
disease are Wuchereria bancrofti and Brugia malayi. The larval form of the parasite
transmits the disease to humans by the bite of a mosquito. In the early stages of the
infection, the patient characteristically complains of fever, chills, headaches and skin
lesions. Any one of several antiparasitic agents may be effective in eliminating the
worm. However, if the disease is left untreated, obstruction of the lymph flow will
cause particular areas of the body especially the legs and external genitals, to swell
profoundly. Symptoms are primarily a response to adult worms that cause
inflammation. Chronic inflammation may progress to hardening of the lymphatic
vessels (fibrosis) and obstruction of the lymph flow.

Signs & Symptoms

Some people with filariasis have no symptoms. Other affected individuals may have
episodes of acute inflammation of lymphatic vessels (lymphangitis) along with high
temperatures, shaking chills, body aches, and swollen lymph nodes. Excessive
amounts of fluid may accumulate (edema) in the affected areas (i.e., arms and/or
legs), but the accumulation typically resolves after the other symptoms are gone.
Attacks may also be accompanied by acute inflammation of the genitalia leading, in
males, to inflammation, pain and swelling of the testes (orchitis), sperm track
(funiculitis), and/or sperm ducts (epididymitis). The scrotum may become abnormally
swollen and painful.
Bancroftian filariasis affects both the legs and the genitals. The Malayan variety
affects the legs below the knees.
Some people with filariasis have abnormally high levels of certain white blood cells
(eosinophilia) during acute episodes of symptoms. When the inflammation resolves,
these levels return to normal.
Filariasis may cause chronic lymph node swelling (lymphadenopathy) even in the
absence of other symptoms. Longstanding obstruction of the lymphatic vessels may
lead to several other conditions. These include accumulation of fluid in the scrotum
(hydrocele), the presence of lymphatic fluid in the urine (chyluria), and/or abnormally
enlarged lymphatic vessels (varices). Other symptoms may include progressive
edema (elephantiasis) of the female external genitalia (vulva), breasts, and/or arms
and legs. Chronic edema may result in skin that is abnormally thick and has a warty
appearance.

Causes
Filariasis is a rare infectious tropical disorder caused by the round worm parasites
(nematode) Wuchereria bancrofti or Brugia malayi. Symptoms result primarily from
inflammatory reactions to the adult worms. Some people may also develop
hypersensitivity reactions to the small larval parasites (microfilariae).

Affected Populations
Filariasis is common disease in tropical regions of the world. The organism W.
bancrofti is present throughout Africa, Asia, China, and South America. B. malayi is
found in southern and southeast Asia. Filariasis is extremely rare in North America
and occurs only when these organisms are imported from tropical regions. The
infection is transmitted by several different types of tropical mosquitos which transfer
the larval stage of the organism (microfilariae) from one host to another. Lymphatic
filariasis affects about 120 million people worldwide. Short-term travelers to areas
where it is endemic are at low risk for this infection. People who visit endemic areas
for extended periods of time, and especially those who are in areas or situations in
which they are intensely exposed to infected mosquitoes, can become infected. Most
infections seen in the U.S. are in immigrants from endemic countries, according to
the Centers for Disease Control and Prevention (CDC).

Related Disorders
Symptoms of the following disorders can be similar to those of Filariasis.
Comparisons may be useful for a differential diagnosis:
Acanthocheilonemiasis is a tropical infectious disease caused by a multicellular
parasite (filarial worm [nematode]), called Acanthocheilonema perstans. This
parasite is found most commonly in Africa. Initially people with
Acanthocheilonemiasis may have no symptoms. Symptoms may include itchy skin
(pruritis), abdominal pain, chest pain, muscle pain (myalgias), and/or areas of
swelling under the skin. Other symptoms may include an abnormally enlarged liver
and spleen (hepatosplenomegaly), and inflammation in the affected organs. (For
more information on this disorder, choose Acanthocheilo as your search term in the
Rare Disease Database.)
Filarial Disease, or the general term filariasis, may also refer to a group of parasitic
diseases caused by various species of filarial worms (nematodes). These include
mumu, loiasis (Calabar swellings), dirofilariasis (human infection by dog heartworm),
and onchocerciasis (river blindness). All these except dirofilariasis can be acquired
only in the tropics, where they are common, but are extremely rare in temperate
climates such as North America. Taken together, filarial diseases of all types affect
approximately 100 million people worldwide.

Diagnosis
The diagnosis of filariasis requires examination of a blood smear for the presence of
the larval round worm W. bancrofti or B. malayi. Since the number of parasites
(parasitemia) in the blood is higher during the night, blood samples are best obtained
at night. When parasites are not found in the blood, the adult worms may
occasionally be found in a lymph node sample from an infected individual.
A somewhat easier diagnostic test was recently developed that may be used at any
time during the day. It is based on detecting the presence of antibodies generated in
reaction to the foreign bodies, the parasites themselves.

Standard Therapies
Treatment
Progressively increasing doses of any one of the major anti-parasiticide drugs is the
treatment for the disorder. Among these drugs are: ivermectin, albendazole, and
diethylcarbamazine. These drugs work to get rid of the larval worm, to inhiobit
reproduction of the adult worm, or to kill the adult worm. Notwithstanding that these
drugs are effective they do, the use of each is subject to substantial side effects
(adverse reactions). These side effects may be alleviated by using antihistamines
and/or anti-inflammatory drugs.
The elimination of adult worms must be undertaken with care because high
concentration of dead worms in the lymph or blood can provoke dangerous allergic
reactions and abscesses.
Surgery may be used to treat some people with filariasis who develop an abnormal
accumulation of fluid in the scrotum (hydrocele). Surgery may also be performed to
remove the remains of adult worms and calcifications developing around them.
Treatment of elephantiasis of the legs usually consists of elevation and support from
elastic stockings.
In the tropical areas of the world, mosquito control is an important part of prevention
of filariasis. Filariasis is usually a self-limited disease unless reinfection occurs.
Therefore some cases, especially those brought into temperate regions of the world
(i.e., North America), may be left untreated because there is no danger of spreading
the disease.

Investigational Therapies
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov.
All studies receiving U.S. Government funding, and some supported by private
industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in
Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: [email protected]
For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com
Research on tropical diseases is ongoing. The development of vaccines is also
being investigated. For more information, contact the World Health Organization
(WHO) listed in the Resources section below.
Supporting Organizations
Centers for Disease Control and Prevention
o 1600 Clifton Road NE
o Atlanta, GA 30333
o Phone: (404) 639-3534
o Toll-free: (800) 232-4636
o Email: [email protected]
o Website: http://www.cdc.gov/
Genetic and Rare Diseases (GARD) Information Center
o PO Box 8126
o Gaithersburg, MD 20898-8126
o Phone: (301) 251-4925
o Toll-free: (888) 205-2311
o Website: http://rarediseases.info.nih.gov/GARD/
NIH/National Institute of Allergy and Infectious Diseases
o NIAID Office of Communications and Government Relations
o 5601 Fishers Lane, MSC 9806
o Bethesda, MD 20892-9806
o Phone: (301) 496-5717
o Toll-free: (866) 284-4107
o Email: [email protected]
o Website: http://www.niaid.nih.gov/
World Health Organization (WHO)
o Avenue Appia 20
o Geneva 27, 1211 Switzerland
o Phone: 41227912111
o Website: http://www.who.int/en/

References
TEXTBOOKS
Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ:
Merck Research Laboratories; 1999:.
Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ:
Merck Research Laboratories; 2003:.
Gorbach SL, Bartlett JG, Blacklow NR. Eds. Infectious Diseases. W.B. Saunders
Company, Philadelphia, PA; 1992.
Mandell GL, Bennett JE, Dolan R. Eds. Mandell, Douglas and Bennetts Principles
and Practice of Infectious Diseases. 4th ed. Churchill Livingstone Inc. New York, NY;
1995.
REVIEW ARTICLES
Michael E, Malecela-Lazaro MN, Simonsen PE, et al. mathematical modelling and
the control of lymphatic filariasis. Lancet Infect Dis. 2004;4:223-34.
Walther M, Muller R. Diagnosis of human filariases (except onchocerciasis). Adv
Paristol. 2003;53:149-93.
Taylor MJ. Walbachia in the inflammatory pathogenesis of human filariasis. Ann N Y
Acad Sci. 2003;990:444-49.
Del Giudice P, Chosidow O, Caumes E. Ivermectin in dermatology. J Drugs
Dermatol. 2003;2:13-21.
Horton J. Albendazole: a broad spectrum anthelminthic for treatment of individuals
and populations. Curr Opin Infect Dis. 2002;15:599-608.
Shenoy RK. Management of disability in lymphatic filariasis-an update. J Commun
Dis. 2002;34:1-14.
Lammie PJ, Cuenco KT, Punkosdy GA. The pathogenesis of filarial lymphedema: is
it the worm or is it the host? Ann N Y Acad Sci. 2002;979:131-42; discussion 188-96.
Weil GJ, Lammie PJ, Weiss NW. The ICT Filariasis Test: A Rapid-format Antigen
Test for the Diagnosis of Bancroftian Filariasis. Parasitol Today. 1997;13:401-05.
FROM THE INTERNET
Addiss D. Filariasis, Lymphatic. CDC TRAVELERS HEALTH. Last reviewed June
30, 2003. 2pp.
www.cdc.gov/travel/diseases/filariasis.htm
Lymphatic Filariasis (Elephantiasis). National Institute of Allergy and Infectious
Disease (NAID). Last updated March 12, 2003. 2pp.
www.niaid.nih.gov/newsroom/focuson/bugborne01/filar.htm
Nissen MD, Walker JC. Filariasis. emedicine. Last Updated: Oct 22, 2003. 24pp.
www.emedicine.com/med/topic794.htm
Turkington CA. Filariasis. Gale Encyclopedia of Medicine. 2002. 4pp.
www.healthatoz.com/healthatoz/Atoz/ency/filariasis.html
The Global Alliance to Eliminate Lymphatic Filariasis. nd.
Epidemiology. 1p
www.filariasis.org/index.pl?iid=1768
Pathogenesis and Pathology. 3pp.
www.filariasis.org/index.pl?iid=1769
Asymptomatic Presentations. 1p.
www.filariasis.org/index.pl?iid=1772
Clinical Features. 4pp.
www.filariasis.org/index.pl?iid=1771
Ottesen E, Karam M, Behbehani K. Lymphatic filariasis: in our lifetime. (c)1997
World Health Organization. 24pp.
www.filariasis.org/docs/Hope_Eng.pdf
Wuchereria bancrofti. Graphic Images of Parasites. nd. 2pp.
www.biosci.ohio-state.edu/~parasite/wuchereria.html
Lymphatic Filariasis Programme. (c)2001-2004. Glaxo, Smith Kline. Key Facts and
Overview. Updated March 15, 2004. 2pp.
www.gsk.com/filariasis/

Years Published
1986, 1994, 1997, 2004, 2009
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