Lymphatic filariasis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Overview
People infected with adult worms can take a yearly dose of medicine, called diethylcarbamazine (DEC), that kills the microscopic worms circulating in the blood. While this drug does not kill all of the adult worms, it does prevent infected people from giving the disease to someone else. Lymphedema and elephantiasis are not indications for DEC treatment because most people with lymphedema are not actively infected with the filarial parasite. Physicians can obtain DEC from CDC after lab results confirm infection.
Medical Therapy
Medicines to treat lymphatic filariasis are most effective when used soon after infection, but they do have some toxic side effects. In addition, the disease is difficult to detect early. Therefore, improved treatments and laboratory tests are needed. Once Filaria is attacked, the patients are likely to get fever once in a year or two with shivering. They are also administered Florocid injections.
General Measures
Relatively simple and well known surgical procedures are available to correct hydrocele. Because secondary bacterial infections play an important role in precipitating acute adenolymphangitis episodes and progression of lymphoedema, simple hygiene measures either alone or in combination with antibiotic treatment play an important role in preventing episodes of acute disease and in the management of lymphoedema. Daily washing of affected limbs with soap and safe water to prevent secondary infection, combined with simple exercises, elevation of the limb, and treatment of cracks and entry points, provides significant relief from acute episodes and slows progression of the disease.
Antibiotics
In 2003 it was suggested that the common antibiotic doxycycline might be effective in treating elephantiasis.[1] The parasites responsible for filariasis have a population of symbiotic bacteria, Wolbachia, that live inside the worm. When the symbiotic bacteria are killed by the antibiotic, the worms themselves also die. Clinical trials in June 2005 by the Liverpool School of Tropical Medicine reported that an 8 week course almost completely eliminated microfilariaemia.[2]
Diethylcarbamazine Citrate (Hetrazan)
The main goal of treatment of an infected person is to kill the adult worm. Diethylcarbamazinecitrate (DEC), which is both microfilaricidal and active against the adult worm, is the drug of choice for lymphatic filariasis. The late phase of chronic disease is not affected by chemotherapy. Ivermectin is effective against the microfilariae of W. bancrofti, but has no effect on the adult parasite. Because lymphatic filariasis is rare in the U.S., DEC is no longer approved by the Food and Drug Administration (FDA) and cannot be sold in the U.S. Physicians can obtain the medication from CDC after confirmed positive lab results. DEC is generally well tolerated. Side effects are generally limited and depend on the number of microfilariae in the blood. The most common side effects are dizziness, nausea, fever, headache, or pain in muscles or joints. Prior to DEC treatment for lymphatic filariasis, onchocerciasis should be excluded in all patients with a consistent exposure history due to the possibility of severe exacerbations of skin and eye involvement (Mazzotti reaction). In addition, DEC should be used with extreme caution in patients with circulating Loa loa microfilarial levels > 2,500/mm3 due to the potential for life-threatening side effects, including encephalopathy and renal failure. Neither steroids pre-treatment nor slow dose escalation prevents these complications.
- Shown below is a table summarizing the preferred and alternative empiric treatment for Lymphatic filariasis.[3]
| Characteristics of the Patient | Possible Pathogens | Preferred Treatment | Duration of Treatment |
| Adults and children > 18 months of age | Wuchereria bancrofti
OR Brugia malayi |
Diethylcarbamazine Citrate
(6mg/kg/day) |
Either a 1 day or 12 day treatment course * |
(*) For tropical pulmonary eosinophilia (TPE), a longer DEC treatment course of 14-21 days is generally recommended.
References
- ↑ Hoerauf A, Mand S, Fischer K, Kruppa T, Marfo-Debrekyei Y, Debrah AY, Pfarr KM, Adjei O, Buttner DW (2003). "Doxycycline as a novel strategy against bancroftian filariasis-depletion of Wolbachia endosymbionts from Wuchereria bancrofti and stop of microfilaria production". Med Microbiol Immunol (Berl). 192 (4): 211–6. PMID 12684759.
- ↑ Taylor MJ, Makunde WH, McGarry HF, Turner JD, Mand S, Hoerauf A (2005). "Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial". Lancet. 365 (9477): 2116–21. PMID 15964448.
- ↑ http://www.cdc.gov/parasites/lymphaticfilariasis/health_professionals/dxtx.html