Lymphatic Filariasis (Elephantiasis)

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Case Definition: Hydrocoele, lymphoedema, elephantiasis or chyluria in a resident of an endemic area for which other causes of these findings have been excluded.

Causative organisms:

Lymphatic filariasis is caused by the following nematodes

1. Wuchereria Bancrofti (most common)
2. Brugia Malayi
3. Brugia Timori

The infection is transmitted by mosquitoes of the anopheles and culicine species. The disease is prevalent in 39 of 63 districts in Zimbabwe which require at least 7 rounds of Mass Drug Administration (MDA) using Albendazole and Diethylcarbamazine (DEC). The use of triple therapy Albendazole, DEC and lvemerctin can shorten the MDA rounds to only 2 or 3.

Clinical Manifestations:

There are three stages of the disease:

Early stage:

Due to infective larvae comprising a triad of eosinophilia , lymphadenopathy and a positive intradermal test. Some patients may be asymptomatic.

Acute Filarial Manifestation: patients have fever, lymphangitis, lymphadenitis and relapsing lymphoedema of various body parts e.g. epididymo-orchitis in males.

Chronic stage: gross persistent lymphoedema of limbs, scrotum, breast or vulva in females.

Diagnosis: this is based on a combination of a clinico-epidemiological information and sometimes demonstration of microfilariae in a blood or fluid smear.

Treatment of the acute phase involves use of Diethylcarbamazine (DEC).

	Medicine	Adult Dose	Frequency	Duration
	diethylcarbamazine po	100mg – 300mg*	single dose	-
and	albendazole po	400mg	single dose	-

* Weight dependent

Patients should be referred for specialist management.

Drug therapy for chronic elephantiasis does not alter the eventual clinical outcome. Surgery for hydrocoele is indicated with local care of the limbs through daily cleaning/hygiene, elevation, exercise and use of foot ware.