FILARIAL LYMPHEDEMA: STRATEGIES FOR MANAGEMENT
Manal Z.M. Abdellatif1; Ahmed M. Sallam2; Morsy R.M. Gneedy3 and Alaa El Din M.K. Sharaby4.
Departments of Parasitology1,2,3 and vascular surgery4 Faculties of Medicine, Menia1 and Al Azhar2,3,4 Universities.
Background: Detection of circulating filarial antigens with Og4C3 monoclonal antibody-based ELISA has been employed as a more accurate diagnosis of Wuchereria bancrofi infection than finding microfilariae in blood. The antibody reacts mainly with the adult antigen and the ELISA is applicable any time in the day regardless of microfilarial periodicity. The employment of the antigen assay exposed an important aspect of filariasis epidemiology which had been neglected or overlooked previously e.g. the existence of antigen-positive patients with negative microfilaremia. Aim: All cases with positive antigenemia (+ve Og4C3) were treated by diethylcarbamazine (DEC) 6mg/kg body weight single oral dose. Cases presented by lymphedema without complications treated by conservative treatment. Cases presented by lymphedema with complications (ulcers, very huge, ugly limb) treated by conservative treatment and surgical debulking. Methodology: All cases were asked for the following: age, residence, occupation, family history of similar condition, travelling, duration of the condition, symptoms suggesting acute dermatolymphangitis attacks, frequency and duration. Subjects then were subjected to clinical examination to detect the site, extension, grade and circumference of lymphedema. Mid-night blood specimens were taken from the patients for detection of microfilaraemia by thick blood film; blood picture and circulating filarial antigen (Og4c3) were done. Skin biopsies from lymphedematous limbs were taken and stained for detection of skin CD3 before treatment and one year after treatment. Results: In the present study 15 cases were presented by non-complicated lymphedema and they were treated with conservative treatment in the form of mechanical compression (pneumatic compression), chemical compression (Unna's boot) and multiple layers elastic stocking. Eight Cases from cases presented by non-complicated lymphedema showed positive circulating filarial antigen (Og4c3) and received treatment in the form diethylcarbamazine (DEC) in a dose of 6mg /kg bodyweight single oral dose. Ten cases were presented by complicated lymphedema and they were treated with conservative treatment and surgical debulking. Six cases from cases presented by complicated lymphedema showed positive circulating filarial antigen (Og4c3) and received treatment in the form diethylcarbamazine (DEC) in a dose of 6mg /kg bodyweight single oral dose. There was a significant decrease in numbers of ADLA attacks /year before and after treatment (P-value =0.001). There was a significant decrease in skin CD3 between before and after treatment z=4.18 and p-value<0.001. Recommendation: Meticulous hygiene is necessary to remove excess keratin and reduce the bacterial load on the skin's surface. Patients must be encouraged to cleanse the skin regularly and subsequently dry the area thoroughly. Regular inspection by the patient is necessary to identify fissuring or developing cellulitis. At the earliest signs of infection, topical or systemic antifungal and antimicrobial therapy should be commenced, to prevent deterioration of the lymphedema.
December 2011