Filariasis Treatment & Management

  • Author: Siddharth Wayangankar, MD, MPH; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Dec 8, 2010
 

Medical Care

The medical management of a filarial infection should be specific and based on the microfilariae isolated or antigenemia detected.

  • Lymphatic filariasis
    • Patients with asymptomatic microfilaremia can be treated on an outpatient basis.
    • Supervision of oral DEC therapy and provocation with postadministration observation is recommended for patient compliance with therapy and for the management of febrile reactions in heavily infected patients.
    • Inpatient care may initially be required for ADL and chronic filariasis and includes antihistamines, steroids, pain relief, and intravenous antibiotics for secondary infections.
    • Bed rest, limb elevation, and compression bandages traditionally have been used for the management of chronic lymphedema.
    • Steroids can be used to soften and reduce the swelling of lymphedematous tissues.
    • Treatment of chronic filariasis does not change the prognosis, as irreversible fibrosis usually destroys lymphatic tissue. However, asymptomatic patients still typically undergo treatment to hopefully diminish progression of the disease, although the benefit of this is unclear.[18]
    • In the treatment of chyluria, a special low-fat, high-protein diet supplemented with medium-chain triglycerides may prove beneficial. In addition, the sclerosing action conferred by diagnostic lymphangiography may plug the leak.
    • Supportive care should include the prevention of secondary infection, especially in patients with advanced disease. Individuals with chronic infections should wash the affected area frequently, apply antiseptic creams on abrasions, keep nails clean, wear comfortable footwear, and exercise the affected limb to aid lymphatic flow.
  • Onchocerciasis: If DEC and suramin are used, inpatient care is recommended to monitor for reactions and complications of therapy.
  • M perstans infection
    • Because M perstans is resistant to standard antiparasitic treatment, doxycycline is sometimes used to eradicate Wolbachia, an endosymbiont found in most filarial species. Doxycycline treatment typically kills or sterilizes the filarial nematode.
    • In an open-label, randomized trial, Coulibaly et al (2009) recruited patients with M perstans infection from 4 African villages in Mali. Patients were randomly assigned to receive doxycycline 200 mg PO qd for 6 weeks (n=106) or no treatment (n=110). At 6 months, patients co-infected with W bancrofti underwent a second randomization to receive a single dose of albendazole (400 mg) plus ivermectin (150 mcg/kg) or no treatment. At 12 months, 97% of patients who received doxycycline had no detectable blood levels of M perstans compared with 16% in the group who did not receive treatment (P < 0.001). At 36 months, M perstans remained suppressed in 75% of patients who received doxycycline. This suggests that doxycycline is an effective therapy for M perstans infection.[19]
  • Annual mass treatment with albendazole and ivermectin is required to interrupt transmission of W bancrofti. One study evaluated effect of higher dose and increased frequency of albendazole-ivermectin given twice yearly on microfilarial clearance. Higher dose, twice annual treatment resulted in complete and more sustained microfilarial clearance than standard dose albendazole-ivermectin.[20]
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Surgical Care

  • Lymphatic filariasis
    • Large hydroceles and scrotal elephantiasis can be managed with surgical excision.
    • Correcting gross limb elephantiasis with surgery is less successful and may necessitate multiple procedures and skin grafting.
  • Onchocerciasis: Nodulectomy with local anesthetic is a common treatment to reduce skin and eye complications.
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Consultations

  • Infectious diseases specialist
  • Urologist
  • Ophthalmologist
  • General surgeon
  • Plastic surgeon
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Diet

Fatty foods are restricted in individuals with proven chyluria that is associated with lymphatic filariasis.

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Activity

Individuals with chronic lymphatic filariasis are encouraged to mobilize (with compression bandage support) the affected limb.

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Contributor Information and Disclosures
Author

Siddharth Wayangankar, MD, MPH  Resident Physician, Department of Internal Medicine, Oklahoma University Health Sciences Center

Siddharth Wayangankar, MD, MPH is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Stuart Bronze, MD  Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Rhett L Jackson, MD  Associate Professor and Vice Chair for Education, Department of Medicine, Director, Internal Medicine Residency Program, University of Oklahoma College of Medicine; Assistant Chief, Medicine Service, Oklahoma City Veterans Affairs Hospital

Rhett L Jackson, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Charles S Levy, MD  Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine

Charles S Levy, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Medical Society of the District of Columbia

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Thomas M Kerkering, MD  Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Filariasis. This figure displays the life cycle of Wuchereria bancrofti in humans and mosquito vectors (ie, Aedes, Anopheles, Culex, Mansonia species). Life cycles of other lymphatic nematodes (ie, Brugia malayi, Brugia timori) are identical, while the life cycles for other filariae differ in the body location of adult worms, the microfilariae present, and the arthropod intermediate hosts and vectors.
Filarial abscess scar on the left upper thigh in a young male who is positive for Wuchereria bancrofti microfilariae
Lymphatic filariasis resulting from Wuchereria bancrofti infection, which is causing limb lymphoedema, inguinal lymphadenopathy, and hydrocele. Photograph taken by Professor Bruce McMillan and donated by John Walker, MD.
Filariasis. Unilateral left lower leg elephantiasis secondary to Wuchereria bancrofti infection in a boy.
Filariasis. This is a close-up view of the unilateral lower leg elephantiasis shown in Image 4. Note the lymphedema and typical skin appearance of depigmentation and verrucosities (warty changes).
Filariasis. Lateral view of the right outer aspect of a leg affected by gross elephantiasis secondary to Wuchereria bancrofti infection.
Filariasis. Inner aspect of the lower leg of the male patient in Image 6, showing gross elephantiasis secondary to Wuchereria bancrofti infection.
Filariasis. Unilateral left hydrocele and testicular enlargement secondary to Wuchereria bancrofti infection in a man who also was positive for microfilariae.
Filariasis. Bilateral hydrocele, testicular enlargement, and inguinal lymphadenopathy secondary to Wuchereria bancrofti infection in a man who also was microfilaremic.
Filariasis. Adult worms of Wuchereria bancrofti in cross section isolated from a testicular lump.
Filariasis. Microfilaria of Wuchereria bancrofti in a peripheral blood smear.
Filariasis. Appearance of microfilariae after concentration of venous blood with a Nuclepore filter.
Filariasis. Onchocercomas of the forearm skin (sowda) in a Sudanese man.
Filariasis. Adult Onchocerca volvulus contained within onchocercomas of the skin.
Filariasis. Microfilariae of Loa loa detected in skin snips.
Filariasis. Microfilariae of Mansonella perstans in peripheral blood.
 
 
 
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