eMedicine Specialties > Pediatrics: General Medicine > Parasitology

Bancroftian Filariasis: Follow-up

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Jan 21, 2009

Follow-up

Further Inpatient Care

  • Observe patients with bancroftian filariasis for complications of therapy, especially if diethylcarbamazine (DEC) is used.

Further Outpatient Care

  • Schedule a posttreatment follow-up visit for 12 months after treatment, with examination of peripheral blood for microfilariae.

Inpatient & Outpatient Medications

  • Observe and monitor oral therapeutic plans with DEC because compliance with therapy is poor and usually incomplete.

Deterrence/Prevention

  • Avoid insect vector bites. This is usually not feasible for residents of endemic areas but visitors should use insect repellent and mosquito nets.

Complications

  • Secondary bacterial infection of elephantiasis may occur.

Prognosis

  • Prognosis is good if bancroftian filariasis is recognized and treated early.

Patient Education

  • Educate patients regarding protection against insect vectors; patients should refrain from using self-treatment regimens, especially with DEC.

Miscellaneous

Medicolegal Pitfalls

  • Incorrect diagnosis: Initially missing the diagnosis of bancroftian filariasis is certainly possible because of the infrequency of cases in the developed world and Western Hemisphere. Major consequences in this scenario include a late diagnosis that results in a greater degree of individual patient morbidity and failure to issue a timely epidemiologic notification of a case. Obtain a travel history from patients with suspicious lesions.
  • Inappropriate treatment: Although this scenario is much less likely, inappropriate treatment of bancroftian filariasis is a potential issue, even if the diagnosis is correctly made. Consult an infectious diseases specialist in cases of suspected bancroftian filariasis outside of endemic nations.
  • Reaction to treatment: Ascertain whether the patient with bancroftian filariasis has ever taken any antiparasitic drugs and whether an adverse reaction was observed. Failure to do so, with a resultant adverse reaction to prescribed medication, is a clear-cut legal pitfall that should be eliminated in practice by following the standards of care and obtaining an appropriate patient history.

Special Concerns

  • Patients with bancroftian filariasis are at risk of other parasitic infections, because areas endemic for bancroftian filariasis are also endemic for other parasites. After treatment, monitor patients for other symptomatology characteristic of parasitic infections.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Michael D Nissen, MBBS, FRACP, FRCPA, and John Charles Walker, MSc, PhD, to the original writing and development of this article.



More on Bancroftian Filariasis

Overview: Bancroftian Filariasis
Differential Diagnoses & Workup: Bancroftian Filariasis
Treatment & Medication: Bancroftian Filariasis
Follow-up: Bancroftian Filariasis
Multimedia: Bancroftian Filariasis
References
Further Reading
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Further Reading

See Image 28 and Image 56 at the McGill Faculty of Medicine Web site.

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Keywords

bancroftian filariasis, adenolymphangitis, ADL, Aedes, Anopheles, chyluria, Culex, elephantiasis, filarial arthritis, filarial-associated immune complex glomerulonephritis, filarial breast abscess, filarial disease, filarial infection, filariasis, hepatomegaly, human filariasis, hydrocele, lymphatic filariasis, Mansonia, microfilaremia, occult bancroftian filariasis, tropical pulmonary eosinophilia, TPE, Wuchereria bancrofti, W bancrofti

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

Rosemary Johann-Liang, MD, Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration
Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Martin Weisse, MD, Program Director, Associate Professor, Department of Pediatrics, West Virginia University
Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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