Filariasis

A 16-year-old boy was evaluated for elephantiasis in a remote village in the mountains of Kenya. He complained of drainage from his left leg and reported that for the past several months, after the limb swelled, fluid began to weep from the bottom of the foot. He denied pain in his leg or foot and reported no fever, chills, or sweats.

Lymphatic filariasis is endemic to Kenya, where it is caused by the nematode Wuchereria bancrofti. The disease is transmitted by infected mosquitoes and is found in tropical and subtropical climates, including Africa, Latin America, and the Indian subcontinent. Clinical manifestations include fever, lymphedema, lymphadenitis, and orchitis. Filariasis can be seen in the United States in persons who have emigrated from or traveled to and returned from regions where the disease is endemic.

Microfilariae can be identified in the blood and lymph. Worms mature in the lymphatic system, and subsequent inflammation and fibrosis lead to progressive lymphatic obstruction.

Elephantiasis is a late manifestation of the disease, indicating long-standing infection or repeated reinfection. Diethylcarbamazine is the treatment for filariasis; ivermectin also appears promising.

Dr Ruric Anderson of the Medical College of Wisconsin in Milwaukee confirms that this patient lived in an area where antimicrobials could not be obtained. He was advised to keep his leg elevated whenever possible and to keep the draining area covered when walking barefoot to avoid bacterial superinfection.

REFERENCES:1. Cao WC, Van der Ploeg CP, Plaisier AP, et al. Ivermectin for the chemotherapy of bancroftian filariasis: a meta-analysis of the effect of single treatment. Trop Med Int Health. 1997;2:393-403.