|
|||||||
Clinical manifestations |
No. screened for Ab |
No. positive* for Abu(%) |
No. screened for Ag |
No. positive* for Ag (%)
| |||
I.
Acute |
2683 |
1541(57) |
1460 |
580(40) | |||
II.
Chronic |
2006 |
1392(69) |
1600 |
701(44) | |||
III.
Occult |
2006 |
914(46) |
1096 |
459(42) | |||
Total |
6695 |
3847(57) |
4156 |
1740(42) | |||
* Cases showing the presence of filarial antigen/antibody at a serum dilution of 1:300 are considered as positive. u
Immunomonitoring detected
filarial etiology in acute and occult cases more
than twice the
number of that of
chronic clinical cases. | |||||||
A
ten year followup
study on immune status
during chemotherapy of microfilaraemic patients showed
disappearance of antigen and antibody with elimination of
microfilariae thus confirming
that presence of antigen / antibody may be used as a marker for infection (8). OpDEC
therepy for clinical filariasis : The objective of treatment is to eliminate the parasite, arrest infection, reduce the recurrent attacks, prevent morbidity and further worsening. Diethylcarbamazine citrate (DEC) is currently the only drug of choice for the treatment of lymphatic filariasis, that is effective, safe and relatively cheap. Long term treatment with DEC appears to be effective against adult worms as well in addition to killing of microfilariae. Appropriate DEC therapy helps in elimination of filarial parasites, prevention of further attacks of acute filariasis, reversal of early lymphoedema, early hydrocele and further worsening of chronic lymphoedema. Real problem the physician faces in treating clinical filarial cases is in determination of the period of the DEC treatment and convincing the patient on the need for continued DEC treatment to be effective in clinical relief and cure. These clinical cases usually do not show microfilaraemia and thus no clear indication for continued DEC treatment. It is a common experience that patients come to the hospital with history of DEC treatment for short periods at intervals. Incomplete DEC treatment is not helpful in destroying the filarial parasite and complete clinical relief thus the physician and patient become helpless. For over a decade at Kasturba hospital we have been diagnosing and immunomonitoring the filarial patients for determining optimal DEC therapy (OpDEC therapy) for clinical relief and cure. Detection of antibody and antigen were not only useful in confirmation of filarial infection, immunomonitoring of their presence helped in determining the period of DEC treatment. Table 4 shows immunomonitoring of clinical filarial patients with sero conversion along with simultaneous clinical relief and cure in filarial patients .Thus absence of Ag and Ab was found to be very helpful as a monitor in termination of DEC treatment. With optimal DEC therapy, the clinical filarial patients experienced clinical relief and cure and further did not have recurrence in most of the cases. Of about 5000 cases, three cases did come with clinical symptoms one year after stopping the DEC treatment. Table 5 shows the period of treatment required for successful management of different filarial cases in a one year followup study of 89 clinical patients done in collaboration with department of surgery emphasizing importance of immunomonitoring for determining the period of DEC therapy.
| |||||||
TaTable 2 : Analysis of blood samples for filarial aetiology in
different clinical manifestations in children – Hospital study (1997 –
2000)
| |||||||
Clinical
|
No.
|
No. showing Positivity* for filarial |
|||||
Ab (%) |
Ag (%) |
Ab/ Ag (%) |
|||||
I.
Classical fialriasis
Lymphadenopathy
|
12 19 |
6(50) 11(58) |
8(67) 6(32) |
10(83)
14(74) | |||
II. Occult
filariasis TPE |
132 |
66(50) |
63(48) |
101(77) | |||
URI (fever & cough, tonsillitis, pharangitis, myalgia) | 118 | 49(42) | 49(42) | 77(65) | |||
Bronchial Asthma | 65 | 30(46) | 27(42) | 41(65) | |||
Pneumonia | 45 | 16(36) | 16(36) | 24(53) | |||
Nutritional anemia | 16 | 4(25) | 2(13) | 5(31) | |||
Pain in abdomen |
9 | 7(78) | 3(33) | 7(78) | |||
Arthritis |
9 | 4(44) | 5(56) | 8(42) | |||
Others (testicular infections, nephrotic syndrome & anasarca). |
16 | 11(69) | 6(37) | 13(81) | |||
Total | 441 | 204(46) | 185(42) | 300(68) | |||
*cases showing the presence
of filarial antigen/antibody at a serum dilution of 1:300 are considered
as positive. |