Table 1 : Clinical cases across the spectrum of filariasis in an endemic area (Kasturba Hospital based study, 1991-2000).

Clinical manifestations

 

No. screened for Ab

No. positive* for Abu(%)

No. screened for Ag

No. positive* for Ag (%)

I.  Acute
Fever with chills,
Lymphadenopathy, Chyluria, Haematuria, Funiculitis & Epididymoorchitis

2683

1541(57)

1460

580(40)

II.  Chronic
Lymphoedema, Hydrocele & Elephantiasis

2006

1392(69)

1600

701(44)

III.  Occult
TPE, Mono & Polyarthritis, Tenosynovitis, Glomerulo-nephropathy, Retro-peritoneal  lymphangitis, EMF, Iridocyclitis, Recurrent scleritis, Macular oedema, Urticaria  & Asthmatic bronchitis.

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.

Immunomonitoring : 

         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).
         The results of analysis of blood samples for filarial IgG antibodies and antigen are summarized in table 1 & 2. In the absence of microfilaraemia number of clinical conditions in filarial endemic area showed presence of either antigen or  antibody or both confirming filaria aetilogy in adults as well as in childrens (6,7) .

 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.

6

 

TaTable 2 : Analysis of blood samples for filarial aetiology in different clinical manifestations in children Hospital study (1997 2000)

 

Clinical
Manifestations

 

No.
examined

 

No. showing Positivity* for filarial

Ab (%)

Ag (%)

Ab/ Ag (%)

I.  Classical fialriasis
 
   Lymphoedema

   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.

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