Evaluation of SEVA FILA CHEK & ICT filariasis test :

    Studies from this laboratory (9) showed that ICT is a rapid-format antigen test  and quite convenient to detect microfilaraemia in field conditions.  The SEVA FILACHEK immunoassays on the other hand are useful to detect active filarial infection as well as clinical disease cases associated with filariasis attending the hospital and thus help in the effective management of clinical morbidity and preventing recurrence in such cases in an endemic area (Table 6).

* Sera showing filarial IgG antibody/ antigen titre of  >300

Management of clinical filariasis:

Acute, chronic and occult cases of lymphatic filariasis usually do not show microfilariae in peripheral blood. However the detection of specific filarial antibody or antigen has been  found to be useful in the confirmation

and monitoring of active filarial infection in acute, chronic & occult cases with appropriate period of DEC     chemotherapy for clinical relief and cure.In the recent years, adult filarial worms have been demonstrated in  filarial cases with clinical manifestations (hydrocele and lymphoedema), by Ultrasonography suggesting a need for chemotherapy for elimination of the parasite in such cases.  OpDEC (optimal DEC therapy) was found to be very effective in acute and atypical clinical manifestations such as asthmatic bronchitis, pulmonary eosinophilia, monoarthritis,  recurrent URI, pneumonia (super imposed infections) in children and minimal hydrocele, epididymoorchitis, lymphanginitis, lymphadenitis, pain and swelling in limbs and joints in adults living  in filaria endemic areas. Judicial use of appropriate antibiotics, analgesics, antihistaminic, diuretics, antifungals for managing secondary infections and inflammatory reactions along with physiotherapy and hygiene help in the successful management of clinical filarial cases.

A)      CHEMOTHERAPY :

1.      OpDEC therapy:

Diethyl carbamazine citrate (DEC) 6mg / kg body wt. / day in 3 divided doses for 21 days in each month for 3 - 12 months or more followed by quarterly immunomonitoring till the antibody / antigen becomes undetectable followed by for clinical relief and cure. Recurrence of manifestations was observed only in 0.2 - 0.5% of clinical filarial cases followed up in hospital study (8).

2. If the patient does not tolerate Op DEC therapy:

Starting with small doses of DEC (2 mg / kg body wt./ day) and gradually increasing to standard regimen (6 mg / kg body wt./ day) over a period of 3-4 days and continuing for 3 weeks in a month (10).

3. Other chemotherapeutic trials in the field:

a)  Coumarin: Apart from the standard regimen of DEC, Coumarin 200 mg twice a day is found to be helpful in the reduction of filarial oedema in the long run (11).

B)  PHYSIOTHERAPY:

It is helpful to apply physiotherapy along with chemotherapy for faster relief and cure.

1. Pressure bandage: Crepe bandage and elasto-crepe stockings are commonly used.

2. Manual massage: It is a technique where gentle pressure is applied on the skin to reduce the pain and oedema of the limbs by promoting lymph circulation from periphery to centre, draining the lymph using the lymphatics of the abdominal wall into the thoracic duct. The massage needs to be done daily and requires a lot of patience, deft and application of gentle pressure by the therapist with full involvement.  

3. Thermotherapy: It is useful both for the reduction of oedema and the associated pain. Wet heat therapy by immersing the affected limbs in a bucket of warm water for about 10-15 mins. daily in the evening when the size of the swelling is increased due to the day's activity to facilitate circulation is recommended. After this, the patient could massage the limb and lie flat with foot end elevated.

4. Pneumatic compression:  Intermittant low pressure or continuous higher pressure is generated in the affected parts using appropriate electrically operated machines. Elastic bandaging after compression as an adjunct is essential.

5. Interferential current therapy: Low frequency interferential current stimulation is given to the affected part of the body, by using two electrodes placed on the skin diametrically opposite with one having a fixed stimulation (4000 Hz) and the other variable (3850 to 4000 Hz). This therapy has been found useful for reduction of pain and oedema particularly in Grade II and Grade III cases (12).

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Filaria patients with lymphoedema may like to contact:

Dr. G. Manokaran

 Conslt. Plastic Surgeon & Lymphologist

Apollo Hospital

21, Greams Lane

CHENNAI - 600 006

Ph: 044 - 28293333 / 28290200 Extn: 2440

Fax: 044 - 28294429

E-mail: ahel@vsnl.com

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AMLA MEDIQUIP

28/31, Old Rajinder Nagar, N. Delhi - 110   060

Ph: ( 011) 25852291,  25854749  

Fax: 91-11-25853090

Website www.amlamed.com

E-mail : amlamediquip@vsnl.com