Lymphatic filariasis is infection with the filarial worms, Wuchereria bancrofti, Brugia malayi or B. timori.

These parasites are transmitted to humans through the bite of an infected mosquito and develop into adult worms in the lymphatic vessels, causing severe damage and swelling (lymphoedema). Elephantiasis painful, disfiguring swelling of the legs and genital organs is a classic sign of late-stage disease. The infection can be treated with drugs. However, chronic conditions may not be curable by anti-filarial drugs and require other measures, eg. surgery for hydrocele, care of the skin and exercise to increase lymphatic drainage in lymphoedema. Annual treatment of all individuals at risk (individuals living in endemic areas) with recommended anti-filarial drugs combination of either diethyl-carbamazine citrate (DEC) and albendazole, or ivermectin and albendazole; or the regular use of DEC fortified salt can prevent occurrence of new infection and disease.

Epidemiology

The vector

Lymphatic filariasis is caused by infection with nematodes of the family Filarioidea: 90% of infections are caused by Wuchereria bancroftiand most of the remainder by Brugia malayi. Humans are the exclusive host of infection withW. bancrofti. Although certain strains of B. malayi can also infect some animal species (felines and monkeys), the life cycle in these animals generally remains epidemiologically distinct from that in humans. The major vectors of W. bancrofti are mosquitoes of the genus Culex (in urban and semiurban areas), Anopheles (in rural areas of Africa and elsewhere) and Aedes (in islands of the Pacific). The parasites of B. malayi are transmitted by various species of the genus Mansonia; in some areas, anopheline mosquitoes are responsible for transmitting infection. Brugian parasites are confined to areas of east and south Asia, notably India, Indonesia, Malaysia and the Philippines.

Forms and diagnosis Clinical manifestations Treatment and prevention

Geographical repartition

An estimated 120 million people in tropical and subtropical areas of the world are infected with lymphatic filariasis; of these, almost 25 million men have genital disease (most commonly hydrocele) and almost 15 million, mostly women, have lymphoedema or elephantiasis of the leg. Approximately 66% of those at risk of infection live in the WHO South-East Asia Region and 33% in the African Region.

Lymphatic filariasis
The disease

Lymphatic filariasis, commonly known as elephantiasis, is a painful and profoundly disfiguring disease. While the infection is usually acquired in childhood, its visible manifestations occur later in life, causing temporary or permanent disability. In endemic countries, lymphatic filariasis has a major social and economic impact. The disease is caused by three species of thread-like nematode worms, known as filariae Wuchereria bancrofti, Brugia malayi and Brugia timori. Male worms are about 34 centimetres in length, and female worms 810 centimetres. The male and female worms together form nests in the human lymphatic system, the network of nodes and vessels that maintain the delicate fluid balance between blood and body tissues. The lymphatic system is an essential component of the bodys immune system. Filarial infection can cause a variety of clinical manifestations, including lymphoedema of the limbs, genital disease (hydrocele, chylocele, and swelling of the scrotum and penis) and recurrent acute attacks, which are extremely painful and are accompanied by fever. The vast majority of infected people are asymptomatic, but virtually all of them have subclinical lymphatic damage and as many as 40% have kidney damage, with proteinuria and haematuria.
The transmission cycle

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Filariae are transmitted by mosquitoes. When a mosquito with infective stage larvae takes a blood meal, the parasites are deposited on the persons skin, from where they enter the body through the skin. These larvae then migrate to the lymphatic vessels and develop into adult worms over a period of 612 months, causing damage to and dilatation of the lymphatic vessels. The adult filariae live for several years in the human host. During this time, they produce millions of immature microfilariae that circulate in the peripheral blood and are ingested by mosquitoes that bite the infected human. The larval forms further develop inside the mosquito before becoming infectious to man. Thus, a cycle of transmission is established 1. Ottesen EA, Hooper PJ, Bradley M, Biswas G. The global programme to eliminate lymphatic filariasis: health impact after 8 years. PLoS Negl Trop Dis2008; 2: e317doi: 10.1371/journal.pntd.0000317 pmid: 18841205. 2. World Health Organization. Global programme to eliminate lymphatic filariasis.Wkly Epidemiol Rec 2006; 81: 221-32 pmid: 16749186. 3. World Health Organization. Elimination of yaws in India. Wkly Epidemiol Rec2008; 83: 125-32 pmid: 18404831.

Berdasarkan data Departemen Kesehatan, sampai Oktober 2009 penderita kronis filariasis tersebar di 386 kabupaten/kota di Indonesia. Sedangkan hasil pemetaan nasional diketahui prevalensi mikrofilaria sebesar 19%, artinya kurang lebih 40 juta orang di dalam tubuhnya mengandung mikrofilaria (cacing filaria) yang mudah ditularkan oleh berbagai jenis nyamuk. Bila tidak dilakukan pengobatan, mereka akan menjadi cacat menetap berupa pembesaran kaki, lengan, kantong buah zakar, payudara dan kelamin wanita. Selain itu, mereka menjadi sumber penularan bagi 125 juta penduduk yang tinggal di daerah sekitarnya.