Five local Malaysian patients with clinical manifestations consistent with lymphatic filariasis were referred to our medical centre between 2003 and 2006. Although no microfilariae (mf) were detected in their nocturnal blood samples, all were diagnosed to have lymphatic filariasis on the basis of clinical findings and positive serology results. PCR on their blood samples revealed that two of the patients were infected with Brugia pahangi, an animal filarial worm hitherto not known to cause human disease in the natural environment. All the patients were successfully treated with anti-filarial drugs: four patients were treated with a combination of diethylcarbamazine (DEC) and albendazole, and one with doxycycline. Four of them were residents of Petaling Jaya, a residential suburbia located 10 km southwest of Kuala Lumpur city, Malaysia. The fifth patient was a frequent visitor of the suburbia. This suburbia has no history or record of B. malayi infection. The most likely vector of the worm was Armigeres subalbatus as extensive entomological surveys within the suburbia revealed only adult females of this mosquito species were infected with B. pahangi larvae. Wild monkeys caught in the suburbia were free from B. pahangi mf, but domestic cats were mf positive. This suggests that infected cats might be the source of the zoonotic infection in the suburbia.
Matched MeSH terms: Diethylcarbamazine/therapeutic use
The lymphatic filarial parasite Brugia timori occurs only in eastern Indonesia where it causes high morbidity. The absence of an animal reservoir, the inefficient transmission by Anopheles mosquitoes and the high sensitivity to DEC/albendazole treatment make this species a prime candidate for elimination by mass drug administration (MDA).
Filariasis continues to be one of the endemic problems worldwide with 40% of the cases in India. We report a case of lymphatic filariasis in a 32-year old female who presented with a non-tender swelling over left upper arm. Blood sample showed no eosinophilia while the FNAC was diagnostic of W. bancrofti. Patient responded well with oral diethylcarbamazine. High index of suspicion of filariasis is indicated when dealing with a swelling of unknown cause especially in filariasis endemic areas.
DEC or ivermectin (IVM) in combination with albendazole (ALB) has been the recommended strategy of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) since 2000. Despite effective population coverage (> 65%) with several rounds of MDA with DEC or combination of DEC plus ALB, microfilariae persist in few individuals and they continue to be the source of infection for transmitting LF. We report an individual's variability in response to DEC by defining the response as complete absence of microfilaria (mf) (post-treatment mf count = 0) and non-response as presence of mf (post-treatment mf count ≥ 1). We analyzed follow-up data on individual's response to treatment from two randomized clinical trials in which 46 microfilaremic individuals were treated with single-dose DEC (6 mg/kg body weight). They were classified into low, medium, and high mf density categories based on their pre-treatment mf counts. Of the 46 individuals, 65.2% have not responded throughout the 12-month post-treatment period. Application of a logistic regression model with fixed (age, gender, mf density, post-treatment time, and their interactions) and random (individual's response over time) effects indicated that treatment response is independent of age, gender, and time. The overall treatment response increases in low and decreases in high mf density categories. Furthermore, the estimates for the random coefficients model showed that there is a greater variability in response between individuals over post-treatment time. The results substantiate that individual variation in response to DEC exists which indicate the importance of studying the parasite as well as host genetic factors associated with DEC action.
Introduction:Filariasis is an endemic infection in tropical and subtropical countries. The disease is caused by para-sites from the group filarodidae. Epidermolysis Bullosa, on the other hand is a group of rare genetic skin diseases that characterize by skin blister and erode facilely. Due to rarity of Epidermolysis Bullosa and uncommon occurrence of Filariasis, there is extremely limited case or paper reporting on safety profile of medication that are used to treat Filariasis patient with underlying Epidermolysis Bullosa.Serious adverse event that is anticipated in this cohort of patient are Stevens-Johnson syndrome and Mazotti reaction. Case description: Surveillance activity is necessary in high endemic localities in Sabah in order to control the spread of this mosquitoes-borne disease. The available tool is Brugia RapidTM kit, a test kit that detects filarial antibodies.A 13 year-old boy with underlying Epidemolysis Bullosa Simplex was detected during surveillance activities. It was further confirmed with night blood on microscopic slide that depicted high density of parasite (microfilaria count: 31). The WHO specifically exempted the following groups from the treatment - children under 5 years of age; pregnant women; and seriously ill individuals i.e. those who are having acute or chronic illness that makes them too sick or weak to get out of bed; and those with an illness who are life-dependent on medical intervention. This is because ingestion of the medications can result in adverse events due to the destruction of killed parasites. No guideline is available for treatment of lymphatic filariasis in rare genetic disorders. Conclusion: The recommended dosage for IDA is Ivermectin 3mcg/kg, Diethylcarbamazine 6mg/kg and Albendazole 400mg for positive patient yearly. Patient was admitted in hospital for observation treatment with the suggested dose. From the case study it shows it is safe to treat this cohort patient. However, it is advisable to treat such rare cases by case basis and in comparison to others where treatment is given in the community this patients should be treat in more control environment such in the hospital.
We are reporting a case of an eye lesion caused by an adult Brugia malayi. The patient was a 3-year-old Chinese boy from Kemaman District, Terengganu, Peninsular Malaysia. He presented with a one week history of redness and palpebral swelling of his right eye. He claimed that he could see a worm in his right eye beneath the conjunctiva. He had no history of traveling overseas and the family kept dogs at home. He was referred from Kemaman Hospital to the eye clinic of Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia. On examination by the ophthalmologist, he was found to have a subconjunctival worm in his right eye. Full blood count revealed eosinophilia (10%). Four worm fragments, each about 1 cm long were removed from his right eye under general anesthesia. A thick blood smear stained with Giemsa was positive for microfilariae of Brugia malayi. A Brugia Rapid test done was positive. He was treated with diethylcarbamazine.
Study site: Opthamolagy clinic, Hospital Tengku Ampuan Afzan
Matched MeSH terms: Diethylcarbamazine/therapeutic use
Annual and biannual mass single dose diethylcarbamazine citrate (DEC) at 6 mg/kg body weight was administered to people in a Brugia malayi endemic area in Shertallai part of Kerala, India, in 1987 and 1988. The coverage of population ranged between 41.33% and 66.01% in different rounds. The highest percentage of treated population developing side reactions was 8.4%. Both annual and biannual regimens were effective in reducing the microfilaria prevalence significantly from 4.90% to 1.23% and from 6.27% to 0.62% respectively and the incidence of infection was minimal in the adult population and zero among children. There was significant reduction in mean microfilaria count in both annual (81.08%) and biannual (98.00%) areas. Marked reduction in the proportion of high density carriers and infectivity index of the population after DEC therapy was also observed. Beneficial effect of mass single dose DEC on clinical cases of filariasis was evident from the reduction in the prevalence of acute manifestations, recent edema cases and the proportion of chronic cases with acute episodes. Results obtained from mass treatment areas were compared with those of the control area.
Matched MeSH terms: Diethylcarbamazine/administration & dosage*; Diethylcarbamazine/adverse effects; Diethylcarbamazine/therapeutic use
The diverse clinical syndromes characterized by asthmatic symptoms, transient pulmonary infiltrates, and eosinophilia have tended to obscure the specific association of one such entity with filarial infections. Serum IgE levels were determined before and after therapy in a group of well-characterized patients with tropical eosinophilia (TE), studied earlier in Singapore. The mean serum IgE level in 14 cases before treatment with diethylcarbamazine was 2,355 ng. per milliliter, with a trend but statistically nonsignificant decrease in levels to 600-1,000 ng. occurring 8 to 12 weeks after therapy. Leukocyte and eosinophil counts showed a rapid reduction after treatment, and although mean complement-fixing (cf) titers to Dirofilarial antigen tended to decrease, they were not significantly reduced until 5 to 6 weeks. The historical development of evidence supporting the filarial etiology of TE was reviewed. Many basic questions engendered by the clinical syndrome of tropical eosinophilia make it an excellent model for study of the immunopathology of parasitic infections.
Matched MeSH terms: Diethylcarbamazine/therapeutic use
Lymphatic filariasis is the most widespread of human filarial infections, a group of vector-borne infestations. After the discovery of diethylcarbamazine (DEC), little advance was made in the development of new chemotherapeutic agents for the treatment of lymphatic filariasis until 1985. Since then, several new initiatives have occurred as the result of a global effort by the World Bank/UNDP/WHO Special Programme on Tropical Diseases and the Onchocerciasis Control Programme. Some of these global research initiatives are reviewed in this paper. Recent observations throw a new light on the rational use of DEC including its deployment as a medicated salt. Ivermectin, an established drug for the treatment of river-blindness is examined for its potential use in the treatment of lymphatic filariasis. Experimental results from two novel compounds out of several being developed by the WHO/OCP Macrofil project are considered in respect to their potential macrofilaricidal activity, particularly in relation to lymphatic filarial infections.
Matched MeSH terms: Diethylcarbamazine/therapeutic use
The chemoprophylactic use of diethylcarbamazine citrate at total oral doses of 15--180 mg/kg body weight was tested against subperiodic Brugia malayi infection in the leaf monkey (Presbytis melalophos). A total dose of 45 mg/kg body weight given over 9 days killed all developing infective larvae. Similarly, a total dose of 35 mg/kg body weight given over 7 days killed all fourth stage larvae. The minimum effective dose that prevents infection would be 5 mg/kg body weight daily for 7 days every month.
The dynamics of the transmission of subperiodic Brugia malayi in a typical endemic area in Malaysia was studied over a period of 4 years. Mass chemotherapeutic control with diethylcarbamazine citrate was found to be inefficient, new cases being detected even after the fifth treatment cycle of 6 mg/kg X 6 days per cycle. This is in marked contrast to the situation in periodic b. malayi areas where mass treatment efficiently controlled the infection. The disparity in results in these two areas is attributed to zoonotic transmission of subperiodic B. malayi from non-human primates where a mean infection rate of 76.3% was found.
Matched MeSH terms: Diethylcarbamazine/therapeutic use
Diethylcarbamazine citrate (DEC) has been used for treatment and control of lymphatic filariasis since the 1950s. Although this remarkable drug is still useful and modified strategies in its usage have been developed, a number of newer antifilarial compounds are now available. Numerous field trials evaluating their efficacy in the control of lymphatic filariasis have been conducted. In particular, ivermectin (IVM), albendazole (ALB), and DEC have been tested singly and in combinations and the results of such field studies should be evaluated. While most of the studies were based on efficacy in the clearance of microfilaraemia, a few clinical trials evaluated the adulticidal activity of these compounds. Some antibiotics are effective in killing Wolbachia bacteria symbionts of filarial worms, but their role in the chemotherapy of lymphatic filariasis is still undefined. This review of randomised controlled field studies and randomised controlled clinical trials with these compounds will summarise the findings and give recommendations on their appropriate use for the control and treatment of lymphatic filariasis.
Brugia malayi and Wuchereria bancrofti infections cause lymphatic filariasis in Malaysia. About 2.5 million people live in endemic areas of filariasis, of whom 5% have microfilaraemia and probably twice as many are infected. There is a wide clinical spectrum of response to the infection. While some have asymptomatic microfilaraemia, others have episodic attacks of fever, lymphadenitis, retrograde lymphangitis and lymphoedema. Elephantiasis is a late complication. Tropical pulmonary eosinophilia and other forms of occult filariasis are due to hyper allergic reactions to microfilarial antigens. Parasitological and serological tests aid in confirming the clinical diagnosis. The drug of choice is diethylcarbamazine citrate.
The known filaricides, suramin and diethylcarbamazine citrate, were tested against subperiodic Brugia malayi infection in the leaf-monkey, Presbytis cristata. As expected, intravenous suramin at 10 mg/kg daily x 5 days or 17 mg/kg weekly x 5 weeks, did not show any microfilaricidal activity, but substantially reduced the recovery of live adult worms to 50.6% and 13.6% of controls respectively. Oral diethylcarbamazine citrate at 6 mg/kg daily x 6 or 10 days reduced final microfilarial counts to 30% of initial counts four weeks post-treatment and adult worm recovery was reduced to 4.5% and 0% of controls respectively. Although the antifilarial activity of these drugs against the infection in this non-human primate model appears to be similar to that seen in man, these results have to be confirmed using larger groups of animals.