infectious diseases
Bancroftian and Brugian Lymphatic Filariasis
Treatment
Diethylcarbamazine Diethylcarbamazine (DEC) kills microfilariae and a variable proportion of adult worms. In the United States, DEC is available from the Centers for Disease Control and Prevention (CDC) after laboratory confirmation of filariasis. Before treatment with DEC, assess patients for coinfection withLoa loaorOnchocerca volvulusbecause DEC can cause serious reactions in patients with those infections. DEC 2 mg/kg orally 3 times a day for 12 days has traditionally been used; 6 mg/kg orally once is an alternative. Generally, the 1-day regimen seems to be as effective as the 12-day regimen. Adverse effects with DEC are usually limited and depend on the number of microfilariae in the blood. The most common are dizziness, nausea, fever, headache, and pain in muscles or joints, which are thought to be related to release of filarial antigens. ( Loiasis ) or A number of drug combinations and regimens have been used in mass treatment programs. Also,doxycyclinehas been given long-term (eg, 100 mg orally twice a day for 4 to 6 weeks).DoxycyclinekillsWolbachiaendosymbiont bacteria within filaria, leading to death of adult filarial worms. It can be given with DEC or used alone. Attacks of acute adenolymphangitis usually resolve spontaneously, although antibiotics may be required to control secondary bacterial infections. Chronic lymphedema requires meticulous skin care, including use of systemic antibiotics to treat secondary bacterial infections; these antibiotics may slow or prevent progression to elephantiasis. Whether DEC therapy prevents or lessens chronic lymphedema remains controversial. Conservative measures such as elastic bandaging of the affected limb reduce swelling. Surgical decompression using nodal-venous shunts to improve lymphatic drainage offers some long-term benefit in extreme cases of elephantiasis. Massive hydroceles can also be managed surgically, but recurrence is common. Tropical pulmonary eosinophilia responds to DEC 2 mg/kg orally 3 times a day for 14 to 21 days, but relapses occur in up to 25% of patients and require additional courses of therapy. 