Filariasis- diagnosis & treatment

Diagnosis
Depends on

Clinical features Hx of exposure in endemic ares Laboratory findings

Lab Findings
Demonstration of micri filaria in peripheral blood/

chylous urine/ hydrocele fluid/ biopsy specimens Demostration of adult worms in biopsy specimens Skin test with filarial antigens Serological tests FBC- eosinophilia- supportive Ix

Unstained film Finger prick- 2/3 drops of blood- low power microscope- actively motile microfilaria. Stained film Thick and thin blood smears.. Thick- dehaemoglobinised- fixed with methanolstained Concentration techniques DEC provocation test

treatment
DEC- diethyl carbamazine- drug of choice

Microfilaricidal, large doses- fatal to adult worms

Allergic reaction- due to release of antigens from

large no of dying microfilaria

 Eradication of the vector mosquito Detection and treatment of carriers

Prevention and control

DEC- 6mg/kg daily* 12 day, 2weeks, 6 days in a week

Ivermectin Studies have established that ivermectin

given as a single dose in Bancroftian filariasis reduces microfilaremia by approximately 90 percent even one year after treatment

Albendazole has also been used in filarial infections.

Prolonged courses of high dose albendazole have a significant macrofilaricidal effect and result in a gradual decrease in microfilarial levels. which has good activity against Wolbachia, leads to sterility of adult worms

Doxycycline Initial studies suggested that coxycycline,

Mass chemotheraphy

Workers in Portau-Prince clean sea salt before spraying it with a deworming drug and bagging it. The treated salt is then sold at a loss to Haitians.

Mass drug administration This approach reduces both the transmission of infection and disease morbidity. The hypothesis is that once populations have been treated long enough, levels of microfilaremia will remain below that required to sustain transmission. This period has been estimated to be four to six years, corresponding to the usual reproductive lifespan of the adult parasite. Ideally, programs should focus on treating both adults and children.