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. Mass drug administration reduces the transmission of filarial infection and disease morbidity by decreasing the burden of microfilaremia. Chief Editor: Pranatharthi Haran Chandrasekar. Log out Cancel Filariasis Treatment & Management Author: Siddharth Wayangankar. Pharma. 49] For example. MPH. 45. you will be required to enter your username and password the next time you visit.. MD more.. 2015 Approach Considerations The medical management of a filarial infection should be specific and based on the microfilariae isolated or antigenemia detected. 47. Updated: Dec 10. MBBS. MD. 46. 48. 16/10/2016 20:43 .medscape. 5 of 11 http://emedicine. Since this species has no alternative hosts..[44. annual mass treatment with albendazole and ivermectin is employed to interrupt the transmission of W bancrofti.Filariasis Treatment & Management: Approach No Results News & Perspective Drugs & Diseases CME & Education close Please confirm that you would like to log out of Medscape. resulting in suboptimal levels for transmission by disease vectors. If you log out.

apply antiseptic creams to abrasions. One study evaluated the effect of higher dose and increased frequency (twice yearly) of albendazole-ivermectin therapy for W bancrofti and found that it resulted in complete microfilarial clearance. 6 of 11 http://emedicine. In addition. Such care includes the use of antihistamines. Onchocerciasis Nodulectomy with local anesthetic is a common treatment to reduce skin and eye complications. inpatient care is recommended to monitor for reactions and complications of therapy. steroids. Onchocerciasis If DEC and suramin (currently the only drug in clinical use for onchocerciasis that is effective against adult worms) are used.[51. but visitors to these regions should use insect repellent and mosquito nets.[56] Bed rest.[55] Surgery Lymphatic filariasis Large hydroceles and scrotal elephantiasis can be managed with surgical excision.[50] The effects of mass treatment on filariasis have reportedly been sustained for up to 6 years. Individuals with chronic infections should wash the affected area frequently. However. limb elevation. Mild to moderate filarial lymphedema has been shown to improve with a 6-week course of doxycycline. pain relief. keep their nails clean. Consultations To prevent inappropriate this approach could theoretically result in eventual eradication of bancroftian filariasis. and compression bandages traditionally have been used for the management of chronic lymphedema. 52. 54] No filariasis vaccine is currently available. Chronic filariasis Treatment of chronic filariasis does not change the prognosis. Other possible consultations include: Urologist Ophthalmologist General surgeon Plastic surgeon Pharmacologic Therapy Lymphatic filariasis Patients with asymptomatic microfilaremia can be treated on an outpatient basis. Secondary infection Supportive care should include the prevention of secondary infection. Pharma. Supervision of oral DEC therapy and provocation with postadministration observation is recommended for patient compliance with therapy and for the management of febrile reactions in heavily infected patients. the sclerosing action conferred by diagnostic lymphangiography may plug the leak.[28] 16/10/2016 20:43 . consult an infectious disease specialist in all cases of suspected filariasis outside of endemic nations.Filariasis Treatment & Management: Approach Considerations.[31] Inpatient care may initially be required for adenolymphangitis (ADL) and chronic filariasis. but efforts to develop an effective one are under way. still typically undergo treatment. hoping to diminish progression of the disease. and intravenous antibiotics for secondary infections.. Diet and activity Fatty foods are restricted in individuals with proven chyluria that is associated with lymphatic filariasis. and exercise the affected limb to aid lymphatic flow. as well as a more sustained clearance than that resulting from standard-dose albendazole-ivermectin treatment. independent of ongoing infection. especially in patients with advanced disease. asymptomatic patients.[57] Chyluria In the treatment of chyluria. Correcting gross limb elephantiasis with surgery is less successful and may necessitate multiple procedures and skin grafting.. Individuals with chronic lymphatic filariasis are encouraged to mobilize (with compression bandage support) the affected limb. wear comfortable footwear. a special low-fat. 53. as irreversible fibrosis usually destroys lymphatic tissue. although the benefit of this is unclear. Prevention Avoidance of bites from insect vectors is usually not feasible for residents of endemic areas. Lymphedema Steroids can be used to soften and reduce the swelling of lymphedematous tissues. high-protein diet supplemented with medium-chain triglycerides may prove beneficial.

After treatment. Stewart G Wolf Endowed Chair in Internal Medicine. American Society for Microbiology.Filariasis Treatment & Management: Approach Considerations. MD David Ross Boyd Professor and Chairman. MBBS. Pharma. patients should be monitored for symptoms that are characteristic of parasitic infections. M perstans remained suppressed in 75% of patients who had received doxycycline.[69] Long-Term Monitoring Patient monitoring includes posttreatment follow-up for 12 months. Medicine Service. an endosymbiont found in most filarial species. 59.. MD is a member of the following medical societies: American College of Physicians. antigenemia. Fellow. 60. Infectious Diseases Society of America Disclosure: Nothing to disclose. 66. 67] M perstans infection Because M perstans is resistant to standard antiparasitic treatment. Coauthor(s) Michael Stuart Bronze. Internal Medicine Residency Program. Oklahoma University Health Sciences Center Siddharth Wayangankar. MD Medical Officer. Observe and monitor oral therapeutic plans with DEC because compliance with therapy is poor and usually incomplete. In the United States. doxycycline is sometimes used to eradicate Wolbachia. at risk for other parasitic infections because areas endemic for bancroftian filariasis are also endemic for other parasites. University of Oklahoma Health Science Center. American Medical Association. Patients were randomly assigned to receive 200 mg of doxycycline orally every day for 6 weeks or no treatment. Division of Special Pathogens 16/10/2016 20:43 . a 3-week course of doxycycline followed by a single dose of DEC was shown to be microfilaricidal. with examination of peripheral blood and skin snips for microfilariae. 97% of patients who received doxycycline had no detectable blood levels of M perstans. Program Director of Infectious Disease Fellowship. Department of Medicine. The addition of albendazole seems to improve response. At 36 months. Oklahoma State Medical Association.[26. Department of Internal Medicine. Department of Internal Medicine. Bancroftian filariasis Ivermectin is now considered the drug of choice for the treatment of bancroftian filariasis. Coulibaly et al recruited patients with M perstans infection from 4 African villages in Mali. MBBS. it can be obtained from the Centers for Disease Control and Prevention (CDC). Patients with filariasis are. Assistant Chief.[69] At 12 months. MD is a member of the following medical societies: Alpha Omega Alpha. Department of Medicine. Infectious Diseases Society of America Disclosure: Nothing to disclose. Department of Medicine. and clinical manifestations.[58. in endemic areas of the world. Master of the American College of Physicians.[50. Southern Society for Clinical Investigation. This agent may shorten the number of annual treatments to 6. Director. 61] Six-week and 8-week courses of doxycycline have compared favorably with ivermectin plus albendazole. International Immunocompromised Host Society. 64. MD Associate Professor and Vice Chair for Education. Association of Professors of Medicine. MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine. it is provided free by the Mectizan Donation Program. Chief Editor Pranatharthi Haran Chandrasekar.[62] Doxycycline therapy may be more readily available and may be better tolerated by some patients. It may also be capable of preventing or reversing lymphatic pathology. randomized trial. Infectious Diseases and Pediatrics. MPH is a member of the following medical societies: American College of Physicians Disclosure: Nothing to disclose. Medication Contributor Information and Disclosures Author Siddharth Wayangankar. MD Professor. American College of Physicians. MD. Infectious Diseases Society of America Michael Stuart Bronze. Acknowledgements Rosemary Johann-Liang. compared with 16% of patients in the group that did not receive treatment.[63] Findings have validated the use of single-dose regimens of ivermectin and DEC or albendazole for large-scale control and eradication programs aimed at reducing Wuchereria bancrofti microfilaremia. Rhett L Jackson. 65. American Medical Association Disclosure: Nothing to disclose. University of Oklahoma College of Medicine. 68] Doxycycline treatment typically kills or sterilizes the filarial nematode.medscape. by default..[63] In one study. Wayne State University School of Medicine Pranatharthi Haran Moxidectin is being investigated as an alternative to ivermectin for the treatment of river blindness. Oklahoma City Veterans Affairs Hospital Rhett L Jackson. 7 of 11 http://emedicine. In an open-label. Chief of Infectious Disease. MD. MPH Resident Physician.

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Royal Children's Hospital Disclosure: Nothing to disclose. Division of Pediatric Infectious Diseases. American College of Physicians. Tulane University School of Medicine Russell W Steele. Meyrowitsch DW.. and Southern Medical Association Disclosure: Nothing to disclose. Drexel University College of Medicine Robert W Tolan Jr. Medical Society of Virginia. Louis-Charles J. Mary L Windle. Nematode infections: filariases. Section of Infectious Disease. Infectious Diseases Society of America. Society for Pediatric Research. Senior Lecturer. 366(13):1169-71. Australia Disclosure: Nothing to disclose. Otogbe FK. Westmead. PhD Head. FRACP. The Children's Hospital at Saint Peter's University Hospital. American Society for Microbiology. 2011 Jun. MD Head. 16/10/2016 20:43 . Knopp S. American Society of Tropical Medicine and Hygiene. Okon OE. 2010 Jan. Alifrangis M. and Physicians for Social Responsibility Disclosure: Novartis Honoraria Speaking and teaching John Charles Walker. 2012 Jun. 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