Treatment and prevention
Treating endemic communities
The primary goal of treating affected communities is to eliminate microfilariae from the blood of infected individuals in order to interrupt transmission of infection by mosquitoes.
Studies have shown that a single dose of diethylcarbamazine citrate (DEC) has the same long-term (1 year) effect in decreasing levels of microfilaraemia as the formerly recommended 12-day regimen of DEC. More importantly, the use of single doses of two drugs administered together (optimally albendazole with DEC or ivermectin) is 99% effective in removing microfilariae from the blood for a full year after treatment. This level of treatment effectiveness has made feasible new efforts to eliminate lymphatic filariasis.
The most significant advance in efforts to alleviate the suffering caused by elephantiasis has been the recognition that much of the progression in pathology is a result of bacterial and fungal “superinfection” of tissues, linked to compromised lymphatic function caused by earlier filarial infection. Rigorous hygiene of affected limbs combined with adjunctive measures to minimize infection and promote lymph flow dramatically reduce the frequency of acute episodes of inflammation (“filarial fevers”) and markedly improve the elephantiasis itself.
Oral ivermectin at a dose of 300 µg/kg single dose repeated after 7 days proved effective for the treatment and prophylaxis of scabies in an infected institutional environment.
Avoidance of mosquito bites through personal protection measures or community-level vector control is the best option to prevent lymphatic filariasis. Periodic examination of blood for infection and initiation of recommended treatment are also likely to prevent clinical manifestations.
Relatively simple and well known surgical procedures are available to correct hydrocele. Because secondary bacterial infections play an important role in precipitating acute adenolymphangitis episodes and progression of lymphoedema, simple hygiene measures – either alone or in combination with antibiotic treatment – play an important role in preventing episodes of acute disease and in the management of lymphoedema. Daily washing of affected limbs with soap and safe water to prevent secondary infection, combined with simple exercises, elevation of the limb, and treatment of cracks and entry points, provides significant relief from acute episodes and slows progression of the disease.
Podoconiosis is a type of tropical lymphoedema resulting from a genetically determined abnormal inflammatory reaction to mineral particles in irritant red clay soils derived from volcanic deposits. It is mostly found in highland areas of tropical Africa, Central America and north-west India.
It is a non-parasitic disease, and like lymphatic filariasis, results in impairments due to lymphodema. Like in the case for lymphatic filariasis, a basic package of care can alleviate suffering and prevent further progression of disease and disability.