|
Table
1 : Clinical cases across the spectrum of filariasis in an endemic area
(Kasturba Hospital based study, 1991-2000).
|
Clinical manifestations
|
No. screened for Ab
|
No. positive* for Abu(%)
|
No. screened for Ag |
No. positive* for Ag (%)
|
|
I.
Acute
Fever with chills,
Lymphadenopathy, Chyluria, Haematuria, Funiculitis & Epididymoorchitis
|
2683 |
1541(57) |
1460 |
580(40) |
|
II.
Chronic
Lymphoedema, Hydrocele
& Elephantiasis |
2006
|
1392(69) |
1600 |
701(44) |
|
III.
Occult
TPE, Mono & Polyarthritis, Tenosynovitis, Glomerulo-nephropathy,
Retro-peritoneal lymphangitis,
EMF, Iridocyclitis, Recurrent scleritis, Macular oedema, Urticaria
& Asthmatic bronchitis.
|
2006
|
914(46) |
1096 |
459(42) |
|
Total |
6695 |
3847(57) |
4156 |
1740(42) |
|
*
Cases showing the presence of filarial antigen/antibody at a serum
dilution of 1:300 are considered as positive.
u
Immunomonitoring detected
filarial etiology in acute and occult cases more
than twice the
number of that of
chronic clinical cases.
|
Immunomonitoring
:
A
ten year followup
study on immune status
during chemotherapy of microfilaraemic patients showed
disappearance of antigen and antibody with elimination of
microfilariae thus confirming
that presence of antigen / antibody may be used as a marker for infection (8).
The
results of analysis of blood samples for filarial IgG antibodies and
antigen are summarized in table 1 & 2. In the absence of
microfilaraemia number of clinical conditions in filarial endemic area
showed presence of either antigen or
antibody or both confirming filaria aetilogy in adults as well as
in childrens (6,7) . OpDEC
therepy for clinical filariasis :
The objective of treatment is to eliminate the parasite, arrest infection,
reduce the recurrent attacks, prevent morbidity and further worsening. Diethylcarbamazine
citrate (DEC) is currently the only drug of choice for the treatment of
lymphatic filariasis, that is effective,
safe and relatively cheap.
Long term
treatment with DEC appears to be effective against adult worms as well in
addition to killing of microfilariae. Appropriate DEC therapy helps in
elimination of filarial parasites, prevention
of further attacks of acute filariasis,
reversal of early lymphoedema, early hydrocele and further
worsening of chronic lymphoedema. Real problem the
physician faces in
treating clinical
filarial cases
is in determination of the period of the DEC treatment
and convincing the patient on
the need for continued DEC treatment to be effective in clinical
relief and cure.
These clinical cases usually do
not show microfilaraemia and thus no clear indication
for continued DEC treatment. It
is a common experience that patients come to the hospital with history of
DEC treatment for short periods at intervals.
Incomplete DEC treatment
is not helpful in destroying
the filarial
parasite and complete clinical
relief thus
the physician and patient
become helpless. For over
a decade at Kasturba hospital we have been diagnosing and immunomonitoring
the filarial patients for
determining optimal DEC therapy (OpDEC therapy) for clinical
relief and cure. Detection
of antibody and antigen were not only
useful in confirmation of filarial infection,
immunomonitoring of their presence helped in determining the period
of DEC treatment. Table 4
shows immunomonitoring of clinical filarial patients with sero conversion
along with simultaneous clinical relief
and cure in filarial patients .Thus absence of Ag and Ab was found
to be very helpful as a monitor in termination of DEC treatment.
With optimal DEC therapy, the clinical filarial patients
experienced clinical relief and cure and further did
not have recurrence in most of the cases.
Of about 5000 cases, three cases did come with clinical symptoms
one year after stopping the DEC treatment. Table 5 shows the period of treatment required
for successful management of different filarial cases in a one year
followup study of 89 clinical patients done in
collaboration
with department of
surgery emphasizing
importance of immunomonitoring
for determining the period of
DEC therapy.
|
|
TaTable 2 : Analysis of blood samples for filarial aetiology in
different clinical manifestations in children – Hospital study (1997 –
2000)
|
|
Clinical
Manifestations
|
No.
examined
|
No. showing Positivity* for
filarial |
|
|
Ab (%) |
Ag (%) |
Ab/ Ag (%) |
|
I.
Classical fialriasis
Lymphoedema
Lymphadenopathy
|
12
19
|
6(50)
11(58) |
8(67)
6(32) |
10(83)
14(74) |
|
II. Occult
filariasis
TPE |
132 |
66(50) |
63(48) |
101(77) |
| URI (fever & cough, tonsillitis,
pharangitis, myalgia) |
118 |
49(42) |
49(42) |
77(65) |
| Bronchial Asthma |
65 |
30(46) |
27(42) |
41(65) |
| Pneumonia |
45 |
16(36) |
16(36) |
24(53) |
| Nutritional anemia |
16 |
4(25) |
2(13) |
5(31) |
| Pain in abdomen
|
9 |
7(78) |
3(33) |
7(78) |
| Arthritis
|
9 |
4(44) |
5(56) |
8(42) |
Others
(testicular infections, nephrotic
syndrome & anasarca).
|
16 |
11(69) |
6(37) |
13(81) |
|
| Total |
441 |
204(46) |
185(42) |
300(68) |
|
*cases showing the presence
of filarial antigen/antibody at a serum dilution of 1:300 are considered
as positive.
|