Lymphatic filariasis is a tropical infectious disease resulting from infestation of the human lymphatic system with parasitic worms. Men represent a special risk group, especially for chronic lymphatic filariasis, which is associated with severe swelling in the genital area.
What is lymphatic filariasis?
According to Healthknowing, lymphatic filariasis is a disease of the lymphatic system that occurs in the tropics and is due to an infection with certain worms (so-called filariae) from the family of roundworms (nematodes) and which is transmitted by mosquitoes.
Lymphatic filariasis manifests itself after an incubation period of one month to several years with acute inflammation of the lymph nodes and vessels, fever attacks, asthmatic symptoms and allergic cough (acute phase). In the advanced stage of the disease, lymphatic filariasis can lead to permanent damage to the lymphatic vessels, through which the lymphatic fluid can no longer drain and lymphatic varices (enlargement of the lymph nodes and vessels) form.
Lymphedema develops as a result of the migration of lymph fluid into neighboring structures, which can take on extreme forms in the area of the limbs, genitals and chest and lead to elephantiasis, which is characteristic of chronic lymphatic filariasis.
Causes
Lymphatic filariasis is due to infection with thread-like worms (filariae) from the nematode family (roundworms). The most important pathogens of lymphatic filariasis are Wuchereria bancrofti (Africa, Southeast Asia, Central and South America, Pacific), Brugia malayi (Southeast Asia) and Brugia timori (Indonesia).
The pathogens of a lymphatic filariasis are transmitted by mosquitoes, so-called Anopheles, which have previously infected an infected person with worm larvae (microfilariae).
These mature into infectious larvae in the mosquito’s organism. If a human is bitten by an infected mosquito, the microfilariae settle via the bloodstream in the lymphatic system, where they mature into sexually mature filariae, produce further larvae and cause the inflammatory reactions that are characteristic of the acute stage of lymphatic filariasis.
About three to eight months after infection, the microfilariae first infiltrate the blood system of those infected with lymphatic filariasis.
Symptoms, Ailments & Signs
Lymphatic filariasis can manifest itself through a wide variety of symptoms. The first signs of illness often only appear after months or years. Bouts of fever and swollen lymph nodes set in three months after infection at the earliest. The relocation of the lymphatic system can repeatedly lead to inflammation of the lymphatic vessels and nodes.
If left untreated, permanent damage to the lymphatic system can remain. Lymphedema typically develops beforehand, causing swelling of the chest, genitals, and limbs. The area around the infection is painful and causes an uncomfortable feeling of pressure when touched. In extreme cases, lymphatic filariasis can cause breathing difficulties and thereby trigger an asthma attack.
This is accompanied by general signs of illness such as tiredness and exhaustion. Those affected feel physically and mentally exhausted and are usually no longer able to carry out daily tasks. Externally, the disease of the lymphatic system can be recognized by the visible swelling and the sickly appearance of those affected.
The doctor can determine increased blood values for eosinophilic granulocytes, which clearly indicate filariasis. If treated promptly, the symptoms usually subside quickly. As a result of the weakening of the immune system, however, secondary fungal or bacterial infections can occur that require independent therapy.
Diagnosis & History
Since lymphatic filariasis is a tropical infectious disease, stays abroad in endangered areas provide a first indication of the diagnosis.
In addition, a lymphatic filariasis is diagnosed on the basis of the characteristic symptoms. A blood analysis can reveal an increased concentration of eosinophilic white blood cells in the serum (eosinophilia) as well as antibodies specific for filariae. In the later course (chronic filariasis), microfilariae can be detected in the serum.
Since the pathogens infiltrate the blood mainly at night, the blood sample should be taken at this time. With early diagnosis and timely start of therapy, the infectious disease has a good prognosis.
If left untreated, lymphatic filariasis leads to severe courses and very pronounced swelling (elephantiasis), which can represent a significant psychological burden for those affected.
Complications
In this disease, those affected primarily suffer from a very high fever. There is also severe exhaustion and fatigue in the patient. The resilience is also significantly reduced, so that there may be various restrictions in the everyday life of the person concerned. Inflammation of the lymph nodes also occurs, which can lead to pain.
In severe cases, people have an asthma attack and generally have difficulty breathing. Severe breathing difficulties can also lead to a loss of consciousness, in which those affected can also fall and injure themselves. Swelling also occurs. Patients often suffer from psychological stress or depression. The patient’s quality of life is significantly reduced and limited by this disease.
The treatment of this disease is usually carried out with the help of medication. There are no particular complications. However, some of the drugs can cause side effects, possibly causing a headache or fever. As a rule, the treatment leads to a positive course of the disease. However, the immune system has to recover after the treatment, so that the person concerned is more susceptible to other diseases or infections.
When should you go to the doctor?
As soon as the typical signs of lymphatic filariasis are noticed, a visit to the doctor’s office is advisable. If the symptoms do not go away on their own after a few days or even get worse, a doctor must also be informed. It is best for the affected person to speak to their family doctor immediately, who can clarify or rule out the filariasis. Appropriate treatment can then be initiated and further complications or long-term effects can be averted.
If the symptoms occur a few months after a trip to one of the risk areas, a doctor’s visit is recommended. A mosquito bite on holiday should be checked out by a doctor immediately after you return home. Even after contact with a potentially infected person, one must pay attention to any warning signs. Lymphatic filariasis is treated by a general practitioner or internist. In severe cases, a lymphologist or a specialist clinic for infectious diseases must be consulted. Children must be immediately presented to the pediatrician with signs of lymphatic filariasis.
Treatment & Therapy
The therapeutic measures are primarily aimed at killing the pathogens with the help of anthelmintics (anthelmintics ). These drugs contain specific toxins that negatively affect the metabolism of the pathogens. Good results have been achieved in this regard with diethylcarbamazine, whereby the drug is administered over several days depending on the body weight of the person concerned (e.g. 50 mg on the 1st, 3 x 50 mg on the 2nd day, 3 x 100 mg on the 3rd day and 3rd day). x 2 mg/kg body weight from days 4 to 21 of treatment).
However, diethylcarbamazine can cause side effects in the form of headaches and fever. In addition, ivermectin (avermectin) for the treatment of microfilariae and albendazole (anthelmintic) against adult (adult) pathogens are used. Under certain circumstances, there are microfilariae in the lymph structures that have already encased themselves in a capsule and therefore do not respond to the therapy.
In these cases, the treatment of lymphatic filariasis must be repeated. Since the immune system is severely weakened in lymphatic filariasis, secondary infections (fungi, bacteria) may be present in some cases, which should be treated accordingly. Lymphatic drainage helps against lymphatic congestion. In the case of pronounced lymphedema (elephantiasis), surgical measures may be indicated for lymphatic filariasis in order to eliminate the lymphatic congestion.
Outlook & Forecast
The tropical disease has a favorable prognosis once medical treatment is sought. The administration of medicines usually quickly leads to an alleviation of the existing symptoms. After a few weeks, the patient can be discharged from treatment as cured.
Without access to medical care, general health often deteriorates. Delays in the healing process are to be expected and breathing problems occur. These can trigger anxiety or an acute and therefore life-threatening situation. For a favorable prognosis, a doctor should be consulted at the first signs and physical changes.
With a stable immune system, the pathogens can usually be fought quickly. The prescribed medication supports the body’s own defense system in the healing process and helps ensure that the dead pathogens can be removed from the body as quickly as possible. Lymphatic drainage also helps against lymphatic congestion. With these treatment measures, the person concerned is well positioned and has a good chance of a speedy recovery.
If complications occur, surgical measures must be initiated. Surgery carries risks and can cause complications. If the procedure goes smoothly, the drug treatment is then continued. Optimal nutrition should support a good prognosis.
Prevention
Since no vaccine is currently available against lymphatic filariasis, preventive measures are limited to exposure prophylaxis. This consists of wearing long clothing, using mosquito nets that may be impregnated with insect repellent, and using so-called repellents (mosquito-repellent gels, sprays, lotions, creams) that protect against mosquito bites and thus lymphatic filariasis.
Aftercare
With this disease, high fever usually occurs in those affected. It comes to a permanent tiredness and exhaustion of those affected. The resilience is significantly reduced, which can lead to many limitations in everyday life. The quality of life of those affected is significantly affected by the disease, so the help of friends and relatives is essential during this time.
In severe cases, those affected suffer from constant shortness of breath and asthma attacks, which is why they should refrain from physical exertion as far as possible. It is not uncommon for those affected to suffer from severe depression and other mental illnesses, as those affected can no longer actively participate in life. Support with the help of a psychologist can help to accept the disease better and make it easier to deal with in the long term.
The disease is treated in most cases with the help of drugs that should be taken according to the prescribed dose. After the treatment, however, the immune system is weakened, so that the sufferers are more susceptible to infections. It is therefore advisable to avoid excessive activity and to gently resume everyday life.
You can do that yourself
In addition to drug therapy, filariasis patients can take some measures themselves to support the healing process. Physical rest and bed rest are particularly important. Especially in the first three to five days of the disease, the immune system should not be further burdened so that the worms can be flushed out as quickly as possible.
A suitable diet also promotes recovery and also alleviates typical symptoms such as abdominal pain and nausea. The nutritional plan is best worked out with the help of a nutritionist. In the case of a lymphatic congestion, the weight should also be reduced. A healthy, low-salt diet combined with plenty of exercise (after the acute phase of the illness) and avoiding stress is recommended.
If pain occurs, various naturopathic remedies can be used in consultation with the doctor. Alternative preparations, such as belladonna, devil’s claw or arnica, can also help with headaches, fever and asthma attacks. If major complications develop during the course of the disease, a doctor must be consulted again with the lymphatic filariasis. If the course is severe, further self-help measures should be avoided unless the responsible doctor suggests otherwise.
